Comparisons of Narrative Psychotherapy to Conventional CBT for the Psychotherapy of Psychosis and Bipolar Disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. s779-s779
Author(s):  
L. Mehl-Madrona ◽  
B. Mainguy
Keyword(s):  
Bipolar Disorder ◽  
Narrative Therapy ◽  
Rating Scales ◽  
Psychotic Disorders ◽  
Rating Scale ◽  
Therapy Group ◽  
Well Being ◽  
Outcome Data ◽  
Symptom Scale ◽  
Young Mania

IntroductionThere is ongoing debate about about both the value of psychotherapy in psychotic disorders and the best type of psychotherapy to use if necessary.MethodsWe conducted narrative psychotherapy with 18 adults, all diagnosed as having bipolar disorder with psychotic features and/or schizo-affective disorder. Outcome data consisted of the Positive and Negative Symptom Scale, the Clinical Global Impressions Scale, the Young Mania Rating Scale, the Hamilton Anxiety and Depression Scales, the My Medical Outcome Profile, Version 2(MYMOP2), and the Outcome Rating Scales of Duncan and Miller. We compare the outcomes of our patients to those of a matched comparison group receiving conventional psycho-education and cognitive behavioural therapy. Patients were seen for a minimum of 16 weeks over an average of 22 weeks. Average age was 31.5 years with a standard deviation of 8.1 years.ResultsThe narrative therapy group showed statistically significant reductions in all outcome measures compared to the conventional treatment group. They continued treatment significantly longer and had fewer re-hospitalizations. They were less distressed by voices.ConclusionsA narrative psychotherapy approach using dialogical theory and therapy ideas is a reasonable approach for the psychotherapy of psychosis. Review of psychotherapy notes showed that narrative approaches allowed the therapist to align with the patient as collaborator in considering the story presented and was therefore less productive of defensiveness and self-criticism than conventional approaches. The therapy included techniques for negotiating changes in illness narratives, identity narratives, and treatment narratives that were more conducive of well-being and recovery.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Case Report: Paliperidone Palmitate in the Management of Bipolar I Disorder With Non-compliance

2021 ◽  
Vol 11 ◽  
Author(s):  
Kanglai Li ◽  
Yingtao Liao ◽  
Zhihua Yang ◽  
Caishuang Yang ◽  
Minhua Chen ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Rating Scale ◽  
Safety Concern ◽  
Paliperidone Palmitate ◽  
Adjunctive Treatment ◽  
Symptom Scale ◽  
Young Mania ◽  
Bipolar I Disorder ◽  
Depressive Episodes

Background: Medication non-adherence is prevalent in patients with bipolar disorder (BD). Long-acting injectable antipsychotics (LAIAs) are widely used to improve compliance with treatment. This study aimed to illustrate the effectiveness, compliance, and safety profile of once-monthly paliperidone palmitate (PP1M), a novel therapeutic LAIA, in the management of bipolar I disorder (BDI).Method: A prospective follow-up was arranged to 11 BDI patients who were prescribed PP1M as monotherapy or adjunctive treatment. Severity of symptoms, disturbing behavior, status of employment, 17-item Hamilton Depression Rating Scale (HAMD-17), and Young Mania Rating Scale (YMRS) were evaluated at the baseline and the endpoint of follow-up. Clinical Global Impression—Bipolar Disorder—Severity of Illness Scale (CGI-BP) and Treatment Emergent Symptom Scale (TESS) were measured at each injection of PP1M. Compliance, relapse or switch, and new hospitalization were monitored through the period of follow-up.Results: The median duration of treatment was 14 months, ranging from 5 to 22 months. The scores (mean ± standard deviation) of HAMD-17, YMRS, and CGI-BP generally decreased from the baseline (16.1 ± 10.3, 30.9 ± 12.6, 5.3 ± 0.7) to the endpoint (7.4 ± 5.7, 3.7 ± 3.2, 2.3 ± 0.7). No disturbing behavior was detected at the endpoint. Neither new hospitalization nor manic/mixed episode occurred during treatment, whereas mild to moderate depressive episodes were reported in three cases. The status of employment of 10 participants (90.9%) was improved, and no new safety concern was detected.Conclusion: PP1M might offer a new valid treatment option in the long-term management of BDI, especially for those with poor compliance with oral medication. However, more studies are needed to further justify such role.

