Social adjustment and self-esteem of bipolar patients: a multicentric study

The Relationship between Meaning in Life and Mental Health in Chinese Undergraduates: The Mediating Roles of Self-Esteem and Interpersonal Trust

To explore the association and the underlying process between meaning in life and psychological health, a stratified random sampling was conducted on undergraduate students from five universities in Fujian Province from March to April 2022, with the Meaning in Life Questionnaire, the Self-Esteem Scale, the Interpersonal Trust Scale, and the Kessler10 Scale. The results indicated that 34.5% of Chinese undergraduates were in poor or worse mental health. There were significant positive correlations among meaning in life, self-esteem, and interpersonal trust; meaning in life, self-esteem, and interpersonal trust were all significantly and positively correlated with mental health. Self-esteem and interpersonal trust played a chain mediating role between meaning in life and mental health. Schools and families should conduct appropriate activities to help them enhance meaning in life so as to improve the level of mental health.

Individuals with genetic high-risk for psychosis experience impaired coping styles compared with healthy controls

BACKGROUND

Individuals with schizophrenia tend to have negative coping styles and low levels of self-esteem, but it is unclear whether coping styles and self-esteem levels are altered in people in the prodromal phase of psychosis.

AIMS

The study was designed to assess the role of coping style and self-esteem in the context of different phases of schizophrenia.

METHODS

Recurrent Schizophrenia (ReSch), first-episode schizophrenia patients (FEP), genetic-high risk for psychosis (GHR) patients, and healthy controls (HC) (40 per group) were subjected to in-person clinical interviews. The results of these interviews were then used to gauge coping style and self-esteem using the Coping Styles Questionnaire (CSQ) and the Rosenberg's Self-Esteem Scale (RSES). Data were analyzed through ANCOVAs and logistic regression analyses.

RESULTS

The results found that positive coping style (CSQ problem-solving and CSQ seeking for help) generally decline with progression through the HC, GHR, and FEP groups, while negative coping style (CSQ fantasy, CSQ repression and CSQ self-blame) generally increase with progression through the HC, GHR, and FEP groups (except that GHR group was slightly lower than HC group in CSQ self-blame). Results for members of ReSch group were in line with those of members of the FEP group in coping style. At the level of self-esteem, the GHR group was similar to the HC group and significantly higher than the FEP group and the ReSch group. Logistic regression analyses indicated that GHR group patients exhibited increased negative coping styles (CSQ fantasy) relative to members of the HC group, but had greater Positive coping style (CSQ problem-solving) than did members of the FEP group.

DISCUSSION

These findings suggest that both GHR individuals experience impaired negative coping styles which expands the understanding of the psychological characteristics of the prodromal group. Further explorations are warranted to develop optimal psychosocial interventions.

[Self-stigma and functioning in patients with bipolar disorder]

Self-stigma of people with bipolar disorder is an underestimated problem, with serious consequences in terms of clinical severity and social and professional functioning.

OBJECTIVES

This study aimed to evaluate self-stigma in patients with bipolar disorder, to identify socio-demographic and clinical factors associated with it and to analyze the links between self-stigma and functioning in this population.

METHODS

We conducted a cross-sectional, descriptive and analytic study including 61 patients with bipolar disorder meeting criteria of remission. We used the internalized stigma of mental illness (ISMI) to investigate self-stigma, and the functioning assessment short test (FAST) to assess functioning.

