Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2017-0073
Trends in Psychiatry and Psychotherapy
Original Article

The relationship between insight and affective temperament in bipolar disorder: an exploratory study

A relação entre insight e temperamento afetivo no transtorno bipolar: um estudo exploratório

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

http://dx.doi.org/10.1590/2237-6089-2017-0073 Trends Psychiatry Psychother, vol.40, n3, p.210-215, 2018
PDF
SciELO
Downloads: 0
Views: 533

Abstract

Abstract Introduction In recent years, the association between temperament and clinical characteristics of mood disorders has been studied. Most bipolar patients show deficits in their awareness of signs and symptoms. The relationship between affective temperament and insight in bipolar patients has not been carried out in the literature so far. Objective To evaluate the relationship between affective temperament and insight in bipolar disorder. Method A group of 65 bipolar patients were followed during a year. Patients underwent a clinical assessment and were diagnosed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Insight was evaluated through the Insight Scale for Affective Disorders (ISAD), and affective temperament, through the TEMPS-Rio de Janeiro. The relationship between affective temperament and insight was explored with Spearman rho correlations between scores on each item of the ISAD and on the TEMPS-Rio de Janeiro subscales. Results In euthymic phases, bipolars with depressive temperament were associated with a higher level of insight about the consequences of the disorder; when in mania, patients showed better insight about having an affective disorder, presenting psychomotor alterations, and suffering from guilt or grandiosity. Similarly, bipolar patients with higher scores of anxious temperament, when in mania, had better insight on alterations in attention. Bipolar patients with higher scores of hyperthymic temperament, when in mania, showed the worst insight about thought disorder. Conclusion In addition to being determined by the phase of the disease and several varying symptoms, the level of insight in bipolar patients is also influenced by affective temperament.

Keywords

Bipolar disorder, insight, affective temperament

Resumo

Resumo Introdução Nos últimos anos, a associação entre temperamento e características clínicas dos transtornos de humor tem sido estudada. A maioria dos pacientes bipolares apresenta déficits na consciência de sinais e sintomas. A relação entre temperamento afetivo e insight em pacientes bipolares não tem sido relatada na literatura até o momento. Objetivo Avaliar a relação entre temperamento afetivo e insight no transtorno bipolar. Métodos Um grupo de 65 pacientes bipolares foi acompanhado por um ano. Os pacientes foram submetidos a uma avaliação clínica utilizando os critérios do Manual Diagnóstico e Estatístico de Transtornos Mentais, 5ª edição (DSM-5). O insight foi avaliado através da Escala de Insight para Transtornos Afetivos (ISAD), e o temperamento afetivo, através da TEMPS-Rio de Janeiro. A relação entre temperamento afetivo e insight foi explorada usando correlações de Spearman entre os escores de cada item da ISAD e as subescalas da TEMPS-Rio de Janeiro. Resultados Nas fases eutímicas, os bipolares com temperamento depressivo relacionaram-se com maior nível de insight sobre as consequências do transtorno; quando em mania, apresentaram melhor insight sobre ter um transtorno afetivo, apresentar alterações psicomotoras e sofrer de culpa ou grandiosidade. Da mesma forma, bipolares com maiores escores de temperamento ansioso, quando em mania, tiveram melhor percepção sobre alterações na atenção. Bipolares com escores mais altos de temperamento hipertímico, quando em mania, mostraram o pior insight sobre o curso do pensamento. Conclusão O nível de insight em pacientes bipolares, além de ser determinado pela fase da doença e por diversos sintomas, é influenciado pelo temperamento afetivo.

Palavras-chave

Transtorno bipolar, insight, temperamento afetivo

References

Kraepelin E. Fundamental states. Manic-depressive insanity and paranoia. 1921:118-32.

Akiskal HS, Mallya G. Criteria for the “soft” bipolar spectrum: treatment implications. Psychopharmacol Bull. 1987;23:68-73.

Akiskal HS. Dysthymia and cyclothymia in psychiatric practice a century after Kraepelin. J Affect Disord. 2001;62:17-31.

Akiskal HS. The temperamental foundations of affective disorders. Interpersonal factors in the origin and course of affective disorders. 1996:3-30.

Iasevoli F, Valchera A, Di Giovambattista E, Marconi M, Rapagnani MP, De Berardis D. Affective temperaments are associated with specific clusters of symptoms and psychopathology: A cross-sectional study on bipolar disorder inpatients in acute manic, mixed, or depressive relapse. J Affect Disord. 2013;151:540-50.

Ferreira AA, Vasconcelos AG, Neves FS, Correa H. Affective temperaments and antidepressant response in the clinical management of mood disorders. J Affect Disord. 2014;155:138-41.

Tohen M, Bowden CL, Calabrese JR, Lin D, Forrester TD, Sachs GS. Influence of sub-syndromal symptoms after remission from manic or mixed episodes. Br J Psychiatry. 2006;189:515-9.

Lewis AJ. The psychopathology of insight. Br J Med Psychol. 1934;14:332-48.

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.

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.

McEvoy JP, Apperson LJ, Appelbaum PS, Ortlip P, Brecosky J, Hammill K. Insight in schizophrenia. Its relationship to acute psychopathology. J Nerv Ment Dis. 1989;177:43-7.

