Bipolar disorder and cumulative trauma: A systematic review of prevalence and illness outcomes

BACKGROUND

The experience of cumulative trauma may be common in bipolar disorder (BD). However, it is not frequently reported as most studies focus on childhood trauma without examining differences in the amount of trauma experienced. This systematic review aimed to determine the prevalence of lifetime cumulative trauma in BD as well as explore associated illness outcomes.

METHODS

A systematic review was completed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Both the prevalence and outcomes of cumulative trauma in BD were assessed. Five electronic databases were searched (Embase, MEDLINE, PsycINFO, Web of Science, and PTSD Pubs) for records from January 2010 until December 2022.

RESULTS

A total of 20 studies, with 9304 participants were included in the narrative synthesis. At least one-third of BD participants had experienced cumulative trauma, with a prevalence range from 29% to 82%. The main outcomes associated with a history of cumulative trauma were earlier age of onset, longer episode duration, more lifetime mood episodes, greater likelihood of experiencing psychotic features, and higher likelihood of past suicide attempts.

LIMITATIONS

This review has been limited by the lack of studies directly assessing cumulative trauma in BD.

CONCLUSIONS

Cumulative trauma is prevalent in BD. Preliminary evidence indicates an association with a range of adverse outcomes, emphasizing the need for clinicians to obtain a detailed trauma history and to consider these risks in the management of the disorder. Future studies should report on the prevalence of cumulative trauma, particularly in adulthood as this area remains unexplored.

Cumulative trauma in bipolar disorder: An examination of prevalence and outcomes across the lifespan

BACKGROUND

Trauma is highly prevalent in bipolar disorder, and while considerable research has been undertaken in relation to childhood trauma, little is known about the experience and the impact of exposure to multiple trauma types across the lifespan, otherwise known as cumulative trauma. This study aimed to examine the prevalence of cumulative trauma in bipolar disorder and explore its association with illness and other outcomes.

METHODS

Participants were recruited online globally and comprised 114 adults aged 23 to 73 years with BD-I (41.2 %) or BD-II (58.8 %). Participants completed an online questionnaire containing items regarding symptoms and trauma history followed by a diagnostic interview to confirm their BD diagnosis and assess BD symptoms.

RESULTS

Cumulative trauma accounted for most of the trauma exposure across both childhood (n = 89; 78.1 %) and adulthood (n = 72; 63.2 %). Those with lifetime cumulative trauma (n = 64; 56 %) were more likely to experience at least one other co-morbid mental health condition in addition to their BD diagnosis (88 %) and report significantly lower ratings of perceived social support compared to those who did not experience any cumulative trauma (N = 15; 13 %).

LIMITATIONS

This study has been limited by the cross-sectional retrospective design as well as the use of self-selection to participate.

CONCLUSIONS

Cumulative trauma is highly prevalent in bipolar disorder and is associated with greater likelihood of experiencing a psychiatric comorbidity and decreased levels of social support. More research is needed to explore the nature of this relationship and determine whether increasing social support may be of benefit.

Emotional autobiographical memory impairment features in three mental disorders

We proposed the Emotional Autobiographical Memory Test (EAMT) as a specialized method for measuring emotional autobiographical memory impairment in patients with mental disorders. The EAMT was tested with 32 patients with schizophrenia, 18 patients with bipolar disorder, 32 patients with depression, and 42 people undiagnosed with such disorders. We extracted 13 indices of five kinds of features from participants' emotional autobiographical memory and compared them among the four groups. The overgeneralization result in the schizophrenia and depression groups was consistent with previous results, supporting the EAMT's validity. However, inconsistent with previous results, overgeneralization was not found in the bipolar disorder group. Further, the count of involuntary memories in the patient groups (vs. control group) was significantly smaller, which can guide future researchers in investigating the psychopathology of mental disorders.

