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Background Studies on insight in bipolar mania are not numerous and usually consider insight as a unitary construct. Objective Evaluate how different facets of insight are affected in bipolar mania and investigate correlations between insight for each specific object in bipolar disorder and manic symptomatology. Method A group of 165 bipolar patients were followed during a year, with 51 patients having manic episodes according to DSM-IV-TR criteria. Patients underwent a clinical assessment and insight was evaluated through the Insight Scale for Affective Disorders. Results The study found that insight regarding symptoms is worse than insight of having bipolar disorder, social relationships and self esteem. Moreover, poor global insight (total ISAD) correlates with more severe changes in mood, speech and thought structure, with worse insight about symptoms correlating with the same alterations and also with more severe symptoms of agitation/energy. Limitations Although a large sample of bipolar patients was followed up, the final sample composed of patients with at least one manic episode was relatively smaller. Moreover, the fact that the study was performed in a university hospital may have led to selection biases. Conclusion Results suggest that patients with BD are reasonably capable of identifying that their condition implies consequences but have more impaired awareness of their energy and activity levels. A lower level of insight specifically about symptoms correlates with more severe symptoms of agitation/energy, which suggests a psychomotor nucleus able to impair insight in mania.

Background In the Diagnostic and Statistical Manual of Mental Disorders , 5th edition, the occurrence of increased energy/activity and elation of mood or irritability became necessary symptoms for the diagnosis of an episode of mania or hypomania. Objective To evaluate whether increases in energy/activity or mood changes represent the core feature of the manic syndrome. Methods The symptomatology of 117 hospitalized patients with bipolar mania was evaluated using the Schedule for Affective Disorders and Schizophrenia-Changed version (SADS-C). Based on six items of the SADS-S related to mania, a Confirmatory Factor Analysis (CFA) was performed. An Item Response Theory (IRT) analysis was used to identify how much each symptom informs about the different levels of severity of the syndrome. Results According to the CFA, the item “increased energy” was the symptom with the highest factorial loadings, which was confirmed by the IRT analysis. Thus, increased energy was the alteration most correlated with the total severity of manic symptoms. Additionally, the analysis of the Item Information Function revealed that increased energy was correlated with the larger amplitude of severity levels compared with the other symptoms of mania. Limitations Only six manic symptoms were considered. The sample might not be representative because the patients were evaluated while presenting peak symptom severity. Conclusions Increased energy/activity is a more important symptom for a diagnosis of mania than mood changes and represents the core feature of this syndrome.

Background Over the last thirty years, Akiskal and collaborators have described and developed operationalized diagnostic criteria for five types of affective temperaments — cyclothymic, irritable, hyperthymic, depressive, and anxious. A 110-item, yes-or-no questionnaire, the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A), was specifically developed for measuring temperamental variation. The TEMPS-A was translated into more than 25 languages and cross-culturally valid versions are now available in Italian, French, German, Japanese, Turkish, Arabic, Polish, Hungarian, Spanish and Portuguese. Recent studies in the US and in Europe, however, have suggested that shorter versions of TEMPS-A can be just as efficient as the full ones while potentially enhancing the compliance of respondents. The main objective of the present study was to validate a brief Brazilian Portuguese version of TEMPS-A (brief TEMPS-Rio de Janeiro). Methods Our main sample consisted of 997 undergraduate students (female = 72.6%) from seven different universities located in the city of Rio de Janeiro, Brazil. An additional group of 167 healthy senior citizens (women = 83.8%) was recruited in senior community centers in the city of Rio de Janeiro, Brazil. All participants were asked to complete the 110-item, Brazilian translation of the full version of the TEMPS-A. Results An exploratory factor analysis (PCA type 2, Varimax rotation) vying for a five-factor solution yielded mixed results, with cyclothymic traits, physical symptoms of anxiety and preoccupation with the well-being of a family member loading together on the first factor. When a forced six-factor solution was attempted, cyclothymic, irritable, hyperthymic, and depressive were delineated as predicted by the theory. The original generalized anxious temperament was split into two sharply delimited components, a “worrying” subscale and an abbreviated anxious subscale, which included physical symptoms of anxiety and concerns with the well-being of relatives. Based on the tripartite model of anxiety and depression, we proposed that the abridged anxious subscale, which includes physical symptoms of anxiety, represents the “true” generalized anxious temperament, while the “worrying” subscale corresponds to the “general distress factor”. The internal consistency of the six subscales thus identified was generally good, ranging from 0.67 (anxious subscale) to 0.81 (worrying subscale), with cyclothymic, irritable, depressive, and hyperthymic subscales exhibiting intermediate values (0.74, 0.74, 0.72, and 0.7, respectively). Limitations The present study was based on a non-clinical sample that does not reflect accurately the characteristics of the Brazilian population. The relative uniformity of the sample in terms of age and education precluded a more in-depth analysis of the influence of these highly relevant factors. Further, we did not assess convergent, divergent or test–retest validity. Conclusions We believe that the brief Brazilian version of the TEMPS-A auto-questionnaire will provide Brazilian researchers and clinicians with a psychometrically sound instrument and thus contribute toward the creation of a worldwide research network dedicated to the investigation of affective temperaments.