RESULTS

The mean age of patients was 43.4 years. The sex ratio was 2.4. Half of the patients were single or divorced (50 %). They had secondary or university education in 69 % of cases and were professionally inactive in 59 % of cases. The socioeconomic level was low or medium in 92 % of cases. A personal judicial record was found in 16 % of patients, a suicide attempt in 41 % of cases. Most patients in our series had bipolar I disorder (92 %). The mean age at onset of the disease was 23.5 years, with a mean duration of disease progression of 20 years. Patients were hospitalized an average of 5.9 times. Most patients (90 %) exhibited psychotic features during their mood relapses. The mean duration of the last remission was 27.9 months. Patients had regular follow-ups at our consultations in 87 % of cases. Among the patients included in the study, 8 % were on long-acting neuroleptics. The mean score on the internalized stigma of mental illness was 2.36±0.56. More than half of our patients (59 %) were self-stigmatized. Discrimination and alienation were found in 51 % of cases, followed by resistance to stigmatization (43 %) and assimilation of stereotypes (41 %). Regarding functioning, a global impairment was noted in more than two thirds of patients (71 %). An alteration in professional functioning was found in 82 % of cases and in cognitive functioning in 69 % of cases. Disruption of the financial sphere concerned 43 % of the patients, and the relational sphere 41 % of them. Autonomy was altered in 41 % of patients. Analysis of the relationships between self-stigma and characteristics of the study population revealed statistically significant associations between higher self-stigma scores and single or divorced status, low socio-economic level and judicial record. In terms of clinical parameters, the mean self-stigma score was significantly associated with a higher total number of thymic episodes and hospitalizations, a longer cumulative duration of hospitalizations and a shorter duration of the last remission. In addition, the mean self-stigma score was associated with significantly more impaired functioning.

CONCLUSIONS

Our study underlines the need to work towards the implementation of management modalities aimed at combating the self-stigmatization of patients with bipolar disorder and mitigating its negative consequences during the course of the disease.

Domain-Based Functional Improvements in Bipolar Disorder After Interpersonal and Social Rhythm Therapy

BACKGROUND

Studies typically report overall change in function when assessing bipolar disorder (BD) interventions, but individual domains are not analyzed. Which aspects of functioning are impacted is clearly important and may differ between treatments.

METHODS

Data were analyzed from two previous clinical trials of Interpersonal and Social Rhythm Therapy (IPSRT) for BD patients. Change in total and subscale scores on the Social Adjustment Scale Self-Report (SAS-SR) from 0 to 78 weeks, were analyzed.

RESULTS

152 BD patients took part in randomized controlled trials of IPSRT (n = 38) vs. Specialist Supportive Care (SSC) (n = 43), and of IPSRT (n = 41) vs. treatment as usual (TAU) which was discharge to primary care (n = 30). IPSRT was superior to TAU on change in the social and leisure activities and extended family subscales, and SAS-SR total score over 18 months.

LIMITATIONS

Studies were not designed to be pooled. Patients in study 1 were younger and symptomatic at baseline. Patients assigned to TAU were more likely to drop-out. Patients did not respond to subscales that were not personally applicable (work, marital, children).

CONCLUSION

IPSRT had a positive impact on two SAS-SR subscales compared to TAU over 18 months. Other subscales were limited by the lack of respondents due to individual applicability. Different psychotherapy may have differential effects on different domains of function. Measures of function and research into functioning in BD should include domain-based measures, and report the numbers of participants who respond to questions in each domain.

Emotional journey of wives of spouses diagnosed with bipolar I disorder: moving from vicissitude towards reconciliation

PURPOSE

Our present study was a qualitative investigation intending to explore the emotional journey of wives whose spouse has been diagnosed with Bipolar I Disorder, using a phenomenological design.

METHOD

Semi-structured face to face interviews were conducted with 5 wives of already diagnosed Bipolar I Disorder patients to uncover their lived experience in terms of the emotional journey they had had. For data analysis, we used Hycner's explicitation process. Moreover, for data verification we employed the strategies of frequent debriefing sessions peer review and member checks.

RESULTS

Our analysis revealed six major themes encapsulating the participants emotional journey. These included Shock, Betrayal and the Incomprehensible, Apprehensions and Uncertainty, Anger and Irritability, Loneliness and Helplessness, Compassion and Acceptance and Reconciliation.

