de Assis da Silva Rafael, Mograbi Daniel C, Bifano Jaqueline, Santana Cristina M T, Cheniaux Elie
Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rua Largo do Machado, 29/411, Catete, Rio de Janeiro, RJ, Brazil.
Laboratório de transtorno bipolar, Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Avenida Venceslau Brás, 71, Fundos, Botafogo, Rio de Janeiro, RJ, CEP 22290-140, Brazil.
Psychiatr Q. 2017 Mar;88(1):47-53. doi: 10.1007/s11126-016-9432-4.
Suicide is a relatively common outcome along the course of bipolar disorder. Studies have shown a positive correlation between ideation or attempts of suicide and higher insight in schizophrenic patients. Nevertheless there are still few studies that evaluate the relationship between suicide and insight in mood disorders. Evaluate the relationship between insight and suicidal ideation or behavior in bipolar depression. A group of 165 bipolar patients were followed up along 1 year. Each patient's mood was assessed in every consultation according to DSM-IV-TR criteria. Suicidal ideation and behavior were prospectively assessed through item 3 of HAM-D whenever a major depressive episode was diagnosed. Insight was evaluated through the Insight Scale for Affective Disorders. A history of suicidal attempts was associated with worse insight in 60 patients with one episode of bipolar depression. The difference remained even when the supposed effect of depression over insight was controlled. No correlation between current suicidal ideation and insight level was found though. Our results suggest that a history of suicide attempts may correlate with higher impairment of insight in bipolar depression. No relationship was found between current suicidal ideation and insight.
自杀是双相情感障碍病程中相对常见的结局。研究表明，精神分裂症患者的自杀观念或自杀企图与自知力增强呈正相关。然而，仍很少有研究评估自杀与心境障碍自知力之间的关系。评估双相抑郁中自知力与自杀观念或行为之间的关系。对165例双相情感障碍患者进行了为期1年的随访。每次会诊时根据《精神疾病诊断与统计手册》第四版修订版（DSM-IV-TR）标准评估每位患者的情绪。每当诊断出重度抑郁发作时，通过汉密尔顿抑郁量表（HAM-D）第3项对自杀观念和行为进行前瞻性评估。通过情感障碍自知力量表评估自知力。在60例有一次双相抑郁发作的患者中，自杀未遂史与自知力较差有关。即使在控制了抑郁对自知力的假定影响后，这种差异仍然存在。不过，未发现当前自杀观念与自知力水平之间存在相关性。我们的结果表明，自杀未遂史可能与双相抑郁中自知力的更高损害相关。未发现当前自杀观念与自知力之间存在关系。
