Perceived Criticism and Family Attitudes as Predictors of Recurrence in Bipolar Disorder.

Background: Bipolar disorder (BD) is a highly recurrent psychiatric condition. While combined pharmacological and psychosocial treatments improve outcomes, not much is known about potential moderators that could affect these treatments. One potential moderator might be the quality of interpersonal relations in families, for example, familial attitudes and perceived criticism. Method: To explore this question we conducted a post-hoc analysis that used an existing data set from a previous study by our group that compared cognitive behavioral therapy (CBT) and supporting therapy (ST) in remitted BD. In the present study, we used Cox proportional hazard models. Results: We found that the relatives' ratings of criticism predicted the likelihood of depressive recurrences, especially in the ST condition. The patients' ratings of negative familial attitudes predicted the risk of recurrences in general, irrespective of the therapy condition. Conclusion: These results suggest that it might be important to assess perceived criticism and familial attitudes as potential moderators of treatment outcome in BD.

Magic Mushrooms - an exploratory look at how mental health professionals feel and think about Psilocybin.

Psilocybin recently received breakthrough status by the FDA for its use in treatment of depression. We therefore investigated mental health professionals' (MHPs) opinions on Psilocybin (n = 155). Overall, attitudes were neutral but self-rated knowledge of Psilocybin was low. The term used in the survey, 'Psilocybin' or 'Magic Mushrooms', did not significantly affect their responses. Some variables (i.e., gender, attitudes towards medical cannabis, and personal history of psychedelic usage) were associated with ratings of Psilocybin. These results provide a baseline of MHPs' thoughts on Psilocybin and what should be considered in the future if it is FDA-approved.

Dysfunctional Cognition in Individuals With an Increased Risk for Mania.

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

Symptoms, course of Illness, and comorbidity as predictors of expressed emotion in bipolar disorder.

High levels of expressed emotions (EE) reflect the amount of criticism and/or over-involvement in families and has been linked to relapse risk in various psychiatric disorders including bipolar disorder (BD). Less clear is which factors contribute to the development and/or maintenance of EE. Therefore, we tested whether patient characteristics, specifically clinical features and personality disorder traits in BD predicted key aspects of EE as assessed by patients and their relatives. Patients with remitted BD and their relatives were asked to complete the Family Attitude Scale (FAS) and the Perceived Criticism Measure (PCM). Patient characteristics were assessed with a variety of measures including SCID I and II. The FAS and PCM shared 25% of the variance for patients and 14% for relatives, suggesting a conceptual overlap, but they may not assess identical constructs. The number of previous mood episodes, current self-rated manic symptoms, and comorbid symptoms of Cluster C personality disorder predicted patient-rated FAS. Relative-rated FAS was only predicted by comorbid symptoms of Cluster A personality disorder. In BD, specific patient characteristics seem to be linked to key aspects of EE even when in remission. However, it might depend whether the patient, his/her relative, or a neutral observer assessed EE.

[Adult ADHD and borderline personality disorder: A pilot study on differences in attachment and early traumatization]. / ADHS im Erwachsenenalter und Borderline-Persönlichkeitsstörung: Eine Pilotstudie zu den Unterschieden im Bindungsstil und frühkindlichen Traumatisierungen.

Adult ADHD and borderline personality disorder: A pilot study on differences in attachment and early traumatization Objective: Attention-deficit/hyperactivity disorder (ADHD) in adulthood and borderline personality disorder (BPD) share commondiagnostic criteria.The present study examined how ADHD in adulthood can be distinguished from BPDregarding attachment style and traumatic experiences. METHOD: The sample consists of N = 30 persons with 50% (n = 15) ADHD patients and 50% (n = 15) BPD patients. The patients were asked to fill out different questionnaires to investigate the criteria for specific symptoms. RESULTS: The results show that most of the patients are insecurely attached. In addition, 80% of both the ADHD and BPD sample claimed traumatic experiences in their childhood or adolescence. Most frequently, patients reported traumatisation following emotional neglect and emotional abuse. No group-specific differences concerning traumatic experiences and the individual attachment style were determined. CONCLUSION: The etiological factors attachment style and traumatic experiences are not suitable for differentiating ADHD in adulthood and BPD.

Does stress play a significant role in bipolar disorder? A meta-analysis.

BACKGROUND: There is evidence that stressful life events (LE) play a crucial role in the etiology of bipolar affective disorder (BD). However, primary studies, as well as narrative reviews, have provided mixed results. The present meta-analysis combined and analyzed previous data in order to address these inconsistencies. METHOD: Forty-two studies published in 53 records were identified by systematically searching MEDLINE, PsychINFO, and PSYCHINDEX using the terms "bipolar disorder" OR "manic-depressive" OR "bipolar affective disorder" OR "mania" AND "stress" OR "life event" OR "daily hassles" OR "goal attainment". Then, meta-analyses were conducted. RESULTS: Individuals diagnosed with BD reported more LE before relapse when compared to euthymic phases. They also experienced more LE relative to healthy individuals and to physically ill patients. No significant difference in the number of LE was found when BD was compared to unipolar depression and schizophrenia. LIMITATIONS: When interpreting the present meta-analytic findings one should keep in mind that most included studies were retrospective and often did not specify relevant information, e.g., if the LE were chronic or acute or if the individuals were diagnosed with BD I or II. We could not entirely rule out a publication bias. CONCLUSION: The present meta-analyses found that individuals with BD were sensitive to LE, which corroborates recent theoretical models and psychosocial treatment approaches of BD. Childbirth, as a specific LE, affected individuals with BD more than individuals with unipolar depression. Future studies that investigate specific LE are warranted.

