The relationship between insight and clinical features in bipolar disorder

the relationship between insight and clinical features in bipolar disorder

Schizophrenia and bipolar disorder share insight between patients with the two symptoms and an uncertain relationship between insight (five subscales). were conducted between insight and clinical symptoms and between insight and 2. In bipolar disorder (BD), clinical insight varies substantially over time. defined as the awareness of having a mental disorder, of specific symptoms and . time in bipolar patients, the relationship of insight to episode subtypes and symptom. PDF | The aim of this study is to examine the relationship between insight dimensions and clinical features in bipolar disorder. One hundred and four inpatients.

the relationship between insight and clinical features in bipolar disorder

As for the age cohorts assessed in the current study, the differences in demographic characteristics [e. Psychopathology CGI total score 3. Functional status GAF total score SOFAS total score Social and Occupational Functioning Assessment Scale.

In addition to the possibility weakened or disappear when demographic characteristics are of exploring potential moderators, the use of these statistical controlled. This conclusion is strengthened by the fact that the analyses will enable us to examine several important issues for groups in the current study did not differ in their awareness of their which we currently lack data: It may be argued that future studies prefrontal neural networks and between insight and executive should apply simple changes in study protocol and statistical functioning [e.

Somewhat surprisingly, affective and positive analyses in order to avoid the confounding effects of differences in symptoms were not correlated to insight.

Diagnosis and monitoring of bipolar disorder in general practice

However, this can be demographic characteristics e. It should also be noted that the study was not 43]. If, in fact, the two patient populations differ in demographic devised in order to assess the relationship between insight and variables e. With regard to daily functioning, the current study arriving for treatment at psychiatric outpatient clinics i.

Diagnosis and monitoring of bipolar disorder in general practice | The Medical Journal of Australia

The current study also patient groups, including the possibility that differences in insight suggests a differential relationship between insight and key may be smaller than initially expected. Lack of differences in of bipolar patients or euthymic unipolar depression. Biol Psychiatry ; 57 2: Statistical power analyses for the behavioural sciences, 2nd ed.

Psychol Bull ; 1: Br J Psychiatry ; Insight into illness in patients with mania, mixed mania, bipolar depression Several potential limitations of the current study should be and major depression with psychotic features. Bipolar Disord ;4 5: Why IQ is mends a 0. J Int genuinely exists. Based on these recommendations, our analyses Neuropsychol Soc ;15 3: Insight, quality of life and cognitive indicate a satisfactory level of power. In addition, effect sizes for functioning in euthymic patients with bipolar disorder.

At the same ; 1—2: Clinical and neurocognitive correlates of insight in sample size may have been more adequate for the current study patients with bipolar I disorder in remission. Acta Psychiatr Scand ; 1: Measuring current study may be more pronounced than that found in earlier cognitive insight in schizophrenia and bipolar disorder: For example, Yen et al. Schizophr Res ;22 3: Is insight in mania state-dependent?

J Nerv Ment Dis ; Neuropsychological aspects of lack this issue should be further assessed by future prospective studies. Psychiatry Res ; These future studies are encouraged to continue the focus of the 65 2: A study of comparison of components of current study, assessing patients who are in full symptomatic insight in patients with schizophrenia and bipolar affective disorder in remis- remission [using recently published criteria; 14,15], as well as sion phase.

Gender and bipolar disorder patients. Am J Psychiatry ; 2: Insight in schizophrenia and mood disorders and its relation to psycho- pathology.

Acta Psychiatr Scand ;90 1: Schizophr Bull ;35 2: A develop- mental model for similarities and dissimilarities between schizophrenia and Acknowledgments bipolar disorder. Insight into illness in schizophre- nia, schizoaffective disorder, and mood disorders with psychotic features. Cross-sectional similarities and differences between schizophrenia, schizoaf- assistance in gathering the data for this research project and Eve fective disorder and mania or mixed mania with mood-incongruent psychotic Horowitz Leibowitz, who assisted with the proofreading and features.

Eur Psychiatry ;19 1: The Maudsley bipolar disorder project. Clinical characteristics of bipolar disorder I in a Catchment area treatment sample. Eur Psychiatry ;18 1: The frontal hypothesis of cognitive aging: Insight in persons with schizophre- ls. J Genet Psychol ; 3: A comparison of insight in schizophrenia, bipolar tics. Prog Neuropsychopharmacol Biol Psychiatry ;26 7—8: Insight in psychosis and neuro- sis. Malays J Psychiatry ;14 1: San Fran- ment of insight in psychosis.