PRICKLE2 revisited-further evidence implicating PRICKLE2 in neurodevelopmental disorders

PRICKLE2 encodes a member of a highly conserved family of proteins that are involved in the non-canonical Wnt and planar cell polarity signaling pathway. Prickle2 localizes to the post-synaptic density, and interacts with post-synaptic density protein 95 and the NMDA receptor. Loss-of-function variants in prickle2 orthologs cause seizures in flies and mice but evidence for the role of PRICKLE2 in human disease is conflicting. Our goal is to provide further evidence for the role of this gene in humans and define the phenotypic spectrum of PRICKLE2-related disorders. We report a cohort of six subjects from four unrelated families with heterozygous rare PRICKLE2 variants (NM_198859.4). Subjects were identified through an international collaboration. Detailed phenotypic and genetic assessment of the subjects were carried out and in addition, we assessed the variant pathogenicity using bioinformatic approaches. We identified two missense variants (c.122 C > T; p.(Pro41Leu), c.680 C > G; p.(Thr227Arg)), one nonsense variant (c.214 C > T; p.(Arg72*) and one frameshift variant (c.1286_1287delGT; p.(Ser429Thrfs*56)). While the p.(Ser429Thrfs*56) variant segregated with disease in a family with three affected females, the three remaining variants occurred de novo. Subjects shared a mild phenotype characterized by global developmental delay, behavioral difficulties ± epilepsy, autistic features, and attention deficit hyperactive disorder. Computational analysis of the missense variants suggest that the altered amino acid residues are likely to be located in protein regions important for function. This paper demonstrates that PRICKLE2 is involved in human neuronal development and that pathogenic variants in PRICKLE2 cause neurodevelopmental delay, behavioral difficulties and epilepsy in humans.

Role of autobiographical memory in the impact of MBCT on dysfunctional attitudes, depressive symptoms and anxiety in bipolar I patients

BACKGROUND

The literature suggests that cognitive reactivity in bipolar patients can increase relapse vulnerability, is enhanced by depressive mood and dysfunctional attitudes, and could be improved with MBCT. Autobiographical memory (AM) could be involved in cognitive reactivity, and improved with MBCT training. This study aims to investigate the effect of MBCT for bipolar patients on depressive and anxious symptoms, dysfunctional attitudes and AM, and the predictive versus mediating role of AM in the impact of MBCT on clinical symptoms.

METHODS

Sixty-two outpatients diagnosed with bipolar I disorder were assigned to MBCT and were compared to 37 bipolar patients on a waiting list. Affective symptoms and dysfunctional attitudes were explored using self-report inventories (BDI, BAI, DAS) and AM was assessed using the Autobiographical Memory Test.

RESULTS

Patients receiving MBCT demonstrated significantly decreased depressive symptoms, dysfunctional attitudes, overgeneral memories and omissions, and increased specific memories. General AM and omissions at baseline respectively predicted lower anxiety and dysfunctional attitudes improvement following therapy, but the improvement of AM did not explain the impact of MBCT on depression and dysfunctional attitudes improvement.

LIMITS

Further studies should consider patients' therapeutic adherence and mechanisms involved in MBCT in order to better apprehend how MBCT may reduce dysfunctional attitudes and improve AM in bipolar patients.

CONCLUSION

Results are consistent with the hypothesis that MBCT reduces cognitive reactivity and AM impairment in bipolar disorders. Findings suggest that AM training prior to MBCT may influence MBCT efficacy, but that MBCT efficacy on AM and clinical symptoms are non-related phenomena.

Remediating reduced memory specificity in bipolar disorder: A case study using a Computerized Memory Specificity Training

OBJECTIVES

Reduced autobiographical memory specificity (rAMS) is a vulnerability factor found across unipolar depression (UD), posttraumatic stress disorder (PTSD), eating disorder, schizophrenia, and bipolar disorder (BD). A group delivered psychological therapy training called Memory Specificity Training (MeST) remediates rAMS in UD and PTSD, with additional downstream effects on related psychological processes and symptoms. Its impact in BD is unknown. In this case study, we examined the impact of a computerized version of MeST (c-MeST) on improving AMS and related symptoms and processes in participant with rapid cycling type I BD.

METHOD

An experimental case study with an ABA design was used. During baseline (14 days, Phase A), the training phase (nine sessions across 17 days, Phase B), and a 1-month follow-up (Phase A), memory specificity, depressive symptoms, and related processes and symptoms were repeatedly measured.

RESULTS

Memory specificity increased significantly after the participant completed c-MeST. Session-to-session scores indicated that AMS improved most from the in-person baseline assessment to the first online session. All other measures of processes and symptoms deteriorated during the training phase but regressed to baseline during follow-up.

