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Rowe AL, Perich T, Meade T. Childhood cumulative trauma, social support and stress as predictors of illness outcomes and quality of life in bipolar disorder. Aust N Z J Psychiatry 2024; 58:334-344. [PMID: 37941361 PMCID: PMC10960312 DOI: 10.1177/00048674231209225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVE Trauma, social support and stress have been identified as factors which may be associated with the bipolar disorder illness course. However, these are yet to be examined in prospective studies as predictors of illness outcomes and overall quality of life in bipolar disorder. METHOD One hundred and fourteen participants (N = 97; 85.1% female) living with bipolar disorder I (41.2%) or II (58.8%) completed a semi-structured interview and a range of self-report measures assessing trauma history, social support, perceived stress, depression, anxiety, mania, suicidality, number of mood episodes and quality of life, at baseline and 6-month follow-up. RESULTS Childhood cumulative trauma, social support and perceived stress accounted for a substantial and significant portion of the variance in quality of life (62%; 23.6%), anxiety severity (34.6%; 24.5%) and depression severity (49.6%; 26.7%), at both baseline and 6-month follow-up. Perceived stress made significant unique contributions to the prediction of all outcomes, and social support made significant unique contributions to depression and quality of life in bipolar disorder. CONCLUSION Stress and social support play an important role in bipolar disorder and in quality of life for people living with this condition. Given that stress and social support are modifiable risk factors, this provides a promising direction for future intervention-based research.
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Affiliation(s)
- Amy-Leigh Rowe
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
| | - Tania Perich
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Tanya Meade
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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2
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Pike CK, Burdick KE, Millett C, Lipschitz JM. Perceived loneliness and social support in bipolar disorder: relation to suicidal ideation and attempts. Int J Bipolar Disord 2024; 12:8. [PMID: 38504041 PMCID: PMC10951160 DOI: 10.1186/s40345-024-00329-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/06/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The suicide rate in bipolar disorder (BD) is among the highest across all psychiatric disorders. Identifying modifiable variables that relate to suicidal thoughts and behaviors (STBs) in BD may inform prevention strategies. Social connectedness is a modifiable variable found to relate to STBs in the general population, but differences exist across subgroups of the general population and findings specifically in BD have been equivocal. We aimed to clarify how perceived social connectedness relates to STBs in BD. METHOD 146 adults (86 BD, 60 healthy controls) completed clinical interviews (Hamilton Depression Rating Scale; Structured Clinical Interview for DSM-5) and self-report measures of loneliness (UCLA Loneliness Scale) and social support (Interpersonal Support Evaluation List). Analyses explored differences in indicators of social connectedness (loneliness and social support) between BD participants and healthy controls, and explored relationships between STBs (lifetime suicide attempts and current suicidal ideation) and indicators of social connectedness in BD participants. RESULTS BD participants reported significantly higher loneliness and lower social support than healthy controls. In BD participants, perceived social support was significantly related to both ever having attempted suicide and number of lifetime attempts. Interestingly, perceived loneliness, but not social support, was significantly associated with current suicidal ideation. CONCLUSIONS Findings expand the evidence base supporting a relationship between perceived social connectedness and STBs in BD. They suggest that this modifiable variable could be a fruitful treatment target for preventing STBs in BD.
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Affiliation(s)
- Chelsea K Pike
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Katherine E Burdick
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Jessica M Lipschitz
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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3
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Bertollo AG, Braga GDC, Tonin PT, Luzardo AR, Bagatini MD, Ignácio ZM. The Impact of Stress from Social Isolation during the COVID-19 Pandemic on Psychiatric Disorders: An Analysis from the Scientific Literature. Brain Sci 2023; 13:1414. [PMID: 37891783 PMCID: PMC10605406 DOI: 10.3390/brainsci13101414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
The COVID-19 pandemic generated, in addition to severe symptoms, hospitalizations and deaths worldwide, as well as stress from the fear of the disease and social uncertainties, from restriction measures and social isolation. Stress from social isolation impacts mental health, aggravating existing conditions and triggering neuropsychiatric symptoms in individuals with biopsychosocial vulnerability. During and immediately after the period of social restriction imposed by the pandemic, the scientific community carried out several research protocols. These revealed results that relevantly demonstrate the harmful effect of the stress induced by the pandemic situation. This narrative review reports and discusses research results demonstrating impairments in psychiatric disorders such as autism spectrum disorder, dementia, eating disorders, schizophrenia, anxiety, and depression. In this sense, the community has identified a significant negative influence of social isolation on the mental health of individuals through the modification of individual routines and the absence of social interactions. Moreover, the community identified perceived differences related to the impacts on men and women. In addition to studies showing the effect of social isolation on disorders, an evaluation of protocols with some possible therapeutic intervention strategies during times of social restriction was developed.
