The Reliability of Self-assessment of Affective State in Different Phases of Bipolar Disorder

Abstract

Some studies have indicated that the capacity of self-assessment of affective state is more compromised during mania than during depression. In the present study, we investigated whether the reliability of self-assessment in bipolar disorder varies as a function of actual affective state (i.e., euthymia, mania, or depression). Sixty-five patients with a diagnosis of type I and type II bipolar disorder were evaluated with regard to the occurrence of an affective syndrome using the Clinical Global Impressions Scale for use in bipolar illness, the Positive and Negative Syndrome Scale, and the Global Assessment of Functioning scale. In parallel, we applied the Analog Visual Mood Scale, a self-assessment tool to evaluate mood changes. The same individual prospectively completed the self-assessment scale in different affective states. During depression, the patients' evaluation was significantly different from when they were in manic or euthymic mood states. However, when in mania, the patients evaluated their mood state similarly to when they were euthymic. The bipolar patients in mania but not in depression did not reliably evaluate themselves with regard to their affective state.

Insight in bipolar disorder: a comparison between mania, depression and euthymia using the Insight Scale for Affective Disorders

“…In past studies, the preservation of insight in the depressive phase of BD has also been observed. 7,16,17 The development of the ISAD was based on the SUMD. 1 The SUMD, in turn, was developed to be applied in studies involving patients with schizophrenia and were significantly associated with high levels of insight impairment.…”

“…However, evaluation of insight through the use of self-evaluation instruments may result in discrepancies when compared with objective evaluations. 16,17 In light of these different measurement tools, Olaya et al 18 developed the Insight Scale for Affective Disorders (ISAD), which relies on hetero-application for patients with mood disorders.…”

Trajectory of insight on various dimensions among bipolar disorder in-patients

“…Another study which was done to evaluate insight in mania, depression and euthymia in 95 bipolar affective disorder patients showed poor insight among mania patients when compared with depressive patients. [ 19 ] The P value was significant 0.001.…”

“…The median prevalence of nonadherence is 44.7% in patients with bipolar affective disorder. [ 19 ] In one study that was done to assess the predictors of nonadherence in bipolar affective disorder patients showed treatment nonadherent individuals had more negative attitudes toward medications and reduced insight into illness when compared with treatment adherent individuals. [ 20 ] We also compared the MDIS scores between good compliance and poor compliance group.…”

Are existing self‐ratings of acute manic symptoms in adults reliable and valid?—A systematic review

“…Brown, et al 39 Somewhat related to the question with regards to sensitivity to minor changes is the observation made by de Assis da Silva et al 66 who found that patients in a manic and euthymic state responded very similar on visual analog scales of mood. This raises the issue of which individual questions and items help differentiate between mood states or between normal and clinically relevant elated states, especially in outpatient samples.…”