Symptom-specific self-referential cognitive processes in bipolar disorder: a longitudinal analysis

2012 ◽  
Vol 43 (9) ◽  
pp. 1895-1907 ◽  
Author(s):  
H. Pavlickova ◽  
F. Varese ◽  
O. Turnbull ◽  
J. Scott ◽  
R. Morriss ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Multilevel Models ◽  
Rating Scale ◽  
Self Esteem ◽  
Dysfunctional Attitudes ◽  
Psychological Processes ◽  
Co Morbidity ◽  
Clinical Measures ◽  
Specific Symptoms ◽  
Over Time

BackgroundAlthough depression and mania are often assumed to be polar opposites, studies have shown that, in patients with bipolar disorder, they are weakly positively correlated and vary somewhat independently over time. Thus, when investigating relationships between specific psychological processes and specific symptoms (mania and depression), co-morbidity between the symptoms and changes over time must be taken into account.MethodA total of 253 bipolar disorder patients were assessed every 24 weeks for 18 months using the Hamilton Rating Scale for Depression (HAMD), the Bech–Rafaelsen Mania Assessment Scale (MAS), the Rosenberg Self-Esteem Questionnaire (RSEQ), the Dysfunctional Attitudes Scale (DAS), the Internal, Personal and Situational Attributions Questionnaire (IPSAQ) and the Personal Qualities Questionnaire (PQQ). We calculated multilevel models using the xtreg module of Stata 9.1, with psychological and clinical measures nested within each participant.ResultsMania and depression were weakly, yet significantly, associated; each was related to distinct psychological processes. Cross-sectionally, self-esteem showed the most robust associations with depression and mania: depression was associated with low positive and high negative self-esteem, and mania with high positive self-esteem. Depression was significantly associated with most of the other self-referential measures, whereas mania was weakly associated only with the externalizing bias of the IPSAQ and the achievement scale of the DAS. Prospectively, low self-esteem predicted future depression.ConclusionsThe associations between different self-referential thinking processes and different phases of bipolar disorder, and the presence of the negative self-concept in both depression and mania, have implications for therapeutic management, and also for future directions of research.

Work motivation in patients with bipolar disorder: Associated factors

2019 ◽  
Vol 65 (4) ◽  
pp. 300-304 ◽  
Author(s):  
Sara Martínez-Camarillo ◽  
María Yoldi-Negrete ◽  
Ana Fresán-Orellana ◽  
Hiram Ortega-Ortiz ◽  
Claudia Becerra-Palars
Keyword(s):  
Bipolar Disorder ◽  
Cognitive Deficits ◽  
Associated Factors ◽  
Rating Scale ◽  
Work Motivation ◽  
Sociodemographic Factors ◽  
Comprehensive Treatment ◽  
Psychological Processes ◽  
Work Related ◽  
Subjective Cognitive Complaints

Background: Occupational functioning is severely impaired in patients with bipolar disorder (BD). Work motivation (WM), defined as the psychological processes that determine the direction, intensity, and persistence of action within the work, is an essential component of work-related functioning. Aim: To assess whether WM is affected in patients with BD and which clinical and sociodemographic factors are related to low WM. Methods: In all, 95 euthymic BD patients were invited to answer the Motivation for Work Questionnaire and the Rating Scale on Subjective Cognitive Deficits in Bipolar Disorder (COBRA). Results: A total of 49.5% ( n = 47) of the patients were classified in the Low Motivated (LM) group. Unemployment and the report of more subjective cognitive complaints were predictors of poor WM in this sample ((OR) = 3.01 and 7.10, respectively). Conclusions: Perceived cognitive deficits related to the disorder and current unemployment negatively impact WM in patients with BD. In addition to symptomatic recovery, the need of the inclusion of personal and occupational areas in the comprehensive treatment of patients with BD is necessary.

scholarly journals Patterns of pharmacological maintenance treatment in a community mental health services bipolar disorder cohort study (SIN-DEPRES)

