Dysfunctional cognition in individuals with an increased risk for mania

Background There is still a lack of knowledge about attitudes and cognitions that are related to bipolar disorder. Theoretically, it was proposed that exaggerated beliefs about the self, relationships, the need for excitement, and goal-related activities might lead to mania in vulnerable individuals, however, the few studies that examined this hypothesis provided mixed results. One of the unresolved issues is if such a cognitive style is associated with current mood symptoms or with different stages of the illness, i.e. at-risk versus diagnosed bipolar disorder. Therefore, the present study aimed at evaluating depression and mania-related cognitive style in individuals at-risk for mania. Method In an online survey, we collected data of 255 students of the University of Klagenfurt, Austria. All participants completed the Hypomanic Personality Scale (HPS), the Cognition Checklist for Mania – Revised (CCL-M-R), the Dysfunctional Attitude Scale (DAS), the Beck Depression Inventory (BDI), and the Internal State Scale (ISS). Results In a hierarchical regression, HPS was positively related to scores of all subscales of the CCL-M-R. The HPS did not significantly predict scores of the DAS. Current manic and depressive symptoms significantly contributed to the models. Conclusion The present results suggest that a trait-like risk for mania is associated with mania-related but not depression-related cognitions.

Emotional awareness, affective dysregulation, and bipolar spectrum psychopathology: A multilevel path analysis

Affective dysregulation is present in those with subsyndromal symptoms of hypomania and mania and prospectively predicts the development of bipolar spectrum disorders. A crucial, understudied area related to the experience and regulation of emotion in this population is emotional awareness – emotional clarity (Clarity) and attention to emotion (Attention). We examined whether scores on the Hypomanic Personality Scale (HPS) were associated with deficits in emotional awareness and b) whether these deficits were associated with heightened intensity and instability of negative (NA) and positive affect (PA). Young adults (n=233), oversampled for HPS scores completed self-reports and 14 days of experience sampling assessing high and low arousal NA and PA. HPS scores were associated with low Clarity and unassociated with Attention. High HPS scores were associated with greater high and low arousal NA intensity and instability only for those at low and mean levels of Attention. In contrast, there was a significant indirect association between HPS scores and intensity of high and low arousal NA and PA, as well as instability of high arousal NA, through low clarity. Results highlighted that individual differences exist in the extent to which facets of emotional awareness differentially link scores on the HPS to emotional outcomes.

The Temporal Stability and Construct Validity of Measures Assessing Mania Symptoms and Risk: A Comparative Analysis

Fluctuations in mood and activity levels are defining features of bipolar disorder, but the temporal stability of measures used to assess symptoms and traits relevant to bipolar disorder is unclear. This study examined the short-term stability of several widely used, contemporary bipolar disorder measures (e.g., Altman Self-Rating Mania Scale, General Behavior Inventory, Hypomanic Personality Scale, Mood Disorder Questionnaire) over a period of roughly 2 weeks (M Retest Interval = 15.17 days) in an undergraduate sample. The stability correlations varied widely, ranging from .49 to .83. As would be expected, measures that were designed to assess traits related to bipolar disorder tended to show stronger stability than scales purporting to assess more transient symptoms of bipolar disorder. Other analyses revealed that—consistent with previous research—some bipolar disorder scales demonstrated moderate to strong positive relations with neuroticism/negative affect and other psychopathology, whereas others related weakly to such measures but showed more robust positive relations with extraversion/positive affect. Taken together, our findings suggest that it is important to consider administration instructions (e.g., trait vs. symptom ratings), subscale properties, and item format when selecting study measures in bipolar disorder research.

Examining the Criterion Validity and Diagnostic Specificity of Self-Report Measures of Narcissism and Mania

We examined the validity of self-report measures of narcissism and mania by relating them to interview-based ratings of psychopathology. Narcissism scales were taken from the Narcissistic Personality Inventory (NPI), the Personality Diagnostic Questionnaire–4+, and the Short Dark Triad. Mania measures included the Altman Self-Rated Mania Scale (ASRM) and scales taken from the Hypomanic Personality Scale (HPS) and Expanded Version of the Inventory of Depression and Anxiety Symptoms. Our analyses addressed two key issues. The first issue was whether these scales demonstrated significant criterion validity (e.g., whether the HPS scales correlated significantly with interview ratings of mania). The second issue was whether they displayed specificity to their target constructs (e.g., whether the NPI scales correlated more strongly with ratings of narcissistic personality disorder than with other forms of psychopathology). All of the narcissism scales—including all three NPI subscales—correlated significantly with interview ratings of narcissistic personality disorder and showed considerable evidence of diagnostic specificity. Most of the mania scales also displayed good criterion validity and diagnostic specificity. However, two measures—the ASRM and the HPS Social Vitality subscale—had weak, nonsignificant associations with interview ratings of manic episodes; these findings raise concerns regarding their validity as specific indicators of mania.

