1
|
Liang L, Zhu W, Yang J, Wang F. Anxiety and emotional-behavioral problems of adolescents in China: evidence for a serial mediation model of alexithymia and dependency. PSYCHOL HEALTH MED 2024; 29:1680-1691. [PMID: 34806499 DOI: 10.1080/13548506.2021.2005249] [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: 02/25/2021] [Accepted: 08/17/2021] [Indexed: 10/19/2022]
Abstract
High prevalence of emotional and behavioral problems among Chinese adolescence has been reported. This study seeks to investigate the mediating effect of alexithymia and dependency on anxiety and emotional-behavioral problems among adolescents. The study population included 519 adolescents. The assessments included the completion of standardized scales such as the Multidimensional Anxiety Scale (MASC), the Toronto Alexithymia Scale (TAS-20), the Depressive Experiences Questionnaire (DEQ), the Strengths and Difficulties Questionnaire (SDQ). Independent-sample t-tests, bivariate correlation, and serial mediation analyses were performed using SPSS23.0. Bivariate analyses revealed that anxiety, emotional-behavioral problem, alexithymia, and dependency were positively correlated. Alexithymia and dependency play a significant role in mediating the effect of multidimensional anxiety on emotional-behavioral problems. The effects of the two mediating paths were 69.86% and 7.81% for indirect effect through alexithymia, dependency, and specific indirect effect by alexithymia and dependency was 12.33%. Anxiety and emotional-behavioral problems mediate the relationship between alexithymia and dependency.
Collapse
Affiliation(s)
- Lijuan Liang
- Department of Psychology, The First Affiliated Hospital, Hainan Medical University, Haikou, China
- Department of Psychiatry, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Wei Zhu
- Department of Public Health, Hainan Medical University, Haikou, China
| | - Juan Yang
- Department of Psychology, The First Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Fei Wang
- Department of Psychiatry, The First Affiliated Hospital, China Medical University, Shenyang, China
| |
Collapse
|
2
|
Woods C, Richardson T, Palmer-Cooper E. Are dysfunctional attitudes elevated and linked to mood in bipolar disorder? A systematic review and meta-analysis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:16-53. [PMID: 37807389 DOI: 10.1111/bjc.12442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES Dysfunctional attitudes (DA) are higher in depression; however, less is understood about their role in bipolar disorder (BD). This paper aimed to explore the presence of DA in BD in comparison to clinical and non-clinical groups. Also explored were the associations between DA and mood states of depression, mania or euthymia in BD. METHODS A systematic review and meta-analysis were conducted. A total of 47 articles were included in the systematic review of which 23 were included in the meta-analysis. The quality of each study was rated. RESULTS The meta-analysis showed significantly higher DA in BD than healthy controls (d = .70). However, no difference was observed between BD and unipolar participants (d = -.16). When reviewing mood state within BD, a significant mean difference was found between DA scores for euthymic and depressed participants (d = -.71), with those who were depressed scoring higher. Three studies found that psychological therapies significantly reduce DA in BD (d = -.38). CONCLUSIONS These findings imply not only that DA are both a characteristic of BD that is not as prevalent in healthy populations but also that a depressed mood state is associated with increased severity. This implies that DA could possibly go 'offline' when mood symptoms are not present. Psychological therapies appear to reduce DA in BD. Implications for future research as well as practice-based implications are expanded on in the discussion.
