title: Insight in bipolar disorder: associations with cognitive and emotional processing and illness characteristics.
abstract: OBJECTIVE
  To investigate the multifactorial relationship between illness insight, cognitive and emotional processes, and illness characteristics in bipolar disorder patients.
  
  
  METHODS
  Data from 85 euthymic or mildly to moderately depressed bipolar disorder patients were evaluated. Insight was measured using the Mood Disorder Insight Scale (total score and subscale scores: awareness of illness, symptom attribution, and need for treatment). Cognitive and emotional functioning was measured in four domains (processing speed, memory, executive functioning, and emotional learning) in addition to premorbid IQ. Illness characteristics were assessed using the Mini-International Neuropsychiatric Interview, the Questionnaire for Bipolar Disorder, and the Inventory of Depressive Symptomatology-self rating scale. Regression analyses were performed for the whole sample. Post-hoc, interactions with lifetime psychotic features (LPF) were statistically tested and if significant, analyses were repeated for patients with (n = 36) and without (n = 49) LPF separately.
  
  
  RESULTS
  In the whole group, better insight was associated with lower processing speed, better memory performance, increased emotional learning, higher level of depressive symptoms, and longer duration of illness. Patients with LPF had worse awareness of illness, but better symptom attribution than patients without LPF. No group differences for need for treatment and overall insight were found. Finally, processing speed significantly predicted subscores for symptom attribution in patients with LPF only.
  
  
  CONCLUSIONS
  Cognitive functioning as well as impairments in emotional learning and psychotic features independently contributes to impaired insight in bipolar disorder. Processing speed seems to be a key variable in the prediction of insight in patients with LPF and not in patients without LPF.
authors.affiliation: Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: van der Werf-Eldering
authors.forename: Lisette
authors.initials: L
authors.lastname: van der Meer
authors.forename: Huibert
authors.initials: H
authors.lastname: Burger
authors.forename: Esther A E
authors.initials: EA
authors.lastname: Holthausen
authors.forename: Willem A
authors.initials: WA
authors.lastname: Nolen
authors.forename: André
authors.initials: A
authors.lastname: Aleman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001364:Awareness; D001714:Bipolar Disorder / Q000150:complications* / Q000523:psychology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008606:Mental Processes; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D055815:Young Adult