CONCLUSION

It became clear to us that wives of individuals diagnosed with Bipolar I Disorder are on a continuous emotional journey dealing with the burden, stress, complications, uncertainty and making many sacrifices along the way. Our study highlighted many culture specific factors of the phenomenon. This insightful exploration has opened up new horizons to conceptualize the challenges of wives dealing with an ailing spouse in the context of a Pakistani society.

Maladaptive personality traits and the course of suicidal ideation in young adults with bipolar disorder: Cross-sectional and prospective approaches

BACKGROUND

Childhood-onset bipolar disorder (BD) has considerable morbidity and mortality, including suicide. Many risk factors have been identified for suicidality, but the potential role of personality traits as assessed by a computer-assisted self-report measure remains unclear.

AIMS

To address this gap in knowledge, we tested relations between pathological-range personality traits and suicidal ideation among young adults whose childhood-onset BD was prospectively confirmed by enrollment in the Course and Outcome of Bipolar Youth study (COBY) as children (n = 45) and a newly enrolled group of typically developing controls (TDCs; n = 52) both cross-sectionally and longitudinally after 1.5 years of follow up.

MATERIALS & METHODS

Personality traits were assessed with the computerized Schedule for Nonadaptive and Adaptive Personality-2 (SNAP-2).

RESULTS

Cross-sectionally, we found that participants with BD had elevated Suicide Proneness and Low Self-esteem versus TDCs at baseline. Furthermore, longitudinal analyses in the BD participants for whom we had 1.5 years of prospectively collected illness-course data showed that greater Suicide Proneness and Low Self-esteem prospectively predicted greater levels, shorter time until occurrence, and greater frequency of suicidal ideation during the follow-up.

CONCLUSION

Our findings suggest the role of specific personality-related vulnerabilities in the course of BD that, pending replication, could contribute to development of interventions focused on personality traits among individuals with BD.

Differential diagnosis of borderline personality disorder and bipolar disorder: Self-concept, identity and self-esteem

Symptoms of borderline personality disorder (BPD) and bipolar disorder (BD) often overlap. In some cases, it is difficult to conduct a differential diagnosis based only on current diagnostic criteria Therefore, it is important to find clinical factors with high discriminatory specificity that, used together with structured or semi-structured interviews, could help improve diagnostic practice. We propose that a clinical analysis of identity, self-concept and self-esteem may help distinguish the two disorders, when they are not co-morbid. Our review of the studies that analyse these constructs in BD and BPD, separately, points in the direction of qualitative differences between the two disorders. In BPD, there is a well-documented identity diffusion, and the self-concept appears predominantly negative; shifts in self-concept and self-esteem are often tied to interpersonal triggers. In BD, patients struggle with their identity, but narrative identity might be less compromised compared with BPD; the shifts in self-concept and self-esteem appear more linked to internal (i.e. mood and motivational) factors. We end the paper by discussing the implications for clinicians and ideas for future comparative research.

Parental and partner role functioning and personal recovery in bipolar disorder

OBJECTIVES

Bipolar disorder research has primarily focused on clinical outcomes but there is increasing understanding of the importance of personal recovery. This study aimed to explore the relationship between functioning in key social roles including parenting and intimate relationships with personal recovery.

METHOD

Participants with bipolar disorder (N = 393) were recruited to participate in an online survey. Participants provided clinical information and completed measures of personal recovery, parental and intimate relationship functioning.

RESULTS

Parental functioning and intimate relationship functioning were found to be significantly associated with recovery scores with higher scores being associated with greater recovery. Parental functioning was also found to have a predictive effect, with higher parental functioning predicting greater recovery scores.

CONCLUSIONS

This study suggests that greater parental functioning may have an important role in the experience of personal recovery for people living with bipolar disorder. Future studies should further assess how supporting parenting may contribute recovery outcomes.