Collapse
Affiliation(s)
- Chloe Woods
- Southampton Psychosis and Bipolar Research and Innovation Group, School of Psychology, University of Southampton, Hampshire, Southampton, UK
| | - Thomas Richardson
- Southampton Psychosis and Bipolar Research and Innovation Group, School of Psychology, University of Southampton, Hampshire, Southampton, UK
| | - Emma Palmer-Cooper
- Southampton Psychosis and Bipolar Research and Innovation Group, School of Psychology, University of Southampton, Hampshire, Southampton, UK
| |
Collapse
|
3
|
Palmer-Cooper EC, Woods C, Richardson T. The relationship between dysfunctional attitudes, maladaptive perfectionism, metacognition and symptoms of mania and depression in bipolar disorder: The role of self-compassion as a mediating factor. J Affect Disord 2023; 341:265-274. [PMID: 37633530 DOI: 10.1016/j.jad.2023.08.117] [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: 03/27/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Maladaptive cognitions appear to be associated with the severity of mood symptoms in bipolar disorder (BD), but findings are mixed and generally cross-sectional in design. METHOD This study (n = 331) explored the associations between maladaptive cognitions and mood symptoms in BD over time (3 months), and the potential mediating effect of self-compassion cross-sectionally. Dysfunctional attitudes, maladaptive perfectionism and maladaptive metacognitions were explored separately with depressive and manic symptoms, and with current mood state in BD. RESULTS The results showed maladaptive metacognitions to be the only significant predictor of depression at 3-month follow-up (β = 0.31, p < .001), with no relationship to mania over time. Cross-sectionally, self-compassion partially mediated the relationship between all maladaptive cognitions and depression, with higher dysfunctional cognitions and lower self-compassion predicting increased severity of depressive symptoms. Only the relationship between dysfunctional attitudes and mania was partially mediated by self-compassion, however, the relationship was weak and suggestive that higher self-compassion predicted increased mania. LIMITATIONS The study duration limited the possible analysis. Future longitudinal research is needed. Also, the study sample was not representative of the clinical population, making results less generalisable. Additionally, limited significant findings regarding manic symptoms supports the need for further research into active cognitions during this phase of BD. CONCLUSIONS Maladaptive metacognitions were predictive of future depression severity, therefore, further exploration of metacognitive therapy for BD should be explored. Furthermore, self-compassion was shown to partially mediate the relationship between negative cognitions and mood, therefore further exploration of compassion-based therapies for BD is needed.
Collapse
Affiliation(s)
- Emma C Palmer-Cooper
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, United Kingdom.
| | - Chloe Woods
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, United Kingdom.
| | - Thomas Richardson
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, United Kingdom.
| |
Collapse
|
4
|
Yang Y, Fletcher K, Murray G. A narrative review of cross-sectional and prospective associations between self-schemas and bipolar disorder. Clin Psychol Psychother 2021; 28:766-783. [PMID: 33386678 DOI: 10.1002/cpp.2547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/16/2020] [Indexed: 01/03/2023]
Abstract
The role of self-concept in bipolar disorder (BD) has not been well understood. The present review utilizes the notion of self-schema and interrogates existing research concerning evidence for cross-sectional and prospective associations between four schema-like constructs (i.e. trait self-esteem, dysfunctional beliefs concerning contingent self-worth, early maladaptive schemas and implicit self-esteem) and various facets of BD. Existing findings demonstrate various types of involvement of self-schemas in BD. Of particular clinical relevance, the present review suggests that low trait self-esteem and dysfunctional beliefs concerning contingent self-worth are risk factors for ongoing BD symptoms and mood episodes. The present review also yields important yet unaddressed questions with respect to the evaluative content of self-schemas associated with the hypo/manic phase of BD.
Collapse
Affiliation(s)
- Yan Yang
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - Kathryn Fletcher
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| |
Collapse
|
5
|
Cui Q, Sheng W, Chen Y, Pang Y, Lu F, Tang Q, Han S, Shen Q, Wang Y, Xie A, Huang J, Li D, Lei T, He Z, Chen H. Dynamic changes of amplitude of low-frequency fluctuations in patients with generalized anxiety disorder. Hum Brain Mapp 2019; 41:1667-1676. [PMID: 31849148 PMCID: PMC7267950 DOI: 10.1002/hbm.24902] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/26/2019] [Accepted: 12/09/2019] [Indexed: 01/18/2023] Open
Abstract
Previous neuroimaging studies have mainly focused on alterations of static and dynamic functional connectivity in patients with generalized anxiety disorder (GAD). However, the characteristics of local brain activity over time in GAD are poorly understood. This study aimed to investigate the abnormal time‐varying local brain activity of GAD by using the amplitude of low‐frequency fluctuation (ALFF) method combined with sliding‐window approach. Group comparison results showed that compared with healthy controls (HCs), patients with GAD exhibited increased dynamic ALFF (dALFF) variability in widespread regions, including the bilateral dorsomedial prefrontal cortex, hippocampus, thalamus, striatum; and left orbital frontal gyrus, inferior parietal lobule, temporal pole, inferior temporal gyrus, and fusiform gyrus. The abnormal dALFF could be used to distinguish between patients with GAD and HCs. Increased dALFF variability values in the striatum were positively correlated with GAD symptom severity. These findings suggest that GAD patients are associated with abnormal temporal variability of local brain activity in regions implicated in executive, emotional, and social function. This study provides insight into the brain dysfunction of GAD from the perspective of dynamic local brain activity, highlighting the important role of dALFF variability in understanding neurophysiological mechanisms and potentially informing the diagnosis of GAD.
