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Azevedo J, Swales M, Carreiras D, Guiomar R, Macedo A, Castilho P. BI-REAL: A 12-session DBT skills group intervention adapted for bipolar disorder - A feasibility randomised pilot trial. J Affect Disord 2024; 356:394-404. [PMID: 38615843 DOI: 10.1016/j.jad.2024.04.033] [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] [Received: 09/01/2023] [Revised: 03/21/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
International guidelines endorse psychological treatment for Bipolar Disorder (BD); however, the absence of a recognised gold-standard intervention requires further research. A Dialectical Behaviour Therapy (DBT) skills group intervention with 12 sessions was developed. This pilot randomised controlled trial (RCT) aims to evaluate the feasibility, acceptability, and outcomes variance of Bi-REAL - Respond Effectively, Assertively, and Live mindfully, tailored for individuals with BD, in preparation for a future RCT. METHODS 52 participants (female = 62.7 %; mean age = 43.2 ± 11.1) with BD were randomised by blocks to either the experimental group (EG; n = 26; Bi-REAL + Treatment as Usual, TAU) receiving 12 weekly 90-minutes sessions, or the control group (CG; n = 26, TAU). Feasibility and acceptability were assessed with a multimethod approach (qualitative interviews, semi-structured clinical interviews and a battery of self-report questionnaires - candidate main outcomes Bipolar Recovery Questionnaire (BRQ) and brief Quality of Life for Bipolar Disorder (QoL.BD)). All participants were evaluated at baseline (T0), post-intervention (T1) and 3-month follow-up (T2). RESULTS Acceptability was supported by participants' positive feedback and ratings of the sessions and programme overall, as well as the treatment attendance (86.25 % of sessions attended). The trial overall retention rate was 74.5 %, with CG having a higher dropout rate across the 3-timepoints (42.31 %). A significant Time × Group interaction effect was found for BRQ and QoL.BD favouring the intervention group (p < .05). LIMITATIONS The assessors were not blind at T1 (only at T2). Recruitment plan was impacted due to COVID-19 restrictions and replication is questionable. High attrition rates in the CG. CONCLUSIONS The acceptability of Bi-REAL was sustained, and subsequent feasibility testing will be necessary to establish whether the retention rates of the overall trial improve and if feasibility is confirmed, before progressing to a definitive trial.
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Affiliation(s)
- Julieta Azevedo
- University of Coimbra, Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Portugal; Bangor University, School of Human and Behavioural Sciences, United Kingdom; Department of Psychology, University of Exeter, Exeter, UK.
| | - Michaela Swales
- Bangor University, School of Human and Behavioural Sciences, United Kingdom
| | - Diogo Carreiras
- University of Coimbra, Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Portugal
| | - Raquel Guiomar
- University of Coimbra, Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Portugal
| | - António Macedo
- University of Coimbra, Faculty of Medicine, Institute of Psychological Medicine (IPM), Portugal; Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Portugal; Centro Hospitalar e Universitário de Coimbra, EPE (CHUC), Coimbra, Portugal
| | - Paula Castilho
- University of Coimbra, Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Portugal
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Hautzinger M. Adjuvant Psychotherapies to Prevent Relapse in Bipolar Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2024:2819406. [PMID: 38837133 PMCID: PMC11154370 DOI: 10.1001/jamapsychiatry.2024.1310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/27/2024] [Indexed: 06/06/2024]
Abstract
Importance Several psychotherapy protocols have been evaluated as adjuncts to pharmacotherapy for patients with bipolar disorder (BD). Little is known about their comparative effectiveness. Objective To compare the effectiveness of 2 types of group psychotherapy, skill-oriented, material-based cognitive behavioral therapy (SEKT) and supportive, patient-centered, emotion-focused therapy (FEST), to prevent relapse in patients with euthymic BD. Design, Setting, and Participants This was a large, observer-blind, randomized clinical trial conducted over 18 months (posttreatment after 6 months; follow-up at 12 and 18 months). In addition to psychiatric care as usual (including mood-stabilizing medication), each participant at 9 clinical outpatient units in Germany received 24 hours of group psychotherapy over 4, full-day sessions spread over 5 months. Patients with euthymic BD type 1 (BD 1) or BD type 2 (BD 2) between the ages of 18 and 50 years were randomly assigned to 1 of 2 forms of psychotherapy, SEKT or FEST. Independent clinicians blinded to patient grouping performed assessments using structured interviews (Structured Clinical Interview for DSM Disorders and Longitudinal Interval Follow-Up Evaluation) and self-rating and clinician rating for inclusion criteria and outcome. Kaplan-Meier survival curves were calculated for time to relapse. Cox proportional hazards statistics and propensity score matching were calculated for the multivariate analysis. Study data were analyzed from March 2020 to September 2022. Interventions SEKT intervention is a structured cognitive behavioral therapy integrating elements of interpersonal social rhythm therapy, and of mindfulness-based cognitive therapy. FEST psychotherapy has its roots in emotion-focused, supportive, and nondirective therapy. Main Outcomes and Measures Recurrence of a new affective episode assessed by blinded interviewer with the LIFE interview. In addition, self-rating and clinician rating of depressive and mania symptoms as well as level of social functioning were assessed. Results Of 348 screened referrals, 305 patients (median [IQR] age, 34 [18-50] years; 162 male [53%]) with euthymic BD 1 or BD 2 were included in the study. A total of 207 patients (68%) had BD 1, 98 (32%) had BD 2, and 278 (91%) received psychiatric care. Both therapies were equally effective in preventing recurrence of a new episode. Outcome (higher rate of new episodes) was not predicted by kind of treatment (SEKT: 69 [49%] relapse; FEST: 63 [46%] relapse) but was predicted by BD 2, comorbidity, attending all sessions, and the interaction of type of treatment by BD 1 or 2. Patients with BD 2 had the highest rate of relapse (60 [61%] relapse), in particular, when treated by SEKT (39 [70%] relapse). Conclusions and Relevance Results of this randomized clinical trial revealed that a structured, skill-oriented, material-based cognitive behavioral therapy (SEKT) and a supportive, patient-centered, emotion-focused therapy (FEST) were equally effective in preventing relapse of affective episodes when delivered in a new, intensive group format. Additionally, there were baseline factors, in particular BD 2, that influenced outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT02506322.
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Affiliation(s)
- Martin Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Giménez-Palomo A, Andreu H, Olivier L, Ochandiano I, de Juan O, Fernández-Plaza T, Salmerón S, Bracco L, Colomer L, Mena JI, Vieta E, Pacchiarotti I. Clinical, sociodemographic and environmental predicting factors for relapse in bipolar disorder: A systematic review. J Affect Disord 2024; 360:276-296. [PMID: 38797389 DOI: 10.1016/j.jad.2024.05.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Bipolar disorder (BD) is a chronic and recurrent illness characterized by manic, mixed or depressive episodes, alternated with periods of euthymia. Several prognostic factors are associated with higher rates of relapse, which is crucial for the identification of high-risk individuals. This study aimed at systematically reviewing the existing literature regarding the impact of sociodemographic, clinical and environmental factors, in clinical relapses, recurrences and hospitalizations due to mood episodes in BD. METHODS A systematic search of electronic databases (PubMed, Cochrane library and Web of Science) was conducted to integrate current evidence about the impact of specific risk factors in these outcomes. RESULTS Fifty-eight articles met the inclusion criteria. Studies were grouped by the type of factors assessed. Family and personal psychiatric history, more severe previous episodes, earlier age of onset, and history of rapid cycling are associated with clinical relapses, along with lower global functioning and cognitive impairments. Unemployment, low educational status, poorer social adjustment and life events are also associated with higher frequency of episodes, and cannabis with a higher likelihood for rehospitalization. LIMITATIONS Small sample sizes, absence of randomized clinical trials, diverse follow-up periods, lack of control for some confounding factors, heterogeneous study designs and diverse clinical outcomes. CONCLUSIONS Although current evidence remains controversial, several factors have been associated with an impaired prognosis, which might allow clinicians to identify patients at higher risk for adverse clinical outcomes and find modifiable factors. Further research is needed to elucidate the impact of each risk factor in the mentioned outcomes.
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Affiliation(s)
- Anna Giménez-Palomo
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), Spain
| | - Helena Andreu
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), Spain
| | - Luis Olivier
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), Spain
| | - Iñaki Ochandiano
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), Spain
| | - Oscar de Juan
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), Spain
| | - Tábatha Fernández-Plaza
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), Spain
| | - Sergi Salmerón
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), Spain
| | - Lorenzo Bracco
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Lluc Colomer
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), Spain
| | - Juan I Mena
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain.
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Zhao HQ, Zhou M, Jiang JQ, Luo ZQ, Wang YH. Global trends and hotspots in pain associated with bipolar disorder in the last 20 years: a bibliometric analysis. Front Neurol 2024; 15:1393022. [PMID: 38846044 PMCID: PMC11153732 DOI: 10.3389/fneur.2024.1393022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/22/2024] [Indexed: 06/09/2024] Open
Abstract
Purpose The prevalence of comorbid pain and Bipolar Disorder in clinical practice continues to be high, with an increasing number of related publications. However, no study has used bibliometric methods to analyze the research progress and knowledge structure in this field. Our research is dedicated to systematically exploring the global trends and focal points in scientific research on pain comorbidity with bipolar disorder from 2003 to 2023, with the goal of contributing to the field. Methods Relevant publications in this field were retrieved from the Web of Science core collection database (WOSSCC). And we used VOSviewer, CiteSpace, and the R package "Bibliometrix" for bibliometric analysis. Results A total of 485 publications (including 360 articles and 125 reviews) from 66 countries, 1019 institutions, were included in this study. Univ Toront and Kings Coll London are the leading research institutions in this field. J Affect Disorders contributed the largest number of articles, and is the most co-cited journal. Of the 2,537 scholars who participated in the study, Stubbs B, Vancampfort D, and Abdin E had the largest number of articles. Stubbs B is the most co-cited author. "chronic pain," "neuropathic pain," "psychological pain" are the keywords in the research. Conclusion This is the first bibliometric analysis of pain-related bipolar disorder. There is growing interest in the area of pain and comorbid bipolar disorder. Focusing on different types of pain in bipolar disorder and emphasizing pain management in bipolar disorder are research hotspots and future trends. The study of pain related bipolar disorder still has significant potential for development, and we look forward to more high-quality research in the future.
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Affiliation(s)
- Hong Qing Zhao
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, China
| | - Mi Zhou
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Jia Qi Jiang
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Zhi Qiang Luo
- Department of Graduate School, Hunan University of Chinese Medicine, Changsha, China
| | - Yu Hong Wang
- Department of Graduate School, Hunan University of Chinese Medicine, Changsha, China
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Farr J, Rhodes JE, Baruch E, Smith JA. Early intervention in psychosis for first episode psychotic mania: the experience of people diagnosed with bipolar disorder. J Ment Health 2024:1-7. [PMID: 38588707 DOI: 10.1080/09638237.2024.2332805] [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: 05/03/2023] [Accepted: 11/03/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Early intervention for people diagnosed with bipolar disorder has been identified as a priority, but little is known about how existing early intervention services are experienced by this group or could be tailored to their needs. AIMS This study examined the experience of early intervention in psychosis (EIP) services for people diagnosed with bipolar disorder, following first episode psychotic mania. METHOD Semi-structured interviews were conducted with 11 adults in EIP services and analysed using Interpretative Phenomenological Analysis. RESULTS One superordinate theme was formed, Rebuilding within EIP service, consisting of five subthemes: (i) Piecing together episode through talking to staff; (ii) Exploring other perspectives during CBT; (iii) Empowered through shared decision-making; (iv) Reconsidering future and purpose; (v) Service as safety-net. EIP provision was pivotal in helping participants understand their episode, adjust their perspective, build confidence and progress. CONCLUSIONS Aspects of the service that were valued, including person-centred relationships with staff, shared decision-making and the development of motivation and opportunities, reflect key principles of mental health care for young people following first episode psychosis. Furthermore, findings point to elements that may be particularly relevant to early intervention following first episode psychotic mania including managing mood escalation and individualised approaches to goals.