2013 ◽  
Vol 16 (3) ◽  
pp. 513-523 ◽  
Author(s):  
Iria Grande ◽  
Rosario de Arce ◽  
Miguel Ángel Jiménez-Arriero ◽  
Federico Guillermo Iglesias Lorenzo ◽  
Juan Ignacio Franch Valverde ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Clinical Features ◽  
Maintenance Treatment ◽  
Rating Scale ◽  
Community Mental Health Services ◽  
Residual Symptoms ◽  
Logistic Regression Models ◽  
Co Morbidity ◽  
Antidepressant Combination ◽  
Clinical Stability

Abstract Maintenance therapy in bipolar disorder (BD) is usually required to prevent relapses and improve residual symptoms. Therefore, in this study, we describe patterns of pharmacological maintenance treatment and identify associated clinical features. This prospective multicentre epidemiological study recruited a cohort of 739 consecutive out-patients with clinically stable BD. Clinical stability was assessed at baseline with the Clinical Global Impression scale for BD and depressive symptoms with the Hamilton Depression Rating Scale. Psychotropic medications were classified and analysed according to their mechanism as well as use. Logistic regression models were used to examine the associations between pharmacological strategies and clinical features. Longer time since last episode [odds ratio (OR) 1.002, p < 0.0001] and family history of psychiatric disorders (OR 1.911, p = 0.028) were associated with lithium in monotherapy; manic polarity of the most recent episode (OR 3.300, p = 0.006) and longer duration of clinical stability (OR 1.009, p = 0.034) with antipsychotic in monotherapy; depressive polarity of the most recent episode (OR 2.567, p = 0.003) and bipolar II disorder diagnosis (OR 2.278, p = 0.008) with antidepressant combination; no ongoing psychiatric co-morbidity (OR 0.230, p = 0.004) with lithium and anticonvulsant; manic polarity of the most recent episode (OR 3.774, p < 0.0001) with lithium and antipsychotic; manic polarity of the most recent episode (OR 2.907, p = 0.028) with lithium, anticonvulsant and antipsychotic. The pharmacological patterns followed published recommendations, except for the excessive use of antidepressants. This study reveals clinical factors closely related to prescription patterns.

Bipolar disorder in childhood and adolescence

2011 ◽  
Vol 26 (S2) ◽  
pp. 242-242
Author(s):  
L. Paixão ◽  
M.J. Avelino ◽  
C. Barroso
Keyword(s):  
Bipolar Disorder ◽  
Chronic Illness ◽  
Children And Adolescents ◽  
Clinical Entity ◽  
Childhood And Adolescence ◽  
Early Stages ◽  
Co Morbidity ◽  
On Line ◽  
Available Information ◽  
Specific Symptoms

IntroductionThe diagnosis of Bipolar Disorder (BD) is still controversial in the early stages of life, not only because of its difficulty, but also because of the precaution of professionals with this diagnosis, since it is a chronic illness.AimsTo review and synthesize available information about paediatric BD.MethodsThe authors consulted, selected and reviewed information concerning the theme, mainly searched on-line articles.ResultsIt is difficult to diagnose BD in youths, considering the fewer specific symptoms and the high co-morbidity.ConclusionsDespite some disagreement on this diagnosis, BD is a valid clinical entity in children and adolescents.

scholarly journals Levetiracetam as an Adjunctive Treatment for Mania: A Double-Blind, Randomized, Placebo-Controlled Trial

2022 ◽  
pp. 1-12
Author(s):  
Amir Keshavarzi ◽  
Aziz Sharifi ◽  
Leila Jahangard ◽  
Alireza Soltanian ◽  
Annette Beatrix Brühl ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Cognitive Performance ◽  
Effect Size ◽  
Rating Scale ◽  
Medium Effect ◽  
Large Effect Size ◽  
Placebo Condition ◽  
Double Blind ◽  
Subjective Sleep ◽  
Over Time

