CNS Spectrums

Original Research

The impact of periventricular white matter lesions in patients with bipolar disorder type I

Gianluca Serafinia1 c1, Maurizio Pompilia1, Marco Innamoratia1, Nicoletta Girardia2, Leonardo Strusia3, Mario Amorea4, Leo Shera5, Xenia Gondaa6a7a8a9, Zoltan Rihmera6a9 and Paolo Girardia1

a1 Department of Neurosciences, Mental Health and Sensory Organs—Suicide Prevention Center, Sant'Andrea Hospital, Rome, Italy

a2 Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy

a3 Casa di Cura “Samadi”, Rome, Italy

a4 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genova, Genova, Italy

a5 Department of Psychiatry, Columbia University College of Physicians and Surgeons, and New York State Psychiatric Institute, New York, New York, USA

a6 Department of Clinical and Theoretical Mental Health, Semmelweis University, Budapest, Hungary

a7 Department of Pharmacodynamics, Semmelweis University, Budapest, Hungary

a8 Neuropsychopharmacology and Neurochemistry Research Group, National Academy of Sciences and Semmelweis University, Budapest, Hungary

a9 National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, Budapest, Hungary


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.

(Received July 08 2013)

(Accepted September 25 2013)

(Online publication January 10 2014)

Key words

  • Affective symptoms;
  • BD-I;
  • insight;
  • MRI;
  • periventricular WMHs


c1 Address for correspondence: Gianluca Serafini, MD, PhD, Department of Neurosciences, Mental Health and Sensory Organs, Sant'Andrea Hospital, Sapienza University of Rome, 1035-1039 Via di Grottarossa, 00189, Rome, Italy. (Email


  Xenia Gonda is recipient of the János Bolyai Research Fellowship of Hungarian Academy of Sciences.