The Hypomania Checklist (HCL) - systematic review of its properties to screen for bipolar disorders.

OBJECTIVE: Bipolar disorders (BDs) are often not recognised with potentially drastic consequences for the individuals and their families. In clinical practice self-reports can be used to screen to enhance recognition. We therefore present a systematic review of the screening properties for the Hypomania Checklist (HCL-32). METHODS: A systematic literature search was conducted to identify all relevant studies looking at the screening properties of the HCL-32 in adults. RESULTS: Out of 196 papers 21 papers reported data on 22 independent samples. We narratively reviewed these studies. Weighted estimated Sensitivity was 80% regardless of whether a BD diagnosis was compared to unipolar depression or any other non-bipolar diagnosis. Specificity indicated that the HCL-32 was better when comparing BD to unipolar depression (65.3%) than to any other diagnostic category (57.3%). Fewer studies provided estimates for predictive powers, leading to less reliable overall estimates for these indicators. CONCLUSIONS: Despite some limitations, using the HCL-32 as a first screening in patients seeking help for depression can be recommended, but should never be used on its own for diagnosing. Future research should examine whether screening properties can be improved by developing an algorithm incorporating the negative consequences reported for different areas in the HCL-32.

Is there evidence for an emotion-related bias in verbal learning or memory in individuals putatively high at risk for mania?

There is broad evidence that individuals with bipolar disorder show deficits in verbal memory and learning. Such deficits seem to be independent of acute mood episodes and to manifest after the onset of the disorder. Less research has been conducted in relation to more specific memory functions, particularly to verbal memory and learning for emotional information. Therefore, the objective of the present study is to investigate if there is evidence for an affective memory bias in at-risk individuals before the onset of affective disorder. We applied the Emotional Auditive Verbal Learning Test to individuals at risk for mania and at risk for depression, as well as to a control group. We hypothesized a mania-related memory bias for individuals at risk of mania. We found no evidence for an overall learning or memory deficit in the high-risk groups. All groups performed better learning and remembering neutral words compared to emotionally valenced words, however, contrary to our hypothesis there was no specific emotion-related learning or memory bias in the two high-risk groups. There was no evidence of impairments in verbal learning and memory overall and for emotional contents before the onset of affective disorders.

Cognitive styles in hypomanic episodes of bipolar I disorder.

OBJECTIVES: Cognitive vulnerability-stress theories have recently been extended to bipolar disorder by suggesting that an activation of negative cognition might lead to depressive mood episodes and an activation of positive cognition might lead to manic mood episodes. Alternatively, the manic defense hypothesis claims that hypomanic and manic states are not the opposite of depression but rather contain similar underlying negative cognitions. The objective of this study was to further evaluate these theories by examining the cognitive patterns in bipolar I hypomania. METHODS: We compared 15 hypomanic bipolar I disorder patients, 26 remitted bipolar I disorder patients, and 21 healthy individuals in a cross-sectional study. All participants completed the Dysfunctional Attitude Scale, the Attributional Style Questionnaire, the Emotional Stroop Task, and the Emotional Auditory Verbal Learning Test. RESULTS: Hypomanic bipolar disorder individuals showed cognitions associated with depressive states as well as cognitions associated with manic states. The results for the remitted bipolar disorder patients paralleled those for the control group. CONCLUSION: Dysfunctional cognition in bipolar disorder seems to relate to state rather than to trait. Hypomania includes depression-related as well as mania-related cognitions and can therefore not be considered as the mere opposite of depression.

No strong evidence for abnormal levels of dysfunctional attitudes, automatic thoughts, and emotional information-processing biases in remitted bipolar I affective disorder.

INTRODUCTION: Beck extended his original cognitive theory of depression by suggesting that mania was a mirror image of depression characterized by extreme positive cognition about the self, the world, and the future. However, there were no suggestions what might be special regarding cognitive features in bipolar patients (Mansell & Scott, 2006). We therefore used different indicators to evaluate cognitive processes in bipolar patients and healthy controls. METHODS: We compared 19 remitted bipolar I patients (BPs) without any Axis I comorbidity with 19 healthy individuals (CG). All participants completed the Beck Depression Inventory, the Dysfunctional Attitude Scale, the Automatic Thoughts Questionnaire, the Emotional Stroop Test, and an incidental recall task. RESULTS: No significant group differences were found in automatic thinking and the information-processing styles (Emotional Stroop Test, incidental recall task). Regarding dysfunctional attitudes, we obtained ambiguous results. CONCLUSIONS: It appears that individuals with remitted bipolar affective disorder do not show cognitive vulnerability as proposed in Beck's theory of depression if they only report subthreshold levels of depressive symptoms. Perhaps, the cognitive vulnerability might only be observable if mood induction procedures are used.