Background Since its first definition in the literature, schizoaffective disorder (SAD) has raised a considerable controversy regarding its clinical distinction from schizophrenia (SCH) and mood disorders (MD) as well as its validity as an independent nosological category. Objective Investigate the validity of SAD as a discrete nosological category and its relationship with SCH and MD. Method A systematic literature review of clinical trial that compared SAD with SCH and/or MD patients was carried out throughout MEDLINE, psycINFO, Cochrane Library, SCIELO and LILACS databases. Results Evaluation of demographic characteristics, symptomatology, other clinical data, dexamethasone suppression test, neuroimage exams, response to treatment, evolution and family morbidity indicated that SAD occupies an intermediate position between SCH and MD. Literature review also failed to indicate a clear cut distinction between SAD and SCH or MD. Discussion Present analysis indicated that SAD cannot be interpreted as atypical forms of SCH or MD. SAD also does not appear to represent a SCH and MD comorbidity or yet an independent mental disorder. It is argued that SAD might constitute a heterogeneous group composed by both SCH and MD patients or a middle point of a continuum between SCH and MD.

Background In the last few decades, several tools for studying insight in bipolar disorders have been used. Olaya and colleagues developed the Insight Scale for Affective Disorders (ISAD), which consists of a scale measuring insight through hetero evaluation for patients with mood disorders. The objective of this work is to translate and adapt the original English version of the ISAD to Brazilian Portuguese (ISAD-BR) and to conduct an evaluation of its psychometric properties. Methods Adaptation procedures included translation/back-translation and consultation with a panel of experts. 95 patients with the diagnosis of Type 1 bipolar disorder were evaluated with the final version of the ISAD-BR, which was applied, simultaneously, but independently, by two examiners. Internal consistency and inter-rater reliability were explored and the latent structure of the scale was investigated with principal axis factoring and promax rotation. A second-order factor analysis was conducted to test if the scale had a hierarchical factor structure. Results The ISAD-BR showed good internal consistency and good inter-rater reliability. The analysis pointed to a four-factor solution of the ISAD-BR: awareness of symptoms associated with activity/energy; awareness of having a disorder; awareness of self-esteem and feelings of pleasure; and awareness of social functioning and relationships. The second order factor analysis indicated a hierarchical factor structure for the ISAD-BR, with the four lower-order factors loading on a single higher-order factor. Conclusions Insight into bipolar disorder is a multidimensional construct, covering different aspects of the condition and its symptomatology. Nevertheless, insight about activity/energy changes may be a crucial aspect of insight into bipolar disorder.

Background There is increasing evidence that neurocognitive dysfunction is associated with the different states in Bipolar Disorder. Gamma coherence is strongly related to cognitive processes and cortico-cortical communication. This paper aims at shedding light on the relationship between cortical gamma coherence within bipolar patients and a control group during a prosaccadic attention task. We hypothesized that gamma coherence oscillations act as a main neural mechanism underlying information processing which changes in bipolar patients. Method Thirty-two (12 healthy controls and 20 bipolar patients) subjects were enrolled in this study. The subjects performed a prosaccadic attention task while their brain activity pattern was recorded using quantitative electroencephalography (20 channels). Results We observed that the maniac group presented lower saccade latency when compared to depression and control groups. The main finding was a greater gamma coherence for control group in the right hemisphere of both frontal and motor cortices caused by the execution of a prosaccadic attention task. Limitations The findings need to be confirmed in larger samples and in bipolar patients before start the pharmacological treatment. Conclusions Our findings suggest a disrupted connection of the brain's entire functioning of maniac patients and represent a deregulation in cortical inhibitory mechanism. Thus, our results reinforce our hypothesis that greater gamma coherence in the right and left frontal cortices for the maniac group produces a “noise” during information processing and highlights that gamma coherence might be a biomarker for cognitive dysfunction during the manic state.