CONCLUSION

Memory specificity was improved as indicated by increased AMS from pre-intervention measurement to 1-month follow-up. Other improvements in symptoms were not observed. Rather, some related maladaptive psychological processes and symptoms worsened during the training phase and regressed to baseline during follow-up.

Autobiographical memory deficits in remitted patients with bipolar disorder I: The effect of impaired memory retrieval

Autobiographical memory (AM) has been studied extensively in different psychiatric disorders. However, less is known about AM in bipolar disorder (BD). Aim of the present study was to investigate BD patients' ability to recall episodic and semantic autobiographical memories after controlling for the effect of other possible neurocognitive deficits. Participants included 30 clinically remitted outpatients with BD type I and 30 healthy controls, matched for age, gender and educational level. Autobiographical memory was examined by the Questionnaire of Autobiographical Memory. Premorbid intellectual functioning, verbal memory, verbal fluency, attention and working memory were also assessed. Bipolar patients were impaired in both episodic and semantic AM, compared with healthy individuals. Deficits involved recall of memories from childhood-adolescence, early adulthood and recent life. Additionally, patients were impaired in verbal memory compared with controls. Differences between study groups in both episodic and semantic AM remained significant even after controlling for the effect of verbal memory deficits. Remitted BD-I patients showed deficits in recalling personal episodic memories and facts dating to three different life periods. These deficits were independent of patients' lower verbal memory performance. Additional research is required to gain a better understanding of the pattern and the mechanisms underlying AM impairment in BD.

Use, Adaptivity, and Need Fulfillment: A Methodological Critique of Tests of the Functions of Autobiographical Memory

In this article, we champion the study of autobiographical memory functions. We review the proposed functions and how they have been investigated. We describe seven commonly used research designs. We argue that although each design offers unique benefits, none of these designs is ideally suited to test the functional nature of autobiographical memory with high internal validity. We stress that each design does have a unique set of benefits in the exploration of autobiographical memory and none should be abandoned. However, we encourage researchers interested in function in particular to consider designs that will illuminate the use, adaptivity, and fulfillment of needs that is inherent in the definition of function.

Establishing the international prevalence of self-reported child maltreatment: a systematic review by maltreatment type and gender

BACKGROUND

Estimating the prevalence of child maltreatment is challenging due to the absence of a clear 'gold standard' as to what constitutes maltreatment. This systematic review aims to review studies using self-report maltreatment to capture prevalence rates worldwide.

METHODS

PubMed, Ovid SP and grey literature from the NSPCC, UNICEF, The UK Government, and WHO from 2000 to 2017 were searched. The literature review focused on the variation found in self-reported lifetime prevalence for each type of maltreatment between studies by continent and gender, and how methodological differences may explain differences found.

RESULTS

Sexual abuse is the most commonly studied form of maltreatment across the world with median (25th to 75th centile) prevalence of 20.4% (13.2% to 33.6%) and 28.8% (17.0% to 40.2%) in North American and Australian girls respectively, with lower rates generally for boys. Rates of physical abuse were more similar across genders apart from in Europe, which were 12.0% (6.9% to 23.0%) and 27.0% (7.0% to 43.0%) for girls and boys respectively, and often very high in some continents, for example, 50.8% (36.0% to 73.8%) and 60.2% (43.0% to 84.9%) for girls and boys respectively in Africa. Median rates of emotional abuse were nearly double for girls than boys in North America (28.4% vs 13.8% respectively) and Europe (12.9% vs 6.2% respectively) but more similar across genders groups elsewhere. Median rates of neglect were highest in Africa (girls: 41.8%, boys: 39.1%) and South America (girls: 54.8%, boys: 56.7%) but were based on few studies in total, whereas in the two continents with the highest number of studies, median rates differed between girls (40.5%) and boys (16.6%) in North America but were similar in Asia (girls: 26.3%, boys: 23.8%).

CONCLUSIONS

Median prevalence rates differ substantially by maltreatment category, gender and by continent. The number of studies and available data also varies and relatively little is known about prevalence for some forms of maltreatment, particularly outside of the North American context. Prevalence rates require caution in interpretation as some variation will reflect methodological differences, including the data collection methods, and how the maltreatment is defined.

Self-reported inhibition predicts history of suicide attempts in bipolar disorder and major depression

BACKGROUND

Studies have reliably identified an association between suicide attempts and executive functions such as decision making (DM) and inhibitory control (IC) in patients with mood disorders. As such, the present study aimed to investigate the association between inhibition, DM, impulsivity and the history of suicide attempts in individuals with bipolar (BD) or major depressive disorder (MDD), identifying which assessment instruments may be most strongly associated with suicide in clinical samples.