Collapse
Affiliation(s)
- Qian Cui
- School of Public Affairs and Administration, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Sheng
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuyan Chen
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yajing Pang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Fengmei Lu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Qin Tang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Shaoqiang Han
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Qian Shen
- Education Center for Students Cultural Qualities, University of Electronic Science and Technology of China, Chengdu, China
| | - Yifeng Wang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Ailing Xie
- School of Public Affairs and Administration, University of Electronic Science and Technology of China, Chengdu, China
| | - Jing Huang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Di Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Ting Lei
- School of Public Affairs and Administration, University of Electronic Science and Technology of China, Chengdu, China
| | - Zongling He
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Huafu Chen
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| |
Collapse
|
6
|
Fletcher K, Yang Y, Johnson SL, Berk M, Perich T, Cotton S, Jones S, Lapsley S, Michalak E, Murray G. Buffering against maladaptive perfectionism in bipolar disorder: The role of self-compassion. J Affect Disord 2019; 250:132-139. [PMID: 30852365 DOI: 10.1016/j.jad.2019.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 02/12/2019] [Accepted: 03/03/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Maladaptive perfectionism is a transdiagnostic risk and maintaining factor for a range of mental health conditions, including bipolar disorder (BD). Self-compassion represents a potential protective factor against maladaptive perfectionism, however no studies to date have examined the relationship of these constructs in BD. The aim of the present study was to examine associations between maladaptive perfectionism, self-compassion and symptoms among individuals with BD. METHODS Baseline data were collected from 302 participants with a DSM-IV diagnosis of BD participating in an international randomised controlled trial. Participants completed measures of maladaptive perfectionism, self-compassion, symptom severity and emotion regulation difficulties. Clinician-administered measures of depression and mania severity were additionally collected. Correlation and mediation analyses were conducted. RESULTS Maladaptive perfectionism was positively associated with depression, anxiety and emotion regulation difficulties. Lower levels of self-compassion correlated with greater self-reported depression, anxiety and emotion regulation difficulties. Self-compassion partially mediated relationships between maladaptive perfectionism, depression, anxiety and emotion regulation difficulties. LIMITATIONS The cross-sectional design limits conclusions about causal relationships between study variables. Results may not be generalizable to other BD populations. The role of maladaptive perfectionism and self-compassion in elevated mood states of BD remains unclear. CONCLUSION Self-compassion represents one mechanism through which maladaptive perfectionism influences symptoms of depression, anxiety and emotion regulation difficulties in BD. Self-compassion represents a modifiable treatment target; individuals with BD exhibiting maladaptive perfectionistic tendencies may benefit from interventions fostering self-compassion.
Collapse
Affiliation(s)
- Kathryn Fletcher
- Centre for Mental Health, Swinburne University, Melbourne, Australia.
| | - Yan Yang
- Centre for Mental Health, Swinburne University, Melbourne, Australia
| | | | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Australia; Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Florey Institute for Neuroscience and Mental Health, Melbourne, Australia
| | - Tania Perich
- Western Sydney University, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Sue Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Steven Jones
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sara Lapsley
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Erin Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Greg Murray
- Centre for Mental Health, Swinburne University, Melbourne, Australia
| |
Collapse
|
7
|
Werner AM, Tibubos AN, Rohrmann S, Reiss N. The clinical trait self-criticism and its relation to psychopathology: A systematic review - Update. J Affect Disord 2019; 246:530-547. [PMID: 30599378 DOI: 10.1016/j.jad.2018.12.069] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 12/03/2018] [Accepted: 12/23/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Self-criticism represents a central phenomenon in a variety of mental disorders. The review looks at the recent body of literature (2012-2018) to summarize the relation of self-criticism and psychopathology beyond depression and aims at detecting how different conceptualizations of self-criticism with psychoanalytical, psychodynamic, or cognitive-evolutionary background are related to psychopathology. Furthermore, latest treatment approaches for dysfunctional forms of self-criticism are reviewed. METHODS The literature research of five databases (PsycINFO, PSYNDEX, PubMed, Medline, and Cochrane Library) took place in August 2018. Inclusion criteria for studies to enter the review narrative were an adult sample, non-clinical samples as well as clinical samples, and an empirical approach, which resulted in quantitative data. RESULTS 48 studies entered the review. Besides depressive symptoms, self-criticism showed positive relations to symptoms of eating disorders, social anxiety disorder, and personality disorders as well as to psychotic symptoms or interpersonal problems through different conceptualizations of self-criticism. Regarding the treatment of self-criticism, compassion- or emotion-focused therapy interventions were investigated in most of the reviewed studies and both reduced self-criticism in clinical and non-clinical samples. However, harsh forms of self-criticism were more persistent and difficult to change. LIMITATIONS The review focused only on the latest empirical findings regarding self-criticism and psychopathology. CONCLUSION Potentially functional forms and functions of self-criticism need further consideration, as they represent a possible goal of psychotherapeutic treatment. Future research should address specific questions regarding antecedents and consequences of self-criticism.