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Affiliation(s)
- Joanna Farr
- Birkbeck University of London, London, United Kingdom
| | - John E Rhodes
- Birkbeck University of London, London, United Kingdom
| | - Ella Baruch
- Tower Hamlets Early Intervention Service, Three Colts Lane, London, United Kingdom
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Girelli F, Rossetti MG, Perlini C, Bellani M. Neural correlates of cognitive behavioral therapy-based interventions for bipolar disorder: A scoping review. J Psychiatr Res 2024; 172:351-359. [PMID: 38447356 DOI: 10.1016/j.jpsychires.2024.02.054] [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] [Received: 08/25/2023] [Revised: 02/20/2024] [Accepted: 02/24/2024] [Indexed: 03/08/2024]
Abstract
Cognitive Behavioral Therapy (CBT) is among the gold-standard psychotherapeutic interventions for the treatment of psychiatric disorders, including bipolar disorder (BD). While the clinical response of CBT in patients with BD has been widely investigated, its neural correlates remain poorly explored. Therefore, this scoping review aimed to discuss neuroimaging studies on CBT-based interventions in bipolar populations. Particular attention has been paid to similarities and differences between studies to inform future research. The literature search was conducted on PubMed, PsycINFO, and Web of Science databases in June 2023, identifying 307 de-duplicated records. Six studies fulfilled the inclusion criteria and were reviewed. All of them analyzed functional brain activity data. Four studies showed that the clinical response to CBT was associated with changes in the functional activity and/or connectivity of prefrontal and posterior cingulate cortices, temporal parietal junction, amygdala, precuneus, and insula. In two additional studies, a peculiar pattern of baseline activations in the prefrontal cortex, hippocampus, amygdala, and insula predicted post-treatment improvements in depressive symptoms, emotion dysregulation, and psychosocial functioning, although CBT-specific effects were not shown. These results suggest, at the very preliminary level, the potential of CBT-based interventions in modulating neural activity and connectivity of patients with BD, especially in regions ascribed to emotional processing. Nonetheless, the discrepancies between studies concerning aims, design, sample characteristics, and CBT and fMRI protocols do not allow conclusions to be drawn. Further research using multimodal imaging techniques, better-characterized BD samples, and standardized CBT-based interventions is needed.
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Affiliation(s)
- Francesca Girelli
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maria Gloria Rossetti
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Cinzia Perlini
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Marcella Bellani
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Matsumoto K, Hamatani S. Impact of cognitive reserve on bipolar disorder: a systematic review. Front Psychiatry 2024; 14:1341991. [PMID: 38371715 PMCID: PMC10869457 DOI: 10.3389/fpsyt.2023.1341991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/27/2023] [Indexed: 02/20/2024] Open
Abstract
Background Cognitive reserve (CR) is a complex concept that includes premorbid IQ, years of education, and exposure to neuropsychological stimuli through work and leisure. Previous studies have suggested that CR has a positive impact on several aspects of bipolar disorder. Synthesizing the evidence to date is an important work in providing directions for future studies. The objectives of this systematic review to summary impact of CR on onsetting, relapsing bipolar episodes, buffering cognitive dysfunctions, and maintaining quality of life (QOL) in bipolar disorder. Methods Two researchers independently reviewed selected paper from three database as PubMed, PsychINFO, and Web of Science. The search keywords were "bipolar disorder" and "cognitive reserve." The selected studies were classified as the levels of evidence according to the criteria of the Oxford Center for Evidence- Based Medicine. The results of the selected studies were summarized according to the objectives. Results Thrity six studies were included in this review. People with high CR may have fewer bipolar episodes and alleviate cognitive impairments and dysfunction. CR may keep the functional level in patients with bipolar disorder. Conclusion The results of this systematic review suggest that CR may be involved in preventing relapse of bipolar episodes and may alleviate cognitive dysfunction. However, effect on prevention of onset-risk and relapse of bipolar episodes need further investigation in prospective studies. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021270293, the protocol was registered with PROSERO (CRD42021270293).
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Affiliation(s)
- Kazuki Matsumoto
- Division of Clinical Psychology, Kagoshima University Hospital, Research and Education Assembly Medical and Dental Sciences Area, Kagoshima University, Kagoshima, Japan
| | - Sayo Hamatani
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan
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Ehrt-Schäfer Y, Rusmir M, Vetter J, Seifritz E, Müller M, Kleim B. Feasibility, Adherence, and Effectiveness of Blended Psychotherapy for Severe Mental Illnesses: Scoping Review. JMIR Ment Health 2023; 10:e43882. [PMID: 38147373 PMCID: PMC10777283 DOI: 10.2196/43882] [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] [Received: 10/29/2022] [Revised: 07/06/2023] [Accepted: 10/29/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Blended psychotherapy (bPT) combines face-to-face psychotherapy with digital interventions to enhance the effectiveness of mental health treatment. The feasibility and effectiveness of bPT have been demonstrated for various mental health issues, although primarily for patients with higher levels of functioning. OBJECTIVE This scoping review aims to investigate the feasibility, adherence, and effectiveness of bPT for the treatment of patients with severe mental illnesses (SMIs). METHODS Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, we conducted searches in PubMed, MEDLINE, Embase, PsycINFO, and PsycArticles for studies published until March 23, 2023. RESULTS Out of 587 screened papers, we incorporated 25 studies encompassing 23 bPT interventions, involving a total of 2554 patients with SMI. The intervention formats and research designs exhibited significant variation. Our findings offer preliminary evidence supporting the feasibility of bPT for SMI, although there is limited research on adherence. Nevertheless, the summarized studies indicated promising attrition rates, spanning from 0% to 37%, implying a potential beneficial impact of bPT on adherence to SMI treatment. The quantity of evidence on the effects of bPT for SMI was limited and challenging to generalize. Among the 15 controlled trials, 4 concluded that bPT interventions were effective compared with controls. However, it is noteworthy that 2 of these studies used the same study population, and the control groups exhibited significant variations. CONCLUSIONS Overall, our review suggests that while bPT appears promising as a treatment method, further research is necessary to establish its effectiveness for SMI. We discuss considerations for clinical implementation, directions, and future research.
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Affiliation(s)
- Yamina Ehrt-Schäfer
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Milan Rusmir
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Johannes Vetter
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Mario Müller
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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Nierenberg AA, Agustini B, Köhler-Forsberg O, Cusin C, Katz D, Sylvia LG, Peters A, Berk M. Diagnosis and Treatment of Bipolar Disorder: A Review. JAMA 2023; 330:1370-1380. [PMID: 37815563 DOI: 10.1001/jama.2023.18588] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Importance Bipolar disorder affects approximately 8 million adults in the US and approximately 40 million individuals worldwide. Observations Bipolar disorder is characterized by recurrent episodes of depression and mania or hypomania. Bipolar depressive episodes are similar to major depressive episodes. Manic and hypomanic episodes are characterized by a distinct change in mood and behavior during discrete time periods. The age of onset is usually between 15 and 25 years, and depression is the most frequent initial presentation. Approximately 75% of symptomatic time consists of depressive episodes or symptoms. Early diagnosis and treatment are associated with a more favorable prognosis. Diagnosis and optimal treatment are often delayed by a mean of approximately 9 years following an initial depressive episode. Long-term treatment consists of mood stabilizers, such as lithium, valproate, and lamotrigine. Antipsychotic agents, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine, are recommended, but some are associated with weight gain. Antidepressants are not recommended as monotherapy. More than 50% of patients with bipolar disorder are not adherent to treatment. Life expectancy is reduced by approximately 12 to 14 years in people with bipolar disorder, with a 1.6-fold to 2-fold increase in cardiovascular mortality occurring a mean of 17 years earlier compared with the general population. Prevalence rates of metabolic syndrome (37%), obesity (21%), cigarette smoking (45%), and type 2 diabetes (14%) are higher among people with bipolar disorder, contributing to the risk of early mortality. The annual suicide rate is approximately 0.9% among individuals with bipolar disorder, compared with 0.014% in the general population. Approximately 15% to 20% of people with bipolar disorder die by suicide. Conclusions and Relevance Bipolar disorder affects approximately 8 million adults in the US. First-line therapy includes mood stabilizers, such as lithium, anticonvulsants, such as valproate and lamotrigine, and atypical antipsychotic drugs, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine.
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Affiliation(s)
- Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Bruno Agustini
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Ole Köhler-Forsberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Department for Affective Disorder, Aarhus University Hospital, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Cristina Cusin
- Harvard Medical School, Boston, Massachusetts
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston
| | - Douglas Katz
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Louisa G Sylvia
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Amy Peters
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
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Valdivieso-Jiménez G. Efficacy of cognitive behavioural therapy for bipolar disorder: A systematic review. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2023; 52:213-224. [PMID: 37867032 DOI: 10.1016/j.rcpeng.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/19/2021] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Bipolar disorder (BD) is a serious mental illness with a chronic course and significant morbidity and mortality. BD has a lifetime prevalence rate of 1%-1.5% and is characterised by recurrent episodes of mania and depression, or a mixture of both phases. Although it has harmacological and psychotherapeutic treatment, cognitive behavioural therapy (CBT) has shown beneficial effects, but there is not enough clinical information in the current literature. METHODS The main aim was to determine the efficacy of CBT alone or as an adjunct to pharmacological treatment for BD. A systematic review of 17 articles was carried out. The inclusion criteria were: quantitative or qualitative research aimed at examining the efficacy of CBT in BD patients with/without medication; publications in English language; and) being 18-65 years of age. The exclusion criteria were: review and meta-analysis articles; articles that included patients with other diagnoses in addition to BD and that did not separate the results based on such diagnoses; and studies with patients who did not meet the DSM or ICD criteria for BD. The PubMed, PsycINFO and Web of Science databases were searched up to 5 January 2020. The search strategy was: "Bipolar Disorder" AND "Cognitive Behavioral Therapy". RESULTS A total of 1531 patients both sexes were included. The weighted mean age was 40.703 years. The number of sessions ranged from 8 to 30, with a total duration of 45-120 min. All the studies show variable results in improving the level of depression and the severity of mania, improving functionality, reducing relapses and recurrences, and reducing anxiety levels and the severity of insomnia. CONCLUSIONS The use of CBT alone or adjunctive therapy in BD patients is considered to show promising results after treatment and during follow-up. Benefits include reduced levels of depression and mania, fewer relapses and recurrences, and higher levels of psychosocial functioning. More studies are needed.
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Affiliation(s)
- Glauco Valdivieso-Jiménez
- Instituto Peruano para el Estudio y Abordaje Integral de la Personalidad, Lima, Peru; Servicio de Psiquiatría, Hospital de Emergencias Villa El Salvador, Lima, Peru.
