Insight impairment occurs commonly in psychotic disorders (including mood episodes with psychotic symptoms). The aim of the present study is to measure changes of insight over the course of a psychotic episode and to investigate its relationships with symptoms and neurocognitive functions, as well as psychosocial factors. Insight was assessed at weekly intervals in 80 consecutive inpatients presenting with a psychotic episode by using a Chinese translation of the Scale to Assess Unawareness of Mental Disorder (SUMD). The relationships between insight change and other variables were explored. Modest but significant changes in insight were found in both directions with clinical resolution of psychotic symptoms. In particular, insight "declined" as symptoms improved in a number of patients. In addition, changes in insight score correlated with changes in Wisconsin Card Sorting Test (WCST) performance. More changes in insight (in either direction) tended to occur in younger patients. These results indicated that adequate control of psychotic symptoms and improvement in neuropsychological functioning might be associated with better insight recovery.