Collapse
Affiliation(s)
- Antonia M Werner
- Department of Psychology, Goethe-Universität, Frankfurt am Main, Campus Westend, PEG-Gebäude, Room 5.G039, Theodor-W.-Adorno-Platz 6, 60323, Germany.
| | - Ana N Tibubos
- University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Psychology, Goethe-Universität, Frankfurt am Main, Campus Westend, PEG-Gebäude, Room 5.G039, Theodor-W.-Adorno-Platz 6, 60323, Germany
| | - Sonja Rohrmann
- Department of Psychology, Goethe-Universität, Frankfurt am Main, Campus Westend, PEG-Gebäude, Room 5.G039, Theodor-W.-Adorno-Platz 6, 60323, Germany
| | - Neele Reiss
- Department of Psychology, Goethe-Universität, Frankfurt am Main, Campus Westend, PEG-Gebäude, Room 5.G039, Theodor-W.-Adorno-Platz 6, 60323, Germany
| |
Collapse
|
8
|
Ironside ML, Johnson SL, Carver CS. Identity in bipolar disorder: Self-worth and achievement. J Pers 2019; 88:45-58. [PMID: 30714166 DOI: 10.1111/jopy.12461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/10/2018] [Accepted: 01/27/2019] [Indexed: 12/17/2022]
Abstract
This article considers self and self-concept in bipolar disorder. Bipolar disorder, defined on the basis of manic symptoms, is a highly debilitating psychopathology. It is heavily grounded in biology but symptom course is still very responsive to psychological and social forces in the lives of persons who have the disorder. This review assumes an overall view of the self that is typical of personality psychology: self as traits, self as goals and aspirations, and ongoing efforts to attain those goals. In this review, we will discuss two different facets of self and identity in bipolar disorder. First, we review a body of goal pursuit literature suggesting that persons with bipolar disorder endorse heightened ambitions for attaining goals and recognition from others. Second, we will review multiple findings which suggest that among persons with bipolar disorder, self-worth depends on measurable success in an extreme way. We will consider how the intersection of these two themes may lead to unique identity challenges for people with bipolar disorder, drawing from self-report, behavioral, and neuroscience findings to critically examine this viewpoint.
Collapse
Affiliation(s)
- Manon L Ironside
- Department of Psychology, University of California, Berkeley, Berkeley, California
| | - Sheri L Johnson
- Department of Psychology, University of California, Berkeley, Berkeley, California
| | - Charles S Carver
- Department of Psychology, University of Miami, Coral Gables, Florida
| |
Collapse
|
9
|
Are Women More Likely than Men Are to Care Excessively about Maintaining Positive Social Relationships? A Meta-Analytic Review of the Gender Difference in Sociotropy. SEX ROLES 2018. [DOI: 10.1007/s11199-018-0980-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Hales SA, Di Simplicio M, Iyadurai L, Blackwell SE, Young K, Fairburn CG, Geddes JR, Goodwin GM, Holmes EA. Imagery-Focused Cognitive Therapy (ImCT) for Mood Instability and Anxiety in a Small Sample of Patients with Bipolar Disorder: a Pilot Clinical Audit. Behav Cogn Psychother 2018; 46:706-725. [PMID: 29983124 PMCID: PMC6140996 DOI: 10.1017/s1352465818000334] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the global impact of bipolar disorder (BD), treatment success is limited. Challenges include syndromal and subsyndromal mood instability, comorbid anxiety, and uncertainty around mechanisms to target. The Oxford Mood Action Psychology Programme (OxMAPP) offered a novel approach within a cognitive behavioural framework, via mental imagery-focused cognitive therapy (ImCT). AIMS This clinical audit evaluated referral rates, clinical outcomes and patient satisfaction with the OxMAPP service. METHOD Eleven outpatients with BD received ImCT in addition to standard psychiatric care. Mood data were collected weekly from 6 months pre-treatment to 6 months post-treatment via routine mood monitoring. Anxiety was measured weekly from start of treatment until 1 month post-treatment. Patient feedback was provided via questionnaire. RESULTS Referral and treatment uptake rates indicated acceptability to referrers and patients. From pre- to post-treatment, there was (i) a significant reduction in the duration of depressive episode relapses, and (ii) a non-significant trend towards a reduction in the number of episodes, with small to medium effect size. There was a large effect size for the reduction in weekly anxiety symptoms from assessment to 1 month follow-up. Patient feedback indicated high levels of satisfaction with ImCT, and underscored the importance of the mental imagery focus. CONCLUSIONS This clinical audit provides preliminary evidence that ImCT can help improve depressive and anxiety symptoms in BD as part of integrated clinical care, with high patient satisfaction and acceptability. Formal assessment designs are needed to further test the feasibility and efficacy of the new ImCT treatment on anxiety and mood instability.
