Abstract
Insight is greatly impaired in Bipolar Disorder (BD), especially during mania. Cognitive impairment is also present in BD. Despite that, few studies have investigated a possible association between these two aspects. The main goal of the current study is to compare BD affective states regarding performance in cognitive testing and investigate clinical and cognitive predictors for insight loss in BD. The study investigated a sample of 65 patients who were evaluated in one of the BD phases (mania, euthymia or depression). All the subjects underwent neuropsychological evaluation and completed the Insight Scale for Affective Disorders (ISAD). The relationship between level of insight and clinical/cognitive variables was analyzed through multiple regression models. No significant differences were found among BD phases regarding performance on cognitive testing. Insight was more impaired in mania then in depression or euthymia. Predictors for loss of insight were: severity of manic symptoms and impairments in selective attention (Symbol search test), divided attention (Trail making test) and inhibition (Stroop test). The sample size is a potential limitation of the current study. Nevertheless, the results suggest this had limited impact, with group differences being detected for a number of variables. The results found have important clinical importance, suggesting, for example, that rehabilitation of specific cognitive skills may improve insight in BD.
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References
Amador XF, David AS. Insight and psychosis: awareness of illness in schizophrenia and related disorders. 2nd ed. Oxford: Oxford University Press; 2004.
Amanzio M, Vase L, Leotta D, Miceli R, Palermo S, Geminiani G. Imparied awareness of deficits in Alzheimer disease: the role of everyday dysfunction. J Int Neuropsychol Soc. 2013;19:63–72.
American Psychiatric Association, editor. Diagnostic and statistical manual of mental disorders. 5th ed. Washington: American Psychiatric Association; 2013.
Braw Y, Sitman R, Sela T, Erez G, Bloch Y, Levkovitz Y. Comparison of insight among schizophrenia and bipolar disorder patients in remission of affective and positive symptoms: analysis and critique. Eur Psychiatry. 2011;27:612–8. https://doi.org/10.1016/j.eurpsy.2011.02.002.
Camelo EVM, Netto T, Velasques B, Ribeiro P, Cheniaux E. Attention impairment in bipolar disorder: a systematic review. Psychol Neurosci. 2013;6(3):299–309.
Cassidy F. Insight in bipolar disorder: relationship to episode subtypes and symptom dimensions. Neuropsychiatr Dis Treat. 2010;6:627–31.
Cely EEP, Fierro M, Pinilla MI. Prevalencia y factores asociados a la no adherencia en el tratamento farmacológico de mantenimiento em adultos com transtorno afectivo bipolar. Revista Colombiana de Psiquiatria. 2011;40(1):85–98.
De Brigard F, Prinz J. Attention and consciousness. Wiley Interdiscip Rev Cogn Sci. 2010;1:51–9.
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(1):28–34.
Fonseca RP, Parente MAMP, Côté H, Ska B, Joanette Y. Bateria Montreal de Avaliação da Comunicação – Bateria MAC. São Paulo: Pró-Fono; 2008.
Gaudino EA, Geisler MW, Squires NK. Construct validity in the trail making test: what makes part B harder? J Clin Exp Neuropsychol. 1995;17(4):529–35.
Goodwin FK, Jamison KR. Manic-depressive illness: bipolar disorders and recurrent depression. 2nd ed. New York: Oxford University Press; 2007.
Hamilton MA. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.
Maalouf FT, Klein C, Clark L, Sahakian BJ, Labarbara EJ, Versace A, et al. Impaired sustained attention and executive dysfunction: bipolar disorder versus depression-specific markers of affective disorders. Neuropsychologia. 2010;48(6):1862–8.
Mahlberg R, Adli M, Bschor T, Kienast T. Age effects on trail making test during acute depressive and manic episode. Int J Neurosci. 2008;118(9):1347–56.
Martínez- Arán A, Vieta E, Reinares M, Colom F, Torrent C, Sánchez-Moreno J, et al. Cognitive function across manic or hypomanic, depressed and euthymic states in bipolar disorder. Am J Psychiatry. 2004;161(2):262–70.
Merikle PM, Joordens S. Measuring unconscious influences. In: Cohen JD, Cohen JWS, editors. Scientific approaches to consciousness. Mahwah: Erlbaum; 1997. p. 109–23.
