These authors contributed equally to this article.
Insight in bipolar disorder: associations with cognitive and emotional processing and illness characteristics
Article first published online: 15 AUG 2011
© 2011 John Wiley and Sons A/S
Volume 13, Issue 4, pages 343–354, June 2011
How to Cite
van der Werf-Eldering, M. J., van der Meer, L., Burger, H., Holthausen, E. A. E., Nolen, W. A. and Aleman, A. (2011), Insight in bipolar disorder: associations with cognitive and emotional processing and illness characteristics. Bipolar Disorders, 13: 343–354. doi: 10.1111/j.1399-5618.2011.00934.x
WAN has received research grants from the Netherlands Organisation for Health Research and Development, the European Union, the Stanley Medical Research Institute, AstraZeneca, Eli Lilly & Co., GlaxoSmithKline, and Wyeth; has received honoraria/speakers fees from AstraZeneca, Pfizer, Servier, and Wyeth; and has served on advisory boards for AstraZeneca, Pfizer, and Servier. MJvdW-E, LvdM, HB, EAEH, and AA do not have any conflicts of interest or commercial associations in connection with this manuscript.
- Issue published online: 15 AUG 2011
- Article first published online: 15 AUG 2011
- Received 6 September 2010, revised and accepted for publication 4 February 2011
- bipolar disorder;
- clinical characteristics;
- emotional learning;
- mood disorders
van der Werf-Eldering MJ, van der Meer L, Burger H, Holthausen EAE, Nolen WA, Aleman A. Insight in bipolar disorder: associations with cognitive and emotional processing and illness characteristics. Bipolar Disord 2011: 13: 343–354. © 2011 The Authors. Journal compilation © 2011 John Wiley & Sons A/S.
Objective: To investigate the multifactorial relationship between illness insight, cognitive and emotional processes, and illness characteristics in bipolar disorder patients.
Methods: Data from 85 euthymic or mildly to moderately depressed bipolar disorder patients were evaluated. Insight was measured using the Mood Disorder Insight Scale (total score and subscale scores: awareness of illness, symptom attribution, and need for treatment). Cognitive and emotional functioning was measured in four domains (processing speed, memory, executive functioning, and emotional learning) in addition to premorbid IQ. Illness characteristics were assessed using the Mini-International Neuropsychiatric Interview, the Questionnaire for Bipolar Disorder, and the Inventory of Depressive Symptomatology-self rating scale. Regression analyses were performed for the whole sample. Post-hoc, interactions with lifetime psychotic features (LPF) were statistically tested and if significant, analyses were repeated for patients with (n = 36) and without (n = 49) LPF separately.
Results: In the whole group, better insight was associated with lower processing speed, better memory performance, increased emotional learning, higher level of depressive symptoms, and longer duration of illness. Patients with LPF had worse awareness of illness, but better symptom attribution than patients without LPF. No group differences for need for treatment and overall insight were found. Finally, processing speed significantly predicted subscores for symptom attribution in patients with LPF only.
Conclusions: Cognitive functioning as well as impairments in emotional learning and psychotic features independently contributes to impaired insight in bipolar disorder. Processing speed seems to be a key variable in the prediction of insight in patients with LPF and not in patients without LPF.