Collapse
Affiliation(s)
- Susie A Hales
- Oxford Institute of Clinical Psychology Training,Oxford,UK
| | | | - Lalitha Iyadurai
- Department of Psychiatry,University of OxfordandOxford Health NHS Foundation Trust,UK
| | | | - Kerry Young
- Central and North West London NHS Foundation Trust,UK
| | | | - John R Geddes
- Department of Psychiatry,University of Oxford;NIHR Oxford Health Biomedical Research Centre and Oxford Health NHS Foundation Trust,UK
| | - Guy M Goodwin
- Department of Psychiatry,University of Oxford and Oxford Health NHS Foundation Trust,UK
| | - Emily A Holmes
- Division of Psychology,Department of Clinical Neuroscience,Karolinska Institutet,Stockholm,Sweden
| |
Collapse
|
11
|
Titone MK, Freed RD, O'Garro-Moore JK, Gepty A, Ng TH, Stange JP, Abramson LY, Alloy LB. The role of lifetime anxiety history in the course of bipolar spectrum disorders. Psychiatry Res 2018; 264:202-209. [PMID: 29653349 PMCID: PMC5972058 DOI: 10.1016/j.psychres.2018.03.087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/13/2018] [Accepted: 03/31/2018] [Indexed: 12/20/2022]
Abstract
Individuals with bipolar spectrum disorder (BSD) frequently meet criteria for comorbid anxiety disorders, and anxiety may be an important factor in the etiology and course of BSDs. The current study examined the association of lifetime anxiety disorders with prospective manic/hypomanic versus major depressive episodes. Participants were 244 young adults (aged 17-26) with milder forms of BSDs (i.e., bipolar-II, cyclothymia, BD-NOS). First, bivariate analyses assessed differences in baseline clinical characteristics between participants with and without DSM-IV anxiety diagnoses. Second, negative binomial regression analyses tested whether lifetime anxiety predicted number of manic/hypomanic or major depressive episodes developed during the study. Third, survival analyses evaluated whether lifetime anxiety predicted time to onset of manic/hypomanic and major depressive episodes. Results indicated that anxiety history was associated with greater illness severity at baseline. Over follow-up, anxiety history predicted fewer manic/hypomanic episodes, but did not predict number of major depressive episodes. Anxiety history also was associated with longer time to onset of manic/hypomanic episodes, but shorter time to onset of depressive episodes. Findings corroborate past studies implicating anxiety disorders as salient influences on the course of BSDs. Moreover, results extend prior research by indicating that anxiety disorders may be linked with reduced manic/hypomanic phases of illness.
Collapse
Affiliation(s)
- Madison K Titone
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Rachel D Freed
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Jared K O'Garro-Moore
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Andrew Gepty
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Tommy H Ng
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Jonathan P Stange
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Lyn Y Abramson
- Department of Psychology, University of Wisconsin-Madison, 1202W. Johnson Street, Madison, WI 53706, USA
| | - Lauren B Alloy
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA.