Differences in the Clinical Picture in Women with a Depressive Episode in the Course of Unipolar and Bipolar Disorder

Due to current depression prevalence, it is crucial to make the correct diagnosis as soon as possible. The study aimed to identify commonly available, easy to apply, and quick to interpret tools allowing for a differential diagnosis between unipolar and bipolar disorder. The study group includes women with long duration of unipolar (UP, N = 34) and bipolar (BP, N = 43) affective disorder. The diagnosis was established according to the DSM criteria using SCID questionnaire. Additional questionnaires were used to differentiate between UP and BP. BP patients had an earlier age of onset, were hospitalized more times, and more often had a family history of psychiatric disorders than UP (p-value < 0.05). Moreover, BP achieved a higher impulsiveness score and more frequently had experienced severe problems with close individuals. To our knowledge, this is the first publication presenting results of numerous questionnaires applied simultaneously in patients on clinical group. Several of them suggest the direction of clinical assessment, such as: the age of onset, family psychiatric burdens, history of stressful life events, learning problems, social and job relations. Further studies are necessary to confirm the utility of this approach.

A narrative review of cross-sectional and prospective associations between self-schemas and bipolar disorder

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.

Subjective Family Socioeconomic Status and Peer Relationships: Mediating Roles of Self-Esteem and Perceived Stress

This study explored the relationships between subjective family socioeconomic status (FSES), self-esteem, perceived stress, and perceived peer relationships among Chinese adolescents. A total of 1,353 adolescents (age range: 15-19 years) were asked to complete a questionnaire. Mediation analysis revealed that subjective FSES influenced perceived peer relationships in three ways: first, through the mediating effect of perceived stress; second, through the mediating effect of self-esteem; and third, through the serial mediating effects of perceived stress and self-esteem. The results remained significant after controlling for parental education. In addition, a contrast analysis showed no significant differences in the mediating effects of self-esteem and perceived stress. Thus, we suggest that steps should be taken to improve adolescents' self-esteem and reduce their stress through training interventions and preventive measures, to help them improve their perceived peer relationships and reduce adverse effects associated with low subjective FSES.

Imbalances in the Study of the Relationship between Leisure and Self-Esteem: A Systematic Review

This systematic review offers a comprehensive examination of the relationship between leisure and self-esteem. The different perspectives were analyzed according to a framework that includes the different approaches for defining and measuring leisure, and a similar one was proposed for self-esteem. Articles indexed in the Web of Science (WoS) up to the end of 2018 were reviewed, specifically those that contained the keywords “leisure”, “self-esteem” or “self esteem” anywhere in the manuscript. Articles that did not present the qualitative or quantitative instruments needed to evaluate leisure or self-esteem were excluded. A total of 49 articles included the final quantitative synthesis. The overall findings showed that the prevailing methodology was objective (external). As regards content, the following combinations predominated: the behavioral approach to leisure with the unidimensional approach to self-esteem and the experiential approach to leisure with the unidimensional approach to self-esteem. Less studies were observed with the combination of mixed approaches and more comprehensive analyses: the behavioral-experiential combined with the multidimensional. To conclude, this study shows there is a demand for further empirical studies that explore the relationships between leisure and self-esteem. It also identified which approaches are most desirable to expand our understanding of the relationships between leisure and self-esteem.

Perceived loss among people living with mental disorders: Validation of the personal loss from mental illness scale

OBJECTIVE

The development of mental illness often leads to pervasive losses in different areas of people's lives. However, previous research has tended to focus on the loss experienced by families while the examination of the loss experienced by individuals who are themselves coping with mental illness has been neglected. The present study tested the factor structure of the Hungarian version of the Personal Loss from Mental Illness (PLMI) scale, and analyzed its associations with age, gender, previous hospitalizations, marital status, loneliness, grief, and quality of life.

METHODS

Mentally ill patients (N = 200) with different diagnoses were recruited from a mental health center in Hungary, and completed self-report questionnaires. Confirmatory factor analysis (CFA) with covariates was conducted.

