1
|
Dempsey RC, Eardley K, Dodd AL. The role of tenacious versus flexible goal pursuit in the vulnerability to bipolar disorder. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00748-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractThe vulnerability to bipolar disorder is characterized by dysregulated goal-related behavior, the setting of ambitious and extreme goals, and increases in goal approach behaviors. To date, no studies have investigated the nature of goal pursuit behaviors amongst individuals at a behavioral risk for bipolar disorder in terms of whether goal pursuit is characterized by a tenacious active striving for goals or a more flexible changeable focus on goals. A non-clinical sample of 168 participants completed online measures of mood, bipolar-vulnerability, reward sensitivity, goal-related perfectionist tendencies, tenacious goal pursuit and flexible goal adjustment behaviors. Our findings demonstrate that bipolar-vulnerability is characterized by the tenacious, not flexible, pursuit of goals, in combination with low regulation of goal behavior, and tendencies towards narcissistic and self-critical perfectionism indicative of setting high ambitious standards and making overly harsh self-judgments when such standards are not met. These findings are similar to those from clinical bipolar samples where there is evidence of prolonged symptom recoveries after the experience of goal frustrations and failures. Reducing the tenacious, active striving for goals amongst at-risk individuals may be a potential avenue for early intervention.
Collapse
|
2
|
Personal recovery in bipolar disorder: Systematic review and "best fit" framework synthesis of qualitative evidence - a POETIC adaptation of CHIME. J Affect Disord 2021; 292:375-385. [PMID: 34139411 DOI: 10.1016/j.jad.2021.05.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/10/2021] [Accepted: 05/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Personal recovery, living a satisfying, hopeful life alongside symptoms, has become an increasingly valued aim across mental health care agendas internationally. However, there is little understanding of how people experience personal recovery alongside the mood challenges characteristic of a bipolar disorder diagnosis. Personal recovery frameworks have been developed for populations with mixed psychiatric diagnoses, predominantly psychotic disorders. METHODS This systematic review of qualitative data used the widely adopted personal recovery processes Connectedness, Hope and optimism, Identity, Meaning and purpose, Empowerment (CHIME) in a "best fit" framework synthesis to understand personal recovery experiences in bipolar disorder. Included studies were coded with deductive framework analysis based on the CHIME processes and inductive thematic analysis for aspects beyond the a priori framework. RESULTS A comprehensive search of six literature databases led to inclusion of twelve articles published 2010-2020. Deductive coding supported the fit with the CHIME framework but revealed difficulties, losses, and tensions within and across recovery processes. The proposed framework for personal recovery in bipolar disorder, Purpose and meaning, Optimism and hope, Empowerment, Tensions, Identity, Connectedness (POETIC), organises all CHIME processes around these tensions. LIMITATIONS Diversity among study participants was limited with majority middle-aged, female, Western participants. CONCLUSIONS The compact POETIC personal recovery framework tailored for bipolar disorder is directly applicable to clinical practice with personal recovery objectives. It highlights the need for professionals to introduce personal recovery in a realistic and balanced way to address recent criticism by service user organisations of personal recovery as overly optimistic.
Collapse
|
3
|
Mezes B, Lobban F, Costain D, Longson D, Jones SH. Psychological factors in personal and clinical recovery in bipolar disorder. J Affect Disord 2021; 280:326-337. [PMID: 33221719 DOI: 10.1016/j.jad.2020.11.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 09/18/2020] [Accepted: 11/07/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Research into bipolar disorder (BD) has primarily focused upon clinical recovery (CR), i.e. symptom reduction, and overlooked personally meaningful recovery outcomes emphasized by service users. Personal recovery (PR) has been a major focus in the formulation of mental health policies and guidelines, and yet, research into factors influencing PR in BD is in its infancy. METHODS This study compared psychological associates of concurrent PR and CR, and determined psychological factors in PR prospectively at 6 months. RESULTS 107 participants completed baseline assessments, of whom 84% completed follow-up at 6 months. Controlling for potential confounders, multiple linear and ordinal regression models showed that some psychological factors underpinned both CR and PR at baseline: worse PR and CR outcomes were associated with higher negative self-dispositional appraisals and dysfunctional attitudes. Better PR, but worse CR ([hypo]mania related) were associated with higher adaptive coping. Additionally, better PR (but not CR) was associated with higher concurrent risk taking at baseline and predicted at follow-up by higher levels of baseline rumination. Better CR ([hypo]mania related), but not PR, was associated with lower impulsivity, but higher BAS processes. LIMITATIONS Psychological and clinical factors were not measured at follow up and may have changed over time. Participants were a convenience sample. CONCLUSIONS Understanding psychological factors driving recovery in BD is essential for refining the conceptual framework of PR, and informing psychological models and related interventions for BD. The identified differences in psychological factors highlight the importance of more individualised, PR focused therapeutic approaches.