P01-243-An open non-randomised study of course and clinical characteristics of bipolar mixed state in comparison with bipolar manic and depressed state in a tertiary hospital

2011 ◽  
Vol 26 (S2) ◽  
pp. 244-244
Author(s):  
K. Raman ◽  
P.S.V.N. Sharma ◽  
K. Haridas ◽  
S.K. Das
Keyword(s):  
Mixed State ◽  
Rating Scales ◽  
Rating Scale ◽  
Age Of Onset ◽  
Psychotic Symptoms ◽  
Symptom Scale ◽  
Young Mania ◽  
Randomised Study ◽  
Depressed State ◽  
Icd 10

ObjectivesThe study attempts to delineate the clinical correlates (suicidal risk, manic, depressive and psychotic symptom severity) and course characteristics (age of onset and details of past affective episodes) of bipolar mixed state and compare with bipolar manic and bipolar depressed state diagnosed according to ICD-10 Diagnostic Criteria for Research(ICD-10 DCR).MethodologyThe study was carried out in inpatient psychiatry setting of Kasturba Hospital, Manipal, India over a period of 10 months. It was an Open, Non-randomised, Naturalistic study with sequential sampling. The rating scales used were Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Positive and Negative Symptom Scale for Schizophrenia (PANSS) and Beck Scale for suicidal ideation.ResultsA total of 70 subjects were included in the study meeting the criteria of bipolar disorder currently manic, depressed and mixed state according to ICD-10 DCR.Manic group constituted the majority (n1 = 47) followed by depressed (n2 = 17) and mixed groups (n3 = 6). Mixed group was characterized by preponderance of females, high suicidal intent, high frequency of mood-incongruent psychotic symptoms, illness severity and significant family history.ConclusionThe study was able to establish some core features that were specific to mixed states. A larger sample size and a prospective follow up study would throw light on the existence of this group as an independent entity.

Daily self-reported and automatically generated smartphone-based sleep measurements in patients with newly diagnosed bipolar disorder, unaffected first-degree relatives and healthy control individuals

2020 ◽  
Vol 23 (4) ◽  
pp. 146-153
Author(s):  
Sharleny Stanislaus ◽  
Maj Vinberg ◽  
Sigurd Melbye ◽  
Mads Frost ◽  
Jonas Busk ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Sleep Disturbances ◽  
Rating Scales ◽  
Rating Scale ◽  
Young Mania ◽  
First Degree Relatives ◽  
Registration Number ◽  
Healthy Control ◽  
Daily Variability ◽  
Off Time

Objectives(1) To investigate daily smartphone-based self-reported and automatically generated sleep measurements, respectively, against validated rating scales; (2) to investigate if daily smartphone-based self-reported sleep measurements reflected automatically generated sleep measurements and (3) to investigate the differences in smartphone-based sleep measurements between patients with bipolar disorder (BD), unaffected first-degree relatives (UR) and healthy control individuals (HC).MethodsWe included 203 patients with BD, 54 UR and 109 HC in this study. To investigate whether smartphone-based sleep calculated from self-reported bedtime, wake-up time and screen on/off time reflected validated rating scales, we used the Pittsburgh Sleep Quality Index (PSQI) and sleep items on the Hamilton Depression Rating Scale 17-item (HAMD-17) and the Young Mania Rating Scale (YMRS).Findings(1) Self-reported smartphone-based sleep was associated with the PSQI and sleep items of the HAMD and the YMRS. (2) Automatically generated smartphone-based sleep measurements were associated with daily self-reports of hours slept between 12:00 midnight and 06:00. (3) According to smartphone-based sleep, patients with BD slept less between 12:00 midnight and 06:00, with more interruption and daily variability compared with HC. However, differences in automatically generated smartphone-based sleep were not statistically significant.ConclusionSmartphone-based data may represent measurements of sleep patterns that discriminate between patients with BD and HC and potentially between UR and HC.Clinical implicationDetecting sleep disturbances and daily variability in sleep duration using smartphones may be helpful for both patients and clinicians for monitoring illness activity.Trial registration numberclinicaltrials.gov (NCT02888262).