Miller EK, Cohen JD. An integrative theory of prefrontal cortex function. Annu Rev Neurosci. 2001;24:167–202.
Mole C. Attention and consciousness. J Conscious Stud. 2008;15(4):86–104.
Morris RG, Mograbi DC. Anosognosia, autobiographical memory and self knowledge in Alzheimer’s disease. Cortex. 2013;49:1553–65. https://doi.org/10.1016/j.cortex.2012.09.006.
Netto TM, Greca DV, Ferracini R, Pereira Denis B, Bizzo B, Doring T, et al. Correlation between frontal cortical thickness and executive functions performance in patients with human immunodeficiency virus infection. Radiol Bras. 2011;44(1):7–12.
Olaya B, Marsà F, Ochoa S, Balanzá-Martínez V, Barbeito S, García-Portilla MP, et al. Development of the insight scale for affective disorders (ISAD): modification from the scale to assess unawareness of mental disorder. J Affect Disord. 2012;142(1–3):65–71.
Posner MI, Dehaene S. Attentional networks. Trends Neurosci. 1994;17:75–9.
Shad MU, Prasad K, Forman SD, Haas GL, Walker JD, Pisarov LA, et al. Insight and neurocognitive functioning in bipolar subjects. Compr Psychiatry. 2015;56:112–20.
Silva RA, Mograbi DC, Silveira LA, Nunes AL, Novis FD. Insight across the different mood states of bipolar disorder. Psychiatry Q. 2014;85(4):391–522.
Silva RA, Mograbi DC, Camelo EVM, Morton GD, Landeira-fernandez J, Cheniaux E. Cross-cultural adaptation, validation and factor structure of the insight scale for affective disorders. J Affect Disord. 2015;178(1):181–7.
Soeiro-de-Souza MG, Post RM, de Sousa ML, Missio G, do Prado CM, Gattaz WF, et al. Does BDNF genotype influence creative output in bipolar I manic patients? J Affect Disord. 2012;139(2):181–6.
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.
Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol. 1935;18:643–62. https://doi.org/10.1037/h0054651.
Van der Werf-Eldering M, Burger H, Jabben N, Holthausen EA, Aleman A, Nolen WA. Is the lack of association between cognitive complaints and objective cognitive functioning in patients with bipolar disorder moderated by depressive symptoms? J Affect Disord. 2011;130(1–2):306–11.
Varga M, Magnusson A, Flekkoy K, Ronneberg U, Opjordsmoen S. Insight, symptoms and neurocognition in bipolar I patients. J Affect Disord. 2006;91:1–9.
Wechsler D. Manual for the Wechler Adult Intelligence Scale-Revised (WAIS-R). San Antonio: Psychological Corporation; 1981.
Yen CF, Cheng CP, Ko CH, Yen JY, Huang CF, Chen CS. Relationship between insight and neurocognition in patients with bipolar I disorder in remission. Compr Psychiatry. 2008;49(4):335–9.
Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978;133:429–35.
Zhou Y, Rosenheck R, Mohamed S, Zhang J, Chang Q, Ou Y, et al. Insight in inpatients with schizophrenia: relationship to symptoms and neuropsychological functioning. Schizophr Res. 2015;161(2–3):376–81.
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Evelyn Camelo declares that she has no conflict of interest.
Daniel Mograbi declares that he has no conflict of interest.
Rafael de Assis da Silva declares that he has no conflict of interest.
Cristina M. T. Santana declares that she has no conflict of interest.
Rodrigo L. Ferreira do Nascimento declares that he has no conflict of interest.
Adriana Cardoso de Oliveira e Silva declares that she has no conflict of interest.
Antônio Egídio Nardi declares that he has no conflict of interest.
Elie Cheniaux declares that he has no conflict of interest.
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Camelo, E., Mograbi, D.C., de Assis da Silva, R. et al. Clinical and Cognitive Correlates of Insight in Bipolar Disorder. Psychiatr Q 90, 385–394 (2019). https://doi.org/10.1007/s11126-019-09627-2
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DOI: https://doi.org/10.1007/s11126-019-09627-2