RESULTS

CFA analyses rejected the previous four-factor structure and suggested a single factor structure to be superior. Higher loss perception was predicted by higher loneliness, grief, and lower quality of life. Patients with mood disorders reported higher loss as compared to patients with other psychiatric diagnoses.

CONCLUSIONS

The present study stresses the magnitude of loss and raises the need to examine further the role of loss in coping and recovery. Asking patients about their feelings in clinical practice is of high importance.

Self-stigma, stigma coping and functioning in remitted bipolar disorder

OBJECTIVE

Stigma has a deleterious effect on functioning in individuals with bipolar disorder (BD). However, there has been no research investigating how stigma coping predicts self-stigma and functioning in BD. Furthermore, how different stages of self-stigma might affect functioning is unclear. The following hypotheses were examined: (1) Stigma coping by withdrawal and secrecy was associated with more self-stigma; (2) Stigma coping by withdrawal and secrecy was associated with worse social functioning; and (3) Later stages of self-stigma were associated with worse social functioning.

METHODS

A random sample of remitted BD in a regional psychiatric clinic was examined using a cross-sectional design (n = 115). Self-stigma was measured using the Chinese versions of Self-Stigma of Mental Illness Scale (C-SSMIS). Social functioning was assessed using the Functional Assessment Short Test (FAST). Stigma coping was evaluated using the Stigma Coping Orientation Scale (SCOS).

RESULTS

Multiple regression analysis revealed that coping by secrecy was associated with the stereotype agreement subscale of C-SSMIS, while coping by withdrawal was associated with the C-SSMIS self-concurrence and self-esteem decrement subscales. Another regression analysis showed that FAST total score was associated with the self-esteem decrement subscale of C-SSMIS and the severity of depressive and manic symptoms.

CONCLUSION

We showed that self-esteem decrement, the final stage of self-stigma, was the most crucial stage in determining psychosocial functioning. Our findings suggested that stigma-reduction intervention should be arranged during the early stage of BD and targeted at various dysfunctional stigma coping.

The impact of a CBT-based bipolar disorder psychoeducation group on views about diagnosis, perceived recovery, self-esteem and stigma

Previous research has shown that psychoeducation for bipolar disorder (BD) improves symptoms and reduces relapse risk, but there is little research on how this impacts stigma, perceived recovery and views about diagnosis. The aim of this study was to explore whether a cognitive behaviour therapy (CBT)-based 12-week BD psychoeducation group conducted in a community mental health team for adults impacted perceived stigma, diagnosis-related self-esteem, recovery and views about diagnosis. The case series pre- and post-group had 23 participants across three groups. The Brief Illness Perception Questionnaire, views on Manic Depression Questionnaire, Bipolar Recovery Questionnaire and author-constructed questions were completed pre and post. Twenty participants completed the group. An intent-to-treat repeated measures multiple analysis of variance showed significantly improved perceived recovery and improvements in sense of control and understanding around their diagnosis. Other specific questions such as understanding of triggers and impact of thinking patterns also improved. However, there was no change in the perceived stigma or self-esteem associated with living with BD. CBT-based psychoeducation groups may help improve perceived recovery and factors such as sense of control in BD. However, there appears to be no impact on stigma and self-esteem, and the role of non-specific factors needs to be examined further.

Key learning aims

(1)

Self-esteem moderates affective and psychotic responses to social stress in psychosis: A virtual reality study

BACKGROUND

Higher liability to psychosis is associated with low self-esteem and increased sensitivity to social stress. Recently, we reported a positive relation between liability to psychosis and affective and psychotic responses to social stress. This study investigated how self-esteem moderates paranoia, peak subjective distress and stress reactivity of people with different psychosis liability in response to social stressors in virtual reality.