Am J Psychiatry ; 6: The Structured Clinical Interview Awareness of illness in schizophrenia and schizoaffective and mood disorders. The functional neuroanatomy of DR.

Mol Psychiatry Am J Psychiatry ; 3: Can J Psychiatry ;48 5: Symptomatic determinants of ;11 5: Compr Psychiatry ;50 6: Insight changes in acute psychotic der: Compr Psychiatry ;48 6: Insight and symptom change ; 1: Schizophr Res ;45 1—2: Sustained attention- [38] West R. In defense of the frontal lobe hypothesis of cognitive aging. During this period, patients received six follow-up assessments. It was observed that insight was constant during the 2-years period in continuously-stable patients.

A decreased insight could be associated with the presence of the manic phase, in both single manic and repeated manic episodes.

The insight returned to the pre-episodic level for patients with a single manic episode, but it remained altered in most of patients with multiple manic episodes. Depressive episodes have shown no change of insight, regardless of the number of episodes.

InCassidy examined lack of insight in bipolar patients in all phases of the illness.

the relationship between insight and clinical features in bipolar disorder

The purely manic group scored a mean SD lack of insight of 2. Differences between the mixed-manic, bipolar-depressed, and euthymic groups were null.

the relationship between insight and clinical features in bipolar disorder

The author findings Psychomotor agitation and irritability, both core features of mania, were predictive of lack of insight during acute episodes. Patients with bipolar disorder in mania show less insight about their condition than patients in depression or euthymia, and less insight about their symptoms than patients with depression, with the exception of awareness of weight change.

the relationship between insight and clinical features in bipolar disorder

The advantage of this study is that the scale used to assess insight ISAD is a specific scale tailored to mood disorders, which allowed the authors to conduct a detailed evaluation of insight into specific symptoms of mood disorders. There are some longitudinal studies of insight in the acute depressive episode [ 23444750 ]. These studies suggest that insight is not very impaired in the acute non-psychotic depressive episode, and that insight may increase as depression worsens.

However, insight is moderately impaired in psychotic depression [ 23 ]. Insight appears to improve markedly upon acute recovery from psychotic depression.

The relationship between insight and suicidality is complex. The results are not similar when analyzing patients with mood disorders. ISAD total scores and sub-scores based on the four factors of the scale insight into symptoms, the condition itself, self-esteem, and social relationship were generated for the analysis.

An altered self-esteem insight was associated not only with suicidal ideation or suicide attempt but also with activity reduction and psychomotor retardation. Altered symptom-related insight correlated also with psychomotor retardation. It was shown that a better insight into having an affective disorder determines more intense hypochondriac symptoms. Worse insight into having an illness was associated with psychotic episodes. The study concluded by exposing that symptoms other than psychosis, that is, suicidal ideation, psychomotor retardation, and reduction of activity, correlate with insight impairment in bipolar depression.

No correlation between current suicidal ideation and insight level was found. The results of this study suggest that a history of suicide attempts may correlate with higher impairment of insight in bipolar depression. The impact of insight on non-adherence One of the greatest problems clinicians face when dealing with chronic illnesses is the effectiveness of treatment.

the relationship between insight and clinical features in bipolar disorder

This is influenced by different factors such as patient tolerance of the drug, the appropriateness of the regimen [ 55 ], and adherence to treatment. Studies demonstrated that antipsychotic medication reduces the severity of serious mental illness and improves patient outcomes if medicines are taken as prescribed.

Medication adherence previously known as compliance [ 56 ], is a process of collaboration between the physician and the patient if during the compliance, the physician is omniscient, the patient must strictly follow the medical prescription; in case of adherence, the patient has an active role in decision-making regarding the type of agreed medication, the way of administration, and the therapy duration.

In this case, the patient may refuse to check-in for appointments or may begin to discontinue his medication. Such behavior has a negative impact on the outcome and leads to higher rates of recurrence and hospitalization [ 57 ]. The non-adherence may be deliberate the patient reduces or stops deliberately the medication, being convinced that he does not need medication for feel good and the medication is harmful for him due to possible side effects or unintentionally the patient skips some medication doses, either by forgetting them or because they do not check-in in time for a new recipe.