| |
Collapse
|
12
|
Corry J, Green M, Roberts G, Fullerton JM, Schofield PR, Mitchell PB. Does perfectionism in bipolar disorder pedigrees mediate associations between anxiety/stress and mood symptoms? Int J Bipolar Disord 2017; 5:34. [PMID: 28983840 PMCID: PMC5629191 DOI: 10.1186/s40345-017-0102-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 09/11/2017] [Indexed: 01/12/2023] Open
Abstract
Background Bipolar disorder (BD) and the anxiety disorders are highly comorbid. The present study sought to examine perfectionism and goal attainment values as potential mechanisms of known associations between anxiety, stress and BD symptomatology. Measures of perfectionism and goal attainment values were administered to 269 members of BD pedigrees, alongside measures of anxiety and stress, and BD mood symptoms. Regression analyses were used to determine whether perfectionism and goal attainment values were related to depressive and (hypo)manic symptoms; planned mediation models were then used to test the potential for perfectionism to mediate associations between anxiety/stress and BD symptoms. Results Self-oriented perfectionism was associated with chronic depressive symptoms; socially-prescribed perfectionism was associated with chronic (hypo)manic symptoms. Self-oriented perfectionism mediated relationships between anxiety/stress and chronic depressive symptoms even after controlling for chronic hypomanic symptoms. Similarly, socially-prescribed perfectionism mediated associations between anxiety/stress and chronic hypomanic symptoms after controlling for chronic depressive symptoms. Goal attainment beliefs were not uniquely associated with chronic depressive or (hypo)manic symptoms. Conclusions Cognitive styles of perfectionism may explain the co-occurrence of anxiety and stress symptoms and BD symptoms. Psychological interventions for anxiety and stress symptoms in BD might therefore address perfectionism in attempt to reduce depression and (hypo)manic symptoms in addition to appropriate pharmacotherapy. Electronic supplementary material The online version of this article (doi:10.1186/s40345-017-0102-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Justine Corry
- School of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia.,Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - Melissa Green
- School of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia.,Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, 2031, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Gloria Roberts
- School of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia.,Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - Janice M Fullerton
- Neuroscience Research Australia, Randwick, NSW, Australia.,School of Medical Sciences, University of New South Wales, Randwick, NSW, Australia
| | - Peter R Schofield
- Neuroscience Research Australia, Randwick, NSW, Australia.,School of Medical Sciences, University of New South Wales, Randwick, NSW, Australia
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia. .,Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, 2031, Australia. .,Prince of Wales Hospital, Randwick, NSW, 2031, Australia.
| |
Collapse
|
13
|
An integrative study of motivation and goal regulation processes in subclinical anxiety, depression and hypomania. Psychiatry Res 2017; 256:6-12. [PMID: 28618249 DOI: 10.1016/j.psychres.2017.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 05/23/2017] [Accepted: 06/01/2017] [Indexed: 12/30/2022]
Abstract
Research has implicated motivation and goal regulation in susceptibility to mood disorders. We studied for the first time key facets of motivation and goal regulation concurrently in relation to affective symptoms. The cross-national sample comprised 510 university students from the United States (n = 279) and United Kingdom (n = 231). Participants completed self-report measures of motivation, conditional goal setting, urgency, depression, anxiety, and mania risk. Structural Equation Modeling results found that behavioral activation system scores correlated negatively with depression and positively with mania risk, but were unrelated to anxiety. High conditional goal setting correlated uniquely with higher depression but not to anxiety or mania risk. Urgency correlated with higher anxiety, depression, and mania risk. Behavioral inhibition system scores correlated negatively with mania risk but unexpectedly did not correlate with anxiety in the multivariate model. The behavioral activation, behavioral inhibition, conditional goal setting, and urgency results showed shared and distinct patterns of relationships with depression, anxiety and mania risk. Our findings indicate unique and common risk vulnerabilities in depressive, anxious, and manic syndromes and extend an integrative knowledge of these syndromes in relation to goal regulation.
Collapse
|
14
|
Pavlova B, Perlis RH, Mantere O, Sellgren CM, Isometsä E, Mitchell PB, Alda M, Uher R. Prevalence of current anxiety disorders in people with bipolar disorder during euthymia: a meta-analysis. Psychol Med 2017; 47:1107-1115. [PMID: 27995827 DOI: 10.1017/s0033291716003135] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anxiety disorders are highly prevalent in people with bipolar disorder, but it is not clear how many have anxiety disorders even at times when they are free of major mood episodes. We aimed to establish what proportion of euthymic individuals with bipolar disorder meet diagnostic criteria for anxiety disorders. METHOD We performed a random-effects meta-analysis of prevalence rates of current DSM-III- and DSM-IV-defined anxiety disorders (panic disorder, agoraphobia, social anxiety disorder, generalized anxiety disorder, specific phobia, obsessive-compulsive disorder, post-traumatic stress disorder, and anxiety disorder not otherwise specified) in euthymic adults with bipolar disorder in studies published by 31 December 2015. RESULTS Across 10 samples with 2120 individuals with bipolar disorder, 34.7% met diagnostic criteria for one or more anxiety disorders during euthymia [95% confidence interval (CI) 23.9-45.5%]. Direct comparison of 189 euthymic individuals with bipolar disorder and 17 109 population controls across three studies showed a 4.6-fold increase (risk ratio 4.60, 95% CI 2.37-8.92, p < 0.001) in prevalence of anxiety disorders in those with bipolar disorder. CONCLUSIONS These findings suggest that anxiety disorders are common in people with bipolar disorder even when their mood is adequately controlled. Euthymic people with bipolar disorder should be routinely assessed for anxiety disorders and anxiety-focused treatment should be initiated if indicated.