METHODS

Ninety-four individuals with lower (41 siblings and 53 controls) and 75 persons with higher psychosis liability (55 with recent onset psychotic disorder and 20 at ultra-high risk for psychosis) explored five times a virtual café with various social stressors (crowdedness, ethnic minority status, and hostility). They rated momentary paranoia (State Social Paranoia Scale) after each experiment and subjective distress on a visual analogue scale before and after the experiments. Positive and negative self-esteem were assessed with the Self-Esteem Rating Scale.

RESULTS

Momentary paranoia, peak subjective distress, and reactivity to social stressors were associated with negative self-esteem, but not positive self-esteem. Effects of both positive and negative self-esteem on psychotic and affective stress responses, but not stress reactivity, became significantly stronger when individuals were exposed to more stressful environments. Effects of self-esteem on momentary paranoia and peak subjective distress did not differ between the high liability and low liability group. Persons with lower psychosis liability had a stronger effect of negative self-esteem on stress reactivity than persons with higher liability.

CONCLUSIONS

Positive and negative self-esteem may play an important role in affective and psychotic responses to social stress.

Effects of personality functioning on the global functioning of patients with bipolar disorder I

Due to the comorbidity of personality traits or disorders and BD, the present study investigated the extent to which the global functioning of patients with BD would be affected by personality functioning. This study included 100 subsequent patients who had been diagnosed with BD-I, and were in the remission phase. Global functioning was assessed with the Bipolar Disorder Functioning Questionnaire (BDFQ) and the Level of Personality Functioning Scale (LPFS) was conducted following psychodynamic-oriented semi-structured interviews to assess the level of personality functioning. Hierarchical linear regression models were conducted. After controlling other variables, the predictability of LPFS components on global functionality was assessed. Global functioning was negatively correlated with subsyndromal depressive symptoms, the presence of a psychiatric comorbidity, alcohol/substance use disorders, the side effects of medication, poor social support, and an impaired level of personality functioning. Finally, a decrease in the level of personality functioning predicted impaired global functioning. The present study demonstrated that the level of personality functioning had a significant impact on global functioning during the euthymic period of BD. Therefore, the assessment of the level of personality functioning in patients with BD will aid in better understanding this population and in the design of long-term treatment plans.

Self-esteem and Symptoms in Individuals at Clinical High Risk for Psychosis

Individuals with psychotic symptoms often report low global self-esteem (GSE). However, it remains unclear whether the low GSE is linked to the presence of psychotic symptoms or it is present before the onset of psychosis. In addition, the specific subdomains of GSE in these populations are unknown. To address this question, we conducted a cross-sectional study comparing global and SE elements among individuals at clinical high risk for psychosis (CHR; n = 36), individuals with schizophrenia (SCZ; n = 43), and healthy controls (HCs; n = 40). We then examined among CHR individuals the association between GSE, subdomains, and symptoms. CHR individuals displayed significantly lower GSE compared to HCs, at a level comparable with those for individuals with SCZ. The low GSE was driven primarily by self-perceptions of work and interpersonal relationships abilities. Lower GSE was associated with overall negative and disorganized symptoms severity, but not positive ones. The authors discuss the implications of the findings to intervention development.

A Mixed Program of Psychoeducational and Psychological Rehabilitation for Patients With Bipolar Disorder in a Day Hospital Setting

The present study describes a new mixed program of psychoeducational and psychological interventions for bipolar patients, applicable during everyday practice. Thirty-two bipolar patients recruited at a psychiatric day-hospital service have been admitted to a program consisting of 30 meetings and 2 follow-ups at 6 and 12 months. The psychoeducational support determined a general improvement of all included patients. At baseline, patients with residual depression had higher Hamilton Depression Rating Scale (HDRS) scores than euthymic patients (mean score ± SD: 21.25 ± 3.92 vs. 7.00 ± 2.95, respectively). After psychoeducation sessions, the HDRS scores of euthymic patients remained stable (mean ± SD: 7.00 ± 3.74), whereas the HDRS scores of depressed patients demonstrated a statistically significant improvement (mean ± SD: 14.00 ± 6.72, t = 2.721, p = 0.03). Results of the Connor-Davidson Resilience scale and specifically constructed questionnaire Questionario per la Valutazione della Conoscenza e dell'Apprendimento per il Disturbo Bipolare showed a statistically significant improvement in resilience and insight in all recruited patients. Psychoeducational intervention as adjunctive treatment to pharmacotherapy seems to be very effective in bipolar patients, not only for those in the euthymic phase, but this model could also be extended to patients with an ongoing mild or moderate depressive episode.

