Factors Associated With Insight Toward Illness in Patients With Bipolar Disorder Type 1 in Manic Episodes

Impaired insight presents a significant obstacle in the management of bipolar disorder. Research on the insight of patients with acute bipolar mania is lacking. The aim of this study was to provide understanding of patient insight in acute bipolar mania.

A total of 52 inpatients who were diagnosed with bipolar disorder during a manic episode were included in the study. The Insight Scale for Affective Disorders (ISAD) was utilized, with high scores indicating poor insight. The Self-Appraisal of Illness Questionnaire (SAIQ) was used to assess patient attitudes and treatment experiences, with higher scores reflecting greater insight. Associated factors were identified through Pearson correlation and multiple linear regression analyses.

A low ISAD score was correlated with older age (p = 0.003), an extended duration of illness (p = 0.007), presence of a medical comorbidity (p = 0.012), and low scores on the Clinical Global Impressions-Severity (CGI-S) scale (p < 0.001), Clinical Global Impressions-Improvement (CGI-I) scale (p < 0.001), Young Mania Rating Scale (YMRS) (p < 0.001), and Frontal Assessment Battery (FAB) scale (p = 0.007). Multiple linear regression analysis revealed that the presence of a medical comorbidity (p = 0.031), low YMRS scores (p < 0.001), and low CGI-S scale scores (p = 0.044) were associated with low ISAD scores.

Inpatients diagnosed with acute bipolar mania, a medical comorbidity, milder disease, and less severe manic symptoms had better insight. Patients with severe symptoms affecting motor activity, energy levels, sexual interest, sleep, and speech rates had less insight.