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Affiliation(s)
- Amanda Gollo Bertollo
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of Fronteira Sul, Chapecó 89815-899, SC, Brazil;
| | - Geórgia de Carvalho Braga
- Cell Culture Laboratory, Graduate Program in Biomedical Sciences, Federal University of Fronteira Sul, Chapecó 89815-899, SC, Brazil; (G.d.C.B.); (M.D.B.)
| | | | - Adriana Remião Luzardo
- Research Laboratory in Health Management, Innovation and Technologies, Graduate Program in Nursing, Federal University of Fronteira Sul, Chapecó 89815-899, SC, Brazil;
| | - Margarete Dulce Bagatini
- Cell Culture Laboratory, Graduate Program in Biomedical Sciences, Federal University of Fronteira Sul, Chapecó 89815-899, SC, Brazil; (G.d.C.B.); (M.D.B.)
| | - Zuleide Maria Ignácio
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of Fronteira Sul, Chapecó 89815-899, SC, Brazil;
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4
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Fleischmann E, Dalkner N, Fellendorf FT, Bengesser SA, Lenger M, Birner A, Queissner R, Platzer M, Tmava-Berisha A, Maget A, Wagner-Skacel J, Stross T, Schmiedhofer F, Smolle S, Painold A, Reininghaus EZ. The Big Five as Predictors of Cognitive Function in Individuals with Bipolar Disorder. Brain Sci 2023; 13:brainsci13050773. [PMID: 37239245 DOI: 10.3390/brainsci13050773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/02/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
The connection between cognitive function and the "Big Five" personality traits (openness, conscientiousness, extraversion, agreeableness, and neuroticism) in the general population is well known; however, studies researching bipolar disorder (BD) are scarce. Therefore, this study aimed to investigate the Big Five as predictors of executive function, verbal memory, attention, and processing speed in euthymic individuals with BD (cross-sectional: n = 129, including time point t1; longitudinal: n = 35, including t1 and t2). Participants completed the NEO Five-Factor Inventory, the Color and Word Interference Test, the Trail Making Test, the d2 Test of Attention Revised, and the California Verbal Learning Test. The results showed a significant negative correlation between executive function and neuroticism at t1. Changes in cognitive function between t1 and t2 did not correlate with and could not be predicted by the Big Five at t1. Additionally, worse executive function at t2 was predicted by higher neuroticism and lower conscientiousness at t1, and high neuroticism was a predictor of worse verbal memory at t2. The Big Five might not strongly impact cognitive function over short periods; however, they are significant predictors of cognitive function. Future studies should include a higher number of participants and more time in between points of measurement.
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Affiliation(s)
- Eva Fleischmann
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Susanne A Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Adelina Tmava-Berisha
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Alexander Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Jolana Wagner-Skacel
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Tatjana Stross
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Franziska Schmiedhofer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Stefan Smolle
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Annamaria Painold
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
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5
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Shokrgozar S, Rouzbehan V, Zare R, Abdollahi E. Evaluation of patient social support, caregiver burden, and their relationship with the course of the disease in patients with bipolar disorder. Int J Soc Psychiatry 2022; 68:1815-1823. [PMID: 34881668 DOI: 10.1177/00207640211061984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bipolar disorder is a chronic disorder that causes significant effects on the patient and exerts a significant care burden on caregivers. This study aimed to investigate the social support of patients, caregivers' burden and their impact on the clinical course of the disease. METHODS The study included 85 patients with bipolar disorder type I and II (in the recovery phase of the disease) and their caregivers in the age range of 18 to 60 years. It was conducted in Shafa psychiatry Hospital in Rasht (Guilan, Iran, 2020). To assess social support and burden, patients and caregivers completed the Multidimensional Perceived Social Support Scale (MSPSS) and Caregiver Burden Inventory (CBI), respectively. Clinical variables were also obtained from patients' medical records; Then ANOVA, MANOVA, Independent T-test were used to compare the data and Regression Analysis and Spearman correlation coefficient were used to find the relationships between variables. RESULTS It was showed that increasing patient social support is associated with reducing caregiver burden. Among the clinical variables, less social support and more caregiver burden were associated with longer duration of illness (p < .0029, p < .012), decrease in last recurrence time (p < .0013, p < .0001), increased number of hospitalizations (p < .0001, r = -.43 and p < .0001, r = +.49), decreased response to treatment (p < .0001, p < .0001), and reduced follow-up (p = .001, OR = 1.12 and p = .001, OR = 0.95). CONCLUSION The relationship between low social support and high caregiver burden and their significant effect on the disease course indicates a vicious cycle that affects patients, caregivers, and the clinical course of the disease. Therefore, it seems that interventions to break this cycle can change the situation in favor of patients and caregivers and improve the clinical course of the disease.
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Affiliation(s)
- Somayeh Shokrgozar
- Department of Psychiatry, Kavosh Behavioral, Cognitive and Addiction Research Center, Shafa Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Vida Rouzbehan
- Department of Psychiatry, Shafa Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Roghayeh Zare
- Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Elahe Abdollahi
- Department of Psychiatry, Kavosh Behavioral, Cognitive and Addiction Research Center, Shafa Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Social and environmental variables as predictors of mania: a review of longitudinal research findings. DISCOVER MENTAL HEALTH 2022; 2:7. [PMID: 35310132 PMCID: PMC8918447 DOI: 10.1007/s44192-022-00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/07/2022] [Indexed: 10/31/2022]
Abstract
AbstractConsiderable evidence suggests that psychosocial variables can shape the course of bipolar disorder. Here, though, we focus on the more specific idea that the social environment can predict the course of mania. We systematically review evidence from longitudinal studies concerning how social support, family interactions, traumatic life events, and recent life events relate to the age of onset, the frequency of episode recurrence, and the severity of manic symptoms. Although we find some evidence that the course of mania can be worsened by social environmental factors, the links are specific. Among social variables, some studies indicate that conflict and hostility are predictive, but more general social relationship qualities have not been found to predict mania. Some research indicates that childhood trauma, and recent life events involving goal attainment or sleep disruption can predict mania. Taken together, the profile of variables involving recent exposure that are most predictive include those that are activating, reward-related, or sleep-disrupting, which fits with general psychological hypotheses of behavioral activation and sleep disruption as important for mania. We discuss gaps in the literature, and we note future directions for research, including the need for more integrative, longitudinal research on a fuller range of social and biological risk variables.