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.

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.

Güçlü O, Karaca O, Yildirim B, Ozköse MM, Erkiran M. The relationship between insight and clinical features in bipolar disorder. Turk Psikiyatri Derg. 2011;22:1-7.

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.

Van Der Werf-Eldering MJ, Van Der Meer L, Burger H, Holthausen EAE, Nolen WA, Aleman A. Insight in bipolar disorder: associations with cognitive and emotional processing and illness characteristics. Bipolar Disord. 2011;13:343-54.

Manual Diagnóstico e Estatístico de Transtornos Mentais. 2014.

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.

Spearing M K, 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.

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.

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.

Akiskal HS, Akiskal KK. TEMPS: Temperament Evaluation of Memphis, Pisa, Paris and San Diego. J Affect Disord. 2005;85:1-2.

Woodruff E, Genaro LT, Landeira-Fernandez J, Cheniaux E, Laks J, Jean-Loius G. Validation of the Brazilian brief version of the temperament auto-questionnaire TEMPS-A: the brief TEMPS-Rio de Janeiro. J Affect Disord. 2011;134:65-76.

Koufaki I, Polizoidou V, Fountoulakis KN. The concept of temperament and its contribution to the understanding of the bipolar spectrum. Psychiatriki. 2017;28:142-55.

Solmi M, Zaninotto L, Toffanin T, Veronese N, Lin K, Stubbs B. A comparative meta-analysis of TEMPS scores across mood disorder patients, their first-degree relatives, healthy controls, and other psychiatric disorders. J Affect Disord. 2016;196:32-46.

Qiu F, Akiskal HS, Kelsoe JR, Greenwood TA. Factor analysis of temperament and personality traits in bipolar patients: Correlates with comorbidity and disorder severity. J Affect Disord. 2017;207:282-90.

Silva RA, Mograbi DC, Silveira LAS, Nunes ALS, Novis FD, Landeira-Fernandez J. Insight across the different mood states of bipolar disorder. Psychiatr Q. 2015;86:395-405.

Silva RA, Mograbi DC, Camelo EVM, Bifano J, Wainstok M, Silveira LAS. Insight in bipolar disorder: A comparison between mania, depression and euthymia using the Insight Scale for Affective Disorders. Trends Psychiatry Psychother. 2015;37:152-6.

Brieger P, Roettig S, Ehrt U, Wenzel A, Blöink R, Marneros A. T EMPS-A scale in ‘mixed’ and ‘pure’ manic episodes: new data and methodological considerations on the relevance of joint anxious–depressive temperament traits. J Affect Disord. 2003;73:99-104.

Roettig D, Roettig S, Brieger P, Marneros A. Temperament and personality in bipolar I patients with and without mixed episodes. J Affect Disord. 2007;104:97-102.

Akiskal HS, Placidi GF, Maremmani I, Signoretta S, Liguori A, Gervasi R. TEMPS-I: delineating the most discriminant traits of the cyclothymic, depressive, hyperthymic and irritable temperaments in a nonpatient population. J Affect Disord. 1998;51:7-19.

Russo M, Mahon K, Shanahan M, Ramjas E, Solon C, Braga RJ. Affective temperaments and neurocognitive functioning in bipolar disorder. J Affect Disord. 2014;169:51-6.

Vöhringer PA, Whitham EA, Thommi SB, Holtzman NS, Khrad H, Ghaemi SN. Affective temperaments in clinical practice: A validation study in mood disorders. J Affect Disord. 2012;136:577-80.

Azorin JM, Adida M, Belzeaux R. Predominant polarity in bipolar disorders: Further evidence for the role of affective temperaments. J Affect Disord. 2015;182:57-63.

Kesebir S, Vahip S, Akdeniz F, Yüncü Z, Alkana M, Akiskal H. Affective temperaments as measured by TEMPS-A in patients with bipolar I disorder and their first-degree relatives: a controlled study. J Affect Disord. 2005;85:127-33.

Kesebir S, Ünübol B, Yaylacı ET, Gündoğar D, Ünübol H. Impact of childhood trauma and affective temperament on resilience in bipolar disorder. Int J Bipolar Disord. 2015;3.

Altinbas K, Guloksuz S, Oral ET. Metabolic syndrome prevalence in different affective temperament profiles in bipolar-I disorder. Rev Bras Psiquiatr. 2013;35:131-5.

Calatayud GL, Sebastián NH, García-Iturrospe EA, Piqueras JCG, Arias JS, Cercós CL. Relationship between insight, violence and diagnoses in psychotic patients. Rev Psiquiatr Salud Ment. 2012;5:43-7.

González-Ortega I, Mosquera F, Echeburúa E, González-Pinto A. Insight, psychosis and aggressive behaviour in mania. Eur J Psychiatry. 2010;24:70-7.

Ghaemi SN, Boiman E, Goodwin FK. Insight and outcome in bipolar, unipolar and anxiety disorders. Compr Psychiatry. 2000;41:167-71.

6169bebba953954dc60e2143 trends Articles
Links & Downloads
2238-0019 (Electronic)
Trends Psychiatry Psychother ©2024 All rights reserved.

Trends Psychiatry Psychother

Share this page
Page Sections