Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2015-0014
Trends in Psychiatry and Psychotherapy
Original Article

Insight in bipolar disorder: a comparison between mania, depression and euthymia using the Insight Scale for Affective Disorders

O insight no transtorno bipolar: uma comparação entre mania, depressão e eutimia usando a Escala de Insight para Transtornos Afetivos

Rafael de Assis da Silva; Daniel C. Mograbi; Evelyn V. M. Camelo; Jaqueline Bifano; Mayra Wainstok; Luciana Angélica Silva Silveira; Elie Cheniaux

Downloads: 0
Views: 382

Abstract

Objective: To evaluate whether having general insight into bipolar disorder and its symptoms is affected by the mood state of the patient, using the Insight Scale for Affective Disorders, a hetero-application scale for people with mood disorders.Methods: Ninety-five patients with bipolar disorder were evaluated and divided into different groups according to the mood state presented during assessment (i.e., euthymia, mania and depression). Sociodemographic and clinical data (Hamilton Depression Scale, Young Mania Rating Scale, and Clinical Global Impressions Scale) were recorded. Insight was evaluated using the Insight Scale for Affective Disorders.Results: 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.Conclusions: Loss of insight during mania may have important implications for treatment compliance and adherence and needs to be taken into account in the clinical management of people with bipolar disorder.

Keywords

Insight, awareness, bipolar disorder, mania, anosognosia

Resumo

Objetivo: Avaliar se o insight global sobre transtorno bipolar e sobre seus sintomas é afetado pelo estado de humor do paciente, usando a Escala de Insight para Transtornos Afetivos, uma escala de heteroaplicação para pacientes com transtorno do humor.Métodos: Noventa e cinco pacientes com transtorno bipolar foram avaliados e divididos em diferentes grupos de acordo com o estado de humor presente durante a avaliação (i.e., eutimia, mania e depressão). Dados sociodemográficos e clínicos (Escala de Depressão de Hamilton, Escala de Avaliação de Mania de Young e Escala de Impressão Clínica Global) foram registrados. Oinsight foi avaliado usando a Escala de Insight para Transtornos Afetivos.Resultados: Pacientes bipolares em mania apresentaram menor insightsobre sua condição do que pacientes em depressão ou eutimia, e menorinsight sobre seus sintomas do que pacientes em depressão, exceto para consciência de mudança de peso.Conclusões: A perda de insight durante a mania pode ter importantes implicações para aceitação do e aderência ao tratamento e precisa ser levada em conta no manejo clínico de pacientes bipolares.

Palavras-chave

Insight, consciência de morbidade, transtorno bipolar, mania, anosognosia

References

Amador XF, Strauss DH, Yale SA, Flaum MM, Endicott J, Gorman JM. Assessment of insight in psychosis. Am J Psychiatry. 1993;150:873-9.

Amador XF, Flaum M, Andreasen NC, Strauss DH, Yale SA, Clark SC. Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch Gen Psychiatry. 1994;51:826-36.

Silva RA, Mograbi DC, Landeira-Fernades J, Cheniaux E. O insight no transtorno bipolar: uma revisão sistemática. J Bras Psiquiatr. 2014;63:242-54.

Pini S, Cassano GB, Dell'Osso L, Amador XF. Insight into illness in schizophrenia, schizoaffective and mood disorders with psychotic features. Am J Psychiatry. 2001;158:122-5.

Yen CF, Chen CS, Ko CH, Yeh ML, Yang SJ, Yen JY. Relationships between insight and medication adherence in outpatients with schizophrenia and bipolar disorder: prospective study. Psychiatry Clin Neurosci. 2005;59:403-9.

Cassidy F. Insight in bipolar disorder: relationship to episode subtypes and symptom dimensions. Neuropsychiatr Dis Treat. 2010;6:627-31.

de Assis da Silva R, Mograbi DC, Silveira LA, Nunes AL, Novis FD, Landeira-Fernandez J. Insight across the different mood states of bipolar disorder. Psychiatr Q. 2015;86:395-405.

Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978;133:429-35.

Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56-62.

Cassidy F, Murry E, Forest K, Carroll BJ. Signs and symptoms of mania in pure and mixed episodes. J Affect Disord. 1998;50:187-201.

Dell'Osso L, Pini S, Tundo A, Sarno N, Musetti L, Cassano GB. Clinical characteristics of mania, mixed mania, and bipolar depression with psychotic features. Compr Psychiatry. 2000;41:242-7.

Dias VV, Brissos S, Frey BN, Kapczinski F. Insight, quality of life and cognitive functioning in euthymic patients with bipolar disorder. J Affect Disord. 2008;110:75-83.

David A, Buchanan A, Reed A, Almeida O. The assessment of insight in psychosis. Br J Psychiatry. 1992;161:599-602.

Sturman ED, Sproule BA. Toward the development of a Mood Disorders Insight Scale: modification of Birchwood's Psychosis Insight Scale. J Affect Disord. 2003;77:21-30.

Beck AT, Baruch E, Balter JM, Steer RA, Warman DM. A new instrument for measuring insight: the Beck Cognitive Insight Scale. Schizophr Res. 2004;68:319-29.

Silva Rde A, Mograbi DC, Silveira LA, Nunes AL, Novis FD, Cavaco PA. Mood self-assessment in bipolar disorder: a comparison between patients in mania, depression, and euthymia. Trends Psychiatry Psychother. 2013;35:141-5.

de Assis da Silva R, Mograbi DC, Silveira LA, Nunes AL, Novis FD, Landeira-Fernandez J. The reliability of self-assessment of affective state in different phases of bipolar disorder. J Nerv Ment Dis. 2014;202:386-90.

Olaya B, Marsà F, Ochoa S, Balanzá-Martínez V, Barbeito S, García-Portilla MP. Development of the Insight Scale for Affective Disorders (ISAD): modification from the Scale to Assess Unawareness. J Affect Disord. 2012;142:65-71.

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 2013.

Spearing MK, Post RM, Leverich GS, Brandt D, Nolen W. Modification of the Clinical Global Impressions (CGI) Scale for use in bipolar illness (BP): the CGI-BP. Psychiatry Res. 1997;73:159-71.

Cross-cultural adaptation, validation and factor structure of the Insight Scale for Affective Disorders. J Affect Disord. 2015;178:181-7.

Bressi C, Porcellana M, Marinaccio PM, Nocito EP, Ciabatti M, Magri L. The association between insight and symptoms in bipolar inpatients: an Italian prospective study. Eur Psychiatry. 2012;27:619-24.

Dell'Osso L, Pini S, Cassano GB, Mastrocinque C, Seckinger RA, Saettoni M. Insight into illness in patients with mania, mixed mania, bipolar depression and major depression with psychotic features. Bipolar Disord. 2002;4:315-22.

Fennig S, Everett E, Bromet EJ, Jandorf L, Fennig SR, Tenenberg-Karant M. Insight in first-admission psychotic patients. Schizophr Res. 1996;22:257-63.

Cheniaux E, Landeira-Fernandez J, Lessa Telles L, Lessa JL, Dias A, Duncan T. Does schizoaffective disorder really exist? A systematic review of the studies that compared schizoaffective disorder with schizophrenia or mood disorders. J Affect Disord. 2008;106:209-17.

Camelo EVM, Velasques B, Ribeiro P, Netto T, Cheniaux E. Attention impairment in bipolar disorder: a systematic review. Psychol Neurosci. 2013;6:299-309.

Dias VV, Brissos S, Carita AI. Clinical and neurocognitive correlates of insight in patients with bipolar I disorder in remission. Acta Psychiatr Scand. 2008;117:28-34.

6169f471a95395629320c662 trends Articles
Links & Downloads

Trends Psychiatry Psychother

Share this page
Page Sections