Collapse
Affiliation(s)
- Barbara Mezes
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Bailrigg, Lancaster LA1 4YW, United Kingdom;.
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Bailrigg, Lancaster LA1 4YW, United Kingdom
| | - Deborah Costain
- Department of Mathematics and Statistics, Lancaster University, Bailrigg, Lancaster LA1 4YW, United Kingdom
| | - Damien Longson
- Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom
| | - Steven H Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Bailrigg, Lancaster LA1 4YW, United Kingdom
| |
Collapse
|
4
|
Koenders M, Dodd A, Karl A, Green M, Elzinga B, Wright K. Understanding bipolar disorder within a biopsychosocial emotion dysregulation framework. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2020. [DOI: 10.1016/j.jadr.2020.100031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
|
5
|
The dual-system theory of bipolar spectrum disorders: A meta-analysis. Clin Psychol Rev 2020; 83:101945. [PMID: 33217713 DOI: 10.1016/j.cpr.2020.101945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 01/05/2023]
Abstract
Bipolar spectrum disorders are characterized by alternating intervals of extreme positive and negative affect. We performed a meta-analysis to test the hypothesis that such disorders would be related to dysregulated reinforcement sensitivity. First, we reviewed 23 studies that reported the correlation between self-report measures of (hypo)manic personality and measures of reinforcement sensitivity. A large relationship was found between (hypo)manic personality and BAS sensitivity (g = .74), but not with BIS sensitivity (g = -.08). This stands in contrast to self-reported depression which has a small, negative relationship with BAS sensitivity and a large positive one with BIS sensitivity (Katz et al., 2020). Next, we reviewed 33 studies that compared reinforcement sensitivity between euthymic, bipolar participants and healthy controls. There, bipolar disorder had a small, positive relationship with BAS sensitivity (g = .20) and a medium, positive relationship with BIS sensitivity (g = .64). These findings support a dualsystem theory of bipolar disorders, wherein BAS sensitivity is more closely related to mania and BIS sensitivity more closely to bipolar depression. Bipolar disorders show diatheses for both states with euthymic participants being BAS- and BIS- hypersensitive. Implications for further theory and research practice are expounded upon in the discussion.
Collapse
|
6
|
Kwan JW, Bauer IE, Hautzinger M, Meyer TD. Reward sensitivity and the course of bipolar disorder: A survival analysis in a treatment seeking sample. J Affect Disord 2020; 261:126-130. [PMID: 31614277 DOI: 10.1016/j.jad.2019.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/20/2019] [Accepted: 10/04/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Reward sensitivity is suggested to be an influence on the onset and reoccurrence of bipolar disorder (BD) in observational longitudinal studies. The current study examined whether reward sensitivity predicted the recurrence of mood episodes in a treatment seeking sample. We also explored if reward sensitivity moderated treatment outcomes of psychosocial treatment. METHODS Seventy-six euthymic adult patients with BD were randomly assigned to either Cognitive Behavioral Therapy (CBT) or Supportive Therapy (ST) and followed up for 2 years after completing therapy (Meyer and Hautzinger, 2012). The primary outcome measure was recurrence of mood episodes. The final multivariate Cox regression models included potential covariates, therapy conditions, BAS reward sensitivity, and the interaction between BAS and therapy conditions. RESULTS BAS emerged as the only significant predictor of time till recurrence of mania, but not depression, but the overall model did not reach significance. There was no interaction between treatment and BAS reward sensitivity. Interestingly, a diagnosis of BD II predicted time till recurrence of depression. CONCLUSION The main result regarding BAS partially confirms prior studies linking BAS and mania, but power and the specific sample seeking psychosocial treatment might have reduced the effect.
Collapse
Affiliation(s)
- Janet W Kwan
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, United States
| | - Isabelle E Bauer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, United States
| | - Martin Hautzinger
- Department of Psychology and Psychotherapy, Eberhard Karls University, Tübingen, Germany
| | - Thomas D Meyer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, United States.
