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

•Insight during mania is more compromised in relation to energy and activity levels.•By contrast, insight about having a condition is relatively more preserved.•Loss of insight about symptoms correlates with more severe agitation/high energy.•The findings suggest a psychomotor nucleus in mania impairing insight.

BackgroundStudies on insight in bipolar mania are not numerous and usually consider insight as a unitary construct.ObjectiveEvaluate how different facets of insight are affected in bipolar mania and investigate correlations between insight for each specific object in bipolar disorder and manic symptomatology.MethodA group of 165 bipolar patients were followed during a year, with 51 patients having manic episodes according to DSM-IV-TR criteria. Patients underwent a clinical assessment and insight was evaluated through the Insight Scale for Affective Disorders.ResultsThe study found that insight regarding symptoms is worse than insight of having bipolar disorder, social relationships and self esteem. Moreover, poor global insight (total ISAD) correlates with more severe changes in mood, speech and thought structure, with worse insight about symptoms correlating with the same alterations and also with more severe symptoms of agitation/energy.LimitationsAlthough a large sample of bipolar patients was followed up, the final sample composed of patients with at least one manic episode was relatively smaller. Moreover, the fact that the study was performed in a university hospital may have led to selection biases.ConclusionResults suggest that patients with BD are reasonably capable of identifying that their condition implies consequences but have more impaired awareness of their energy and activity levels. A lower level of insight specifically about symptoms correlates with more severe symptoms of agitation/energy, which suggests a psychomotor nucleus able to impair insight in mania.