<b><i>Background:</i></b> Levetiracetam is an anticonvulsant with a low side effect profile and favorable properties for individuals with bipolar I disorder during their manic phase. Despite initial promising results until about 2008, it appears that this track of research has not been followed-up. To counter this, we tested the influence of adjuvant levetiracetam on acute mania, compared to placebo. More specifically, we performed a randomized, double-blind, placebo-controlled clinical trial among inpatients with bipolar disorder I during their acute phase of mania. <b><i>Methods:</i></b> A total of 72 inpatients (mean age: 33.98 years; 23.6% females) with diagnosed bipolar disorder I and during their acute manic phase were randomly assigned either to the adjuvant levetiracetam (250 mg to a maximum of 1,500 mg) or to the placebo condition. Standard medication was lithium at therapeutic dosages. At baseline, participants completed a series of self-rating questionnaires covering sociodemographic information and subjective sleep. Subjective sleep was re-assessed 24 days later at the end of the study. Experts rated participants’ acute state of mania with the Young Mania Rating Scale at baseline and at day 12 and day 24. Participants’ cognitive performance was assessed at baseline and at day 24 at the end of the study. <b><i>Results:</i></b> Over time, mania scores significantly decreased (large effect size), but more so in the levetiracetam condition, compared to the placebo condition (medium effect size). Likewise, over time, subjective sleep improved (large effect size), but more so in the levetiracetam condition, compared to the placebo condition (large effect size). Over time, cognitive performance improved (large effect size), irrespective of the study condition. <b><i>Conclusions:</i></b> Compared to placebo, adjuvant levetiracetam to lithium improved symptoms of mania, as rated by experts, and subjective sleep quality. Adjuvant levetiracetam had no further favorable (or detrimental) impact on cognitive performance.

Cognitive vulnerability in patients with bipolar disorder

2000 ◽  
Vol 30 (2) ◽  
pp. 467-472 ◽  
Author(s):  
J. SCOTT ◽  
B. STANTON ◽  
A. GARLAND ◽  
I. N. FERRIER
Keyword(s):  
Bipolar Disorder ◽  
Problem Solving ◽  
Autobiographical Memory ◽  
Rating Scale ◽  
Cognitive Vulnerability ◽  
Social Problem Solving ◽  
Memory Test ◽  
Dysfunctional Attitudes ◽  
Control Subjects ◽  
Bipolar Patients

Background. No study has simultaneously explored key components of Beck's model of cognitive vulnerability to depression in people with bipolar disorders.Methods. We compared 41 euthymic bipolar patients with 20 healthy control subjects. All subjects were assessed on the Hamilton Rating Scale for Depression, the Autobiographical Memory Test and the Mean Ends Problem-Solving procedure and also completed the Beck Depression Inventory, the Dysfunctional Attitude Scale, the Sociotropy Autonomy Scale and the Rosenberg Self-Esteem Questionnaire.Results. In comparison to control subjects, patients with bipolar disorder demonstrated significantly higher levels of dysfunctional attitudes (particularly perfectionism and need for approval) and sociotropy, significantly greater over-general recall on an autobiographical memory test and significantly less ability to generate solutions to social problem-solving tasks. These between group differences remained significant when age, intelligence, latency to respond to autobiographical memory test cue words, and subjective mood ratings were included as co-variates in the statistical analysis. Within the patient group, cognitive dysfunction was significantly correlated with level of morbidity (as measured by number of previous illness episodes).Conclusions. This study suggests that cognitive vulnerability in patients with bipolar disorder is similar to that described in unipolar disorders. It is not clear whether this dysfunction is a cause or an effect of repeated episodes of bipolar disorder. However, the findings may have implications for clinical treatment as well as suggesting a number of important new avenues of research into psychological models of affective disorder.

Co-morbid Obsessive-compulsive Disorder and Bipolar Disorder in Highly Endogamous Population: Which Came First?

2017 ◽  
Vol 41 (S1) ◽  
pp. S119-S119
Author(s):  
A. Bener
Keyword(s):  
Bipolar Disorder ◽  
Obsessive Compulsive Disorder ◽  
Rating Scale ◽  
Obsessive Compulsive ◽  
Young Mania ◽  
Compulsive Disorder ◽  
Oppositional Defiant ◽  
Co Morbidity ◽  
Endogamous Population ◽  
The Impact