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7
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Panchal P, de Queiroz Campos G, Goldman DA, Auerbach RP, Merikangas KR, Swartz HA, Sankar A, Blumberg HP. Toward a Digital Future in Bipolar Disorder Assessment: A Systematic Review of Disruptions in the Rest-Activity Cycle as Measured by Actigraphy. Front Psychiatry 2022; 13:780726. [PMID: 35677875 PMCID: PMC9167949 DOI: 10.3389/fpsyt.2022.780726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Disruptions in rest and activity patterns are core features of bipolar disorder (BD). However, previous methods have been limited in fully characterizing the patterns. There is still a need to capture dysfunction in daily activity as well as rest patterns in order to more holistically understand the nature of 24-h rhythms in BD. Recent developments in the standardization, processing, and analyses of wearable digital actigraphy devices are advancing longitudinal investigation of rest-activity patterns in real time. The current systematic review aimed to summarize the literature on actigraphy measures of rest-activity patterns in BD to inform the future use of this technology. METHODS A comprehensive systematic review using PRISMA guidelines was conducted through PubMed, MEDLINE, PsycINFO, and EMBASE databases, for papers published up to February 2021. Relevant articles utilizing actigraphy measures were extracted and summarized. These papers contributed to three research areas addressed, pertaining to the nature of rest-activity patterns in BD, and the effects of therapeutic interventions on these patterns. RESULTS Seventy articles were included. BD was associated with longer sleep onset latency and duration, particularly during depressive episodes and with predictive value for worsening of future manic symptoms. Lower overall daily activity was also associated with BD, especially during depressive episodes, while more variable activity patterns within a day were seen in mania. A small number of studies linked these disruptions with differential patterns of brain functioning and cognitive impairments, as well as more adverse outcomes including increased suicide risk. The stabilizing effect of therapeutic options, including pharmacotherapies and chronotherapies, on activity patterns was supported. CONCLUSION The use of actigraphy provides valuable information about rest-activity patterns in BD. Although results suggest that variability in rhythms over time may be a specific feature of BD, definitive conclusions are limited by the small number of studies assessing longitudinal changes over days. Thus, there is an urgent need to extend this work to examine patterns of rhythmicity and regularity in BD. Actigraphy research holds great promise to identify a much-needed specific phenotypic marker for BD that will aid in the development of improved detection, treatment, and prevention options.
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Affiliation(s)
- Priyanka Panchal
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | | | - Danielle A Goldman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT, United States
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, United States
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, United States
| | - Holly A Swartz
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Anjali Sankar
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Department of Radiology and Biomedical Imaging, and the Child Study Center, Yale School of Medicine, New Haven, CT, United States
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8
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Follesø HS, Austad SB, Olsen A, Saksvik-Lehouillier I. The development, inter-rater agreement and performance of a hierarchical procedure for setting the rest-interval in actigraphy data. Sleep Med 2021; 85:221-229. [PMID: 34364093 DOI: 10.1016/j.sleep.2021.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/24/2021] [Accepted: 07/13/2021] [Indexed: 12/13/2022]
Abstract
The aim of this study was to develop and empirically test a hierarchical procedure for defining rest intervals in actigraphy data. BACKGROUND This is a two-part study. The aim of study 1 was to identify common practices for setting rest intervals in actigraphy research and investigate whether standardized guidelines for setting the rest interval exist, as a base to develop a new procedure for defining rest intervals in actigraphy. The aim of study 2 was to empirically test this procedure (The Rest Interval Setting, RISE Procedure). The RISE procedure was applied to a dataset of 537 nights from the sleep study SLEEPIC. PARTICIPANTS Participants (N = 55) were aged 19-33 (M = 22.7, SD = 3.0). METHODS Study 1: Structured overview of the methods used to correct actigraphy data. Study 2: Three scorers independently applied the RISE procedure to the dataset. RESULTS Study 1 demonstrated that methods and reporting practices are inconsistent and that there is a need for a standardized procedure for setting the rest interval. The results in study 2 revealed that using the new procedure for setting rest intervals provided high agreement between scorers for both rest onsets (α= 0.975) and offsets (α= 0.998). Applying the procedure to the dataset resulted in a shortening of the rest interval by 36 min and 19 s on average. There were significant changes (p < 0.001) in all sleep estimate outcomes after applying the RISE procedure. CONCLUSION Methods for processing and reporting actigraphy data are highly inconsistent across studies. Here we present empirical support for a new standardized procedure for setting the rest interval, which is likely to improve transparency and reproducibility in achigraphy research.