scholarly journals Smartphone-based activity measurements in patients with newly diagnosed bipolar disorder, unaffected relatives and control individuals

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Sharleny Stanislaus ◽  
Maj Vinberg ◽  
Sigurd Melbye ◽  
Mads Frost ◽  
Jonas Busk ◽  
...  
Keyword(s):  
Physical Activity ◽  
Bipolar Disorder ◽  
Rating Scales ◽  
Rating Scale ◽  
Social Activity ◽  
Activity Level ◽  
Activity Levels ◽  
Young Mania ◽  
Activity Measurements ◽  
Activity Questionnaire

Abstract Background In DSM-5 activity is a core criterion for diagnosing hypomania and mania. However, there are no guidelines for quantifying changes in activity. The objectives of the study were (1) to investigate daily smartphone-based self-reported and automatically-generated activity, respectively, against validated measurements of activity; (2) to validate daily smartphone-based self-reported activity and automatically-generated activity against each other; (3) to investigate differences in daily self-reported and automatically-generated smartphone-based activity between patients with bipolar disorder (BD), unaffected relatives (UR) and healthy control individuals (HC). Methods A total of 203 patients with BD, 54 UR, and 109 HC were included. On a smartphone-based app, the participants daily reported their activity level on a scale from −3 to + 3. Additionally, participants owning an android smartphone provided automatically-generated data, including step counts, screen on/off logs, and call- and text-logs. Smartphone-based activity was validated against an activity questionnaire the International Physical Activity Questionnaire (IPAQ) and activity items on observer-based rating scales of depression using the Hamilton Depression Rating scale (HAMD), mania using Young Mania Rating scale (YMRS) and functioning using the Functional Assessment Short Test (FAST). In these analyses, we calculated averages of smartphone-based activity measurements reported in the period corresponding to the days assessed by the questionnaires and rating scales. Results (1) Smartphone-based self-reported activity was a valid measure according to scores on the IPAQ and activity items on the HAMD and YMRS, and was associated with FAST scores, whereas the majority of automatically-generated smartphone-based activity measurements were not. (2) Daily smartphone-based self-reported and automatically-generated activity correlated with each other with nearly all measurements. (3) Patients with BD had decreased daily self-reported activity compared with HC. Patients with BD had decreased physical (number of steps) and social activity (more missed calls) but a longer call duration compared with HC. UR also had decreased physical activity compared with HC but did not differ on daily self-reported activity or social activity. Conclusion Daily self-reported activity measured via smartphone represents overall activity and correlates with measurements of automatically generated smartphone-based activity. Detecting activity levels using smartphones may be clinically helpful in diagnosis and illness monitoring in patients with bipolar disorder. Trial registration clinicaltrials.gov NCT02888262

Exploring Clinical Characteristics of Bipolar Depression: Internal Structure of the Bipolar Depression Rating Scale

2009 ◽  
Vol 43 (9) ◽  
pp. 830-837 ◽  
Author(s):  
Jae Seung Chang ◽  
Yong Min Ahn ◽  
Han Young Yu ◽  
Hye Jean Park ◽  
Kyu Young Lee ◽  
...  
Keyword(s):  
Internal Structure ◽  
Rating Scales ◽  
Rating Scale ◽  
Bipolar Depression ◽  
Cluster Structure ◽  
Hierarchical Cluster ◽  
Symptom Cluster ◽  
Extrapyramidal Symptoms ◽  
Young Mania ◽  
Drug Induced

