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Insight is a multidimensional construct, defined as the awareness of having a mental disorder, of specific symptoms and their attribution to the disorder, the awareness of social consequences, and of need for treatment. Although insight has been studied specifically in schizophrenia and its study in mood disorders has traditionally received limited attention, the evaluation of this concept in mood disorders is also very important because of the impact on treatment compliance and outcome. In bipolar disorder (BD), clinical insight varies substantially over time. Most researchers observed that insight is more impaired during an illness episode than during remission, in mixed than in pure manic episodes, in bipolar II than in bipolar I patients, and in pure mania than in bipolar or unipolar depression. Lack of insight is a consistent factor of non-adherence to medication in bipolar patients, along with severity of BD, side effects of medication, effectiveness, and patient-related factors. Also, impaired insight into treatment and a great number of previous hospitalizations are associated with poorer clinical outcomes (psychiatric hospitalization, emergency room visits, violent or suicidal behavior) among the patients with bipolar I disorder. In the management of bipolar disorder, improving quality of life (QoL) and outcome should be one the most important goals.

Lack of Insight in Bipolar Disorder: The Impact on Treatment Adherence, Adverse Clinical Outcomes and Quality of Life