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Affiliation(s)
- Hanna Størksen Follesø
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigrun Borgen Austad
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Alexander Olsen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; St. Olavs Hospital, Trondheim University Hospital, Department of Physical Medicine and Rehabiliation, Trondheim, Norway
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9
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Van Meter A, Stoddard J, Penton-Voak I, Munafò MR. Interpretation bias training for bipolar disorder: A randomized controlled trial. J Affect Disord 2021; 282:876-884. [PMID: 33601731 DOI: 10.1016/j.jad.2020.12.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/19/2020] [Accepted: 12/23/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with emotion interpretation biases that can exacerbate depressed mood. Interpretation bias training (IBT) may help; according to the "virtuous cycle" hypothesis, interpreting others' emotions as positive can lead to interactions that improve mood. Our goals were to determine whether IBT can shift emotion interpretation biases and demonstrate clinical benefits (lower depressed mood, improved social function) in people with BD. METHOD Young adults with BD were recruited for three sessions of computer-based IBT. Active IBT targets negative emotion bias by training judgments of ambiguous face emotions towards happy judgments. Participants were randomized to active or sham IBT. Participants reported on mood and functioning at baseline, intervention end (week two), and week 10. RESULTS Fifty participants (average age 22, 72% female) enrolled, 38 completed the week 10 follow-up. IBT shifted emotion interpretations (Hedges g = 1.63). There was a group-by-time effect (B = -13.88, p < .0001) on self-reported depression; the IBT group had a larger decrease in depressed mood. The IBT group also had a larger increase in perceived familial support (B = 3.88, p < .0001). Baseline learning rate (i.e., how quickly emotion judgments were updated) was associated with reduced clinician- (B = -54.70, p < 0.001) and self-reported depression (B = -58.20, p = 0.009). CONCLUSION Our results converge with prior work demonstrating that IBT may reduce depressed mood. Additionally, our results provide support for role of operant conditioning in the treatment of depression. People with BD spend more time depressed than manic; IBT, an easily disseminated intervention, could augment traditional forms of treatment without significant expense or side effects.
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Affiliation(s)
- Anna Van Meter
- Feinstein Institutes for Medical Research, Institute of Behavioral Science; The Zucker Hillside Hospital, Department of Psychiatry Research; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, New York.
| | - Joel Stoddard
- Pediatric Mental Health Institute, Children's Hospital Colorado, Department of Psychiatry & Neuroscience Program, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Ian Penton-Voak
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit, School of Psychological Science, University of Bristol, Bristol, United Kingdom
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10
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Léda-Rêgo G, Bezerra-Filho S, Miranda-Scippa Â. Functioning in euthymic patients with bipolar disorder: A systematic review and meta-analysis using the Functioning Assessment Short Test. Bipolar Disord 2020; 22:569-581. [PMID: 32243046 DOI: 10.1111/bdi.12904] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Systematically review the prevalence of functional impairment (FI) in euthymic patients with bipolar disorder (BD), as assessed only with the Functioning Assessment Short Test (FAST), explore the prevalence of this impairment among all the domains, identify the most compromised of them and the clinical variables associated with low functioning in this population. METHODS Meta-analyses were performed, searching for relevant papers published from 2007 to 2019 in Medline, Embase, Cochrane, PsycINFO databases and via hand-searching, without language restrictions. 1128 studies were initially identified, 13 of which were ultimately chosen based on the eligibility criteria. A two-step meta-analysis was performed using the mean difference with a 95% confidence interval for continuous variables and proportion estimation with a fixed-effects model for categorical variables. RESULTS In the first step, all FAST domains showed worse FI in patients than in healthy controls, with significant differences between groups. In the second step, the prevalence of FI domains were as follows: global, 58.6%; occupational, 65.6%; cognitive, 49.2%; autonomy, 42.6%; interpersonal relationships, 42.1%; leisure, 29.2%; and financial issues, 28.8%. Residual depressive symptoms were the most frequently cited variable associated with FI. CONCLUSIONS This study reinforces the relevant functional impact of BD in this population and suggests that the occupational domain may be the most impaired. Greater efforts should be directed toward targeting functioning in patient care, as it constitutes the most meaningful endpoint of response to treatment, especially with occupational and cognitive rehabilitation, thus allowing patients to overcome the course of illness and carry fulfilling lives.