Collapse
Affiliation(s)
- B Pavlova
- Nova Scotia Health Authority,Halifax, Nova Scotia,Canada
| | - R H Perlis
- Department of Psychiatry,Harvard Medical School,Boston, MA,USA
| | - O Mantere
- Douglas Mental Health University Institute,Montréal, Québec,Canada
| | - C M Sellgren
- Department of Psychiatry,Harvard Medical School,Boston, MA,USA
| | - E Isometsä
- Department of Psychiatry,University of Helsinki and Helsinki University Hospital,Helsinki,Finland
| | - P B Mitchell
- University of New South Wales, School of Psychiatry,Sydney,Australia
| | - M Alda
- Nova Scotia Health Authority,Halifax, Nova Scotia,Canada
| | - R Uher
- Nova Scotia Health Authority,Halifax, Nova Scotia,Canada
| |
Collapse
|
15
|
Berkol TD, Kırlı E, Islam S, Pınarbaşı R, Özyıldırım İ. Comparison of clinical and sociodemographic features of bipolar disorder patients with those of social anxiety disorder patients comorbid with bipolar disorder in Turkey. Saudi Med J 2016; 37:309-14. [PMID: 26905355 PMCID: PMC4800897 DOI: 10.15537/smj.2016.3.13108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To assess the impact of social anxiety disorder (SAD) comorbidity on the clinical features, illness severity, and response to mood stabilizers in bipolar disorder (BD) patients. Methods: This retrospective study included bipolar patients that were treated at the Department of Psychiatry, Haseki Training and Research Hospital, Istanbul, Turkey in 2015, and who provided their informed consents for participation in this study. The study was conducted by assessing patient files retrospectively. Two hundred bipolar patients were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition axis-I (SCID-I) in order to detect all possible comorbid psychiatric diagnoses. The sample was split according to the presence of SAD comorbidity and the groups were compared. Results: The SAD comorbidity was detected in 17.5% (35/200) of the BD patients. The SAD comorbid bipolar patients were more educated, had earlier onset of BD, lower number of manic episodes, and more severe episodes. There was no difference between groups in terms of total number of episodes, hospitalization, suicidality, being psychotic, treatment response to lithium and anticonvulsants. Conclusion: Social anxiety disorder comorbidity may be associated with more severe episodes and early onset of BD. However, SAD comorbidity may not be related to treatment response in bipolar patients.
Collapse
Affiliation(s)
- Tonguç D Berkol
- Department of Psychiatry, DışkapıYıldırım Beyazıt Research and Training Hospital, Ankara, Turkey. E-mail.