METHODS

The sample included 80 control subjects and two groups of patients with BD and MDD, matched by age and education (26 with a history of suicide attempts [MD+], and 26 with no such history [MD-]). Participants completed behavioral and self-report measures of DM and IC, which were compared between groups using ANCOVA, followed by logistic regression for patients with mood disorders only, and the presence or absence of a history of suicide as the outcome.

RESULTS

Cognitive performance did not differ between groups. The MD+ group showed significantly higher motor and attentional impulsivity on the BIS-11 than the MD- and control groups. A regression analysis containing these scores showed that motor impulsivity was the only significant predictor of a history of suicide (OR = 1.14; 95%CI 1.00-1.30).

CONCLUSIONS

Self-reported motor impulsivity was a significant predictor of suicide. These findings underscore the importance of self-report measures in neuropsychological assessment, and their contributions to the management and prognosis of patients with mood disorders. Lastly, they point to the role of impulsivity as a target for interventions and public policy on suicide prevention.

Meta-Analysis of the Association Between Autobiographical Memory Specificity and Exposure to Trauma

Cognitive models of emotional disorders suggest that reduced autobiographical memory specificity that results from exposure to traumatic events may play an important role in the aetiology and maintenance of these disorders. However, there has yet to be a comprehensive meta-analysis of the association between trauma exposure and memory specificity, and the role of posttraumatic stress symptoms on this association. We searched PsycINFO and MEDLINE databases and extracted data from studies regarding the mean number or proportion of specific memories that participants with and without trauma exposure recalled on the Autobiographical Memory Test. We also extracted data on differences between groups in terms of posttraumatic stress and depressive symptoms, along with data on trauma timing and participants' ages at the time of assessment. The effect size of memory specificity between participants with and without exposure to trauma was large, d = 0.77, and differed significantly from zero, p < .001. In metaregression, trauma timing was a significant predictor of the heterogeneity in trauma-exposure specificity effect sizes, but posttraumatic stress and depressive symptoms were not. Compromised memory specificity represents an important cognitive consequence of trauma exposure that might have an important influence on risk for, and maintenance of, subsequent emotional pathologies.

The association between childhood trauma, parental bonding and depressive symptoms and interpersonal functioning in depression and bipolar disorder

Objectives

This study explores rates of a history of childhood trauma in adult patients with bipolar disorder and depression and the impact of such trauma and parental bonding patterns on depressive mood and interpersonal functioning at the time of assessment.

Methods

A cross-sectional design was used and a sample of 49 participants was recruited from a mental health outpatient service in Northern Ireland. Data were subject to correlations, one-way analysis of variance and hierarchal regression analyses. A cut-off point of r=±0.25 was used to select variables for inclusion in the hierarchal regression analyses.

Results

High rates of childhood trauma were present in both samples: 74% in bipolar disorder and 82% in depression. Childhood trauma and poor parental bonding (with mother) were significant predictors of higher rates of current inter-episode depressive mood and interpersonal difficulties.

Conclusions

This finding adds to the evidence that routine assessment of early childhood experience is likely to prove helpful in clinical care.

Bipolar Disorder and Early Emotional Trauma: A Critical Literature Review on Indicators of Prevalence Rates and Clinical Outcomes

LEARNING OBJECTIVES

After participating in this activity, learners should be better able to:• Evaluate the prevalence of early emotional trauma in patients with bipolar disorder (BD)• Assess the impact of these traumas on patients and on their development of BD OBJECTIVES: We performed a systematic literature review to (1) evaluate the prevalence of early emotional trauma (EET) in patients with bipolar disorder (BD) and the impact of these traumas on the development of the disorder, and (2) integrate the findings of our review with those previously reported by Fisher and Hosang, Daruy-Filho and colleagues, and Maniglio.

METHODS

The literature search was performed on PubMed, SciELO, and PsycINFO databases using the keywords bipolar disorder, early trauma, physical abuse, emotional abuse, sexual abuse, maltreatment, adversity, and neglect.