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Affiliation(s)
- Gabriela Léda-Rêgo
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil
| | - Severino Bezerra-Filho
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil
| | - Ângela Miranda-Scippa
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil.,Department of Neurosciences and Mental Health, Medical School, UFBA, Salvador, Brazil
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11
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Serravalle L, Iacono V, Hodgins S, Ellenbogen MA. A comprehensive assessment of personality traits and psychosocial functioning in parents with bipolar disorder and their intimate partners. Int J Bipolar Disord 2020; 8:8. [PMID: 32037491 PMCID: PMC7008107 DOI: 10.1186/s40345-019-0172-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 11/11/2019] [Indexed: 12/21/2022] Open
Abstract
Background Individuals with bipolar disorder (BD) often possess maladaptive traits and present with various difficulties in psychosocial functioning. However, little is known about the intimate partners of adults with bipolar disorder (BD) and how mental illnesses other than BD within couples may further complicate the picture. Such knowledge is needed to inform both couple and family interventions. Methods Participants were parents whose children were enrolled in a prospective study: 55 with BD and their partners, and 47 healthy control couples. All completed diagnostic interviews, and questionnaires describing personality traits, negative life events, coping skills, social support, marital adjustment and inter-partner verbal aggression. Parents with BD and healthy control parents were compared, as were the intimate partners. A series of exploratory analyses focused on the average measures within couples, with and without BD, and took account of comorbid personality disorders among those with BD and major depressive disorder among their partners. Results Intimate partners of adults with BD, relative to healthy control partners, presented with more mental disorders, higher neuroticism, lower extraversion, more emotion-focused coping, smaller social networks, less satisfaction with their social networks, and little, satisfying social contact. Additionally, they reported less consensus and satisfaction in their marital relationships, and engaged in more verbal aggression towards their partners. Participants with BD showed similar, more extreme, characteristics. Marital distress and verbal aggression were greatest among couples with an adult having BD and a comorbid personality disorder or a partner with major depressive disorder. Conclusion This study contributes to the literature by demonstrating that both parents with BD and their intimate partners exhibit high levels of mental illness, maladaptive personality traits and psychosocial difficulties, thus limiting their partners’ ability to provide support and stability in the these high risk families. Moreover, mental illnesses other than BD may contribute to marital problems within couples. Some statistical analyses, particularly those involving comorbid conditions, were under-powered in this study. As clinical implications, the current study suggests that both individuals with BD and their partners could benefit from interventions aimed at lowering emotionality and verbal aggression, and increasing social support and effective coping skills.
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Affiliation(s)
- Lisa Serravalle
- Centre for Research in Human Development, Concordia University, Montréal, Canada
| | - Vanessa Iacono
- Centre for Research in Human Development, Concordia University, Montréal, Canada
| | - Sheilagh Hodgins
- Département de Psychiatrie, Université de Montréal, Montréal, Canada.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Mark A Ellenbogen
- Centre for Research in Human Development, Concordia University, Montréal, Canada.
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Chao YY, Katigbak C, Zhang NJ, Dong X. Association Between Perceived Social Support and Depressive Symptoms Among Community-Dwelling Older Chinese Americans. Gerontol Geriatr Med 2018; 4:2333721418778194. [PMID: 30035199 PMCID: PMC6050614 DOI: 10.1177/2333721418778194] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/23/2018] [Accepted: 01/04/2018] [Indexed: 11/16/2022] Open
Abstract
Purpose: This study examined the association between social support and depressive symptoms among U.S. Chinese older adults. Methods: Data were from the Population Study of Chinese Elderly in Chicago (PINE) study. Independent variables were positive and negative perceived social support (PSS). Dependent variable was depressive symptoms. Multinomial logistic regression analyses were performed. Results: A total of participants were 3,157 Chinese older adults with the mean age of 72.8 years (range 60-105 years). After controlling for confounding factors, Chinese older adults with higher positive PSS were 12% (odds ratio [OR] = 0.88, 95% confidence interval [CI] = [0.85, 0.92]) and 18% (OR = 0.82, 95% CI = [0.79, 0.86]) less likely to report mild and moderate-severe depressive symptoms, respectively, compared to reporting minimal depressive symptoms; On the contrary, Chinese older adults with higher negative PSS were 34% (OR = 1.34, 95% CI = [1.24, 1.46]) and 38% (OR = 1.38, 95% CI = [1.26, 1.52]) more likely to report mild and moderate-severe depressive symptoms, respectively. Discussion: The study findings corroborate previous research that social support is significantly associated with depressive symptoms. Our findings reinforce the importance of developing strategies to utilize positive social support and limit negative support in practice for the depressed older adults. Further studies should be conducted to better understand the associations between different dimensions of social support and depression among U.S. Chinese older adults.
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Affiliation(s)
- Ying-Yu Chao
- Rutgers, The State University of New Jersey, Newark, NJ, USA
| | | | | | - XinQi Dong
- Rush University Medical Center, Chicago, IL, USA
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13
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Actigraphic features of bipolar disorder: A systematic review and meta-analysis. Sleep Med Rev 2017; 33:58-69. [DOI: 10.1016/j.smrv.2016.05.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 12/21/2022]
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14
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Studart P, Galvão-de Almeida A, Bezerra-Filho S, Caribé A, Reis Afonso N, Daltro C, Miranda-Scippa Â. Is history of suicidal behavior related to social support and quality of life in outpatients with bipolar I disorder? Psychiatry Res 2016; 246:796-802. [PMID: 28029441 DOI: 10.1016/j.psychres.2016.10.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 11/24/2022]
Abstract
Bipolar disorder (BD) affects the social functioning and quality of life (QoL) of its patients. This study aimed to investigate whether there is an association between social support (SS), and suicidal behavior in BD I patients compared to healthy controls; secondarily, we evaluated the influence of QoL on those variables. A total of 119 euthymic outpatients with BD I, 46 of whom had attempted suicide (SAs) and 73 who had not (non-SAs), were compared to 63 healthy controls, through the Medical Outcomes Study Social Support Scale and World Health Organization's Quality of Life Instrument. No differences were noted in SS and QoL between SAs and non-SAs. Compared to healthy controls, non-SAs showed lower values in the positive social interaction domain of SS, and the patients, as a whole, showed lower values in affectionate and positive social interaction domains of SS. Compared to healthy controls, SAs had lower values in the environmental domain of QoL, and the patients, as a whole, had lower values in the environmental, social, and psychological domains of QoL. There was positive correlation between SS and QoL. Although BD is a disabling disease, patients receive inadequate SS. Interventions that may alter the SS in these patients should be investigated.
