Clinical and neurocognitive correlates of insight in patients with bipolar I disorder in remission

OBJECTIVE: The relationship between insight and neurocognition in bipolar disorder has not been clearly established. METHOD: A neuropsychological battery assessing attention, mental control, perceptual-motor skills, executive functions, verbal fluency and abstraction, and visuo-spatial attention was administered to 50 bipolar remitted patients and 50 healthy controls. Insight was assessed with the Scale to Assess Unawareness of Mental Disorder. RESULTS: Patients presented significantly worse neurocognitive performance. Insight was impaired in 60% of patients, and age, educational level, manic symptoms, age of disease onset, number of admissions, and performance on several neurocognitive tests correlated significantly with insight. A regression model revealed that age and Trail Making Test part B (TMT-B) performance accounted for 32% of the variance in overall illness awareness, while performance on the TMT-B alone accounted for 28% of the variance. CONCLUSION: Impaired insight and neurocognitive dysfunction seem to be present in euthymic bipolar patients. Insight in bipolar disorder may be partially dependent on intact neurocognition.