RESULTS

Twenty-eight articles were selected and analyzed. Taken together, the articles described a high prevalence of EET in BD, consisting mainly of emotional neglect/abuse (approximately 40%), particularly when compared to healthy subjects. The review also identified substantial evidence regarding an association between the presence of EET, early disease onset, rapid cycling, comorbidity with anxiety/stress disorders, and cannabis use.

CONCLUSION

The integration of the current findings with the identified studies reveals that (1) the methodological limitations noted by Daruy-Filho and colleagues have been largely resolved in more recent studies and (2) the presence of EET in patients with BD is associated with worse clinical outcomes, particularly early disease onset, presence of clinical or psychiatric comorbidities, suicide, and presence of psychotic episodes/symptoms. The review shows that patients with BD experience more traumatic situations than controls and that emotional trauma is the most frequent type of trauma in this group.

Crack cocaine addiction, early life stress and accelerated cellular aging among women

BACKGROUND

Early life stress (ELS) and addiction are related to age-related diseases and telomere shortening. However, the role of telomere length (TL) in crack cocaine addiction remains unknown. The purpose of this study was to investigate the TL in a sample of crack cocaine dependent-women who reported an ELS history and in a community-based sample of elderly women as a reference group for senescence.

METHODS

This study included treatment seeking crack cocaine dependents women (n=127) and elderly women without a psychiatric diagnosis (ELD, n=49). The crack cocaine sample was divided in two groups according to their Childhood Trauma Questionnaire (CTQ) scores: presence of history of childhood abuse and neglect (CRACK-ELS) and absence of ELS history (CRACK). TL was assessed by T/S ratio obtained from peripheral blood DNA using quantitative PCR assay.

RESULTS

CRACK and CRACK-ELS subjects exhibited shortened TL in comparison to the ELD group, despite their younger age. Among crack cocaine sample, CRACK-ELS group had significantly shorter telomeres than the CRACK group. Correlation analysis within crack cocaine group indicated that TL was negatively correlated with emotional abuse scores.

CONCLUSIONS

These results support previous findings associating telomere shortening with both ELS and drug addiction. This study suggests new evidence of a distinct biological phenotype for drug-dependent women with ELS. The results support the biological senescence hypothesis underpinning ELS experience.

Reliability of reports of childhood trauma in bipolar disorder: A test-retest study over 18 months

This study aimed to explore the reliability of self-reported trauma histories in a population with a diagnosis of bipolar disorder using the Childhood Trauma Questionnaire. Previous studies in other populations suggest high reliability of trauma histories over time, and it was postulated that a similar high reliability would be demonstrated in this population. A total of 39 patients with a confirmed diagnosis (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria) were followed up and readministered the Childhood Trauma Questionnaire after 18 months. Cohen's kappa scores and intraclass correlations suggested reasonable test-retest reliability over the 18-month time period of the study for all types of childhood abuse, namely, emotional, physical, and sexual abuse and physical and emotional neglect. Intraclass correlations ranged from r = .50 (sexual abuse) to r = .96 (physical abuse). Cohen's kappas ranged from .44 (sexual abuse) to .76 (physical abuse). Retrospective reports of childhood trauma can be seen as reliable and are in keeping with results found with other mental health populations.

Childhood maltreatment and unfavourable clinical outcomes in bipolar disorder: a systematic review and meta-analysis

BACKGROUND

Bipolar disorder affects up to one in 25 individuals and identification of early risk indicators of negative outcomes could facilitate early detection of patients with greatest clinical needs and risk. We aimed to investigate the association between childhood maltreatment and key negative outcomes in patients with bipolar disorder.

METHODS

For this systematic review and meta-analysis we searched MEDLINE, PsycINFO, and Embase to identify articles published before Jan 1, 2015, examining the association of maltreatment (physical, sexual, or emotional abuse, neglect, or family conflict) before age 18 years with clinical features and course of illness in bipolar disorder. Data were extracted from published reports and any missing information was requested from investigators. We did 12 independent random-effects meta-analyses to quantify the associations between childhood maltreatment and course of illness or clinical features.

