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Insight in bipolar disorder: a systematic review

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; bipolar disorder; mania; mood


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