Gianluca Serafini1, Maurizio Pompili1, Marco Innamorati1, Nicoletta Girardi2, Leonardo Strusi3, Mario Amore4, Leo Sher5, Xenia Gonda6, Zoltan Rihmer6, Paolo Girardi1. 1. 1Department of Neurosciences,Mental Health and Sensory Organs-Suicide Prevention Center,Sant'Andrea Hospital,Rome,Italy. 2. 2Department of Neurology and Psychiatry,Sapienza University of Rome,Rome,Italy. 3. 3Casa di Cura "Samadi",Rome,Italy. 4. 4Department of Neuroscience,Rehabilitation,Ophthalmology,Genetics,Maternal and Child Health,Section of Psychiatry,University of Genova,Genova,Italy. 5. 5Department of Psychiatry,Columbia University College of Physicians and Surgeons,and New York State Psychiatric Institute,New York,New York,USA. 6. 6Department of Clinical and Theoretical Mental Health,Semmelweis University,Budapest,Hungary.
Abstract
INTRODUCTION: White matter hyperintensities (WMHs) are one the most common neuroimaging findings in patients with bipolar disorder (BD). It has been suggested that WMHs are associated with impaired insight in schizophrenia and schizoaffective patients; however, the relationship between insight and WMHs in BD type I has not been directly investigated. METHODS: Patients with BD-I (148) were recruited and underwent brain magnetic resonance imaging (MRI). Affective symptoms were assessed using Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS17); the presence of impaired insight was based on the corresponding items of YMRS and HDRS17. RESULTS: Multiple punctate periventricular WMHs (PWMHs) and deep WMHs (DWMHs) were observed in 49.3% and 39.9% of the cases, respectively. Subjects with lower insight for mania had significantly more PWMHs (54.6% vs 22.2%; p < 0.05) when compared to BD-I patients with higher insight for mania. The presence of PWMHs was independently associated with lower insight for mania: patients who denied illness according to the YMRS were 4 times more likely to have PWMHs (95% CI: 1.21/13.42) than other patients. CONCLUSIONS: Impaired insight in BD-I is associated with periventricular WMHs. The early identification of BD-I subjects with PWMHs and impaired insight may be crucial for clinicians.
INTRODUCTION: White matter hyperintensities (WMHs) are one the most common neuroimaging findings in patients with bipolar disorder (BD). It has been suggested that WMHs are associated with impaired insight in schizophrenia and schizoaffective patients; however, the relationship between insight and WMHs in BD type I has not been directly investigated. METHODS:Patients with BD-I (148) were recruited and underwent brain magnetic resonance imaging (MRI). Affective symptoms were assessed using Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS17); the presence of impaired insight was based on the corresponding items of YMRS and HDRS17. RESULTS: Multiple punctate periventricular WMHs (PWMHs) and deep WMHs (DWMHs) were observed in 49.3% and 39.9% of the cases, respectively. Subjects with lower insight for mania had significantly more PWMHs (54.6% vs 22.2%; p < 0.05) when compared to BD-I patients with higher insight for mania. The presence of PWMHs was independently associated with lower insight for mania: patients who denied illness according to the YMRS were 4 times more likely to have PWMHs (95% CI: 1.21/13.42) than other patients. CONCLUSIONS: Impaired insight in BD-I is associated with periventricular WMHs. The early identification of BD-I subjects with PWMHs and impaired insight may be crucial for clinicians.
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