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Affiliation(s)
- Paula Studart
- Medicine and Health Postgraduate Program, Federal University of Bahia, Salvador, BA, Brazil; Program of Mood and Anxiety Disorders (CETHA), Federal University of Bahia, Salvador, BA, Brazil.
| | - Amanda Galvão-de Almeida
- Program of Mood and Anxiety Disorders (CETHA), Federal University of Bahia, Salvador, BA, Brazil; Department of Neurosciences and Mental Health, Medical School, Federal University of Bahia, Salvador, BA, Brazil
| | - Severino Bezerra-Filho
- Medicine and Health Postgraduate Program, Federal University of Bahia, Salvador, BA, Brazil; Program of Mood and Anxiety Disorders (CETHA), Federal University of Bahia, Salvador, BA, Brazil
| | - André Caribé
- Medicine and Health Postgraduate Program, Federal University of Bahia, Salvador, BA, Brazil; Program of Mood and Anxiety Disorders (CETHA), Federal University of Bahia, Salvador, BA, Brazil; Bahiana School of Medicine and Public Health, Salvador, BA, Brazil
| | | | - Carla Daltro
- Medicine and Health Postgraduate Program, Federal University of Bahia, Salvador, BA, Brazil; Bahiana School of Medicine and Public Health, Salvador, BA, Brazil
| | - Ângela Miranda-Scippa
- Medicine and Health Postgraduate Program, Federal University of Bahia, Salvador, BA, Brazil; Program of Mood and Anxiety Disorders (CETHA), Federal University of Bahia, Salvador, BA, Brazil; Department of Neurosciences and Mental Health, Medical School, Federal University of Bahia, Salvador, BA, Brazil
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15
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Ng TH, Chung KF, Lee CT, Yeung WF, Ho FYY. Eveningness and Its Associated Impairments in Remitted Bipolar Disorder. Behav Sleep Med 2016; 14:650-64. [PMID: 26549008 DOI: 10.1080/15402002.2015.1065407] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sleep-wake and circadian rhythm disturbances are common in remitted bipolar disorder. These disturbances include difficulty initiating and maintaining sleep, daytime sleepiness, sleep irregularity, and a circadian tendency toward eveningness. To date, few studies have examined the impact of eveningness on impairments in remitted bipolar disorder. Ninety-eight adults diagnosed with bipolar disorder I, II, or not otherwise specified were evaluated. Hierarchical linear regression analyses showed that eveningness was associated with greater sleep-wake disturbances, more unhealthy dietary habits, worse quality of life, more impaired interpersonal relationships, and more dysfunctional sleep-related cognitions and behaviors, controlling for age, gender, and years of education. Targeted intervention on dysfunctional sleep-related cognitions and behaviors may reverse eveningness and improve functioning in bipolar disorder.
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Affiliation(s)
- Tommy H Ng
- a Department of Psychiatry University of Hong Kong, Hong Kong Special Administrative Region , China
| | - Ka-Fai Chung
- a Department of Psychiatry University of Hong Kong, Hong Kong Special Administrative Region , China
| | - Chit-Tat Lee
- b Department of Psychiatry Queen Mary Hospital, Hong Kong Special Administrative Region , China
| | - Wing-Fai Yeung
- c School of Chinese Medicine University of Hong Kong, Hong Kong Special Administrative Region , China
| | - Fiona Y Y Ho
- d Department of Psychology University of Hong Kong, Hong Kong Special Administrative Region , China
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16
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Correlates and prognostic relevance of sleep irregularity in inter-episode bipolar disorder. Compr Psychiatry 2016; 69:155-62. [PMID: 27423356 DOI: 10.1016/j.comppsych.2016.05.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/05/2016] [Accepted: 05/28/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Sleep-wake disturbances, such as sleep irregularity, are common in bipolar disorder. Early studies suggest that sleep irregularity is associated with mood symptoms in bipolar disorder, but little research has been conducted to identify other correlates of sleep irregularity. We investigated the relationship between sleep irregularity and sleep quality, social rhythms, eveningness, sleep-related cognitions and behaviors, and past and future mood episodes in 84 patients with inter-episode bipolar I or II disorder. METHODS This is a retrospective and prospective, naturalistic follow-up study. The Expanded Consensus Sleep Diary, Pittsburgh Sleep Quality Index (PSQI), Social Rhythm Metric (SRM-II-5), Composite Scale of Morningness (CSM), Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS-16), and Sleep Hygiene Practice Scale (SHPS) were administered. The Square Successive Difference (SSD), derived from a week-long sleep diary, was used as an index of sleep irregularity. Multilevel modeling analysis, which adjusts for biases in parameter estimates, was used to minimize the impact of missing data. Bonferroni correction was performed to account for multiple testing. RESULTS Higher SSD scores of sleep diary variables were significantly associated with higher PSQI, SRM-II-5, DBAS-16, and SHPS scores. Irregularity in total sleep time was related to more depressive episodes in the past 5years (p=.002), while irregularity in wake after sleep onset predicted the onset of depressive episodes over the next 2years (p=.002). CONCLUSION Sleep irregularity was associated with poor sleep quality, irregular social rhythms, dysfunctional sleep-related cognitions and behaviors, and greater number of depressive episodes in bipolar disorder.
