Clinical and Cognitive Correlates of Insight in Bipolar Disorder

Camelo, Evelyn V. M.; Mograbi, Daniel C.; Silva, Rafael de Assis da; Santana, Cristina M T; Nascimento, Rodrigo Leão Ferreira do; Silva, Adriana Cardoso de Oliveira e; Nardi, Antônio Egídio; Cheniaux, Elie

doi:10.1007/s11126-019-09627-2

Cited by 13 publications

(9 citation statements)

References 30 publications

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“…Lastly, while below threshold for significance when included in a model with other clinical and neurocognitive predictors, we observed a trend toward impaired performance on the Switching of Attention test as a correlate of clutter underreporting, particularly when controlling for level of clutter. This is consistent with findings from OCD 66 , 73 , anorexia nervosa 74 , and bipolar disorder 70 , 75 , in which relative deficits in the Trail Making Test Part B have been found to correlate with impaired clinical insight. The observation that abnormalities of response inhibition, interference processing, and attention switching might correlate with insight impairment across diagnoses supports a general model in which awareness is intrinsically related to cognitive control.…”

Section: Discussionsupporting

confidence: 90%

“…We additionally identified differential response time on a Stroop color/word task as a predictor of clutter underreporting. Correlations between Stroop performance and clinical insight impairment have been reported for OCD 65 and for bipolar disorder 70 , on which basis insight impairment has similarly been suggested to reflect deficits in response inhibition and the processing of conflictual information. For our participants, we observed that increased clutter underreporting predicted better normalized response time performance on the ink color naming task relative to the word reading task.…”

Section: Discussionmentioning

confidence: 96%

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Anosognosia in hoarding disorder is predicted by alterations in cognitive and inhibitory control

Roessel

Marzke

Varias

et al. 2022

Sci Rep

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Insight impairment contributes significantly to morbidity in psychiatric disorders. The neurologic concept of anosognosia, reflecting deficits in metacognitive awareness of illness, is increasingly understood as relevant to psychopathology, but has been little explored in psychiatric disorders other than schizophrenia. We explored anosognosia as an aspect of insight impairment in n = 71 individuals with DSM-5 hoarding disorder. We used a standardized clutter severity measure to assess whether individuals with hoarding disorder underreport home clutter levels relative to independent examiners. We then explored whether underreporting, as a proxy for anosognosia, is predicted by clinical or neurocognitive behavioral measures. We found that individuals with hoarding disorder underreport their clutter, and that underreporting is predicted by objective severity of clutter. In an n = 53 subset of participants, we found that underreporting is predicted by altered performance on tests of cognitive control and inhibition, specifically Go/No-Go and Stroop tests. The relation of underreporting to objective clutter, the cardinal symptom of hoarding disorder, suggests that anosognosia may reflect core pathophysiology of the disorder. The neurocognitive predictors of clutter underreporting suggest that anosognosia in hoarding disorder shares a neural basis with metacognitive awareness deficits in other neuropsychiatric disorders and that executive anosognosia may be a transdiagnostic manifestation of psychopathology.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 96%

Anosognosia in hoarding disorder is predicted by alterations in cognitive and inhibitory control

Roessel

Marzke

Varias

et al. 2022

Sci Rep

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“…One clinical feature of bipolar disorder (BD) is variable awareness of symptoms, their severity, and impact on others; this appears especially true when manic [1]. Fortunately, smartphones today enable active and passive measurement of mood and behavior for those with mental health conditions [2][3][4], including BD [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Ecological Momentary Assessment of Bipolar Disorder Symptoms and Partner Affect: Longitudinal Pilot Study