FINDINGS

We initially identified 527 records and after unsuitable studies were removed, our search yielded 148 publications of which 30 were used in the meta-analysis. Patients with bipolar disorder and history of childhood maltreatment had greater mania severity (six studies, 780 participants; odds ratio [OR] 2·02, 95% CI 1·21-3·39, p=0·008), greater depression severity (eight studies, 1007 participants; 1·57, 1·25-1·99, p=0·0001), greater psychosis severity (seven studies, 1494 participants; 1·49, 1·10-2·04, p=0·011), higher risk of comorbidity with post-traumatic stress disorder (eight studies, 2494 participants; 3·60, 2·45-5·30, p<0·0001), anxiety disorders (seven studies, 5091 participants; 1·90, 1·39-2·61, p<0·0001), substance misuse disorders (11 studies, 5469 participants; 1·84, 1·41-2·39, p<0·0001), alcohol misuse disorder (eight studies, 5040 participants; 1·44, 1·13-1·83, p=0·003), earlier age of bipolar disorder onset (14 studies, 5733 participants; 1·85, 1·43-2·40, p<0·0001), higher risk of rapid cycling (eight studies, 3010 participants; 1·89, 1·45-2·48, p<0·0001), greater number of manic episodes (seven studies, 3909 participants; 1·26, 1·09-1·47, p=0·003), greater number of depressive episodes (eight studies, 4025 participants; 1·38, 1·07-1·79, p=0·013), and higher risk of suicide attempt (13 studies, 3422 participants; 2·25, 1·88-2·70, p<0·0001) compared with those with bipolar disorder without childhood maltreatment. Overall, these associations were not explained by publication bias, undue effects of individual studies, or variation in study quality.

INTERPRETATION

Childhood maltreatment predicts unfavourable clinical features and course of illness in patients with bipolar disorder.

FUNDING

None.

Autobiographical memory and its association with neuropsychological function in bipolar disorder

OBJECTIVE

The aim of this study was to investigate the overgeneralization of autobiographical memory (AM) in bipolar disorder (BD) and assess its association with multiple cognitive domains.

METHOD

Twenty-eight clinically stable bipolar I patients and an equal number of age- and gender-matched healthy controls (HC) were included. All participants were examined using the autobiographical memory test (AMT) and the neuropsychological battery including the general intelligence, attention, verbal memory, verbal fluency, visual memory, and executive functions domain. Demographic, clinical, and test variables were compared between BD and HC groups. Correlation analyses of AMT scores with cognitive functions were performed within each group, controlling for demographic and clinical variables.

RESULTS

Total and negative scores of AMT were significantly lower in BD patients compared to HC individuals. AMT scores were significantly correlated with WAIS similarities, WCST perseverative errors, and WCST categories completed in BD, whereas AMT scores were correlated with verbal memory and verbal fluency in HC.

CONCLUSION

Our findings suggest that overgeneral AM is a characteristic of BD and is related to executive function. Future studies should investigate the benefit of additional treatment focusing on overgeneral AM in BD.

Modeling bipolar disorder suicidality

OBJECTIVES

To review the psychosocial, neuropsychological, and neurobiological evidence regarding suicide and bipolar disorder (BD), to enable the development of an integrated model that facilitates understanding, and to provide a useful framework for future research.

METHODS

A two-stage literature review was conducted. First, an electronic literature search was performed using key words (e.g., bipolar disorder, suicide risk, and neuroimaging) and standard databases (e.g., MEDLINE). Second, theoretical suicide models were reviewed, and their evidence base and relevance to BD were evaluated in order to determine a guiding theoretical framework for contextualizing suicide in BD.

RESULTS

Although accumulating clinical, cognitive, and neurobiological correlates of suicide have been identified in BD, extant research has been largely atheoretical. The Cry of Pain (CoP) and an adapted version of the model, the Schematic Appraisals Model of Suicide (SAMS), provide a useful schema for examining vulnerability to suicide in BD, by taking into account biopsychosocial determinants of suicidality. In combination, these also provide a model within which the neural correlates of suicide can be integrated.

CONCLUSIONS

The proposed Bipolar Suicidality Model (BSM) highlights the psychosocial precursors to suicidality in BD, while recognizing the key role of cognitive deficits and underlying functional neurobiological abnormalities. It usefully integrates our knowledge, and provides a novel perspective that is intended to meaningfully inform future research initiatives, and can lead to a better understanding of suicidality in bipolar disorder. Ultimately, it is hoped that it will facilitate the development of targeted interventions that diminish the risk of suicide in bipolar disorder.

The impact of child sexual abuse on the course of bipolar disorder: a systematic review

OBJECTIVES

The aim of this review was to elucidate the impact of child sexual abuse on all clinical phenomena that occur after the onset of bipolar disorder, including associated clinical features that are not part of the diagnostic criteria for the disorder.