The aim of this study was to determine the prevalence of co-morbidity with obsessive-compulsive disorder (OCD) among bipolar disorder (BD) patients in order to assess the impact of OCD on the socio-demographic and clinical features of patients in a highly endogamous population. A cohort study was carried out on 396 patients enrolled between November 2011 to October 2013. We employed the WHO Composite International Diagnostic Interview (WHO-CIDI) and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-IV/Clinical Version for diagnoses, the Yale-Brown Obsessive Compulsive Scale Symptom Checklist for scoring OCD. Patients were grouped in BD patients with OCD (BD-OCD) and BD patients without OCD.Groups were compared for socio-demographic and clinical variables. There were no significant differences for age, gender, BMI, and marital status, between BD patients with and without OCD. We found significant differences in level of education (P = 0.022), occupation status (P = 0.025), household income, (P = 0.049), cigarette smoking (P = 0.038), sheesha smoking (P = 0.007), and prevalence of consanguinity (P = 0.036) among these groups. Number of hospitalizations and Young Mania Rating Scale score were not different among BD patients with or without OCD whereas there were significant differences in Hamilton-Depression score, Clinical Global Impression-BD Score, duration of illnesses, and Global Assessment of Functioning (GAF). Also specific phobia, somatization, depression, mania, any mood disorder, oppositional defiant disorder, ADHD and personality disorder were more common in BD than OCD–BD group. This study confirms that BD-OCD is a common co-morbidity, largely under-recognized in clinical practice, which may significantly change BD presentation and outcome.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Clinically relevant and simple immune system measure is related to symptom burden in bipolar disorder

2017 ◽  
Vol 30 (5) ◽  
pp. 297-305 ◽  
Author(s):  
Ole Köhler-Forsberg ◽  
Louisa Sylvia ◽  
Thilo Deckersbach ◽  
Michael Joshua Ostacher ◽  
Melvin McInnis ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Clinical Trials ◽  
Immune System ◽  
Rating Scale ◽  
Lithium Treatment ◽  
Symptom Burden ◽  
Multinomial Regression ◽  
Cross Sectional ◽  
Wide Range ◽  
Specific Symptoms

ObjectiveImmunological theories, particularly the sickness syndrome theory, may explain psychopathology in mood disorders. However, no clinical trials have investigated the association between overall immune system markers with a wide range of specific symptoms including potential gender differences.MethodsWe included two similar clinical trials, the lithium treatment moderate-dose use study and clinical and health outcomes initiatives in comparative effectiveness for bipolar disorder study, enrolling 765 participants with bipolar disorder. At study entry, white blood cell (WBC) count was measured and psychopathology assessed with the Montgomery and Aasberg depression rating scale (MADRS). We performed analysis of variance and linear regression analyses to investigate the relationship between the deviation from the median WBC, and multinomial regression analysis between different WBC levels. All analyses were performed gender-specific and adjusted for age, body mass index, smoking, race, and somatic diseases.ResultsThe overall MADRS score increased significantly for each 1.0×109/l deviation from the median WBC among 322 men (coefficient=1.10; 95% CI=0.32–1.89; p=0.006), but not among 443 women (coefficient=0.56; 95% CI=−0.19–1.31; p=0.14). Among men, WBC deviations were associated with increased severity of sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, inability to feel, and suicidal thoughts. Among women, WBC deviations were associated with increased severity of reduced appetite, concentration difficulties, lassitude, inability to feel, and pessimistic thoughts. Both higher and lower WBC levels were associated with increased severity of several specific symptoms.ConclusionImmune system alterations were associated with increased severity of specific mood symptoms, particularly among men. Our results support the sickness syndrome theory, but furthermore emphasise the relevance to study immune suppression in bipolar disorder. Due to the explorative nature and cross-sectional design, future studies need to confirm these findings.

scholarly journals Associations between family cohesion, adaptability, and functioning of patients with bipolar disorder with clinical syndromes in Hebei, China

2019 ◽  
Vol 47 (12) ◽  
pp. 6004-6015 ◽  
Author(s):  
Xujing Zhang ◽  
Mingkun Zhao ◽  
Jing Li ◽  
Ling Shi ◽  
Xiafei Xu ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Family Functioning ◽  
Family Cohesion ◽  
Rating Scale ◽  
Family System ◽  
Family Type ◽  
Family Adaptability ◽  
The Family ◽  
Family Types ◽  
Over Time

