Insight in bipolar mania: evaluation of its heterogeneity and correlation with clinical symptoms

Silva, Rafael de Assis da; Mograbi, Daniel C.; Bifano, Jaqueline; Santana, Cristina M T; Cheniaux, Elie

doi:10.1016/j.jad.2016.04.019

Cited by 19 publications

(15 citation statements)

References 47 publications

(25 reference statements)

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“…6,20 To the best of our knowledge, no other study has evaluated the correlation between insight and depressive symptoms. It is worth noting that the correlations found in the current study (bipolar depression) were generally weaker than those reported for bipolar mania, 8 which may reflect a more limited contribution of symptoms to loss of insight in bipolar depression or a reduced variance of insight into this condition.…”

Section: Discussioncontrasting

confidence: 81%

“…8 In contrast with bipolar mania, the current study found that insight in bipolar depression did not fluctuate according to the object. 8 It is possible that insight in bipolar depression is influenced by a general factor, such as a negative bias in appraisal of self-ability that does not change with different objects.…”

Section: Discussioncontrasting

confidence: 75%

“…8 The relationship Psychotic episodes were associated with increased loss of insight into having a condition. This may indicate This study has a few limitations related to sampling.…”

Section: Discussionmentioning

confidence: 99%

“…3,7 A broad study on insight in mania recently showed that worse insight level specifically regarding symptoms is correlated with higher levels of energy/agitation, which suggests the existence of a psychomotor core in mania causing insight impairments. 8 By contrast, studies have so far indicated that depression is not associated with significant impairment of insight. Several of those studies included patients with bipolar and unipolar depression in the same sample, which limits specific findings about insight in bipolar depression.…”

Section: Affective States Especially Mania May Influence Insight Smentioning

confidence: 94%

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Clinical correlates of loss of insight in bipolar depression

Silva

Mograbi

Camelo

et al. 2017

Trends Psychiatry Psychother.

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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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Section: Discussioncontrasting

confidence: 81%

Section: Discussioncontrasting

confidence: 75%

“…8 The relationship Psychotic episodes were associated with increased loss of insight into having a condition. This may indicate This study has a few limitations related to sampling.…”

Section: Discussionmentioning

confidence: 99%

Section: Affective States Especially Mania May Influence Insight Smentioning

confidence: 94%

See 2 more Smart Citations

Clinical correlates of loss of insight in bipolar depression

Silva

Mograbi

Camelo

et al. 2017

Trends Psychiatry Psychother.

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“…Previous studies exploring the relationship between specific neuropsychological abilities and medical decision-making showed that tests evaluating executive functioning correlated with the reasoning component of treatment consent capacity in clinical and healthy populations (for review, see Palmer and Savla, 2007). Additionally, mania has been associated with reduced awareness about the condition (de Assis da Silva et al, 2015a,b; 2016), including in patients with AD (Migliorelli et al, 1995). Lack of awareness about the condition may impact negatively reasoning about the treatment.…”

Section: Discussionmentioning

confidence: 99%

Behavioral and Psychological Symptoms Impact Clinical Competence in Alzheimer’s Disease

Bertrand

Duinkerken

Landeira-Fernández

et al. 2017

Front. Aging Neurosci.

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Decision-making is considered a fundamental aspect of personal autonomy and can be affected in psychiatric and neurologic diseases. It has been shown that cognitive deficits in dementia impact negatively on decision-making. Moreover, studies highlighted impaired clinical competence in neuropsychiatric disorders, such as schizophrenia and bipolar disorder. In this context, the current study explored the relationship between behavioral and psychological symptoms of dementia (BPSD) and clinical competence, especially the capacity to consent to treatment, in Alzheimer’s disease (AD). Seventy-one patients with mild to moderate AD participated, completing assessments for capacity to consent to treatment, general cognition and neuropsychiatric disturbances. For each neuropsychiatric symptom, patients with and without the particular disturbance were compared on the different subscales of the MacArthur Competence Tool for Treatment (MacCAT-T; Understanding, Appreciation, Reasoning and Expression). The results showed that patients presenting delusions, as well as apathetic patients, had a lower ability to express a clear treatment choice compared to patients without these symptoms. By contrast, patients with dysphoria/depression had higher scores on this variable. Additionally, AD patients with euphoria had more difficulties discussing consequences of treatment alternatives compared to patients without this disturbance. None of the differences were confounded by global cognition. There were no between-group differences in clinical decision-making for patients with hallucinations, agitation/aggression, anxiety, irritability, disinhibition and aberrant motor behavior. These findings highlight the importance of taking BPSD into account when assessing decision-making capacity, especially clinical competence, in AD. Furthermore, reducing BPSD may lead to better clinical competence in patients with AD, as well as to improvements in patients and caregivers’ quality of life.

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