| | | | | | | | | |
Collapse
|
16
|
Pavlova B, Perlis RH, Alda M, Uher R. Lifetime prevalence of anxiety disorders in people with bipolar disorder: a systematic review and meta-analysis. Lancet Psychiatry 2015; 2:710-717. [PMID: 26249302 DOI: 10.1016/s2215-0366(15)00112-1] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/08/2015] [Accepted: 03/11/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Anxiety disorders are increasingly recognised as an important determinant of outcomes in patients with bipolar disorder. However, a reliable estimate of their prevalence is still missing, because the published prevalence of anxiety disorders in individuals with bipolar disorder varies widely. In this study, we aimed to quantify the lifetime prevalence of anxiety disorders in individuals with bipolar disorder and compare it with rates in people without the disorder. METHODS We searched the Web of Knowledge and Medline (through the PubMed interface) for articles published in any language from the database inception dates up until June 1, 2014, using a combination of the word "bipolar" and search terms for anxiety disorders. We included studies that reported original data about the lifetime prevalence of DSM-III and DSM-IV anxiety disorders in adults with bipolar disorder that recruited participants irrespective of comorbidities and that used a validated diagnostic interview to establish the diagnoses of bipolar disorder and at least one anxiety disorder. We excluded studies that reported only the current prevalence or if we were unable to establish whether they described current or lifetime prevalence, and those with discrepancies in the data that could not be resolved by contacting the authors. We did a random-effects meta-analysis of lifetime prevalence of DSM-III and DSM-IV anxiety disorders in adults with bipolar disorder, in which we quantified the lifetime prevalence of any anxiety disorder in people with bipolar disorder. We compared this prevalence in people with bipolar I disorder versus those with bipolar II disorder, and in people with bipolar disorder versus population controls. FINDINGS Data from 40 studies, including 14 914 individuals from North America, Europe, Australia, South America, and Asia, indicate that the lifetime prevalence of anxiety disorders in individuals with bipolar disorder is 45% (95% CI 40-51). Direct comparison in five samples with a total of 1378 individuals with bipolar disorder and 56 812 population controls without bipolar disorder indicates a three-fold increase (risk ratio [RR] 3·22 [95% CI 2·41-4·29]; p<0·0001) in the prevalence of anxiety disorders in those with bipolar disorder. 13 studies that included both individuals with bipolar I disorder (n=4270) and those with bipolar II disorder (n=1939) showed no difference in the lifetime prevalence of anxiety disorders between these subtypes (RR 1·07 [95% CI 0·96-1·20]; p=0·223). We noted significant heterogeneity among included studies that was not accounted for by reported differences in study characteristics. INTERPRETATION People with bipolar disorder are at increased risk of anxiety disorders compared with those without bipolar disorder; nearly one in two has an anxiety disorder in their lifetime. Anxiety disorders should therefore be assessed alongside the mood symptoms in patients with bipolar disorder. FUNDING Capital Health Research Fund.
Collapse
Affiliation(s)
- Barbara Pavlova
- Nova Scotia Health Authority, Halifax, NS, Canada; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
| | - Roy H Perlis
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Martin Alda
- Nova Scotia Health Authority, Halifax, NS, Canada; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Rudolf Uher
- Nova Scotia Health Authority, Halifax, NS, Canada; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
17
|
Hsu YC, Hsu CC, Chang KH, Lee CY, Chong LW, Wang YC, Kao CH. Increased Subsequent Risk of Peptic Ulcer Diseases in Patients With Bipolar Disorders. Medicine (Baltimore) 2015; 94:e1203. [PMID: 26200637 PMCID: PMC4602988 DOI: 10.1097/md.0000000000001203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Previous studies have reported that patients with bipolar disorders (BDs) exhibit increased physical comorbidity and psychological distress. Studies have shown that schizophrenia and anxiety increase the risk of peptic ulcer diseases (PUDs). Therefore, we conducted this study to determine the association between these 2 diseases and examine the possible risk factors. We used patients diagnosed with BDs from the Taiwan National Health Insurance Research Database. A comparison cohort comprising patients without BDs was frequency matched by age, sex, and comorbidities, and the occurrence of PUDs was evaluated in both the cohorts. The BD and non-BD cohort consisted of 21,060 patients with BDs and 84,240 frequency-matched patients without BDs, respectively. The incidence of PUDs (hazard ratio, 1.51; 95% confidence interval, 1.43-1.59; P < 0.001) was higher among the patients with BDs than the control patients. Cox models showed that irrespective of comorbidities, BDs were an independent risk factor for PUDs. Patients with BDs exhibit a substantially higher risk for developing PUDs. According to our data, we suggest that, following a diagnosis of BD, practitioners could notice the occurrence of PUD and associated prevention. Further prospective clinical studies investigating the relationship between BDs and PUDs are warranted.
Collapse
Affiliation(s)
- Yi-Chao Hsu
- From the Department of Psychiatry (C-CH), Kaohsiung Veterans General Hospital, Kaohsiung; Institute of Biomedical Sciences (Y-CH), Mackay Medical College, Taipei; Department of Medical Research (K-HC), Taichung Veterans General Hospital, Taichung; School of Chinese Medicine for Post-Baccalaureate (C-YL), I-Shou University, Kaohsiung; Division of Hepatology and Gastroenterology (L-WC), Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei; Management Office for Health Data (Y-CW), China Medical University Hospital, Taichung; College of Medicine (Y-CW), China Medical University, Taichung; Department of Nuclear Medicine and PET Center (C-HK), China Medical University Hospital, Taichung; Graduate Institute of Clinical Medical Science and School of Medicine (C-HK), College of Medicine, China Medical University, Taichung, Taiwan
| | | | | | | | | | | | | |
Collapse
|