Objective: Due to its pleomorphic phenomenology, the clinical features of bipolar depression are difficult to assess. The objective of the present study was therefore to explore the internal structure of the Bipolar Depression Rating Scale (BDRS) in terms of the phenomenological characteristics of bipolar depression. Methods: Sixty patients with DSM-IV bipolar depression completed the BDRS, depression and excitement subscales of the Positive and Negative Syndrome Scale (PANSS-D and PANSS-E), 17-item Hamilton Depression Rating Scale, Montgomery–Äsberg Depression Rating Scale, Young Mania Rating Scale (YMRS), and the Drug-Induced Extrapyramidal Symptoms Scale. The internal structure of the BDRS was explored through hierarchical cluster analysis (HCA) using Ward's method and multidimensional scaling (MDS). Results: From 20-item BDRS data, the HCA yielded two symptom clusters. The first cluster included 12 items of conventional depressive symptoms. The second cluster included eight items of mixed symptoms. The MDS identified a depressive–mixed dimension. The depressive symptom cluster showed a more cohesive and conglomerate cluster structure on the MDS map compared to the mixed symptom cluster. After controlling for the effects of treatment-emergent extrapyramidal symptoms, strong positive correlations were observed between the BDRS and other depression rating scales, and the BDRS also weakly correlated with the YMRS and the PANSS-E. Conclusions: The internal structure of BDRS appears to be sensitive to complex features of bipolar depression. Hence, the BDRS may have an advantage in evaluating clinical changes in patients with bipolar depression within the therapeutic process.

Recovery and its correlates among patients with bipolar disorder: A study from a tertiary care centre in North India

2016 ◽  
Vol 62 (8) ◽  
pp. 726-736 ◽  
Author(s):  
Sandeep Grover ◽  
Nandita Hazari ◽  
Jitender Aneja ◽  
Subho Chakrabarti ◽  
Sunil Sharma ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Mental Illness ◽  
Depressive Symptoms ◽  
Rating Scale ◽  
Tertiary Care ◽  
North India ◽  
Personal Recovery ◽  
Tertiary Care Centre ◽  
Young Mania ◽  
Level Of Functioning

Background and Aim: The goal of treatment in mental illness has evolved from a symptom-based approach to a personal recovery–based approach. The aim of this study was to evaluate the predictors of personal recovery among patients with bipolar disorder. Methodology: A total of 185 patients with bipolar disorder, currently in remission, were evaluated on Recovery Assessment Scale (RAS), Internalized Stigma of Mental Illness Scale (ISMIS), Brief Religious coping scale (RCOPE), Duke University Religiosity Index (DUREL), Religiousness Measures Scale, Hamilton depression rating scale (HDRS), Young Mania rating scale (YMRS) and Global Assessment of Functioning (GAF) scale. Results: The mean age of the sample was 40.5 (standard deviation (SD), 11.26) years. Majority of the participants were male, married, working, Hindu by religion and belonged to extended/joint families of urban background. In the regression analysis, RAS scores were predicted significantly by discrimination experience, stereotype endorsement and alienation domains of ISMIS, level of functioning as assessed by GAF, residual depressive symptoms as assessed by HDRS and occupational status. The level of variance explained for total RAS score and various RAS domains ranged from 36.2% to 46.9%. Conclusion: This study suggests that personal recovery among patients with bipolar disorder is affected by stigma, level of functioning, residual depressive symptoms and employment status of patients with bipolar disorder.

scholarly journals Check the effects: systematic assessment of antipsychotic side-effects in an inpatient cohort