Objective We aimed to investigate the symptoms of inpatients with bipolar disorder (BD) in different types of families, and to explore the correlations between family coherence, family adaptability, and family functioning among inpatients with BD. Methods Inpatients with BD in Hebei, China (n = 61; mean age = 33.85±10.54; 39 males) participated in this study. Participants’ symptoms were evaluated using the Bech–Rafaelsen Mania Scale (BRMS) and Hamilton Depression Rating Scale (HDRS) at weeks 1, 4, and 8 after their admission to the hospital. Participants’ family type was assessed using the Family Adaptability and Cohesion Scale II–Chinese Version. Family functioning was assessed using Family Assessment Device. Results Participants were classified into three family types: balanced (n = 13), mid-range (n = 28), and extreme (n = 20). BRMS scores improved over time in patients from all three family types. Improvement was slightly better with the balanced than the extreme family type. HDRS scores showed an improving trend over time, although this was not significant. Family coherence, adaptability, and functioning were mutually correlated. Conclusion The family system and family functioning are important factors that clinicians should keep in mind when treating people with BD.

Negative Cognitions Predict the Course of Bipolar Depression, Not Mania

2004 ◽  
Vol 18 (2) ◽  
pp. 149-162 ◽  
Author(s):  
Sheri L. Johnson ◽  
Randy Fingerhut
Keyword(s):  
Bipolar Disorder ◽  
Symptom Severity ◽  
Bipolar Depression ◽  
Automatic Thoughts ◽  
Dysfunctional Attitudes ◽  
Cognitive Variables ◽  
Negative Cognitions ◽  
Cognitive Interventions ◽  
Over Time

Cognitive interventions for bipolar disorder have received increased attention, but very few prospective studies have focused on whether cognitive variables predict the course of bipolar disorder. Available studies have yielded conflicting results concerning the effects of negative cognitions on mania. In this study, 60 individuals with bipolar I disorder completed monthly symptom severity interviews. At a 6-month follow-up, they completed the Dysfunctional Attitudes Scale, the Negative Automatic Thoughts Questionnaire, and the Positive Automatic Thoughts Questionnaire. Participants then completed monthly symptom severity interviews for another 6 months. Cognitive scales were correlated with current depression and predicted increases in depression over time, but were not related to mania. Although results do not support negative cognitions as a predictor of mania, they do provide support for the increasingly common use of cognitive interventions to treat bipolar depression.

Cognitive styles in individuals with bipolar disorders

2003 ◽  
Vol 33 (6) ◽  
pp. 1081-1088 ◽  
Author(s):  
JAN SCOTT ◽  
MARIE POPE
Keyword(s):  
Bipolar Disorder ◽  
Cognitive Style ◽  
Emotional Processing ◽  
Network Models ◽  
Bipolar Disorders ◽  
Self Esteem ◽  
Small Sample ◽  
Dysfunctional Attitudes ◽  
Clinical Samples ◽  
Neural Network Models

Background. Published studies of emotional processing and cognitive style in bipolar disorders tend to have small sample sizes or use non-clinical samples. Larger clinically representative studies are needed.Method. Self-esteem, dysfunctional attitudes and personality style were compared in unipolar (N=16) and bipolar disorder (N=77); and then investigated in the different phases of bipolar disorder (remitted=26; depressed=38; hypomanic=13). One-year outcome was assessed in 36 bipolar subjects.Results. Unipolar subjects and bipolar subjects differed significantly in their mean levels of negative self-esteem (unipolar=15·5; bipolar=12·7; P<0·05). Bipolar subjects with hypomania reported mean levels of dysfunctional beliefs that were higher than individuals in remission but lower than depressed subjects (remitted=136·7; depressed=153·8; hypomanic=144·8; P<0·05). Hypomanic subjects recorded the highest levels of negative as well as positive self-esteem. In the exploratory analysis of outcome, negative self-esteem (Exp [B] 1·91; 95% CI 1·11 to 3·32; P<0·05) was the most robust predictor of relapse.Conclusions. There are similarities in the cognitive style of individuals with unipolar as compared to bipolar disorders. Cognitive style in hypomania represents a phase between remission and depression rather than the polar opposite of depression. The implications of these findings are considered for psychological and neural network models.

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