title: The impact of insight in a first-episode mania with psychosis population on outcome at 18 months.
abstract: BACKGROUND
  To explore whether poor initial insight during a first episode of mania with psychotic features was predictive of poor psychosocial and clinical outcomes at 18 months.
  
  
  METHODS
  Secondary analysis was performed on data collected during an 8-week RCT comparing the efficacy of olanzapine versus chlorpromazine as an adjunct to lithium, and at 18-month follow-up. 74 participants were divided into three groups (no insight, partial insight, and full insight) according to the insight item from the Young Mania Rating Scale (YMRS). Differences between these three groups were examined at baseline and at 18 months on measures of symptoms (YMRS, HAMD-21, and CGI-S), and social and occupational functioning (SOFAS). Baseline differences between the three groups were determined using general linear models and chi-squared analyses. Group differences from baseline to 18-month follow-up were determined using repeated measures general linear models.
  
  
  RESULTS
  At baseline there were significant differences between the three insight groups in terms of mania and functioning, but at 18 months all groups had improved significantly in terms of psychopathology, mania, depression and social and occupational functioning. There were no significant differences between the three groups at study completion with respect to these domains.
  
  
  CONCLUSIONS
  The study was limited by the lack of availability of a more detailed rating scale for insight, and it did not account for the duration of untreated psychosis (DUI).
  
  
  CONCLUSIONS
  Poor initial insight during a first episode of mania with psychotic features does not predict poor clinical and psychosocial outcome at 18 months.
authors.affiliation: Early Psychosis Prevention and Intervention Centre (EPPIC) and ORYGEN Research Centre, Orygen Youth Health Clinical Program, Melbourne, Australia. Electronic address: leotomsmith@doctors.org.uk.
authors.forename: Leo T
authors.initials: LT
authors.lastname: Smith
authors.affiliation: Early Psychosis Prevention and Intervention Centre (EPPIC) and ORYGEN Research Centre, Orygen Youth Health Clinical Program, Melbourne, Australia.
authors.forename: Clare L
authors.initials: CL
authors.lastname: Shelton
authors.affiliation: Department of Psychiatry, University of Melbourne, Australia; Florey Institute for Neuroscience and Mental Health, Melbourne, Australia; Orygen Youth Health Research Centre, Melbourne, Australia; IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
authors.affiliation: Early Psychosis Prevention and Intervention Centre (EPPIC) and ORYGEN Research Centre, Orygen Youth Health Clinical Program, Melbourne, Australia.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Hasty
authors.affiliation: Orygen Youth Health Research Centre, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia.
authors.forename: Sue M
authors.initials: SM
authors.lastname: Cotton
authors.affiliation: Orygen Youth Health Research Centre, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Henry
authors.affiliation: Orygen Youth Health Research Centre, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia.
authors.forename: Rothanthi
authors.initials: R
authors.lastname: Daglas
authors.affiliation: Orygen Youth Health Research Centre, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia.
authors.forename: Ellen
authors.initials: E
authors.lastname: Gentle
authors.affiliation: Orygen Youth Health Research Centre, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: McGorry
authors.affiliation: Early Psychosis Prevention and Intervention Centre (EPPIC) and ORYGEN Research Centre, Orygen Youth Health Clinical Program, Melbourne, Australia; Orygen Youth Health Research Centre, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Macneil
authors.affiliation: Treatment and early Intervention in Psychosis Program (TIPP), Service de Psychiatrie Générale, Département de Psychiatrie CHUV, Université de Lausanne, Clinique de Cery, 1008 Prilly, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Conus
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001364:Awareness; D001569:Benzodiazepines / Q000008:administration & dosage; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D016009:Chi-Square Distribution; D002746:Chlorpromazine / Q000008:administration & dosage; D003863:Depression / Q000150:complications / Q000523:psychology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007600:Judgment; D016014:Linear Models; D018020:Lithium Compounds / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D011237:Predictive Value of Tests; D011379:Prognosis; D011618:Psychotic Disorders / Q000150:complications / Q000523:psychology*; D012720:Severity of Illness Index; D012917:Social Adjustment
chemical_list: D014150:Antipsychotic Agents; D018020:Lithium Compounds; D001569:Benzodiazepines; D000077152:Olanzapine; D002746:Chlorpromazine
keywords: Bipolar disorder; First-episode; Insight; Mania; Prognosis