title: The impact of periventricular white matter lesions in patients with bipolar disorder type I.
abstract: BACKGROUND
  White matter hyperintensities (WMHs) are one the most common neuroimaging findings in patients with bipolar disorder (BD). It has been suggested that WMHs are associated with impaired insight in schizophrenia and schizoaffective patients; however, the relationship between insight and WMHs in BD type I has not been directly investigated.
  
  
  METHODS
  Patients with BD-I (148) were recruited and underwent brain magnetic resonance imaging (MRI). Affective symptoms were assessed using Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS17); the presence of impaired insight was based on the corresponding items of YMRS and HDRS17.
  
  
  RESULTS
  Multiple punctate periventricular WMHs (PWMHs) and deep WMHs (DWMHs) were observed in 49.3% and 39.9% of the cases, respectively. Subjects with lower insight for mania had significantly more PWMHs (54.6% vs 22.2%; p < 0.05) when compared to BD-I patients with higher insight for mania. The presence of PWMHs was independently associated with lower insight for mania: patients who denied illness according to the YMRS were 4 times more likely to have PWMHs (95% CI: 1.21/13.42) than other patients.
  
  
  CONCLUSIONS
  Impaired insight in BD-I is associated with periventricular WMHs. The early identification of BD-I subjects with PWMHs and impaired insight may be crucial for clinicians.
authors.affiliation: 1Department of Neurosciences,Mental Health and Sensory Organs-Suicide Prevention Center,Sant'Andrea Hospital,Rome,Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Serafini
authors.affiliation: 1Department of Neurosciences,Mental Health and Sensory Organs-Suicide Prevention Center,Sant'Andrea Hospital,Rome,Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Pompili
authors.affiliation: 1Department of Neurosciences,Mental Health and Sensory Organs-Suicide Prevention Center,Sant'Andrea Hospital,Rome,Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Innamorati
authors.affiliation: 2Department of Neurology and Psychiatry,Sapienza University of Rome,Rome,Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Girardi
authors.affiliation: 3Casa di Cura "Samadi",Rome,Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Strusi
authors.affiliation: 4Department of Neuroscience,Rehabilitation,Ophthalmology,Genetics,Maternal and Child Health,Section of Psychiatry,University of Genova,Genova,Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Amore
authors.affiliation: 5Department of Psychiatry,Columbia University College of Physicians and Surgeons,and New York State Psychiatric Institute,New York,New York,USA.
authors.forename: Leo
authors.initials: L
authors.lastname: Sher
authors.affiliation: 6Department of Clinical and Theoretical Mental Health,Semmelweis University,Budapest,Hungary.
authors.forename: Xenia
authors.initials: X
authors.lastname: Gonda
authors.affiliation: 6Department of Clinical and Theoretical Mental Health,Semmelweis University,Budapest,Hungary.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Rihmer
authors.affiliation: 1Department of Neurosciences,Mental Health and Sensory Organs-Suicide Prevention Center,Sant'Andrea Hospital,Rome,Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Girardi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000473:pathology* / Q000523:psychology; D002552:Cerebral Ventricles / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D066127:White Matter / Q000473:pathology*; D055815:Young Adult
keywords: Affective symptoms; BD-I; MRI; insight; periventricular WMHs