Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2017-0007
Trends in Psychiatry and Psychotherapy
Original Article

Clinical correlates of loss of insight in bipolar depression

Correlatos clínicos da perda de insight no transtorno bipolar

Rafael de Assis da Silva; Daniel C. Mograbi; Evelyn V. M. Camelo; Cristina M. T. Santana; Jesus Landeira-Fernandez; Elie Cheniaux

http://dx.doi.org/10.1590/2237-6089-2017-0007 Trends Psychiatry Psychother, vol.39, n4, p.264-269, 2017
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Abstract

Abstract Introduction Affective state may influence insight, especially regarding mania. Nevertheless, studies have so far suggested that depression seems not to significantly impair insight. To the best of our knowledge, this study pioneers the evaluation of how insight variations in bipolar depression correlate with clinical variables. Method A group of 165 bipolar patients, 52 of whom had depressive episodes according to DSM-5 criteria, were followed during a year. All patients underwent clinical assessment, and insight was evaluated through the Insight Scale for Affective Disorders (ISAD). Repeated-measures ANOVA was calculated comparing scores on the four ISAD factors (insight into symptoms, the condition itself, self-esteem and social relationships) in order to investigate differences in insight according to different objects. Correlational analysis explored which clinical symptoms were linked to reduced insight. Results Worse total insight correlated with suicide attempt/ideation and fewer subsyndromal manic symptoms such as mood elevation, increased energy and sexual interest. Worse self-esteem insight was associated with not only suicide ideation/attempt but also with activity reduction and psychomotor retardation. Worse symptom insight also correlated with psychomotor retardation. Better insight into having an affective disorder was associated with more intense hypochondria symptoms. Finally, worse insight into having an illness was associated with psychotic episodes. Conclusion Our study found that symptoms other than psychosis – suicide ideation, psychomotor retardation and reduction of activity and work – correlate with insight impairment in bipolar depression.

Keywords

Insight, bipolar depression, bipolar disorder

Resumo

Resumo Introdução O estado afetivo pode influenciar o insight , especialmente a mania. No entanto, até o momento os estudos mostram que a depressão parece não prejudicar significativamente o insight . De acordo com o conhecimento dos autores, este estudo é pioneiro em avaliar como as alterações de insight na depressão bipolar se correlacionam com variáveis clínicas. Método Um grupo de 165 pacientes bipolares, com 52 pacientes apresentando episódios depressivos de acordo com os critérios do DSM-5, foi acompanhado por um ano. Os pacientes foram submetidos a avaliação clínica, e o insight foi avaliado utilizandose a Insight Scale for Affective Disorders (ISAD). Diferenças no insight de acordo com o objeto foram investigadas utilizandose ANOVA de medidas repetidas, comparando os escores dos quatro fatores da ISAD ( insight sobre sintomas, sobre sua condição, autoestima e relações sociais). Análises de correlação exploraram quais sintomas clínicos estiveram associados a redução de insight . Resultados Pior insight total correlacionou-se com ideação/tentativa de suicídio e com sintomas subsindrômicos de mania (elevação do humor, energia aumentada e interesse sexual). Pior insight sobre autoestima associou-se não somente a ideação/tentativa de suicídio, mas também a redução de atividade e alentecimento psicomotor. Pior insight sobre sintomas também mostrou correlação com alentecimento psicomotor. Melhor insight sobre ter uma doença afetiva associou-se a sintomas hipocondríacos mais intensos. Finalmente, pior insight sobre a condição esteve associado a sintomas psicóticos. Conclusão O estudo mostrou que, além da psicose, outros sintomas parecem se correlacionar com prejuízo de insight na depressão bipolar, como ideação suicida, redução de atividade e alentecimento psicomotor.

Palavras-chave

Insight, depressão bipolar, transtorno bipolar

References

Cely EE, Fierro M, Pinilla MI. Prevalencia y factores asociados a la no adherencia en el tratamento farmacológico de mantenimiento em adultos com transtorno afectivo bipolar. Rev Colomb Psiquiatr. 2011;40:85-98.

Sajatovic M, Ignacio RV, West JA, Cassidy KA, Safavi R, Kilbourne AM. Predictors of nonadherence among individuals with bipolar disorder receiving treatment in a community mental health clinic. Compr Psychiatry. 2009;50:100-7.

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.

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

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.

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

Yen CF, Chen CS, Ko CH, Yen JY, Huang CF. Changes in insight among patients with bipolar I disorder: a 2-year prospective study. Bipolar Disord. 2007;9:238-42.

Silva RA, Mograbi DC, Bifano J, Santana CMT, Cheniaux E. Insight in bipolar mania: evaluation of its heterogeneity and correlation with clinical symptoms. J Affect Disord. 2016;199:95-8.

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

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

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

Chaves AC, Shirakawa I. Positivive and Negative Syndrome Scale - PANSS and it use in Brazil. Rev Psiq Clin. 1998;25:337-43.

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.

Silva RA, Mograbi DC, Filgueiras A, Camelo EVM, Morton GD, Landeira-Fernandez J. Cross-cultural adaptation, validation and factor structure of the Insight Scale for Affective Disorders. J Affect Disord. 2015;178:181-7.

Amador XF, Flaum MM, 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.

Hochberg Y. A sharper Bonferroni procedure for multiple tests of significance. Biometrika. 1988;75:800-2.

Peralta V, Cuesta MJ. Lack of insight in mood disorders. J Affect Disord. 1998;49:55-8.

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.

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.

David AS. Insight and psychosis. Br. J. Psychiatry. 1990;156:798-808.

Silva RA, Mograbi DC, Bifano J, Santana CMT, Cheniaux E. Correlation between insight level and suicidal behavior/ideation in bipolar depression. Psychiatr Q. 2016;88:47-53.

Mograbi DC, Morris RG. On the relation among mood, apathy, and anosognosia in Alzheimer's Disease. J Int Neuropsychol Soc. 2014;20:2-7.

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