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Abaatyo J, Kaggwa MM, Favina A, Olagunju AT. Readmission and associated clinical factors among individuals admitted with bipolar affective disorder at a psychiatry facility in Uganda. BMC Psychiatry 2023; 23:474. [PMID: 37380963 DOI: 10.1186/s12888-023-04960-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/14/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Bipolar affective disorder (BAD) is a common severe mental health condition with a relapsing course that may include periods of hospital re-admissions. With recurrent relapses and admissions, the course, prognosis, and patient's overall quality of life can be affected negatively. This study aims to explore the rates and clinical factors associated with re-admission among individuals with BAD. METHOD This study used data from a retrospective chart review of all records of patients with BAD admitted in 2018 and followed up their hospital records for four years till 2021 at a large psychiatric unit in Uganda. Cox regression analysis was used to determine the clinical characteristics associated with readmission among patients diagnosed with BAD. RESULTS A total of 206 patients living with BAD were admitted in 2018 and followed up for four years. The average number of months to readmission was 9.4 (standard deviation = 8.6). The incidence of readmission was 23.8% (n = 49/206). Of those readmitted during the study period, 46.9% (n = 23/49) and 28.6% (n = 14/49) individuals were readmitted twice and three times or more, respectively. The readmission rate in the first 12 months following discharge was 69.4% (n = 34/49) at first readmission, 78.3% (n = 18/23) at second readmission, and 87.5% (n = 12/14) at third or more times. For the next 12 months, the readmission rate was 22.5% (n = 11/49) for the first, 21.7% (n = 5/23) for the second, and 7.1% (n = 1/14) for more than two readmissions. Between 25 and 36 months, the readmission rate was 4.1% (n = 2/49) for the first readmission and 7.1% (n = 1/14) for the third or more times. Between 37 and 48 months, the readmission rate was 4.1% (n = 2/49) for those readmitted the first time. Patients who presented with poor appetite and undressed in public before admission were at increased risk of being readmitted with time. However, the following symptoms/clinical presentations, were protective against having a readmission with time, increased number of days with symptoms before admission, mood lability, and high energy levels. CONCLUSION The incidence of readmission among individuals living with BAD is high, and readmission was associated with patients' symptoms presentation on previous admission. Future studies looking at BAD using a prospective design, standardized scales, and robust explanatory model are warranted to understand causal factors for hospital re-admission and inform management strategies.
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Affiliation(s)
- Joan Abaatyo
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Alain Favina
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, 5000, Australia
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12
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Tiba AI, Trip S, Bora CH, Drugas M, Borz F, Miclăuş DC, Voss L, Iova SC, Pop S. Positive irrational beliefs are associated with hypomanic personality. Front Psychol 2023; 14:1053486. [PMID: 37020915 PMCID: PMC10067582 DOI: 10.3389/fpsyg.2023.1053486] [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: 09/25/2022] [Accepted: 03/06/2023] [Indexed: 03/22/2023] Open
Abstract
Primary irrational beliefs, such as demanding about attaining personal goals, are a common trans-diagnostic factor involved in many emotional disorders. Although Bipolar Disorder (BPD) is a severe emotional disorder, little is known about the role of primary irrational beliefs in the risk of BPD. Given that the risk for mania is related to responses to positive rather than adverse events, we developed a measure of irrational beliefs in response to cues of positive events. This is the first study that examines the relationship between positive primary irrational beliefs and the risk of BPD. 119 participants completed an online survey including measures for the risk of BPD, irrational beliefs, positive irrational beliefs, mania-related cognitions, and mood measures (depressive and manic mood). Results revealed significant associations between the risk of BPD and positive primary irrational beliefs, irrational beliefs, positive generalization, and mood. Regression analyses revealed that positive primary irrational beliefs, such as demanding to attain significant goals in response to cues for positive events, uniquely predict the risk for BPD independently of mood, mania-related cognitions and irrational beliefs. These findings encourage the treatment approaches focused on restructuring primary irrational beliefs in response to positive situations to reduce the risk of BPD.
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Affiliation(s)
| | - Simona Trip
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Carmen H. Bora
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Marius Drugas
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Feliciana Borz
- Department of Psychology, University of Oradea, Oradea, Romania
| | | | - Laura Voss
- Hull York Medical School, Hull, United Kingdom
| | - Sorin C. Iova
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Simona Pop
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
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13
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Hardman JR, Rees CS, Bonnar D, Ree MJ. Group cognitive behavioural therapy for insomnia: impact on psychiatric symptoms and insomnia severity in a psychiatric outpatient setting. CLIN PSYCHOL-UK 2023. [DOI: 10.1080/13284207.2022.2155034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
| | - Clare S. Rees
- School of Psychology, Curtin University, Perth, Australia
| | - Daniel Bonnar
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Melissa J. Ree
- School of Psychological Science, University of Western Australia, The Marian Centre, Perth, Australia
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14
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Nielssen O, Staples L, Karin E, Kayrouz R, Dear B, Titov N. Effectiveness of internet delivered cognitive behaviour therapy provided as routine care for people in the depressed phase of bipolar disorder treated with Lithium. PLOS DIGITAL HEALTH 2023; 2:e0000194. [PMID: 36812646 PMCID: PMC9946241 DOI: 10.1371/journal.pdig.0000194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 01/13/2023] [Indexed: 02/24/2023]
Abstract
There is little research reporting the outcome of internet delivered cognitive behaviour therapy, (iCBT), which helps patients identify and modify unhelpful cognitions and behaviours, for the depressed phase of bipolar disorder as part of routine care. Demographic information, baseline scores and treatment outcomes were examined for patients of MindSpot Clinic, a national iCBT service who reported taking Lithium and their clinic records confirmed the diagnosis of bipolar disorder. Outcomes were completion rates, patient satisfaction and changes in measures of psychological distress, depression and anxiety measured by the Kessler-10 item (K-10), Patient Health Questionnaire 9 Item (PHQ-9), and Generalized Anxiety Disorder Scale 7 Item (GAD-7), compared to clinic benchmarks. Out of 21,745 people who completed a MindSpot assessment and enrolled in a MindSpot treatment course in a 7 year period, 83 reported taking Lithium and had a confirmed a diagnosis of bipolar disorder. Outcomes of reductions in symptoms were large on all measures (effect sizes > 1.0 on all measures, percentage change between 32.4% and 40%), and lesson completion and satisfaction with the course were also high. MindSpot treatments appear to be effective in treating anxiety and depression in people diagnosed with bipolar, and suggest that iCBT has the potential to overcome the under-use of evidence based psychological treatments of people with bipolar depression.
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Affiliation(s)
- Olav Nielssen
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
- MindSpot Clinic, Macquarie Health, Macquarie University, Sydney, Australia
- * E-mail:
| | - Lauren Staples
- MindSpot Clinic, Macquarie Health, Macquarie University, Sydney, Australia
| | - Eyal Karin
- eCentreClinic, Macquarie University, Sydney, Australia
| | - Rony Kayrouz
- MindSpot Clinic, Macquarie Health, Macquarie University, Sydney, Australia
| | - Blake Dear
- MindSpot Clinic, Macquarie Health, Macquarie University, Sydney, Australia
- eCentreClinic, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- MindSpot Clinic, Macquarie Health, Macquarie University, Sydney, Australia
- eCentreClinic, Macquarie University, Sydney, Australia
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15
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Goulding EH, Dopke CA, Rossom R, Jonathan G, Mohr D, Kwasny MJ. Effects of a Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder on Relapse, Symptom Burden, and Quality of Life: A Randomized Clinical Trial. JAMA Psychiatry 2023; 80:109-118. [PMID: 36542401 PMCID: PMC9857325 DOI: 10.1001/jamapsychiatry.2022.4304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022]
Abstract
Importance Bipolar disorder-specific psychotherapy combined with pharmacotherapy improves relapse risk, symptom burden, and quality of life, but psychotherapy is not easily accessible. Objective To determine if a smartphone-based self-management intervention (LiveWell) can assist individuals with bipolar disorder to maintain wellness. Design, Setting, and Participants An assessor-blind randomized clinical trial enrolled participants from March 20, 2017, to April 25, 2019, with 48-week follow-up ending on April 10, 2020. Participants were randomly assigned to usual care or usual care plus the smartphone intervention stratified by relapse risk based on initial clinical status (low risk: asymptomatic recovery; high risk: continued symptomatic, prodromal, recovering, symptomatic recovery). Participants with bipolar disorder I were recruited from clinics in the Chicago and Minneapolis-Saint Paul areas. Data were analyzed from June 19, 2020, to May 25, 2022. Interventions The smartphone-based self-management intervention consisted of an application (app), coach, and website. Over 16 weeks, participants had a coach visit followed by 6 phone calls, and they completed daily and weekly app check-ins. The app provided adaptive feedback and information for developing a personalized wellness plan, the coach provided support, and the website provided summary data and alerts. Main Outcomes and Measures The primary outcome was time to relapse. Secondary outcomes were percentage-time symptomatic, symptom severity, and quality of life. Results Of the 205 randomized participants (mean [SD] age, 42 [12] years; 125 female individuals [61%]; 5 Asian [2%], 21 Black [10%], 13 Hispanic or Latino [6%], 7 multiracial [3%], 170 White [83%], 2 unknown race [1%]), 81 (40%) were randomly assigned to usual care, and 124 (60%) were randomly assigned to usual care plus the smartphone intervention. This clinical trial did not detect a reduction in relapse risk for the smartphone intervention (hazard ratio [HR], 0.65; 95% CI, 0.39-1.09; log-rank P = .08). However, decreased relapse was observed for low-risk individuals (HR, 0.32; 95% CI, 0.12-0.88; log-rank P = .02) but not high-risk individuals (HR, 0.86; 95% CI, 0.47-1.57; log-rank P = .62). Reduced manic symptom severity was observed for low-risk individuals (mean [SE] difference, -1.4 [0.4]; P = .001) but not for high-risk individuals (mean [SE] difference, 0 [0.3]; P = .95). The smartphone-based self-management intervention decreased depressive symptom severity (mean [SE] difference, -0.80 [0.34]; P = .02) and improved relational quality of life (mean [SE] difference, 1.03 [0.45]; P = .02) but did not decrease percentage-time symptomatic (mean [SE] difference, -5.6 [4.3]; P = .20). Conclusions and Relevance This randomized clinical trial of a smartphone-based self-management intervention did not detect a significant improvement in the primary outcome of time to relapse. However, a significant decrease in relapse risk was observed for individuals in asymptomatic recovery. In addition, the intervention decreased depressive symptom severity and improved relational quality of life. These findings warrant further work to optimize the smartphone intervention and confirm that the intervention decreases relapse risk for individuals in asymptomatic recovery. Trial Registration ClinicalTrials.gov Identifier: NCT03088462.
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Affiliation(s)
- Evan H. Goulding
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Cynthia A. Dopke
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | | | - Geneva Jonathan
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - David Mohr
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Mary J. Kwasny
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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16
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van den Berg KC, Hendrickson AT, Hales SA, Voncken M, Keijsers GPJ. Comparing the effectiveness of imagery focussed cognitive therapy to group psychoeducation for patients with bipolar disorder: A randomised trial. J Affect Disord 2023; 320:691-700. [PMID: 36206888 DOI: 10.1016/j.jad.2022.09.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bipolar disorder is a severe, chronic mental disorder. Treatment options are limited, with pharmacological approaches continuing to dominate. However, relapse rates remain high. Several adjunctive psychosocial interventions, mostly psychoeducation (PE) and cognitive behavioural therapy (CBT), have been trialled, but treatment innovation is still needed. In the past, brief group PE has proven as beneficial as longer individual CBT in reducing levels of depression and increasing self-management strategies. We compared the relative effectiveness of group PE to an imagery focussed cognitive behavioural therapy (ImCT). STUDY DESIGN This was a randomised parallel group study with both daily and weekly measures. A total of 62 adult patients were randomly allocated to either ImCT or group PE. Daily, weekly and pre-and post-intervention measures were used to assess impact on (i) mood instability, (ii) overall levels of depression, anxiety and mania, and (iii) general functioning, hopelessness and imagery characteristics. A four-week baseline and 16-week follow-up period were included. RESULTS Mood instability reduced in both conditions after intervention. Levels of mania, depression and anxiety also reduced in both conditions, but on the daily measures, depression and anxiety significantly more so in the ImCT condition. Compared with the PE condition, the ImCT condition additionally showed increased level of functioning, reduced hopelessness, and a decrease in intrusive, problematic imagery. LIMITATIONS These findings need to be replicated in a larger trial. CONCLUSIONS Findings suggest that ImCT is a promising new avenue for management of bipolar disorder, an area in which treatment development is urgently needed.