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Depp CA, Dev S, Eyler LT. Bipolar Depression and Cognitive Impairment: Shared Mechanisms and New Treatment Avenues. Psychiatr Clin North Am 2016; 39:95-109. [PMID: 26876321 PMCID: PMC4758200 DOI: 10.1016/j.psc.2015.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Depression and cognitive impairment are pervasive and highly disabling aspects of bipolar disorder. Although cognitive impairment is partially independent from mood episodes, depressive symptoms may increase the risk of cognitive impairment in bipolar disorder through inflammatory processes as well as health risks such as obesity and sedentary behavior. Novel treatment avenues at the intersection of bipolar depression and cognitive impairment target inflammation directly or indirectly health behaviors such as diet, physical activity, and sleep hygiene.
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Affiliation(s)
- Colin A Depp
- Department of Psychiatry, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Desert-Pacific Mental Illness Research, Education, and Clinical Center, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
| | - Sheena Dev
- Department of Psychiatry, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; SDSU-UCSD Joint Doctoral Program, Clinical Psychology, San Diego, CA, USA
| | - Lisa T Eyler
- Department of Psychiatry, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Desert-Pacific Mental Illness Research, Education, and Clinical Center, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
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18
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Koenders MA, Giltay EJ, Hoencamp E, Elzinga BM, Spinhoven P, Spijker AT. The bidirectional impact of perceived and enacted support on mood in bipolar outpatients: A two-year prospective study. Compr Psychiatry 2015; 60:59-67. [PMID: 25935461 DOI: 10.1016/j.comppsych.2015.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/23/2015] [Accepted: 03/14/2015] [Indexed: 11/30/2022] Open
Abstract
Bipolar disorder (BD) is a chronic illness, and a great need has been expressed to elucidate factors affecting the course of the disease. Social support is one of the psychosocial factors that is assumed to play an important role in the course of BD, but it is largely unknown whether the depressive and/or manic symptoms also affect the patients' support system. Further, the perception of one's social support appears to have stronger effects on disease outcomes than one's enacted or received support, but whether this also applies to BD has not been investigated. The objective of this study is to examine temporal, bidirectional associations between mood states (depression and mania) and both enacted and perceived support in BD patients. The current study was conducted among 173 BD I and II outpatients, with overall light to mild mood symptoms. Severity of mood symptoms and social support (enacted as well as perceived) were assessed every 3months, for 2years (1146 data points). Multilevel regression analyses (linear mixed-models) showed that lower perceived support during 3months was associated with subsequent higher levels of depressive, but not of manic symptoms in the following 3months. Vice versa, depressive symptoms during 3months were associated with less perceived support in the following 3months. Further, manic symptoms during 3months were associated with less enacted support in the subsequent 3 months. The current study suggests that perceived, but not enacted, support is consistently related to depressive symptoms in a bidirectional way, while mania is specifically associated with a subsequent loss of enacted support. Clinical implications of the current findings are discussed.
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Affiliation(s)
- M A Koenders
- PsyQ The Hague, Department of Mood Disorders, The Hague, The Netherlands; Leiden University, Institute of Psychology, Section of Clinical Psychology, Leiden, The Netherlands.
| | - E J Giltay
- Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands
| | - E Hoencamp
- PsyQ The Hague, Department of Mood Disorders, The Hague, The Netherlands; Leiden University, Institute of Psychology, Section of Clinical Psychology, Leiden, The Netherlands
| | - B M Elzinga
- Leiden University, Institute of Psychology, Section of Clinical Psychology, Leiden, The Netherlands
| | - P Spinhoven
- Leiden University, Institute of Psychology, Section of Clinical Psychology, Leiden, The Netherlands; Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands
| | - A T Spijker
- PsyQ Rijnmond, Department of mood and anxiety disorders, Rotterdam, The Netherlands
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Ng TH, Chung KF, Ho FYY, Yeung WF, Yung KP, Lam TH. Sleep–wake disturbance in interepisode bipolar disorder and high-risk individuals: A systematic review and meta-analysis. Sleep Med Rev 2015; 20:46-58. [DOI: 10.1016/j.smrv.2014.06.006] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 06/13/2014] [Accepted: 06/15/2014] [Indexed: 10/25/2022]
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Park JW, Park KH. Validation of the bipolar disorder etiology scale based on psychological behaviorism theory and factors related to the onset of bipolar disorder. PLoS One 2014; 9:e116265. [PMID: 25549262 PMCID: PMC4280146 DOI: 10.1371/journal.pone.0116265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/27/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aim of this study was to identify psychosocial factors related to the onset of bipolar I disorder (BD). To do so, the Bipolar Disorder Etiology Scale (BDES), based on psychological behaviorism, was developed and validated. Using the BDES, common factors related to both major depressive disorder (MDD) and BD and specific factors related only to BD were investigated. METHOD The BDES, which measures 17 factors based on psychological behaviorism hypotheses, was developed and validated. This scale was administered to 113 non-clinical control subjects, 30 subjects with MDD, and 32 people with BD. ANOVA and post hoc analyses were conducted. Subscales on which MDD and BD groups scored higher than controls were classified as common factors, while those on which the BD group scored higher than MDD and control groups were classified as specific factors. RESULTS The BDES has acceptable reliability and validity. Twelve common factors influence both MDD and BD and one specific factor influences only BD. Common factors include the following: learning grandiose self-labeling, learning dangerous behavior, reinforcing impulsive behavior, exposure to irritability, punishment of negative emotional expression, lack of support, sleep problems, antidepressant problems, positive arousal to threat, lack of social skills, and pursuit of short-term pleasure. The specific factor is manic emotional response. CONCLUSIONS Manic emotional response was identified as a specific factor related to the onset of BD, while parents' grandiose labeling is a candidate for a specific factor. Many factors are related to the onset of both MDD and BD.