METHODS

Five databases were searched and supplemented with a hand search of reference lists from retrieved papers. Study quality was assessed using a validated quality assessment tool. Blind assessments of study eligibility and quality were conducted by two independent researchers to reduce bias, minimize errors, and enhance the reliability of findings. Disagreements were resolved by consensus.

RESULTS

Eighteen studies that included a total of 2996 adults and youths with bipolar disorder and met the minimum quality criteria necessary to ensure objectivity and not invalidate results were analyzed. Across studies, child sexual abuse was strongly (and perhaps directly) associated with posttraumatic stress disorder; whereas it was less strongly (and perhaps indirectly) related to suicide attempts, alcohol and/or drug abuse or dependence, psychotic symptoms, and an early age of illness onset. In regard to the association between child sexual abuse and other clinical variables concerning the course of bipolar disorder, evidence was scant or conflicting.

CONCLUSIONS

Child sexual abuse is associated (either directly or indirectly) with some clinical phenomena that represent a more severe form of bipolar disorder. Although such a traumatic experience may directly affect the development of posttraumatic stress disorder, the effects of early sexual abuse on later suicidal behavior, substance abuse, and psychotic symptoms may operate through the mediating influences of certain psychopathological or neurobiological variables.

Genetic and neurocognitive foundations of emotion abnormalities in bipolar disorder

INTRODUCTION

Bipolar Disorder (BD) is a serious mood disorder, the aetiology of which is still unclear. The disorder is characterised by extreme mood variability in which patients fluctuate between markedly euphoric, irritable, and elevated states to periods of severe depression. The current research literature shows that BD patients demonstrate compromised neurocognitive ability in addition to these mood symptoms. Viable candidate genes implicated in neurocognitive and socioemotional processes may explain the development of these core emotion abnormalities. Additionally, links between faulty neurocognition and impaired socioemotional ability complement genetic explanations of BD pathogenesis. This review examines associations between cognition indexing prefrontal neural regions and socioemotional impairments including emotion processing and regulation. A review of the effect of COMT and TPH2 on these functions is also explored.

METHODS

Major computer databases including PsycINFO, Google Scholar, and Medline were consulted in order to conduct a comprehensive review of the genetic and cognitive literature in BD.

RESULTS

This review determines that COMT and TPH2 genetic variants contribute susceptibility to abnormal prefrontal neurocognitive function which oversees the processing and regulation of emotion. This provides for greater understanding of some of the emotional and cognitive symptoms in BD.

CONCLUSIONS

Current findings in this direction show promise, although the literature is still in its infancy and further empirical research is required to investigate these links explicitly.

Prevalence of child sexual abuse among adults and youths with bipolar disorder: a systematic review

To estimate the prevalence and social and demographic correlates of child sexual abuse among people with bipolar disorder, the findings of all the pertinent studies were qualitatively and semi-quantitatively analyzed. Five databases were searched. Blind assessments of study eligibility and quality were conducted by two independent researchers. Twenty studies, meeting minimum quality standards and including 3407 adults and youths with bipolar disorder across 10 countries and 3 continents, were examined. The prevalence of child sexual abuse was 24% (23% without outliers); however, such prevalence rate might be underestimated, because many studies restricted definitions to the most severe forms of abuse. Child sexual abuse was a common experience for both males and females, while it was more frequent for adults than for youths. Compared to healthy individuals, patients with bipolar disorder reported higher rates of child sexual abuse; compared to populations with other mental disorders, participants with bipolar disorder reported similar or lower rates of such abuse. Individuals with bipolar disorder are at risk of having a history of child sexual abuse, although such risk seems to be neither more specific to nor stronger for these individuals, compared to people with other psychiatric disorders.

Impaired episodic memory for events encoded during mania in patients with bipolar disorder

To date, very few studies have focused on autobiographical memory in patients with bipolar disorder. We examined whether mood state at the time of event encoding (i.e., manic, depressed, euthymic) influences subsequent recollection in these patients. We administered the Autobiographical Interview, a method that allowed us to dissociate episodic and semantic aspects of autobiographical memory. We also compared the memory perspective from which patients recollected these events. Patients were selectively impaired in recollecting episodic details of events encoded during mania but not depression or euthymia. No significant differences emerged between patients and controls for recollection of non-episodic details, regardless of mood state. Patients with bipolar disorder were also more likely than matched controls to recall memories from an observer perspective. These preliminary findings indicate a moderating influence of mood state at the time of event encoding on the subsequent recollection of autobiographical events in patients with bipolar disorder.