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Affiliation(s)
- K C van den Berg
- Medical Psychiatric Research Group, Geestelijke Gezondheidszorg Eindhoven (GGzE), the Netherlands; Department of Clinical Psychological Sciences, Maastricht University, the Netherlands.
| | - A T Hendrickson
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, the Netherlands
| | - S A Hales
- Oxford Institute of Clinical Psychology Training, University of Oxford, UK; Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - M Voncken
- Department of Clinical Psychological Sciences, Maastricht University, the Netherlands
| | - G P J Keijsers
- Department of Clinical Psychological Sciences, Maastricht University, the Netherlands; Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
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A Meta-Analysis of Group Cognitive Behavioral Therapy and Group Psychoeducation for Treating Symptoms and Preventing Relapse in People Living with Bipolar Disorder. Healthcare (Basel) 2022; 10:healthcare10112288. [PMID: 36421612 PMCID: PMC9691241 DOI: 10.3390/healthcare10112288] [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: 09/18/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: This meta-analysis aims to evaluate the treatment outcomes of patients treated with Group cognitive behavioural therapy (GCBT) or group psychoeducation (GPE) as an adjunct to pharmacotherapy. Methods: Systematic search of PubMed, EMBASE, PsycINFO, and CENTRAL from inception till 1 March 2022 was conducted. Randomized-controlled-trials (RCTs) comparing GCBT/GPE with controls (treatment-as-usual/individualized therapy) in adults with bipolar disorder were eligible. The outcomes were relapse rates of any depressive or manic episodes and control of depressive and manic symptoms post-intervention. Overall odds-ratio was used to evaluate the relapse rates. Standard Mean Differences were pooled using a random-effects model for the control of depressive and manic symptoms. Results: 25 articles were assessed full-text independently by two members, and 11 studies were included in this meta-analysis. 601 and 590 participants were randomized into group-therapy (GCBT/GPE) and control, respectively. GPE significantly reduces relapse rates at post-intervention with Odds ratio of 0.43 (95% CI = 0.28-to-0.62, p < 0.0001) (I² = 41%) compared to control, however, no significant results were found for GPE on control of depressive or manic symptoms. No significant results were found for GCBT in all outcomes. Conclusion: This meta-analysis provides some evidence that GPE could be an efficacious treatment as an adjunct to treatment-as-usual in reducing the relapse rates of patients with bipolar disorder.
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18
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Wei P. The impact of social support on students' mental health: A new perspective based on fine art majors. Front Psychol 2022; 13:994157. [PMID: 36405200 PMCID: PMC9672807 DOI: 10.3389/fpsyg.2022.994157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/12/2022] [Indexed: 11/06/2022] Open
Abstract
College students face a variety of challenges today, and the degree of their psychological health directly impacts their ability to overcome these challenges. A good psychological state helps college students to invest better in their career development and improve the degree of social integration. This paper uses the SCL-90 Symptom Self-Assessment Scale and the Social Support Rating Scale (SSRS) to investigate the mental health, psychological support, and social support of students from low income backgrounds in two universities in Hainan City. The research results showed that there was no significant difference between the objective support scores of students from low income backgrounds in higher vocational colleges and non-poor students, while the subjective support and utilization of support scores were significantly lower than those of non-poor students. In essence, successful social support should not only be one-dimensional support from the subject to the object, but should be a process of two-sided interaction, or a process of “mutual construction” between supporters and those supported. According to the research conclusions, this paper suggests how to improve the degree of mental health of college students by way of forming a comprehensive educational environment including campus culture construction, ideological and moral education, and economic assistance system.
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Nook EC, Jaroszewski AC, Finch EF, Choi-Kain LW. A Cognitive-Behavioral Formulation of Narcissistic Self-Esteem Dysregulation. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:378-388. [PMID: 37200882 PMCID: PMC10187391 DOI: 10.1176/appi.focus.20220055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Narcissistic personality disorder (NPD) is a commonly encountered diagnosis, affecting approximately 1%-6% of the population, with no evidence-based treatments. Recent scholarship has focused on self-esteem dysregulation as a key component of NPD: Excessively high expectations for oneself and how one should be treated leads to brittle self-esteem and maladaptive reactions to self-esteem threats. The current article builds on this formulation, introducing a cognitive-behavioral model of narcissistic self-esteem dysregulation that clinicians can use in providing a relatable model of change for their patients. Specifically, symptoms of NPD can be seen as a set of cognitive and behavioral habits that serve to regulate difficult emotions emerging from maladaptive beliefs and interpretations of self-esteem threats. This perspective renders narcissistic dysregulation amenable to cognitive-behavioral therapy (CBT) in which patients learn skills that help them gain awareness around these habitual reactions, reshape cognitive distortions, and engage in behavioral experiments that serve to transform maladaptive belief systems that consequently free them from symptomatic reactions. Here, we provide a precis of this formulation and examples of how CBT skills can be used to treat narcissistic dysregulation. We also discuss future research that could provide empirical support for the model and test the efficacy of CBT approaches to NPD. Conclusions focus on the notion that narcissistic self-esteem dysregulation likely varies continuously in the population and transdiagnostically across disorders. Greater insight into the cognitive-behavioral mechanisms of self-esteem dysregulation could foster tools for ameliorating distress both in people with NPD and the general populace.
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Affiliation(s)
- Erik C Nook
- Department of Psychology, Princeton University, Princeton, New Jersey (Nook); Department of Psychiatry, Harvard Medical School, Boston (Jaroszewski, Choi-Kain); Department of Psychiatry, Massachusetts General Hospital, Boston (Jaroszewski); Department of Psychology, Harvard University, Cambridge, Massachusetts (Finch); McLean Hospital, Harvard Medical School, Boston (Choi-Kain)
| | - Adam C Jaroszewski
- Department of Psychology, Princeton University, Princeton, New Jersey (Nook); Department of Psychiatry, Harvard Medical School, Boston (Jaroszewski, Choi-Kain); Department of Psychiatry, Massachusetts General Hospital, Boston (Jaroszewski); Department of Psychology, Harvard University, Cambridge, Massachusetts (Finch); McLean Hospital, Harvard Medical School, Boston (Choi-Kain)
| | - Ellen F Finch
- Department of Psychology, Princeton University, Princeton, New Jersey (Nook); Department of Psychiatry, Harvard Medical School, Boston (Jaroszewski, Choi-Kain); Department of Psychiatry, Massachusetts General Hospital, Boston (Jaroszewski); Department of Psychology, Harvard University, Cambridge, Massachusetts (Finch); McLean Hospital, Harvard Medical School, Boston (Choi-Kain)
| | - Lois W Choi-Kain
- Department of Psychology, Princeton University, Princeton, New Jersey (Nook); Department of Psychiatry, Harvard Medical School, Boston (Jaroszewski, Choi-Kain); Department of Psychiatry, Massachusetts General Hospital, Boston (Jaroszewski); Department of Psychology, Harvard University, Cambridge, Massachusetts (Finch); McLean Hospital, Harvard Medical School, Boston (Choi-Kain)
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20
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Stefana A, D’Imperio D, Dakanalis A, Vieta E, Fusar-Poli P, Youngstrom E. Probing the impact of psychoanalytic therapy for bipolar disorders: A scoping review. INTERNATIONAL FORUM OF PSYCHOANALYSIS 2022. [DOI: 10.1080/0803706x.2022.2097307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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21
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Kamal ZM, Dutta S, Rahman S, Etando A, Hasan E, Nahar SN, Wan Ahmad Fakuradzi WFS, Sinha S, Haque M, Ahmad R. Therapeutic Application of Lithium in Bipolar Disorders: A Brief Review. Cureus 2022; 14:e29332. [PMID: 36159362 PMCID: PMC9484534 DOI: 10.7759/cureus.29332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/05/2022] Open
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22
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Katz D, Miklowitz D, Gaudiano B, Weinstock L, Gold A, Nierenberg A, Sylvia L. Reports of the demise of CBT for bipolar disorder have been greatly exaggerated: a response to Samamé. Bipolar Disord 2022; 24:472-473. [PMID: 35224834 PMCID: PMC9418383 DOI: 10.1111/bdi.13196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Douglas Katz
- Massachusetts General Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
| | - David Miklowitz
- University of California, Los Angeles, California, USA,University of Oxford, Oxford, UK
| | - Brandon Gaudiano
- Brown University, Providence, Rhode Island, USA,Butler Hospital, Providence, Rhode Island, USA,Providence VA Medical Center, Providence, Rhode Island, USA
| | | | - Alexandra Gold
- Massachusetts General Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA,Boston University, Boston, Massachusetts, USA
| | - Andrew Nierenberg
- Massachusetts General Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
| | - Louisa Sylvia
- Massachusetts General Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
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23
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Levenberg K, Cordner ZA. Bipolar depression: a review of treatment options. Gen Psychiatr 2022; 35:e100760. [PMID: 36035376 PMCID: PMC9358943 DOI: 10.1136/gpsych-2022-100760] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/13/2022] [Indexed: 11/24/2022] Open
Abstract
Bipolar depression (BD-D) is both common and incredibly challenging to treat. Even treated individuals with BD-D experience depression approximately 19% of the time, and subsyndromal depression an additional 18%. This stands in clear contrast to the approximately 10% of time spent in hypomania and 1% of time spent in mania. Despite this high illness burden, there remain relatively few treatment options approved by the US Food and Drug Administration for BD-D. Of the approved medications, four are second-generation antipsychotics (SGAs) and one is an SGA combined with an antidepressant. However, particularly when used long-term, antipsychotics can pose a significant risk of adverse effects, raising the clinical conundrum of weighing the risks associated with long-term antipsychotic use versus the risk of relapse when patients are off medications. Here, we review commonly used treatments for BD-D, including antipsychotics, classic mood stabilisers, electroconvulsive therapy and psychotherapy. We then address the somewhat controversial topic of antidepressant use in BD-D. Finally, we summarise emerging treatment options and highlight ongoing clinical trials. We hope this review will help compare the risks and benefits of several common and novel options for the treatment of patients with BD-D. In doing so, we also hope this review will aid the individualised selection of treatments based on each patient’s history and treatment goals.