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Affiliation(s)
- Jae Woo Park
- Department of General Counseling, Korea Counseling Graduate School, Seoul, South Korea
| | - Kee Hwan Park
- Department of Psychology, The Catholic University of Korea, College of Social Science, Bucheon, South Korea
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McGlinchey EL, Gershon A, Eidelman P, Kaplan KA, Harvey AG. Physical activity and sleep: Day-to-day associations among individuals with and without Bipolar Disorder. Ment Health Phys Act 2014; 7:183-190. [PMID: 25506392 PMCID: PMC4260416 DOI: 10.1016/j.mhpa.2014.05.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the relative role of psychopathology in the relationship between physical activity and sleep, the present study investigated the day-to-day relationship between physical activity and sleep in individuals without a psychiatric disorder and individuals with bipolar disorder using a longitudinal, naturalistic design. METHOD Participants in two groups-a healthy group with no psychiatric illness (N=36) and an inter-episode bipolar disorder group (N=32)- were studied over a two-month period. Physical health was assessed by the SF-36. Daily subjective and objective measures of physical activity and sleep were collected. A total of 6,670 physical activity measurements and 6,548 sleep measurements were logged. RESULTS The bipolar disorder group exhibited poorer physical health on the SF-36 and more sleep disturbance relative to the healthy group. No group differences were found in physical activity, nor in models examining the relationship between physical activity and sleep. Hierarchical linear models indicated that for every standard deviation increase in sleep disturbance (i.e., increased total wake time), there was a three percent decrease in subsequent day physical activity, in both the healthy and bipolar groups. Increased physical activity was associated with improved sleep for participants who reported greater average sleep disturbance. CONCLUSIONS The results for all participants in the study suggest that reduced physical activity and sleep difficulties may be mutually maintaining processes, particularly for individuals who suffer from poor sleep. Findings also raise the potential importance of targeting physical activity and sleep concurrently in interventions aimed at improving physical and mental health.
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Affiliation(s)
| | - Anda Gershon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
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Saunders EF, Novick DM, Fernandez-Mendoza J, Kamali M, Ryan KA, Langenecker SA, Gelenberg AJ, McInnis MG. Sleep quality during euthymia in bipolar disorder: the role of clinical features, personality traits, and stressful life events. Int J Bipolar Disord 2013; 1:16. [PMID: 25505683 PMCID: PMC4230686 DOI: 10.1186/2194-7511-1-16] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 08/16/2013] [Indexed: 11/16/2022] Open
Abstract
Background Poor sleep quality is known to precede the onset of mood episodes and to be associated with poor treatment outcomes in bipolar disorder (BD). We sought to identify modifiable factors that correlate with poor sleep quality in BD independent of residual mood symptoms. Methods A retrospective analysis was conducted to assess the association between the Pittsburgh Sleep Quality Index and clinical variables of interest in euthymic patients with DSM-IV BD (n = 119) and healthy controls (HC; n = 136) participating in the Prechter Longitudinal Study of Bipolar Disorder. Multivariable linear regression models were constructed to investigate the relationship between sleep quality and demographic and clinical variables in BD and HC participants. A unified model determined independent predictors of sleep quality. Results and discussion Euthymic participants with BD and HC differed in all domains. The best fitting unified multivariable model of poor sleep quality in euthymic participants with BD included rapid cycling (β = .20, p = .03), neuroticism (β = .28, p = 2 × 10−3), and stressful life events (β = .20, p = .02). Poor sleep quality often persists during euthymia and can be a target for treatment. Clinicians should remain vigilant for treating subjective sleep complaints independent of residual mood symptoms in those sensitive to poor sleep quality, including individuals with high neuroticism, rapid cycling, and recent stressful life events. Modifiable factors associated with sleep quality should be targeted directly with psychosocial or somatic treatment. Sleep quality may be a useful outcome measure in BD treatment studies.
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Affiliation(s)
- Erika Fh Saunders
- University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA
| | - Danielle M Novick
- University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA
| | - Julio Fernandez-Mendoza
- University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA
| | - Masoud Kamali
- University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA
| | - Kelly A Ryan
- University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA
| | - Scott A Langenecker
- University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA
| | | | - Melvin G McInnis
- University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA
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