Yerushalmi¹,

Sixsmith²,

Star³

et al. 2021

JMIR Form Res

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Background The World Health Organization ranks bipolar disorder (BD) as the 7th leading cause of disability. Although the effects on those with BD are well described, less is reported on the impact of BD on cohabiting partners or any interactions between the two; this requires in vivo data collection measured each day over several months. Objective We set out to demonstrate the utility of ecological momentary assessment with BD couples measured using yoked smartphone apps. When randomly prompted over time, we assumed distinct patterns of association would emerge between BD symptoms (both depression and hypo/mania) and partner mood (positive and negative affect). Methods For this pilot study, we recruited an international sample of young and older adults with BD and their cohabiting partners where available. Both participants and partners downloaded separate apps onto their respective smartphones. Within self-specified “windows of general availability,” participants with BD were randomly prompted to briefly report symptoms of depression and hypo/mania (ie, BDSx), positive and negative mood (ie, POMS-15; partners), and any important events of the day (both). The partner app was yoked to the participant app so that the former was prompted roughly 30 minutes after the participant with BD or the next morning if outside the partner’s specified availability. Results Four couples provided 312 matched BD symptom and partner mood responses over an average of 123 days (range 65-221 days). Both were GPS- and time-stamped (mean 3:11 hrs between questionnaires, SD 4:51 hrs). Total depression had a small but significant association with positive (r=–.14; P=.02) and negative partner affect (r=.15; P=.01]. Yet total hypo/mania appeared to have no association with positive partner affect (r=–.01; P=.87); instead, negative partner affect was significantly correlated with total hypo/mania (r=.26; P=.01). However, when we look specifically at BD factors, we see that negative partner affect is associated only with affrontive symptoms of hypo/mania (r=.38; P=.01); elation or loss of insight appears unrelated to either positive (r=.10; P=.09) or negative partner affect (r=.02; P=.71). Yet affrontive symptoms of hypo/mania were significantly correlated with negative affect, but only when couples were together (r=.41; P=.01), not when apart (r=.22; P=.12). That is, these angry interpersonal symptoms of hypo/mania appear to be experienced most negatively by spouses when couples are together. Conclusions These initial findings demonstrate the utility of in vivo ambulatory data collection in longitudinal mental health research. Preliminary analyses suggest different BD symptoms are associated with negative and positive partner mood. These negative effects appear greater for hypo/mania than depressive symptoms, but proximity to the person with BD is important.

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“…In individuals suffering from severe and persistent psychiatric disorders, metacognition is a multi-faceted construct encompassing the recognition that one is ill, the awareness of one's own cognitive style and beliefs, and the awareness of one's own cognitive performance [1]. Lack of insight into the illness is frequent in BD 1 [2], particularly during the manic phase [3]. Several studies have identified dysfunctional metacognitive beliefs in BD [4], which is associated with a higher level of depression, earlier onset of affective illness [5], and worse cognitive impairments [6].…”

Section: Introductionmentioning

confidence: 99%

Exploring Clinical Correlates of Metacognition in Bipolar Disorders Using Moderation Analyses: The Role of Antipsychotics

Roux¹,

Faivre²,

Cannavo³

et al. 2021

Preprint

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The determinants of metacognition are still poorly understood in bipolar disorders (BD). We aimed to examine the clinical determinants of metacognition, defined as the agreement between objective and subjective cognition in individuals with BD. The participants consisted of 281 patients with BD who underwent an extensive neuropsychological battery and clinical evaluation. To assess subjective cognition, participants provided a general rating of their estimated cognitive difficulties. Clinical characteristics of BD were also recorded, along with medication. We studied the potential moderation of the association between cognitive complaints and global objective cognitive performance by several clinical variables with ordinal logistic regressions. Depression and impulsivity were associated with greater cognitive complaints. The only variable that moderated the relationship between objective and subjective cognition in the global model was the prescription of antipsychotics. Patients taking antipsychotics had a poorer association between cognitive complaints and objective neuropsychological performance. This result suggests a role for dopamine in the modulation of metacognitive performance, and calls for the systematic control of antipsychotic medication in future studies documenting metacognitive deficits in severe and persistent mental disorders. Depression and impulsivity should be investigated as potential therapeutic targets for individuals with BD and cognitive complaints, before proposing an extensive neuropsychological evaluation.

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Clinical and Cognitive Correlates of Insight in Bipolar Disorder

Cited by 13 publications

References 30 publications

Anosognosia in hoarding disorder is predicted by alterations in cognitive and inhibitory control

Anosognosia in hoarding disorder is predicted by alterations in cognitive and inhibitory control

Ecological Momentary Assessment of Bipolar Disorder Symptoms and Partner Affect: Longitudinal Pilot Study

Exploring Clinical Correlates of Metacognition in Bipolar Disorders Using Moderation Analyses: The Role of Antipsychotics

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