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Affiliation(s)
- Kate Levenberg
- Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Zachary A Cordner
- Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Bi B, Che D, Bai Y. Neural network of bipolar disorder: Toward integration of neuroimaging and neurocircuit-based treatment strategies. Transl Psychiatry 2022; 12:143. [PMID: 35383150 PMCID: PMC8983759 DOI: 10.1038/s41398-022-01917-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 01/23/2023] Open
Abstract
Bipolar disorder (BD) is a complex psychiatric disorder characterized by dysfunctions in three domains including emotional processing, cognitive processing, and psychomotor dimensions. However, the neural underpinnings underlying these clinical profiles are not well understood. Based on the reported data, we hypothesized that (i) the core neuropathology in BD is damage in fronto-limbic network, which is associated with emotional dysfunction; (ii) changes in intrinsic brain network, such as sensorimotor network, salience network, default-mode network, central executive network are associated with impaired cognition function; and (iii) beyond the dopaminergic-driven basal ganglia-thalamo-cortical motor circuit modulated by other neurotransmitter systems, such as serotonin (subcortical-cortical modulation), the sensorimotor network and related motor function modulated by other non-motor networks such as the default-mode network are involved in psychomotor function. In this review, we propose a neurocircuit-based clinical characteristics and taxonomy to guide the treatment of BD. We draw on findings from neuropsychological and neuroimaging studies in BD and link variations in these clinical profiles to underlying neurocircuit dysfunctions. We consider pharmacological, psychotherapy, and neuromodulatory treatments that could target those specific neurocircuit dysfunctions in BD. Finally, it is suggested that the methods of testing the neurocircuit-based taxonomy and important limitations to this approach should be considered in future.
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Affiliation(s)
- Bo Bi
- Department of Clinical Psychology, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.
| | - Dongfang Che
- grid.452787.b0000 0004 1806 5224Neurosurgery department, Shenzhen Children’s Hospital, Shenzhen, China
| | - Yuyin Bai
- grid.12981.330000 0001 2360 039XDepartment of Clinical Psychology, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
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Yilmaz S, Huguet A, Kisely S, Rao S, Wang J, Baur K, Price M, O'Mahen H, Wright K. Do psychological interventions reduce symptoms of depression for patients with bipolar I or II disorder? A meta-analysis. J Affect Disord 2022; 301:193-204. [PMID: 35007645 DOI: 10.1016/j.jad.2021.12.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/18/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psychological therapies may play an important role in the treatment of bipolar disorders. Several meta-analyses that examine the effectiveness of psychotherapies for patients with bipolar disorder include conclusions about the impact upon bipolar depression. However, these tend not to consider differences in depression outcome depending upon whether the therapy primarily targets acute depression, nor severity of baseline depression. This may affect the conclusions drawn about the effectiveness of these therapies for acute bipolar depression treatment. OBJECTIVES This meta-analysis explored the effectiveness of psychological therapies in reducing bipolar depression, in particular examining whether: (1) the effect of therapy is greater when baseline depressive symptoms are more severe, and (2) the effect of therapy is greater when the primary focus of the therapy is the treatment of acute bipolar depression? DATA SOURCES A systematic search was conducted using the following electronic databases; Cochrane Controlled Register of Trials (1996), MEDLINE (1966 onwards), EMBASE (1980 onwards), PsycINFO (1974 onwards), Scopus, Web of Science and Clinical Trials Registries (listed at:https://www.hhs.gov/ohrp/international/clinical-trial-registries/index.html). ELIGIBILITY CRITERIA Eligible studies were randomized controlled trials evaluating a psychological intervention for adults diagnosed with Bipolar I or II disorder. The comparators were usual care, wait-list, placebo, active treatment control. Post-treatment depression status was required to be measured continuously using a validated self- or observer- report measure, or categorically by a validated diagnostic instrument or clinical diagnosis by a suitably qualified person. DATA EXTRACTION AND SYNTHESIS Titles and abstracts were screened, followed by full texts. Two reviewers conducted each stage until agreement was reached, and both independently extracted study information. Means, standard deviations (SDs) and number of participants were retrieved from articles and used to perform a meta-analysis. The primary outcome was depressive symptom score. RESULTS The database search identified 6388 studies. After removing the duplicates, 3298 studies remained, of which, 28 studies were included in the qualitative review and 22 in the meta-analysis. Effect sizes range from -1.99 [-2.50, -1.49] to 0.89 [-0.12, 1.90]. There was low quality evidence of a significant effect on symptoms of depression for cognitive behavioral therapy and dialectical behavior therapy. Trials of psychoeducation, mindfulness-based therapy, family therapy and interpersonal and social rhythm therapy showed no evidence of any effect on depression. We found no significant relationship between baseline depression score and depression outcome post-treatment when we controlled for therapy type and comparator. The result also showed that the effect sizes for studies targeting acute depression to be tightly clustered around a small overall effect size. CONCLUSIONS Some psychological therapies may reduce acute bipolar depression although this conclusion should be viewed with caution given the low quality of evidence. More research using similar therapy types and comparators is needed to better understand the relationship between depression status at baseline and outcome.
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Affiliation(s)
- Sakir Yilmaz
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK.
| | - Anna Huguet
- Department of Community Health and Epidemiology, Dalhousie University, Canada; Departament de Psicologia, Universitat Rovira I Virgili, Spain; IWK Health Center, Canada
| | - Steve Kisely
- Department of Community Health and Epidemiology, Dalhousie University, Canada; University of Queensland, Psychiatry, Australia; Metro South Addiction and Mental Health Epidemiology Service, Australia
| | - Sanjay Rao
- Faculty of Medicine, Psychiatry, University of Ottawa, Canada
| | - JianLi Wang
- Department of Psychiatry, University of Ottawa, School of Epidemiology, Public Health and Preventive Medicine, Canada
| | | | | | - Heather O'Mahen
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK
| | - Kim Wright
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK
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Risch N, Dubois J, M’bailara K, Cussac I, Etain B, Belzeaux R, Dubertret C, Haffen E, Schwan R, Samalin L, Roux P, Polosan M, Leboyer M, Courtet P, Olié E. Self-Reported Pain and Emotional Reactivity in Bipolar Disorder: A Prospective FACE-BD Study. J Clin Med 2022; 11:jcm11030893. [PMID: 35160345 PMCID: PMC8836480 DOI: 10.3390/jcm11030893] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/24/2022] [Accepted: 02/01/2022] [Indexed: 02/05/2023] Open
Abstract
In patients with bipolar disorder (BD), pain prevalence is close to 30%. It is important to determine whether pain influences BD course and to identify factors associated with pain in BD in order to guide BD management. This naturalistic, prospective study used data on 880 patients with BD from the French FACE-BD cohort who were divided into two groups according to the presence or absence of pain. Multivariate models were used to test whether pain was associated with affective states and personality traits while controlling for confounders. Then, multivariate models were used to test whether pain at baseline predicted global life functioning and depressive symptomatology at one year. At baseline, 22% of patients self-reported pain. The pain was associated with depressive symptomatology, levels of emotional reactivity in a quadratic relationship, and a composite variable of personality traits (affective lability, affective intensity, hostility/anger, and impulsivity). At one year, the pain was predictive of depression and lower global life functioning. Pain worsens mental health and well-being in patients with BD. The role of emotions, depression, and personality traits in pain has to be elucidated to better understand the high prevalence of pain in BD and to promote specific therapeutic strategies for patients experiencing pain.
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Affiliation(s)
- Nathan Risch
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 34094 Montpellier, France; (J.D.); (P.C.); (E.O.)
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, 34295 Montpellier, France
- Clinique de la Lironde, Clinea Psychiatrie, 34980 Saint-Clément-de-Rivière, France
- Correspondence: ; Tel.: +33-46-733-8581
| | - Jonathan Dubois
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 34094 Montpellier, France; (J.D.); (P.C.); (E.O.)
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, 34295 Montpellier, France
| | - Katia M’bailara
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- LabPsy, University of Bordeaux, EA 4139, F-33000 Bordeaux, France
- Department of Clinical and Academic Psychiatry, Charles-Perrens Hospital, 33076 Bordeaux, France
| | - Irena Cussac
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- Psychiatric Center, Hospital Princesse Grace, 1 Ave. Pasteur, 98000 Monaco, Monaco
| | - Bruno Etain
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Fernand Widal, 75010 Paris, France
- INSERM UMRS 1144-Université de Paris, 75006 Paris, France
| | - Raoul Belzeaux
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France
- INT-UMR 7289, CNRS Aix-Marseille Université, 13385 Marseille, France
| | - Caroline Dubertret
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- Department of Psychiatry, University of Paris, AP-HP, Louis Mourier Hospital, INSERM UMR 1266 Paris, 92700 Colombes, France
| | - Emmanuel Haffen
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- Service de Psychiatrie de l’Adulte, CIC-1431 INSERM, CHU de Besançon, Laboratoire de Neurosciences, Université de Franche-Comté, UBFC, 25000 Besançon, France
| | - Raymund Schwan
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- Université de Lorraine, Centre Psychothérapique de Nancy, Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, INSERM U1254, 54000 Nancy, France
| | - Ludovic Samalin
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal (IP), 63178 Clermont-Ferrand, France
| | - Paul Roux
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- Centre Hospitalier de Versailles, Service de Psychiatrie et D’addictologie Adulte, Le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin-en-Yvelines, Versailles, France and Université Paris-Saclay, UVSQ, Inserm, CESP, Equipe “PsyDev”, 94807 Villejuif, France
| | - Mircea Polosan
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- Université Grenoble Alpes, Inserm U1216, Grenoble Institut de Neurosciences, CHU de Grenoble, F-38000 Grenoble, France
| | - Marion Leboyer
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- Université Paris Est Creteil (UPEC), AP-HP, Hôpitaux Universitaires «H. Mondor», DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, F-94010 Creteil, France
| | - Philippe Courtet
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 34094 Montpellier, France; (J.D.); (P.C.); (E.O.)
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, 34295 Montpellier, France
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
| | - Emilie Olié
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 34094 Montpellier, France; (J.D.); (P.C.); (E.O.)
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, 34295 Montpellier, France
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
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Madireddy S, Madireddy S. Therapeutic Interventions to Mitigate Mitochondrial Dysfunction and Oxidative Stress–Induced Damage in Patients with Bipolar Disorder. Int J Mol Sci 2022; 23:ijms23031844. [PMID: 35163764 PMCID: PMC8836876 DOI: 10.3390/ijms23031844] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/26/2021] [Accepted: 12/30/2021] [Indexed: 01/10/2023] Open
Abstract
Bipolar disorder (BD) is characterized by mood changes, including recurrent manic, hypomanic, and depressive episodes, which may involve mixed symptoms. Despite the progress in neurobiological research, the pathophysiology of BD has not been extensively described to date. Progress in the understanding of the neurobiology driving BD could help facilitate the discovery of therapeutic targets and biomarkers for its early detection. Oxidative stress (OS), which damages biomolecules and causes mitochondrial and dopamine system dysfunctions, is a persistent finding in patients with BD. Inflammation and immune dysfunction might also play a role in BD pathophysiology. Specific nutrient supplements (nutraceuticals) may target neurobiological pathways suggested to be perturbed in BD, such as inflammation, mitochondrial dysfunction, and OS. Consequently, nutraceuticals may be used in the adjunctive treatment of BD. This paper summarizes the possible roles of OS, mitochondrial dysfunction, and immune system dysregulation in the onset of BD. It then discusses OS-mitigating strategies that may serve as therapeutic interventions for BD. It also analyzes the relationship between diet and BD as well as the use of nutritional interventions in the treatment of BD. In addition, it addresses the use of lithium therapy; novel antipsychotic agents, including clozapine, olanzapine, risperidone, cariprazine, and quetiapine; and anti-inflammatory agents to treat BD. Furthermore, it reviews the efficacy of the most used therapies for BD, such as cognitive–behavioral therapy, bright light therapy, imagery-focused cognitive therapy, and electroconvulsive therapy. A better understanding of the roles of OS, mitochondrial dysfunction, and inflammation in the pathogenesis of bipolar disorder, along with a stronger elucidation of the therapeutic functions of antioxidants, antipsychotics, anti-inflammatory agents, lithium therapy, and light therapies, may lead to improved strategies for the treatment and prevention of bipolar disorder.