Bipolar Spectrum Psychopathology is Associated with Altered Emotion Dynamics Across Multiple Timescales

Emotion dysregulation is a core feature of bipolar spectrum psychopathology and may confer risk for poor outcomes or progression along the bipolar spectrum. However, previous research on bipolar psychopathology has primarily concentrated on characterizing distinct mood episodes and failed to characterize micro-level dynamics of the experience of emotion. This is the first study to our knowledge to comprehensively examine the extent to which bipolar spectrum psychopathology, as measured by the Hypomanic Personality Scale (HPS), is associated with altered dynamics of positive (PA) and negative affect (NA) across multiple timescales. Young adults (n=233) oversampled for high HPS scores (>1.5 SD) completed self-report questionnaires and 14 days of experience sampling questionnaires assessing high and low arousal NA and PA. Four emotion dynamics (reactivity, variability, instability, inertia) were computed from each participant’s time-series. As predicted, HPS were positively associated with variability and instability of high arousal NA and PA both within- and between-days (over-and-above mean-levels of emotions, depression, and neuroticism). Further, HPS scores were associated with large fluctuations in low but not high arousal NA and moderated stress-reactivity. Specifically, those high scorers on the HPS were more likely to report feeling like their emotions were out of control (but not high intensity NA) when experiencing stress. Contrary to expectation, HPS scores were unassociated with inertia of high arousal PA. Findings indicated that micro-level emotion dynamics are disrupted across multiple timescales in those high in bipolar spectrum psychopathology. Examining emotion dynamics should enhance understanding of risk for bipolar disorders and facilitate development of mood-monitoring interventions.

Vulnerability to bipolar disorder is linked to sleep and sleepiness

Sleep impairments are a hallmark of acute bipolar disorder (BD) episodes and are present even in the euthymic state. Studying healthy subjects who are vulnerable to BD can improve our understanding of whether sleep impairment is a predisposing factor. Therefore, we investigated whether vulnerability to BD, dimensionally assessed by the hypomanic personality scale (HPS), is associated with sleep disturbances in healthy subjects. We analyzed participants from a population-based cohort who had completed the HPS and had either a 7-day actigraphy recording or a Pittsburgh sleep quality index (PSQI) assessment. In addition, subjects had to be free of confounding diseases or medications. This resulted in 771 subjects for actigraphy and 1766 for PSQI analyses. We found strong evidence that higher HPS scores are associated with greater intraindividual sleep variability, more disturbed sleep and more daytime sleepiness. In addition, factor analyses revealed that core hypomanic features were especially associated with self-reported sleep impairments. Results support the assumption of disturbed sleep as a possibly predisposing factor for BD and suggest sleep improvement as a potential early prevention target.

Looking on the bright side and seeing it vividly: interpretation bias and involuntary mental imagery are related to risk for bipolar disorder

Background:Involuntary mental imagery is elevated among people with bipolar disorder, and has been shown to shape biases in interpretation of ambiguous information. However, it is not clear whether biases in interpretation of ambiguous scenarios can be observed in those at risk for bipolar disorder, or whether involuntary imagery is related to such a bias.Aims:In the present study, we extended a prominent model of bipolar cognition to an at-risk sample. We specifically tested whether positive interpretation bias and involuntary mental imagery are linked to a greater risk of bipolar disorder.Method:Young adults (N = 169) completed measures of risk for bipolar disorder (the Hypomanic Personality Scale [HPS]), interpretation bias, and involuntary mental imagery.Results:Higher scores on the HPS were significantly correlated with more positive interpretations of ambiguous scenarios (β = 0.29, p <. 01) and more frequent involuntary mental imagery (β = 0.22, p < .01). There was no evidence of an interaction between interpretation bias and mental imagery in predicting HPS score, β = .04, p = .62.Conclusions:Further research is warranted to determine if intrusive imagery or interpretation bias influence the development of bipolar disorder over time in those at risk.

Affective Dynamics in Bipolar Spectrum Psychopathology: Modeling Inertia, Reactivity, Variability, and Instability in Daily Life

Background: Bipolar psychopathology is characterized by affective dysregulation independent of mood episodes. However, previous research has relied on laboratory-based emotion-eliciting tasks or retrospective questionnaires that do not take into account temporal dynamics of affect. Thus, the present study examined affective dynamics (reactivity, variability, instability, and inertia) of low and high arousal negative affect (NA) and positive affect (PA) in daily life in those at risk for bipolar psychopathology. Methods: Undergraduates (n=135) completed the Hypomanic Personality Scale and experience sampling surveys assessing affective experiences 8 times daily for 7 days. Results: HPS scores were associated with greater reactivity of NA when experiencing negative or stressful events, variability of NA (high and low arousal) and PA (high arousal), and instability of NA and PA (high and low arousal) in daily life. HPS scores were associated with a high probability of acute increases in NA and PA and were unassociated with levels of inertia. Limitations: This study only examined short-term dynamics over 7 days. Future studies should model both short- and long-term dynamics and whether these dynamics predict behavioral outcomes. Conclusions: These results provide evidence that bipolar spectrum psychopathology is characterized by reactivity of NA as well as variability, instability, and acute increases in NA and PA in daily life over-and-above mean levels of affect. Modeling affective dynamics may provide context-relevant information about the course and trajectory of bipolar spectrum psychopathology and should facilitate the use of experience sampling methodology to study and intervene in mood lability in patients with bipolar disorders.