title: Insight into illness in patients with mania, mixed mania, bipolar depression and major depression with psychotic features.
abstract: BACKGROUND
  Poor insight into illness is a common feature of bipolar disorder and one that is associated with poor clinical outcome. Empirical studies of illness awareness in this population are relatively scarce with the majority of studies being published over the previous decade. The study reported here sought to replicate previous report findings that bipolar patients frequently show high levels of poor insight into having an illness. We also wanted to examine whether group differences in insight exist among bipolar manic, mixed and unipolar depressed patients with psychotic features.
  
  
  METHODS
  A cohort of 147 inpatients with DSM-III-R bipolar disorder and 30 with unipolar depression with psychotic features, were evaluated in the week prior to discharge using the Structured Clinical Interview for DSM-III-R-Patient Edition (SCID-P), the Brief Psychiatric Rating Scale (BPRS) and the Scale to assess Unawareness of Mental Disorder (SUMD).
  
  
  RESULTS
  Insight into specific aspects of the illness was related to the polarity of mood episode: patients with mania showed significantly poorer insight compared with those with mixed mania, bipolar depression and unipolar depression. A linear regression analysis using SUMD score as the dependent variable and symptoms of mania as the independent variable found that specific manic symptoms did not account for level of insight. Similar results were obtained when the mean insight scores of patients with and without grandiosity were contrasted.
  
  
  CONCLUSIONS
  We hypothesize that the lack of association between level of insight and total number of manic symptoms or with specific manic symptoms may be related to the persistence of subsyndromal symptoms in patients remitting from a manic episode.
authors.affiliation: Department of Psychiatry, Pharmacology, Neurobiology and, Biotechnology, University of Pisa, Pisa, Italy. ldellosso@psico.med.unipi.it
authors.forename: Liliana
authors.initials: L
authors.lastname: Dell'Osso
authors.forename: Stefano
authors.initials: S
authors.lastname: Pini
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Cassano
authors.forename: Concettina
authors.initials: C
authors.lastname: Mastrocinque
authors.forename: Regine Anna
authors.initials: RA
authors.lastname: Seckinger
authors.forename: Marco
authors.initials: M
authors.lastname: Saettoni
authors.forename: Alessandra
authors.initials: A
authors.lastname: Papasogli
authors.forename: Scott A
authors.initials: SA
authors.lastname: Yale
authors.forename: Xavier F
authors.initials: XF
authors.lastname: Amador
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001294:Attitude to Health; D001364:Awareness; D001714:Bipolar Disorder / Q000150:complications* / Q000175:diagnosis; D003865:Major Depressive Disorder / Q000150:complications* / Q000175:diagnosis; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D011618:Psychotic Disorders / Q000150:complications* / Q000175:diagnosis; D012720:Severity of Illness Index; D013997:Time Factors