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Affiliation(s)
- Sahithi Madireddy
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Correspondence:
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Wittenborn AK, Woods SB, Priest JB, Morgan PC, Tseng CF, Huerta P, Edwards C. Couple and family interventions for depressive and bipolar disorders: Evidence base update (2010-2019). JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:129-153. [PMID: 34750834 DOI: 10.1111/jmft.12569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/23/2021] [Indexed: 06/13/2023]
Abstract
This article systematically reviews the evidence base for couple and family interventions for depressive and bipolar disorders published from 2010 to 2019. Included in the review were intervention studies on depression for couples (n = 6), depression for families (n = 13), and bipolar for families (n = 5); zero studies on couple interventions for bipolar were located. Well-established interventions include cognitive and/or behavioral couple and family interventions for depression and psychoeducational family interventions for bipolar. Attachment-based couple and family interventions for depression are probably efficacious. Finally, family psychoeducation for depression is possibly efficacious, and integrative couple interventions and family play-based interventions for depression are experimental. Couple and family interventions also improved relationship dynamics, which is noteworthy since poor relationships are associated with non-remission, relapse, and recurrence of depressive and bipolar symptoms. Future research is needed on couple interventions for bipolar disorders and interventions for minoritized populations.
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Affiliation(s)
- Andrea K Wittenborn
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
- Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Sarah B Woods
- Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jacob B Priest
- Psychological and Quantitative Foundations, University of Iowa, Iowa City, Iowa, USA
| | - Preston C Morgan
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Chi-Fang Tseng
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Patricia Huerta
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Caitlin Edwards
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
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Samamé C. The rise and fall of cognitive-behavioral approaches to the treatment of bipolar disorder: A critical overview from a quaternary prevention perspective. Bipolar Disord 2021; 23:751-753. [PMID: 34723409 DOI: 10.1111/bdi.13146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Cecilia Samamé
- Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CIIPME-CONICET), Buenos Aires, Argentina
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Hemanny C, Sena EPD, de Oliveira IR. Behavioural activation and trial-based cognitive therapy may be beneficial to reduce suicidal ideation in major depressive disorder: A post hoc study from a clinical trial. J Clin Pharm Ther 2021; 47:46-54. [PMID: 34617303 DOI: 10.1111/jcpt.13535] [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: 04/12/2021] [Revised: 09/03/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The suicidality spectrum is a clinical challenge because of the difficulty of its management and its association with mortality. Few studies have investigated psychotherapies for reducing the components of suicidality. In this study, we compared the effect of behavioural activation (BA), trial-based cognitive therapy (TBCT) - both added to antidepressant (AD) treatment - and treatment as usual (TAU) in mitigating suicidal ideation in patients with major depressive disorder (MDD). METHODS A post hoc study was conducted with data from a randomized clinical trial. Secondary analyses compared the treatments using scores from the items that evaluated suicidal ideation with the HAM-D (HAM-D-3) and BDI (BDI-9). A composite measurement was constructed by summing the scores from the two items (HAM-D-3 plus BDI-9). RESULTS AND DISCUSSION Seventy-six patients were analysed (BA + AD = 24; TBCT + AD = 26 and TAU = 26). In HAM-D-3, the BA + AD group showed a statistically greater reduction than the TAU group. In BDI-9, the three groups did not show significant differences. In the HAM-D-3 plus BDI-9, TBCT + AD reduced ideations more than the TAU group. There were no differences among the psychotherapies in any of the measures. Sensitivity analyses showed improvement in suicidal ideation in both psychotherapies compared to TAU. WHAT IS NEW AND CONCLUSION This is one of the few studies that evaluated the effect of BA and TBCT in lowering suicidal ideation. Adding these therapies to ADs seems to decrease suicidal ideation. We suggest the possible beneficial effects of BA and TBCT in the management of suicidal ideation in patients with recurrent MDD. Our findings need further studies to confirm these results.
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Affiliation(s)
- Curt Hemanny
- Postgraduate Program of Interactive Process of Organs and Systems, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
| | - Eduardo Pondé de Sena
- Postgraduate Program of Interactive Process of Organs and Systems, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil.,Department of Pharmacology, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
| | - Irismar Reis de Oliveira
- Postgraduate Program of Interactive Process of Organs and Systems, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil.,Department of Neurosciences and Mental Health, School of Medicine, Federal University of Bahia, Salvador, Brazil
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ÖZDEL K, KART A, TÜRKÇAPAR MH. Cognitive Behavioral Therapy in Treatment of Bipolar Disorder. Noro Psikiyatr Ars 2021; 58:S66-S76. [PMID: 34658638 PMCID: PMC8498810 DOI: 10.29399/npa.27419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/23/2021] [Indexed: 11/21/2022] Open
Abstract
Biological underpinnings (i.e., "bio" of bio-psycho-social approach) of Bipolar Disorder (BD) comes to the forefront when addressing its etiology and treatment. However, it is a condition that is challenging to manage with medication, and often the medication alone is insufficient since the symptoms of the disease have different episode characteristics. When the prevalence and inefficacy of drug treatments are considered together, the cruciality of psychosocial interventions in the treatment of the is undeniable. Moreover, treatment non-compliance is another problem that needs to be addressed psychosocially. Cognitive Behavioral Therapy (CBT) has its unique place among psychosocial interventions with numerous features such as being empirical and flexible, and it is recommended as an evidence-based adjuvant therapy in all stages of the disorder except acute mania. In this review, we discuss how CBT is used in specific domains of the disorder, following a general outlook on the evidence for CBT in BD. We focused on the essentials of psychotherapy practice with a pragmatic approach from the CBT point of view.
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Affiliation(s)
- Kadir ÖZDEL
- University of Health Science, Diskapi Yildirim Beyazit, Teaching and Research Hospital, Department of Psychiatry, Ankara, Turkey
| | - Ayşegül KART
- Bakırköy Mental Health and Neurological Diseases Education and Research Hospital, Department of Psychiatry, İstanbul, Turkey
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Valdivieso-Jiménez G. Efficacy of Cognitive Behavioural Therapy for Bipolar Disorder: a Systematic Review. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 52:S0034-7450(21)00102-5. [PMID: 34243900 DOI: 10.1016/j.rcp.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/25/2021] [Accepted: 05/19/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Bipolar disorder (BD) is a serious mental illness with a chronic course and significant morbidity and mortality. BD has a lifetime prevalence rate of 1% to 1.5% and is characterised by recurrent episodes of mania and depression, or a mixture of both phases. Although it has harmacological and psychotherapeutic treatment, cognitive behavioural therapy (CBT) has shown beneficial effects, but there is not enough clinical information in the current literature. METHODS The main aim was to determine the efficacy of CBT alone or as an adjunct to pharmacological treatment for BD. A systematic review of 17 articles was carried out. The inclusion criteria were: quantitative or qualitative research aimed at examining the efficacy of CBT in BD patients with/without medication; publications in English language; and) being 18-65 years of age. The exclusion criteria were: review and meta-analysis articles; articles that included patients with other diagnoses in addition to BD and that did not separate the results based on such diagnoses; and studies with patients who did not meet the DSM or ICD criteria for BD. The PubMed, PsycINFO and Web of Science databases were searched up to 5 January 2020. The search strategy was: "Bipolar Disorder" AND "Cognitive Behavioral Therapy". RESULTS A total of 1,531 patients both sexes were included. The weighted mean age was 40.703 years. The number of sessions ranged from 8-30, with a total duration of 45-120minutes. All the studies show variable results in improving the level of depression and the severity of mania, improving functionality, reducing relapses and recurrences, and reducing anxiety levels and the severity of insomnia. CONCLUSIONS The use of CBT alone or adjunctive therapy in BD patients is considered to show promising results after treatment and during follow-up. Benefits include reduced levels of depression and mania, fewer relapses and recurrences, and higher levels of psychosocial functioning. More studies are needed.
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Affiliation(s)
- Glauco Valdivieso-Jiménez
- Instituto Peruano para el Estudio y Abordaje Integral de la Personalidad, Lima, Perú; Servicio de Psiquiatría, Hospital de Emergencias Villa El Salvador, Lima, Perú.
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Lintel H, Corpuz T, Paracha SUR, Grossberg GT. Mood Disorders and Anxiety in Parkinson's Disease: Current Concepts. J Geriatr Psychiatry Neurol 2021; 34:280-288. [PMID: 34219518 DOI: 10.1177/08919887211018267] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Mood disorders and anxiety significantly impact the prognosis and disease course of Parkinson's disease. Non-motor symptoms of Parkinson's disease such as apathy, anhedonia, and fatigue overlap with diagnostic criteria for anxiety and depression, thus making accurate diagnosis of mood disorders in Parkinson's disease patients difficult. Furthermore, treatment options for mood disorders can produce motor complications leading to poor adherence and impaired quality of life in Parkinson's disease patients. This review aims to clarify the current state of diagnostic and treatment options pertaining to anxiety and mood disorders in Parkinson's disease. It explores both the pharmacologic and non-pharmacologic treatment modalities for various mood disorders in comorbid Parkinson's disease with a brief discussion of the future outlook of the field given the current state of the literature.
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Affiliation(s)
- Hendrik Lintel
- 7547Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Timothy Corpuz
- 7547Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Saif-Ur-Rahman Paracha
- Department of Psychiatry and Behavioral Neuroscience, 7547Saint Louis University School of Medicine, MO, USA
| | - George T Grossberg
- Samuel W. Fordyce Professor and Director of Geriatric Psychiatry, 7547Saint Louis University School of Medicine, MO, USA
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Uzzan S, Azab AN. Anti-TNF-α Compounds as a Treatment for Depression. Molecules 2021; 26:molecules26082368. [PMID: 33921721 PMCID: PMC8073844 DOI: 10.3390/molecules26082368] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 12/13/2022] Open
Abstract
Millions of people around the world suffer from psychiatric illnesses, causing unbearable burden and immense distress to patients and their families. Accumulating evidence suggests that inflammation may contribute to the pathophysiology of psychiatric disorders such as major depression and bipolar disorder. Copious studies have consistently shown that patients with mood disorders have increased levels of plasma tumor necrosis factor (TNF)-α. Given these findings, selective anti-TNF-α compounds were tested as a potential therapeutic strategy for mood disorders. This mini-review summarizes the results of studies that examined the mood-modulating effects of anti-TNF-α drugs.
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Affiliation(s)
- Sarit Uzzan
- Department of Clinical Biochemistry and Pharmacology, School for Community Health Professions—Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 8410501, Israel;
| | - Abed N. Azab
- Department of Clinical Biochemistry and Pharmacology, School for Community Health Professions—Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 8410501, Israel;
- Department of Nursing, School for Community Health Professions—Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 8410501, Israel
- Correspondence: ; Tel.: +972-8-6479880; Fax: +972-8-6477683
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Dysfunctional cognition in individuals with an increased risk for mania. CLINICAL PSYCHOLOGY IN EUROPE 2021; 3:e3733. [PMID: 36397786 PMCID: PMC9667121 DOI: 10.32872/cpe.3733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background There is still a lack of knowledge about attitudes and cognitions that are related to bipolar disorder. Theoretically, it was proposed that exaggerated beliefs about the self, relationships, the need for excitement, and goal-related activities might lead to mania in vulnerable individuals, however, the few studies that examined this hypothesis provided mixed results. One of the unresolved issues is if such a cognitive style is associated with current mood symptoms or with different stages of the illness, i.e. at-risk versus diagnosed bipolar disorder. Therefore, the present study aimed at evaluating depression and mania-related cognitive style in individuals at-risk for mania. Method In an online survey, we collected data of 255 students of the University of Klagenfurt, Austria. All participants completed the Hypomanic Personality Scale (HPS), the Cognition Checklist for Mania – Revised (CCL-M-R), the Dysfunctional Attitude Scale (DAS), the Beck Depression Inventory (BDI), and the Internal State Scale (ISS). Results In a hierarchical regression, HPS was positively related to scores of all subscales of the CCL-M-R. The HPS did not significantly predict scores of the DAS. Current manic and depressive symptoms significantly contributed to the models. Conclusion The present results suggest that a trait-like risk for mania is associated with mania-related but not depression-related cognitions. Individuals at-risk for mania show mania-specific rather than depression-specific thinking patters. Current subclinical mood symptoms are related to mood-congruent attitudes and cognitions.