Medication adherence is a dynamic behavior, influenced by multiple factors [ 58 ]: Rates of low adherence have been reported to be as high as two-thirds in patients with schizophrenia [ 61 ]. Bipolar patients have also low rates of adherence [ 626364 ]. Factors influencing adherence to antipsychotic medication in bipolar disorder and schizophrenia [ 65 ].

Lack of insight seems to be the most crucial factor impacting adherence [ 66 ]. A considerable number of patients with schizophrenia exhibit a diminished or completely absent insight into their ailment, being more likely to completely reject their need for treatment, therefore being sustainably noncompliant.

Lacks in the capability of recognizing the presence of a mental illness and the beneficial effect of antipsychotic medication would definitely increase the likelihood of altered compliance. Also, insight has a beneficial impact over the therapeutic relationship [ 67 ]. There are several studies which proved the importance of insight as patient-related factor on adherence in patients diagnosed with bipolar disorder.

Its design was meant to evaluate the outcome of patients treated with two oral formulations of olanzapine over a 1-year period through several evaluation tools, as follows: An increased insight was associated with a better treatment adherence. Higher levels of insight were related to a powerful therapeutic alliance SCC ranging from 0.

A total of patients were included. Greater insight into medication was negatively associated with both measures of poor adherence.

The relationship between insight and clinical features in bipolar disorder.

Poor adherence was increased for women, African Americans, mania, and hazardous drinking. Past psychotic symptoms, longer illness duration, past psychiatric diagnoses, and a past history of dropouts significantly influenced the time to dropout in bipolar patients.

The main reasons for dropout were denial of therapeutic need and lack of treatment efficacy.

  • The relationship between insight and clinical features in bipolar disorder.

A total of 86 patients 45 with a diagnosis of schizophrenia and 41 with bipolar disorder were initially included in the study. Most of them were diagnosed with schizophrenia. Intentional and unintentional adherence was evaluated through several indicators for each category, as follows: A total of 20 insight-related studies 11 prospective and 9 cross-sectional analyzed the relationship between insight and adherence. Several prospective studies have shown that a better insight, evaluated through three insight scores, was associated with an improved adherence in both schizophrenic and bipolar patients [ 69 ].

Patients with bipolar disorder presented poor awareness of their disease after acute mania treatment, associating a higher probability of non-adherence during the maintenance therapy [ 68 ]. Poor insight was identified as a cause for non-adherence in more than half of the studies, followed by substance abuse, a negative attitude toward medication, side effects, and cognitive impairments.

Having a negative attitude toward medication is a determinant factor of intentional non-adherence, being considered to mediate effects of insight and of the therapeutic alliance.

Quality of life and its association with insight in bipolar patients. It is important to note that the impact of insight on quality of life may be subtle during remission and may be more substantially affected in full-blown manic symptoms.

Impaired insight into treatment and a greater number of previous admissions significantly increased the risk of adverse clinical outcomes with bipolar disorder. A neuropsychological battery assessing attention, mental control, perceptual-motor skills, executive functions, verbal fluency, abstraction and visuospatial attention was administered to 70 remitted bipolar patients and 50 healthy controls.

No differences in quality of life and cognitive performance were observed between bipolar patients with impaired and preserved insight. Insight was found to be correlated with poorer psychological and environmental quality of life. Manic patients presented the lowest GAF measures but reported same overall QoL as euthymic patients and controls, and better QoL than depressed patients. Authors suggested that this mismatch between objective and subjective measures during acute mania may be associated with a lack of insight or awareness of their own illness.

The impact of insight, adverse effects of medication, and use of atypical antipsychotics over the quality of life was analyzed [ 79 ]. A total of 96 subjects with bipolar disorder in remission, 96 subjects with schizophrenia in remission, and healthy control subjects were included in the study.

Bipolar Symptoms

The results demonstrated that the subjects with bipolar disorder in remission had similarly poor levels of quality of life in all four domains as those with schizophrenia in remission, and both groups had poorer quality of life than subjects in control group. Insight was negatively associated with quality of life on the physical domain in schizophrenia and bipolar patients in remission. The results indicate that subjects with bipolar disorder are dissatisfied with their quality of life, even when they are in remitted state.

Insight and outcome in bipolar disorder Research has revealed that a lack of insight is associated with poorer clinical outcomes in both schizophrenia and bipolar disorder. They included patients and the mean follow-up period was 3. Initial impairment in insight did not correlate with poor outcome.