Clinical correlates of loss of insight in bipolar depression

Abstract

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. Descritores: Insight, depressão bipolar, transtorno bipolar. AbstractIntroduction: 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 redu...

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Impact of response shift effects in the assessment of self-reported depression during treatment: Insights from a rTMS versus Venlafaxine randomized controlled trial

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