ABSTRACT
BACKGROUND: To correlate measures of insight for own psychopathology to structural and functional brain imaging findings in 21 patients with DSM-IV bipolar I disorder. METHODS: Insight was assessed using the Scale to Assess Unawareness of Mental Disorder (SUMD). Resting single photon emission computed tomography (SPECT) and computed tomography (CT) was conducted in patients and 21 normal comparison subjects matched for age, gender and handedness. RESULTS: Reduced general insight and symptom awareness, but not symptom attribution, were significantly related to cortical and subcortical atrophy, respectively. No correlations between SPECT and insight measures were identified. LIMITATIONS: Limited sample size and the use of resting state SPECT. CONCLUSIONS: General and symptom awareness were related to measures of brain atrophy but not to neurofunctioning as measured by SPECT. Future research should consider the structure and function of specific cortical regions, including the frontal and parietal cortices.
Subject(s)
Awareness , Bipolar Disorder/pathology , Bipolar Disorder/physiopathology , Brain/pathology , Brain/physiopathology , Tomography, Emission-Computed, Single-Photon , Adult , Atrophy , Bipolar Disorder/diagnostic imaging , Bipolar Disorder/psychology , Brain/diagnostic imaging , Brain Mapping/methods , Case-Control Studies , Cerebral Cortex/pathology , Cerebral Cortex/physiopathology , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Image Processing, Computer-Assisted , Male , Middle Aged , Psychiatric Status Rating Scales , Self Concept , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Level of insight and its relationship to clinical variables and neurocognitive functions was assessed in bipolar I patients. METHODS: Verbal memory, executive functioning, sustained attention, general intelligence and other neurocognitive functions were compared between 37 chronic in- and outpatients and 31 matched normal controls. Detailed psychiatric interviews were completed to define the level of symptomatology and psychosocial functioning. Insight was assessed by the Scale to Assess Unawareness of Mental Disorder (SUMD). RESULTS: Seventy percent of the patients were classified as having impaired insight. Prevalence of impaired insight was 47% and 94% in remitted and symptomatic patients, respectively. Symptomatic patients scored significantly below remitted patients on insight and neurocognition. Illness and symptom unawareness were related to overall level of symptoms, measures of memory, conceptual ability and right hand psychomotor speed and accuracy. Misattribution of symptoms and signs was correlated to visuomotor speed and visuospatial performance in addition to affective symptoms and thought disturbance. CONCLUSIONS: Our findings support the hypothesis that impaired insight and other neurocognitive dysfunctions were present in a large percentage of cases among symptomatic as well as remitted bipolar patients. This may be of clinical relevance and raises important questions about the course and outcome of the illness.
Subject(s)
Awareness , Bipolar Disorder/diagnosis , Cognition Disorders/diagnosis , Neuropsychological Tests , Adult , Ambulatory Care , Bipolar Disorder/psychology , Chronic Disease , Cognition Disorders/psychology , Female , Humans , Interview, Psychological , Male , Middle Aged , Patient Admission , Personality Inventory , Psychiatric Status Rating Scales , Reference Values , Sick Role , Social AdjustmentABSTRACT
The present study seeks to elucidate the relationship between unawareness of illness in schizophrenia and frontal lobe dysfunction, in addition to investigating the relationship between lack of insight and sociodemographic and clinical variables. Twenty-one medicated schizophrenic patients, recruited from in- and out-patient wards at Ullevâl Hospital, underwent the Scale to Assess Unawareness of Mental Disorder (SUMD), neuropsychological testing, psychiatric symptom ratings and neuroimaging procedures (CT). Also, 21 matched normal controls were neuropsychologically tested. CT data were assessed blindly by two experienced neuroradiologists, according to the degree of ventricular enlargement and/or sulcal widening, and an assessment of localisation of atrophy was made. Unawareness of illness was correlated with neuropsychological measures related to executive functioning, but not with other neuropsychological measures. Five patients showed slight frontal atrophy, while two showed moderate frontal atrophy. The remaining 13 patients did not show signs of frontal lobe atrophy. Frontal lobe atrophy documented by structural brain measures was associated with poor insight in schizophrenia. Furthermore, Anergia (BPRS), GAF score and 'undifferentiated' sub-diagnosis correlated with SUMD scores. Unawareness of illness in schizophrenia may be related to frontal lobe deficit. Also, awareness of illness may not be related to general psychopathology, but rather to specific aspects.