2020 ◽  
Vol 10 ◽  
pp. 204512532095711
Author(s):  
Caroline Hynes ◽  
Stephen McWilliams ◽  
Mark Clarke ◽  
Ita Fitzgerald ◽  
Larkin Feeney ◽  
...  
Keyword(s):  
Side Effects ◽  
Rating Scales ◽  
Rating Scale ◽  
Standard Dose ◽  
Well Being ◽  
High Dose ◽  
Negative Consequences ◽  
Adherence Assessment ◽  
Dose Combination ◽  
Antipsychotic Side Effects

Background: Antipsychotics are associated with a range of side-effects that can influence patients’ subjective well-being negatively resulting in poor adherence. In order to limit the negative consequences of side-effects, they should be regularly systematically assessed. The aim of this study was to systematically assess antipsychotic side-effects in an inpatient cohort using validated rating scales. Methods: Eligible individuals prescribed an antipsychotic for at least 2 weeks were invited to have their side-effects assessed systematically. Results: A total of 208 individuals were assessed systematically for antipsychotic side-effects; 71.5% ( n = 138) stated that they had not reported side-effects to their clinician prior to the assessment. The most commonly reported side-effects were daytime drowsiness (75%), dry mouth (58.2%) and weight gain (50.0%), while the most distressing side-effects reported were erectile dysfunction (35.0%), sexual dysfunction (26.3%) and amenorrhoea (26.3%). There was no evidence of an association between side-effect severity/number of side-effects reported/distress caused by those taking high dose/combination antipsychotics versus standard dose monotherapy. Conclusion: Side-effects must be regularly and systematically assessed using a validated rating scale. As distress caused by side-effects plays a major role in non-adherence, assessment should examine distress and data on distressing side-effects should be available to those choosing an antipsychotic. Given the lack of correlation between high dose/combination antipsychotics and side-effects, treatment should be tailored to the individual based on response/tolerance and dose reduction/avoidance of polypharmacy should not be recommended to minimise side-effects.

scholarly journals Mothers with and without bipolar disorder and their infants: group differences in mother-infant interaction patterns at three months postpartum

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Teija M. S. Anke ◽  
Kari Slinning ◽  
Vibeke Moe ◽  
Cathrine Brunborg ◽  
Torill S. Siqveland ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Rating Scale ◽  
Depressive Symptomatology ◽  
Group Differences ◽  
Maternal Behaviour ◽  
Interaction Patterns ◽  
Young Mania ◽  
Significant Group ◽  
Interaction Quality ◽  
Affective Symptoms

Abstract Background Women with bipolar disorder (BD) have a high risk of illness relapse postpartum. The risk coincides with the period when mother-infant interactions are evolving. We compared mother-infant interactions in dyads where the mothers have BD with dyads where the mothers have no mental disorder. The association between concurrent affective symptoms of BD mothers and interaction quality was investigated. Methods Twenty-six women with BD and 30 comparison women with infants were included. The Parent-Child Early Relational Assessment (PCERA) was used to assess maternal behaviour, infant behaviour and dyadic coordination in interactions at 3 months postpartum. The Inventory of Depressive Symptomatology and Young Mania Rating Scale were used to assess affective symptoms of BD mothers at the time of interaction. Results There were significant group differences with medium to large effect sizes (0.73–1.32) on five of six subscales within the three interactional domains. Most interactional concerns were identified in dyadic coordination. No significant associations were found between maternal symptom load and interaction quality within the BD sample. Forty-six percent of the BD mothers experienced a mood episode within 0–3 months postpartum. Conclusions The present study identified challenges for mothers with BD and their infants in “finding” each other in interaction at 3 months postpartum. If sustained, this interaction pattern may have a long-term impact on children’s development. We suggest interventions specifically focusing on sensitising and supporting mothers to read infants’ cues on a micro-level. This may help them to respond contingently and improve dyadic coordination and synchronicity.