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Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 232] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
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Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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Riemann G, Chrispijn M, Weisscher N, Regeer E, Kupka RW. A Feasibility Study of the Addition of STEPPS in Outpatients With Bipolar Disorder and Comorbid Borderline Personality Features: Promises and Pitfalls. Front Psychiatry 2021; 12:725381. [PMID: 34858221 PMCID: PMC8631960 DOI: 10.3389/fpsyt.2021.725381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Pharmacotherapy is a cornerstone in bipolar disorder (BD) treatment whereas borderline personality disorder (BPD) is treated primarily with psychotherapy. Given the overlap in symptomatology, patients with BD may benefit from psychotherapy designed for BPD. Aims: This paper reports the findings of a non-controlled open feasibility study of STEPPS training in patients with BD and borderline personality features (BPF). Methods: Outpatients with BD were screened for BPD, and if positive interviewed with SCID-II. Patients with at least three BPF, always including impulsivity and anger burst, were included in the intervention study. Severity of BD and BPD and quality of life were assessed. Descriptive statistics were performed. Results: Of 111 patients with BD 49.5% also screened positive on BPD according to PDQ-4+, and 52.3% of these had BPD according to SCID-II. Very few participants entered the intervention study, and only nine patients completed STEPPS. Descriptive statistics showed improvement on all outcome variables post treatment, but no longer at 6-month follow up. We reflect on the potential reasons for the failed inclusion. Conclusion: Features of BPD were highly prevalent in patients with BD. Still, recruiting patients for a psychological treatment originally designed for BPD proved to be difficult. Feedback of participants suggests that the association of STEPPS with "borderline" had an aversive effect, which may have caused limited inclusion for screening and subsequent drop-out for the treatment. Therefore, STEPPS should be adapted for BD to be an acceptable treatment option. Clinical Trial Registration: www.ClinicalTrials.gov/3856, identifier: NTR4016.
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Affiliation(s)
- Georg Riemann
- Department of Applied Psychology, Saxion University of Applied Sciences, Deventer, Netherlands.,Dimence Mental Health, Center for Bipolar Disorders, Deventer, Netherlands
| | - Melissa Chrispijn
- Dimence Mental Health, Center for Bipolar Disorders, Deventer, Netherlands
| | - Nadine Weisscher
- Geestelijke Gezondheids Zorg (GGZ) Heuvelrug, Center for Mental Health, Driebergen, Netherlands
| | - Eline Regeer
- Center for Bipolar Disorders, Altrecht Institute for Mental Health Care, Utrecht, Netherlands
| | - Ralph W Kupka
- Center for Bipolar Disorders, Altrecht Institute for Mental Health Care, Utrecht, Netherlands.,Amsterdam University Medical Center (UMC), Department of Psychiatry, VU University, Amsterdam, Netherlands.,Geestelijke Gezondheids Zorg (GGZ) InGeest, Center for Mental Health Care, Amsterdam, Netherlands
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Moring JC, Koch LM, Cherrington A, Peterson AL, Resick PA. Cognitive Processing Therapy for PTSD and Bipolar Disorder Comorbidity: A Case Study. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Dialectical behavior therapy (DBT) is a third wave, behavioral therapy that is designed to target emotion dysregulation. The current study investigated whether DBT could be an effective treatment intervention for bipolar disorder and how it could be adapted for this population. Although empirical study of DBT and bipolar disorder is limited, there is evidence to suggest that DBT is a promising treatment for bipolar disorder. In this study, adapted DBT products were created for bipolar disorder, and feedback on the products was elicited from five experts in the field through semi-structured interviews. Interviews were transcribed and coded for analyses. The findings from the interviews were integrated into revised products with the intention to be used in the clinical community. Several experts reported currently using DBT for bipolar disorder treatment. We conclude that a form of DBT using adapted materials could be a promising intervention for the treatment of bipolar disorder, although more research is needed to demonstrate efficacy. Future directions include conducting randomized controlled trials on DBT and bipolar disorder, as well as testing the created product in clinical practice.
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Affiliation(s)
- Alyson DiRocco
- California School of Professional Psychology, Alliant International University, Los Angeles, CA, USA. .,, Alhambra, CA, USA.
| | - Lisa Liu
- California School of Professional Psychology, Alliant International University, Los Angeles, CA, USA
| | - Molly Burrets
- California School of Professional Psychology, Alliant International University, Los Angeles, CA, USA
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40
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Cognitive Behavioral Therapy for Three Patients with Bipolar II Disorder during Depressive Episodes. Case Rep Psychiatry 2020; 2020:3892024. [PMID: 32733735 PMCID: PMC7376417 DOI: 10.1155/2020/3892024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/07/2020] [Accepted: 07/02/2020] [Indexed: 11/17/2022] Open
Abstract
Bipolar II disorder is a recurrent mental health disorder characterized by alternating hypomanic and depressive episodes. Providing cognitive behavioral therapy (CBT) as an adjuvant to pharmacotherapy can reduce the recurrence rate of bipolar disorder. It has not been examined whether CBT can be started during a depressive episode in patients with bipolar II disorder; however, the use of CBT during the remission period has been demonstrated to reduce recurrence. The current study is a case report involving three Japanese patients with bipolar II disorder, who started CBT during the depressive phase after a hypomanic episode was stabilized by pharmacotherapy. All patients experienced excessively positive thinking one week apart and were able to choose behaviors that would stabilize bipolar mood by observing its precursors. After intervention, patients' bipolar mood according to the Internal State Scale (ISS) and the Beck Depression Inventory-II (BDI-II) was improved. Our findings suggested that providing CBT to patients with bipolar II disorder during depressive episodes as an adjunct to pharmacotherapy is feasible.
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Affiliation(s)
- Andre F Carvalho
- From the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto (A.F.C.); the IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC (A.F.C.), and the NICM Health Research Institute, Western Sydney University, Westmead, NSW (J.F.) - both in Australia; the Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom (J.F.); and the Psychiatry and Psychology Department of the Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS (August Pi i Sunyer Biomedical Research Institute), and CIBERSAM (Biomedical Research Networking Center for Mental Health Network), Barcelona (E.V.)
| | - Joseph Firth
- From the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto (A.F.C.); the IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC (A.F.C.), and the NICM Health Research Institute, Western Sydney University, Westmead, NSW (J.F.) - both in Australia; the Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom (J.F.); and the Psychiatry and Psychology Department of the Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS (August Pi i Sunyer Biomedical Research Institute), and CIBERSAM (Biomedical Research Networking Center for Mental Health Network), Barcelona (E.V.)
| | - Eduard Vieta
- From the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto (A.F.C.); the IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC (A.F.C.), and the NICM Health Research Institute, Western Sydney University, Westmead, NSW (J.F.) - both in Australia; the Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom (J.F.); and the Psychiatry and Psychology Department of the Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS (August Pi i Sunyer Biomedical Research Institute), and CIBERSAM (Biomedical Research Networking Center for Mental Health Network), Barcelona (E.V.)
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Enrique A, Duffy D, Lawler K, Richards D, Jones S. An internet-delivered self-management programme for bipolar disorder in mental health services in Ireland: Results and learnings from a feasibility trial. Clin Psychol Psychother 2020; 27:925-939. [PMID: 32445611 PMCID: PMC7754375 DOI: 10.1002/cpp.2480] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/11/2020] [Accepted: 05/22/2020] [Indexed: 01/03/2023]
Abstract
Bipolar disorder (BD) is a chronic condition that requires continued care. Psychological interventions are recommended by clinical guidelines but there are treatment barriers that prevent patients to access these services. Internet-delivered self-management interventions are promising alternatives to improve treatment accessibility in patients with BD. Several studies indicate that these interventions are acceptable and beneficial for patients with BD, but no studies have been conducted in routine care settings. This trial aimed to examine the feasibility, acceptability, and preliminary efficacy of implementing an internet-delivered, clinician-supported intervention for BD as an adjunct to treatment as usual at two secondary-care services in Ireland. This study used an uncontrolled design with mixed-methods evaluation. Feasibility and acceptability were assessed in terms of recruitment, use of the intervention, and satisfaction from both clinicians and patients' perspectives. Personal recovery, quality of life, and severity of symptoms were measured at baseline and post-intervention. Fifteen patients signed consent and used the programme for 10 weeks. Usage of the intervention was adequate with high frequency of tool usage. There was a significant improvement in patients' sense of personal recovery (z = 2.38, p = .017). The intervention was found acceptable and easy-to-use; however, implementation barriers will need to be overcome for scaling the intervention. This is the first study testing the feasibility of a digital intervention for patients with BD in public mental health services in Ireland. More research is needed in order to increase the understanding of how to promote the integration and the uptake of digital interventions for individuals with BD.
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Affiliation(s)
- Angel Enrique
- E-mental Health Research Group, School of Psychology, University of Dublin, Trinity College, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Daniel Duffy
- E-mental Health Research Group, School of Psychology, University of Dublin, Trinity College, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Kate Lawler
- E-mental Health Research Group, School of Psychology, University of Dublin, Trinity College, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Derek Richards
- E-mental Health Research Group, School of Psychology, University of Dublin, Trinity College, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Steven Jones
- Spectrum Centre for Mental Health Research, University of Lancaster, Lancaster, UK
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Sepede G, Brunetti M, Di Giannantonio M. Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges. Neuropsychiatr Dis Treat 2020; 16:415-426. [PMID: 32103961 PMCID: PMC7020916 DOI: 10.2147/ndt.s202881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/30/2020] [Indexed: 12/16/2022] Open
Abstract
Bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD) are two cyclic mood illnesses, sometimes presenting together. Their comorbidity appears to be linked to common biological mechanisms and usually results in more severity of mood symptoms and a poorer long-term outcome. Nevertheless, the management of comorbid PMDD/BD has been scarcely studied. Therefore, the aim of the present paper was to review the published literature on the treatment of comorbid PMDD/BD and to provide point-by-point hypotheses to address these complex clinical cases. We searched PubMed to identify the studies focused on the treatment and management of comorbid PMDD/BD using the following search words, alone and in combination: premenstrual dysphoric disorder, bipolar disorder, comorbid, treatment, management, pharmacotherapy, psychotherapy. The search was conducted on the 1st of June 2019 and yielded 55 records. Four papers met our inclusion/exclusion criteria and were therefore included in our qualitative synthesis. Integrating the few data pertaining to the treatment of comorbid PMDD/BD with the large amount of published data on the two conditions separately, we can suggest that the management of comorbid PMDD/BD needs as a first step to stabilize the bipolar symptoms by means of optimal dosages of mood stabilizers. Then, in euthymic BD patients, the PMDD symptoms could be treated with estroprogestins (first-line treatment). On the contrary, during acute phases of BD, antidepressants (for major depressive episodes) and atypical antipsychotics/hormonal modulators (for manic episodes) could be considered as promising add-on treatments to mood stabilizers. In case of resistant PMDD/BD symptoms, combined strategies should be taken into account, as well as alternative treatments, such as lifestyle changes. In conclusion, RCTs on comorbid PMDD/BD are still lacking. The management of this complex condition is therefore challenging and it requires a tailored treatment.
