title: The predictive effect of insight on adverse clinical outcomes in bipolar I disorder: a two-year prospective study.
abstract: Research has revealed that a lack of insight is associated with poorer clinical outcomes in schizophrenia; however, the predictive value of insight on adverse clinical outcomes among bipolar patients is quite understudied. The aim of this prospective study was to examine the impact of insight on adverse clinical outcomes among the patients with bipolar I disorder over a 2-year period. Sixty-five remitted bipolar I disorder patients received follow-up assessments at 3, 6, 9, 12, 18, and 24 months to detect the adverse clinical outcomes defined by the incidence of bipolar-related psychiatric hospitalization, emergency room visits, violent or suicidal behavior. The Schedule of Assessment of Insight was used to provide a baseline insight score. Cox regression analysis was used to examine the predictive value of insight on the adverse clinical outcomes. Impaired insight into treatment and a greater number of previous hospitalizations significantly increased the risk of adverse clinical outcomes with bipolar disorder in the 2-year period. However, insight into recognition of the illness and re-labeling of psychotic phenomena did not have any significant effect on adverse clinical outcomes. Bipolar patients' insight into treatment is an independent predictor of adverse clinical outcomes. Improving insight into treatment might be a promising target for a better outcome.
authors.affiliation: Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Cheng-Fang
authors.initials: CF
authors.lastname: Yen
authors.forename: Cheng-Sheng
authors.initials: CS
authors.lastname: Chen
authors.forename: Ju-Yu
authors.initials: JY
authors.lastname: Yen
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Ko
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018692:Antimanic Agents / Q000627:therapeutic use; D001364:Awareness; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000523:psychology; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D055502:Secondary Prevention; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D013624:Taiwan; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data
chemical_list: D018692:Antimanic Agents