Therapeutic effect and tolerability of quetiapine XR in patients with manic episode, bipolar disorder I

2011 ◽  
Vol 26 (S2) ◽  
pp. 220-220
Author(s):  
M. Ladea ◽  
L.S. Grosu ◽  
M.C. Sinca ◽  
M.C. Sarpe
Keyword(s):  
Bipolar Disorder ◽  
Aggressive Behavior ◽  
Rating Scale ◽  
Involuntary Movement ◽  
Good Control ◽  
Manic Episode ◽  
Extrapyramidal Symptoms ◽  
Young Mania ◽  
Acute Relapse ◽  
Quetiapine Xr

IntroductionAgitation and aggressive behavior are common symptoms in patients with an acute relapse of bipolar mania.ObjectivesQuetiapine XR is an effective treatment in agitated patients with an acute relapse of bipolar disorder.AimsThe aim of this study was to assess the efficacy and tolerability of Quetiapine XR in patients with manic episode.MethodsThis naturalistic, observational study evaluated 45 patients diagnosed with manic episode, bipolar disorder I (DSM IV-TR) for a period of 4 weeks, during which the patients received Quetiapine XR, in doses between 800 mg and 1000 mg per day, using a rapid titration scheme.Efficacy of the treatment was measured using Young Mania Rating Scale (YMRS) and Clinical Global Impression Scale (CGI), performed at baseline, and then weekly. The Overt Aggression Scale-Modified (OAS-M) was used daily until day 4 and then once per week. Extrapyramidal symptoms were assessed with Barnes Akathisia Rating Scale and Abnormal Involuntary Movement Scale.ResultsImportant improvement of OAS-M total score was observed from the second day of treatment. After 4 weeks, more than a half of the patients presented a decrease of YMRS score with more than 50%. The CGI score also significantly improved. The treatment was well tolerated, mild to moderated adverse reactions being registered, without extrapyramidal symptoms.ConclusionsThese results confirm that Quetiapine XR is an effective and safe treatment for patients with an acute relapse of bipolar disorder I, the rapid titration scheme of the doses leading to a good control of aggressive behavior.

scholarly journals Does the efficacy of asenapine in bipolar disorder increase in the presence of comorbidity with a substance use disorder? A naturalistic study

2016 ◽  
Vol 7 (2) ◽  
pp. 67-77 ◽  
Author(s):  
Sergio De Filippis ◽  
Ilaria Cuomo ◽  
Georgios D. Kotzalidis ◽  
Daniela Pucci ◽  
Pietro Zingaretti ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Substance Use ◽  
Substance Use Disorder ◽  
Repeated Measures ◽  
Rating Scale ◽  
Type I ◽  
Open Label ◽  
Young Mania ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

Background: Asenapine is a second-generation antipsychotic approved in Europe for treating moderate-to-severe manic episodes in adults affected by type I bipolar disorder (BD-I). We aimed to compare its efficacy in psychiatric inpatients with BD-I, with or without substance use disorder (SUD). Methods: We administered flexible asenapine doses ranging from 5–20 mg/day to 119 voluntarily hospitalized patients with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) BD-I diagnosis, with or without SUD. Patients were assessed with clinician-rated questionnaires [i.e. Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and Global Assessment of Functioning (GAF)]. Assessments were carried out at baseline (T0, prior to treatment), and 3 (T1), 7 (T2), 15 (T3), and 30 days (T4) after starting treatment for all clinical scales and at T0 and T4 for the GAF. Results: Patients improved on all scales ( p < 0.001) across all timepoints, as shown both by paired-sample comparisons and by applying a repeated-measures, generalized linear model (GLM). Patients without comorbid SUD showed greater reductions in BPRS scores at T2 and T3, greater reduction in YMRS scores at T3, and lower HARS scores at all timepoints. HDRS scores did not differ between the two groups at any timepoint. However, the reduction in HARS scores in the comorbid group was stronger than in the BD-I only group, albeit not significantly. Side effects were few and mild-to-moderate. Conclusions: The open-label design and the relatively short observation period may expose to both type I and type II statistical errors (false positive and false negatives). Asenapine showed effectiveness and safety in hospitalized BD-I patients. Its effect was stronger in patients without comorbid SUD.

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