The aims of this prospective study were to explore patterns of insight change during recovery from acute manic episodes, and to investigate the factors influencing these changes of insight. Thirty-three bipolar patients were interviewed to determine the level of insight into their manic states using the Schedule of Assessment of Insight (SAI) and its expanded version (SAI-E), and then were reassessed upon recovery. The subjects were divided into improved, unchanged, and deteriorated groups according to the direction of change in insight score, determined from a comparison of the two states. The respective sample percentages were calculated, and the factors influencing the change of insight examined. The results of the analysis reveal that insight can improve, remain unchanged, or decline during recovery from manic episodes. Notably, poorer scores were determined for insight into treatment compliance where manic episodes included psychotic features. Further, some residual insight impairment was still observed after remission. These results indicate that adequate treatment of manic symptoms is the first step toward managing insight impairment, and clinicians should keep close observations for the treatment compliance of patients with psychotic features occurring in their manic episodes.