| |
Collapse
|
7
|
Bilderbeck AC, Raslescu A, Hernaus D, Hayen A, Umbricht D, Pemberton D, Tiller J, Søgaard B, Sambeth A, van Amelsvoort T, Reif A, Papazisis G, Pérez V, Elices M, Maurice D, Bertaina-Anglade V, Dawson GR, Pollentier S. Optimizing Behavioral Paradigms to Facilitate Development of New Treatments for Anhedonia and Reward Processing Deficits in Schizophrenia and Major Depressive Disorder: Study Protocol. Front Psychiatry 2020; 11:536112. [PMID: 33250788 PMCID: PMC7674850 DOI: 10.3389/fpsyt.2020.536112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/22/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Behavioral tasks focusing on different subdomains of reward processing may provide more objective and quantifiable measures of anhedonia and impaired motivation compared with clinical scales. Typically, single tasks are used in relatively small studies to compare cases and controls in one indication, but they are rarely included in larger multisite trials. This is due to limited systematic standardization as well as the challenges of deployment in international studies and stringent adherence to the high regulatory requirements for data integrity. The Reward Task Optimization Consortium (RTOC) was formed to facilitate operational implementation of reward processing tasks, making them suitable for use in future large-scale, international, multisite drug development studies across multiple indications. The RTOC clinical study aims to conduct initial optimization of a set of tasks in patients with major depressive disorder (MDD) or schizophrenia (SZ). Methods: We will conduct a multicenter study across four EU countries. Participants (MDD = 37, SZ = 37, with ≤80 age- and gender-matched healthy volunteers) will attend a study visit comprising screening, self-report and clinically rated assessments of anhedonia and symptom severity, and three reward processing tasks; specifically, the Grip Strength Effort task, the Doors task, and the Reinforcement Learning Working Memory task. The Grip Strength Effort and Doors tasks include simultaneous electroencephalography/event-related potential recordings. Outcomes will be compared using a two-way group design of MDD and SZ with matched controls, respectively. Further analyses will include anhedonia assessment scores as covariates. Planned analyses will assess whether our findings replicate previously published data, and multisite deployment will be evaluated through assessments of quality and conduct. A subset of participants will complete a second visit, to assess test-retest reliability of the task battery. Discussion: This study will evaluate the operational deployment of three reward processing tasks to the regulatory standards required for use in drug development trials. We will explore the potential of these tasks to differentiate patients from controls and to provide a quantitative marker of anhedonia and/or impaired motivation, establishing their usefulness as endpoints in multisite clinical trials. This study should demonstrate where multifaceted reward deficits are similar or divergent across patient populations. Registration: ClinicalTrials.gov (NCT04024371).
Collapse
Affiliation(s)
| | | | - Dennis Hernaus
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Anja Hayen
- P1vital Ltd, Wallingford, United Kingdom
| | | | | | - Jane Tiller
- BlackThorn Therapeutics, San Francisco, CA, United States
| | | | - Anke Sambeth
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Therese van Amelsvoort
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Victor Pérez
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Departament de Psiquitria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Matilde Elices
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Departament de Psiquitria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | | | | | | |
Collapse
|
8
|
Rizvi SJ, Lambert C, Kennedy S. Presentation and Neurobiology of Anhedonia in Mood Disorders: Commonalities and Distinctions. Curr Psychiatry Rep 2018. [PMID: 29520717 DOI: 10.1007/s11920-018-0877-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW To focus on the clinical and behavioral presentation of anhedonia in mood disorders, as well as the differences and commonalities in the underlying neurocircuitry. RECENT FINDINGS Evidence suggests that depression is characterized by hypofunction of the reward system, while bipolar disorder manifests dysregulation of the behavioral activation system that increases goal-directed reward behavior. Importantly, strong evidence does not exist to suggest significant differences in anhedonia severity between depressed unipolar and bipolar patients, suggesting that there are more nuanced fluctuations in reward processing deficits in bipolar patients depending on their state. Both euthymic unipolar and bipolar patients frequently report residual reward dysfunction, which highlights the potential of reward processing deficits that give rise to the clinical symptom of anhedonia to be trait factors of mood disorders; however, the possibility that therapies are not adequately treating anhedonia could also explain the presence of residual symptoms. Reward processing represents a potential diagnostic and treatment marker for mood disorders. Further research should systematically explore the facets of reward processing in at-risk, affected, and remitted patients.
Collapse
Affiliation(s)
- Sakina J Rizvi
- Li Ka Shing Knowledge Institute, Arthur Sommer Rotenberg Suicide and Depression Studies Unit, St. Michael's Hospital, University of Toronto, 193 Yonge St, 6-009, Toronto, ON, M5B 1M8, Canada. .,Department of Psychiatry, Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Clare Lambert
- Li Ka Shing Knowledge Institute, Arthur Sommer Rotenberg Suicide and Depression Studies Unit, St. Michael's Hospital, University of Toronto, 193 Yonge St, 6-009, Toronto, ON, M5B 1M8, Canada
| | - Sidney Kennedy
- Li Ka Shing Knowledge Institute, Arthur Sommer Rotenberg Suicide and Depression Studies Unit, St. Michael's Hospital, University of Toronto, 193 Yonge St, 6-009, Toronto, ON, M5B 1M8, Canada.,Department of Psychiatry, Institute of Medical Science, University of Toronto, Toronto, Canada
| |
Collapse
|