O insight no transtorno bipolar: uma revisão sistemática

Abstract

rESUMo objetivos: Realizar uma revisão sistemática para compreender que fatores estão relacionados a uma maior ou menor consciência de morbidade no transtorno bipolar (TB), como o insight varia em função do estado afetivo e estabelecer uma comparação com outros transtornos mentais. Métodos: Realizou-se uma revisão sistemática da literatura científica sobre o insight em pacientes com TB. Foram buscados estudos clínicos originais sobre o tema nas bases de dados Medline, ISI e SciELO. Os termos de busca empregados foram: "insight" OR "awareness" AND "bipolar" OR "mania" OR "manic". resultados: Foram selecionados 55 artigos. O insight no TB parece ser mais prejudicado do que na depressão unipolar, porém menos do que na esquizofrenia. Com relação ao TB, um menor nível de insight está relacionado à presença de sintomas psicóticos e de alterações cognitivas. Além disso, um comprometimento do insight está associado a uma menor adesão ao tratamento. Por outro lado, uma maior preservação do insight pode estar associada a maior ideação suicida. Finalmente, a fase maníaca cursa com um nível inferior de insight quando comparada à fase depressiva ou de eutimia. Conclusão: No TB, o insight está significativamente prejudicado, especialmente na mania. Diversos fatores clínicos parecem influenciar o nível de insight. aBStraCt objectives: To conduct a systematic review to understand which factors are related to insight in bipolar disorder (BD), how insight varies depending on affective state and to establish a comparison between BD and other mental disorders. Methods: We performed a systematic review of the scientific literature on insight in BD patients. Clinical studies on the topic were searched in the Medline, SciELO and ISI databases. The search terms used were: "insight" OR "Awareness" AND "bipolar" OR "mania". results: Fifty-five articles were selected. Insight in BD is more compromised than in unipolar depression, but less than in schizophrenia. A lower level of insight is related to the presence of psychotic symptoms and cognitive disorders. Moreover, insight impairment is associated with lower adherence to treatment. On the other hand, a greater preservation of insight may be associated with increased suicidal ideation. Finally, the manic phase is characterized by a lower level of insight than the depressive phase or euthymia. Conclusion: Insight is greatly impaired in BD, especially during mania. Several clinical factors seem to influence the level of insight.

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

“…2 However, in the last few years, there has been an increase in interest about insight in patients with bipolar disorder (BD). 3 A large proportion of patients studied have shown a lack of awareness about being ill or a poor understanding of the specific signs and symptoms associated with the condition. 4 The degree of awareness about having a disorder or about its symptoms or even about the psychosocial negative consequences of such illnesses may significantly influence the course of these disorders.…”

“…4 The degree of awareness about having a disorder or about its symptoms or even about the psychosocial negative consequences of such illnesses may significantly influence the course of these disorders. 3 For instance, insight may have an effect on the patient's adherence to prescribed treatments. 5 Many studies have been published on insight into behavioral disorders, with a wide spectrum of assessment methods being used to evaluate insight.…”

Neuropsychological Characterization of Autosomal Recessive Intellectual Developmental Disorder 59 Associated with IMPA1 (MRT59)

“…Low performance on the similarities subtest has been reported in patients with bipolar disorder [16]. Despite the higher frequency of psychiatric symptoms in MRT59 patients, bipolar disorder has been associated with changes in IMPA2 and not in IMPA1 [17].…”

Metacognição no transtorno bipolar: uma revisão sistemática

“…Embora os déficits cognitivos sejam mais graves na esquizofrenia, eles podem ser comparáveis aos do TB 30,31 . Além disso, como na esquizofrenia, pacientes bipolares apresentam prejuízos proeminentes na percepção clínica de sua doença e de seus sintomas [32][33][34] . Embora o prejuízo de insight seja maior durante os episódios afetivos 35 , também pode ser observado em pacientes eutímicos 36,37 .…”