Patterns of autobiographical memory in bipolar disorder examined by psychometric and functional neuroimaging methods

This is the first study to combine psychometric and functional neuroimaging methods to study altered patterns of autobiographical memory in bipolar disorder (BD). All participants were interviewed with an expanded version of the Bielefelder Autobiographical Memory Inventory (Bielefelder Autobiographisches Gedächtnis Inventar 2004;Lisse: Swets and Zeitlinger). We then acquired functional magnetic resonance imaging data during a task of individually designed autobiographical recall. Compared with healthy controls, BD patients reported a stronger emotionality of autobiographical memories and more frequent recollections of autobiographical events during their everyday life. Furthermore, they failed to deactivate areas in the cuneus and lingual gyrus and showed decreased activation in the inferior frontal and precentral areas compared with the control group. More frequent intrusions from a person's past, which had a neural correlate in the lack of deactivation in some default mode network areas in BD patients, may contribute to manic or depressive symptoms.

Cognitions in bipolar affective disorder and unipolar depression: imagining suicide

OBJECTIVE

Bipolar disorder has the highest rate of suicide of all the psychiatric disorders. In unipolar depression, individuals report vivid, affect-laden images of suicide or the aftermath of death (flashforwards to suicide) during suicidal ideation but this phenomenon has not been explored in bipolar disorder. Therefore the authors investigated and compared imagery and verbal thoughts related to past suicidality in individuals with bipolar disorder (n = 20) and unipolar depression (n = 20).

METHODS

The study used a quasi-experimental comparative design. The Structured Clinical Interview for DSM-IV was used to confirm diagnoses. Quantitative and qualitative data were gathered through questionnaire measures (e.g., mood and trait imagery use). Individual interviews assessed suicidal cognitions in the form of (i) mental images and (ii) verbal thoughts.

RESULTS

All participants reported imagining flashforwards to suicide. Both groups reported greater preoccupation with these suicide-related images than with verbal thoughts about suicide. However, compared to the unipolar group, the bipolar group were significantly more preoccupied with flashforward imagery, rated this imagery as more compelling, and were more than twice as likely to report that the images made them want to take action to complete suicide. In addition, the bipolar group reported a greater trait propensity to use mental imagery in general.

CONCLUSIONS

Suicidal ideation needs to be better characterized, and mental imagery of suicide has been a neglected but potentially critical feature of suicidal ideation, particularly in bipolar disorder. Our findings suggest that flashforward imagery warrants further investigation for formal universal clinical assessment procedures.

Enquiring about traumatic experiences in bipolar disorder: a case note and self- report comparison

OBJECTIVES

This study examined: (i) the prevalence of lifetime trauma, childhood trauma and trauma related to civil unrest in a Bipolar Disorder sample, and (ii) the agreement between rates of disclosure of trauma in case notes and self-report questionnaires.

METHODS

The case notes of sixty participants, recruited from a geographically well-defined mental health service in Northern Ireland, were examined for reports of experiences of lifetime, childhood and traumatic events related to civil conflict. The participants also completed self-report measures of trauma.

RESULTS

Considerable differences were found between the prevalence of trauma as measured by self-report questionnaires and case notes reports. The prevalence of lifetime trauma as measured by the Trauma History Questionnaire was 61.7% (compared to case notes prevalence of 33.3%). The prevalence of moderate and severe levels of childhood trauma as measured by the Childhood Trauma Questionnaire was 65% (case notes 21.7%). Rates of trauma related to civil unrest were 35% (case notes 3.3%). Poor levels of agreement were found between all self-report trauma measures and case notes reports. Agreement on two categories of trauma (childhood emotional neglect and childhood physical neglect) reached statistical significance but kappa scores suggest this agreement was poor (κ=.14, p<.05; κ=.127, p<.05).

CONCLUSIONS

It is probable that the increased rate of trauma disclosed in the self-report questionnaire arises because clinicians during initial assessment and subsequent treatment do not consistently enquire about trauma. The need for staff training is discussed.