The association between meditation practice and treatment outcome in Mindfulness-based Cognitive Therapy for bipolar disorder.

This study aimed to examine the impact of quantity of mindfulness meditation practice on the outcome of psychiatric symptoms following Mindfulness-based Cognitive Therapy (MBCT) for those diagnosed with bipolar disorder. Meditation homework was collected at the beginning of each session for the MBCT program to assess quantity of meditation practice. Clinician-administered measures of hypo/mania and depression along with self-report anxiety, depression and stress symptom questionnaires were administered pre-, post-treatment and at 12-month follow-up. A significant correlation was found between a greater number of days meditated throughout the 8-week trial and clinician-rated depression scores on the Montgomery-Åsberg Depression Rating Scale at 12-month follow-up. There were significant differences found between those who meditated for 3 days a week or more and those who meditated less often on trait anxiety post-treatment and clinician-rated depression at 12-month follow-up whilst trends were noted for self-reported depression. A greater number of days meditated during the 8-week MBCT program was related to lower depression scores at 12-month follow-up, and there was evidence to suggest that mindfulness meditation practice was associated with improvements in depression and anxiety symptoms if a certain minimum amount (3 times a week or more) was practiced weekly throughout the 8-week MBCT program.

Mindfulness, response styles and dysfunctional attitudes in bipolar disorder.

BACKGROUND: This study aimed to examine differences between mindfulness, dysfunctional attitudes and response styles in subjects with bipolar disorder, major depressive disorder and controls. METHOD: A total of 192 participants were included in this study: 90 with bipolar disorder, 36 with remitted major depressive disorder and 66 subjects without a current or past history of a mood disorder. RESULTS: After controlling for current mood state and co-morbid anxiety disorders, the groups did not differ on mindfulness or response styles scores, however, those with bipolar disorder scored significantly higher on the Dependency and Achievement subscales of the Dysfunctional Attitudes Scale than the other two groups. LIMITATIONS: Sample sizes were relatively small for the control and remitted major depressive disorder groups making it difficult to draw definitive conclusions. CONCLUSIONS: Participants with bipolar disorder appear to significantly differ from remitted depressives and controls on certain cognitive styles such as Dependency and Achievement on the Dysfunctional Attitudes Scale. Further research may help to understand how these cognitive domains impact on the course and outcome of bipolar disorder.

Characteristics of bipolar disorder in an Australian specialist outpatient clinic: comparison across large datasets.

OBJECTIVES: There have been relatively few detailed reports on the sociodemographic and clinical characteristics of bipolar disorder in large outpatient clinical samples. This paper reports on findings from the Black Dog Institute Bipolar Disorders Clinic (BDI-BDC) and compares this dataset with the predominantly outpatient Stanley Foundation Bipolar Disorders Network (SFBN) and Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) samples. METHODS: A total of 217 patients with DSM-IV bipolar disorder were assessed in detail in the BDI-BDC using a series of standardized and non-standardized structured interviews. Ninety per cent had bipolar I disorder, and 10% bipolar II disorder. This sample was compared with the SFBN and STEP-BD datasets. RESULTS: The sociodemographic characteristics of the three samples were remarkably similar. Female gender and younger age were overrepresented compared to the general population. Functional impairment, indicated by marital status and labour force participation, was clearly more common among the study subjects than in the general population. In all three samples, prior educational attainment was higher than the general population. With respect to clinical features, approximately half of each sample was euthymic and approximately one-third was in a DSM-IV episode of depression at study entry. One-half reported depression as their first episode of mood disturbance. Similar proportions identified positive family histories of bipolar disorder (40%) and unipolar depression (55%). Other clinical characteristics demonstrated more variation between the samples. The STEP-BD population reported an earlier age of onset. The SFBN subjects reported higher numbers of overall episodes, but psychotic features and suicide attempts were less common than in the BDI-BDC sample. CONCLUSIONS: This report highlights the marked commonalities of the sociodemographic and clinical characteristics of patients with bipolar disorder recruited predominantly in the outpatient setting in three different continents, that is, Australia, North America and Europe. It also demonstrates some critical distinctions between such samples, emphasizing the need to be aware of these differences when interpreting findings, such as treatment outcome, from different bipolar disorder datasets.

The management of bipolar disorder in general practice.

General practitioners have a key role in managing patients with bipolar disorder, a condition which affects at least one in 200 Australians each year and is the sixth leading cause of disability in the population. Although diagnosis and treatment of the illness is complex, effective treatment can lead to good outcomes for many patients. GPs can contribute significantly to early recognition of bipolar disorder, avoiding the long delays in accurate diagnosis that have been reported. As in other complex recurrent or persistent illnesses, GPs are well placed to coordinate multidisciplinary "shared care" with specialists and other health care professionals. GPs also provide continuing general medical care for patients with bipolar disorder, and are in a unique position to understand patients' life circumstances and to monitor their progress over time. The last decade has seen many advances in medication for bipolar disorder, including the introduction of new therapies and the refinement of treatment protocols using older medications. There has also been increasing recognition of the contribution of psychological therapies to symptom relief, relapse prevention, optimal function, and quality of life.

A randomized controlled trial of cognitive therapy for bipolar disorder: focus on long-term change.

BACKGROUND: This study reports the outcome of a randomized controlled trial of cognitive therapy (CT) for bipolar disorder. The treatment protocol differed from other published forms of CT for bipolar disorder through the addition of emotive techniques. METHOD: Fifty-two patients with DSM-IV bipolar I or II disorder were randomly allocated to a 6-month trial of either CT or treatment as usual, with both treatment groups also receiving mood stabilizers. Outcome measures included relapse rates, dysfunctional attitudes, psychosocial functioning, hopelessness, self-control, and medication adherence. Patients were assessed during treatment by independent raters blind to the patients' group status. RESULTS: At posttreatment, patients allocated to CT had experienced less severe depression scores (Beck Depression Inventory and Montgomery-Asberg Depression Rating Scale) and less dysfunctional attitudes. After controlling for the presence of major depressive episode at baseline, there was a statistical trend toward a greater time to depressive relapse (p=.06) for the CT group. At 12-month follow-up, the CT group showed a trend toward lower Young Mania Rating Scale scores and improved behavioral self-control. The Clinical Global Impressions-Improvement scale, comparing the 18 months prior to treatment to the severity of illness status at follow-up, showed a substantial difference between groups in favor of CT. CONCLUSION: Our findings corroborate previous bipolar disorder research in demonstrating the value of CT, particularly immediately post-treatment, and indicate some continuation (albeit diminishing) of benefits in the succeeding 12 months. These findings suggest that psychological booster sessions may be crucial for maintaining the beneficial effects of cognitive therapy.

Major advances in bipolar disorder.

There have been major advances in clinical understanding and treatment of bipolar disorder over the past decade. Randomised controlled trials of pharmacological treatments and psychological interventions have shown that there are effective short-term and long-term treatments for the disorder. Despite advances in treatment, diagnosis is often delayed or mistaken, and many people who could benefit are not using the treatments available. Functional and symptomatic recovery from episodes of bipolar disorder is frequently less complete than previously considered, and disability is often profound. Although manic episodes are the distinguishing feature of bipolar disorder, it appears that depression is the predominant mood disturbance and that much of the functional impairment associated with bipolar disorder results from this. Comorbidity with anxiety disorders or substance misuse is common. Advances in genetics, brain imaging and basic pharmacology are starting to provide understanding of the complex causative processes.