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Affiliation(s)
- Gianna Sepede
- Department of Neuroscience, Imaging, and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Marcella Brunetti
- Department of Neuroscience, Imaging, and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging, and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy.,Department of Mental Health - Chieti, National Health Trust, Chieti, Italy
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Sayegh L, Touré EH, Farquhar E, Beaulieu S, Renaud S, Rej S, Perreault M. Group Cognitive Behavioral Analysis System of Psychotherapy (CBASP): A Pilot Study for Bipolar Depression. Front Psychiatry 2020; 11:565681. [PMID: 33173513 PMCID: PMC7538805 DOI: 10.3389/fpsyt.2020.565681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/03/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is an individually administered treatment model designed specifically for Persistent Depression however bipolar patients have traditionally been excluded from CBASP studies. There is a perception that bipolar depression will be harder to treat and requires a unique psychological approach. This pilot study reports on the feasibility of administering the same 20-week manualized group CBASP therapy with bipolar patients currently in a depressive episode. METHODS This non-randomized, single-arm prospective pilot study, reports on an a posteriori exploration of benefits to bipolar depressed patients (n=26) of the same 20-week group CBASP intervention administered to unipolar depressed patients (n=81). The clinical trial for the initial phase examining benefits of the manualized 20-week group CBASP intervention with unipolar patients was registered with the ISRCTN registry, study ID: ISRCTN95149444. Results reported here include mixed ANOVA analyses, across group treatment models and diagnostic categories. Changes over time in self-reported depressive symptoms (Inventory of Depressive Symptoms -IDS-SR), self-reported social functioning, interpersonal problems and interpersonal dispositions are documented for all patients. An exploratory longitudinal latent class analysis was used to examine patients' trajectories of improvement in depressive symptoms. Finally, the best predictors of change in reported depressive symptoms were explored with a logistic regression for all patients. RESULTS Improvements in depressive symptoms and in social functioning over time were significant for all patients with bipolar patients trending towards a greater improvement in depressive symptoms after controlling for baseline differences. An exploratory Latent Class Analysis identified two different treatment trajectories for the entire sample: 1) moderate to severely depressed patients who improved significantly (49%) and 2) severely depressed patients who did not improve (51%). The best predictors of non-response to group therapy include high baseline problems in social functioning and low rates of self-reported Perceived Improvements in overall health. CONCLUSION Bipolar patients in a depressive episode appear to benefit from the same 20-week group CBASP model designed originally for the treatment of Persistent Depressive Disorder. Bipolar patients seem more easily mobilized both during and outside of group therapy sessions and report more interpersonal confidence and more agency than unipolar depressed patients.
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Affiliation(s)
- Liliane Sayegh
- Bipolar Disorders Program, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychology, McGill University, Montreal, QC, Canada
| | - El Hadj Touré
- Department of Sociology, University of Montreal, Montreal, QC, Canada.,Douglas Research Center, Douglas Mental Health University Institute, Montreal, QC, Canada
| | | | - Serge Beaulieu
- Bipolar Disorders Program, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Suzane Renaud
- Bipolar Disorders Program, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada.,Complex Mood, Comorbid and Personality Disorders Program, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Soham Rej
- Bipolar Disorders Program, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada.,GeriPARTy Research Group, Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada
| | - Michel Perreault
- Douglas Research Center, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
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Spain D, Happé F. How to Optimise Cognitive Behaviour Therapy (CBT) for People with Autism Spectrum Disorders (ASD): A Delphi Study. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2019. [DOI: 10.1007/s10942-019-00335-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AbstractChildren and adults with autism spectrum disorders (ASD) can benefit from cognitive behaviour therapy (CBT), yet the prevailing opinion is that this requires adaptations to accommodate commonly experienced socio-communication and neuropsychological impairments. There are, however, no empirically-derived guidelines about how best to adapt standard practice. In a three round Delphi survey, we asked expert clinicians and clinical-researchers, based in England, about how to optimise the design, delivery and evaluation of CBT for people with ASD. Of 50 people approached, 18 consented to take part in Round 1, nine in Round 2 and eight in Round 3. Using a five-point scale, participants rated the degree to which 221 statements—pertaining to the referral process, assessment, engagement, formulation, goal setting, therapy structure, interventions and techniques, homework, outcome measurement, managing endings and therapist attributes—were integral to CBT. The consensus was that 155 statements represented essential or important components of CBT. Adaptations to the structure and process of therapy were consistently endorsed, and an individualised formulation-derived approach was favoured when deciding upon which interventions and techniques to offer. Further studies are needed to clarify if adapted CBT is associated with improved treatment outcomes and acceptability.
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Abstract
It is not yet clear what mental disorders are and what are the causal pathways that lead to them. That makes it difficult to decide what the targets and outcomes of psychotherapies should be. In this paper, the main types of targets and outcomes of psychotherapies are described, and a brief overview is provided of some of the main results of research on these types. These include symptom reduction, personal targets and outcomes from the patient's perspective, improvement of quality of life, intermediate outcomes depending on the theoretical framework of the therapist, negative outcomes to be avoided, and economic outcomes. In line with the dominance of the DSM and ICD systems for diagnoses, most research has been focused on symptom reduction. This considerable body of research, with hundreds of randomized trials, has shown that for most mental disorders effective psychotherapies are available. There is also research showing that psychotherapies can result in improvement of quality of life in most mental disorders. However, relatively little research is available on patient-defined outcomes, intermediate outcomes, negative outcomes and economic outcomes. Patients, relatives, therapists, employers, health care providers and society at large each have their own perspectives on targets and outcomes of psychotherapies. The perspective of patients should have more priority in research, and a standardization of outcome measures across trials is much needed.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
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Kato T. Current understanding of bipolar disorder: Toward integration of biological basis and treatment strategies. Psychiatry Clin Neurosci 2019; 73:526-540. [PMID: 31021488 DOI: 10.1111/pcn.12852] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 12/18/2022]
Abstract
Biological studies of bipolar disorder initially focused on the mechanism of action for antidepressants and antipsychotic drugs, and the roles of monoamines (e.g., serotonin, dopamine) have been extensively studied. Thereafter, based on the mechanism of action of lithium, intracellular signal transduction systems, including inositol metabolism and intracellular calcium signaling, have drawn attention. Involvement of intracellular calcium signaling has been supported by genetics and cellular studies. Elucidation of the neural circuits affected by calcium signaling abnormalities is critical, and our previous study suggested a role of the paraventricular thalamic nucleus. The genetic vulnerability of mitochondria causes calcium dysregulation and results in the hyperexcitability of serotonergic neurons, which are suggested to be susceptible to oxidative stress. Efficacy of anticonvulsants, animal studies of candidate genes, and studies using induced pluripotent stem cell-derived neurons have suggested a relation between bipolar disorder and the hyperexcitability of neurons. Recent genetic findings suggest the roles of polyunsaturated acids. At the systems level, social rhythm therapy targets circadian rhythm abnormalities, and cognitive behavioral therapy may target emotion/cognition (E/C) imbalance. In the future, pharmacological and psychosocial treatments may be combined and optimized based on the biological basis of each patient, which will realize individualized treatment.
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Affiliation(s)
- Tadafumi Kato
- Laboratory for Molecular Dynamics of Mental Disorders, RIKEN Center for Brain Science, Wako, Japan
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Novick DM, Swartz HA. Evidence-Based Psychotherapies for Bipolar Disorder. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2019; 17:238-248. [PMID: 32047369 DOI: 10.1176/appi.focus.20190004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Bipolar disorder is a recurrent psychiatric disorder marked by waxing and waning affective symptoms and impairment in functioning. Some of the morbidity and mortality associated with the illness may be reduced with evidence-based psychotherapies (EBPs) along with pharmacotherapy. To enhance clinicians' understanding of which therapy modalities have evidence supporting their use, the authors conducted a systematic literature review to identify randomized controlled trials (RCTs) of psychotherapy for adults with bipolar disorder. A strong evidence base exists for psychoeducation, cognitive-behavioral therapy, family-focused therapy, interpersonal and social rhythm therapy, and peer-support programs. Promising modalities include functional remediation, mindfulness-based cognitive therapy, illness management and recovery, and technology-assisted strategies. RCTs demonstrate a consistent advantage of these psychotherapies plus pharmacotherapy, compared with the use of pharmacotherapy alone. Adjunctive EBPs hasten time to remission, delay time to recurrence, and improve functional outcomes. EBPs play an important role in helping individuals develop skills needed to manage the persistent and lifelong psychosocial, neurocognitive, vocational, and interpersonal consequences of bipolar disorder. Continued efforts to improve the effectiveness of EBPs for adults with bipolar disorder are warranted.
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Affiliation(s)
- Danielle M Novick
- Outpatient Mood Disorders Clinic and Clinical Training Committee, VA Pittsburgh Healthcare System, Pittsburgh (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz)
| | - Holly A Swartz
- Outpatient Mood Disorders Clinic and Clinical Training Committee, VA Pittsburgh Healthcare System, Pittsburgh (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz)
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Abstract
Bipolar II disorder causes significant suffering among patients and their families, some of which may be alleviated by psychotherapy alone or as an adjunct to pharmacotherapy. Psychotherapies may be more effective if modified to meet the specific needs of patients with bipolar II disorder.
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Affiliation(s)
- Danielle M Novick
- Outpatient Mood Disorders Clinic and Clinical Training Committee, VA Pittsburgh Healthcare System (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine (Swartz)
| | - Holly A Swartz
- Outpatient Mood Disorders Clinic and Clinical Training Committee, VA Pittsburgh Healthcare System (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine (Swartz)
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'What people diagnosed with bipolar disorder experience as distressing': A meta-synthesis of qualitative research. J Affect Disord 2019; 248:108-130. [PMID: 30731279 DOI: 10.1016/j.jad.2019.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/10/2019] [Accepted: 01/19/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is considered to have a significantly negative impact on functioning and prognosis is considered poor. Current treatments are modestly effective and predominantly focus on reducing extreme mood fluctuations and symptoms, yet less is known about what patients themselves describe as distressing. Therefore we aimed to assess this through a systematic review. METHODS A comprehensive literature search was conducted in four major bibliographic databases in August 2017, updated in July 2018. Qualitative studies exploring BD were included if they contained themes related to distress. First person accounts from people with BD discussing what they experience as distressing were extracted and synthesised using thematic synthesis. Author interpretations were also extracted to support the synthesis. RESULTS Twenty-four studies were included. Five main analytical themes were developed: 1) diagnosis, 2) loss, 3) uncertainty, 4) threat and 5) relationships. Two further crosscutting themes were identified as 1) stigma and 2) fear of relapse. Implications for interventions to focus on these causes of distress also emerged. LIMITATIONS The included studies did not adequately examine the authors' potential own biases and influences within their interpretations of the data. One author predominantly undertook data extraction and coding for the current review, although research team discussions led to an agreed consensus on themes. CONCLUSIONS This was the first qualitative study to specifically explore distress in BD. The meta-synthesis highlights important areas that people with BD experience as distressing. Adaptations to current interventions, to focus on what people find distressing could seek to improve treatment outcomes.
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