Interepisodic Functioning in Patients with Bipolar Disorder in Remission

BACKGROUND AND OBJECTIVES

Patients with bipolar disorder (BD), despite recovering symptomatically, suffer from several functional impairments even in remission. The actual causes of impaired functioning are less known.

MATERIALS AND METHODS

The study aimed to examine the clinical and psychosocial determinants of functioning in patients with BD in remission. A cross-sectional single-group design was adopted (n = 150). Participants meeting the study criteria were screened with Mini-International Neuropsychiatric Interview Scale. The selected participants were administered various tools to assess the level of functioning and the clinical, psychosocial determinants of functioning.

RESULTS

The clinical characteristics of the sample included early age of onset of illness, presence of precipitating factors, fewer episodes, minimal comorbidities, history of psychotic episodes, family history of mental illness, good medication adherence, and low depression and mania scores. Psychosocial factors included higher stress and moderate social support and self-esteem in the sample. Poor functioning patients had a history of longer hospital stay and had greater scores on depression, mania, stress, and maladaptive coping styles than better functioning patients.

CONCLUSION

Higher depression, mania, stress, and maladaptive coping strategies were related to poor functioning, while higher medication adherence, self-esteem, and social support were related to better functioning.

Attachment, dysfunctional attitudes, self-esteem, and association to depressive symptoms in patients with mood disorders

BACKGROUND

Cognitive factors might be the link between early attachment experiences and later depression. Similar cognitive vulnerability factors are discussed as relevant for both unipolar and bipolar disorders. The goals of the study were to test if there are any differences concerning attachment style and cognitive factors between remitted unipolar and bipolar patients compared to controls, and to test if the association between attachment style and depressive symptoms is mediated by cognitive factors.

METHODS

A path model was tested in 182 participants (61 with remitted unipolar and 61 with remitted bipolar disorder, and 60 healthy subjects) in which adult attachment insecurity was hypothesized to affect subsyndromal depressive symptoms through the partial mediation of dysfunctional attitudes and self-esteem.

RESULTS

No differences between patients with remitted unipolar and bipolar disorders concerning attachment style, dysfunctional attitudes, self-esteem, and subsyndromal depressive symptoms were found, but both groups reported a more dysfunctional pattern than healthy controls. The path models confirmed that the relationship between attachment style and depressive symptoms was mediated by the cognitive variables 'dysfunctional attitudes' and 'self-esteem'.

LIMITATIONS

With the cross-sectional nature of the study, results cannot explain causal development over time.

CONCLUSIONS

The results emphasize the relevance of a more elaborate understanding of cognitive and interpersonal factors in mood disorders. It is important to address cognitive biases and interpersonal experiences in treatment of mood disorders.

[Factors predicting functioning in type 1 bipolar patients during remission period]

INTRODUCTION

Recent studies indicate that bipolar disorder is associated with a profound impairment in almost all areas of functioning. This study aims to evaluate functional recovery in type 1 bipolar patients during remission period.

METHOD

We conducted a cross-sectional study of euthymic type 1 bipolar patients followed up on an ambulatory basis. In the analysis to be reported here we used Hamilton Depression Scale, Young Mania Rating Scale (YMRS), Rosenberg Self-Esteem Scale, and Functioning Assessment Short Test (FAST).

RESULTS

More than half of the study population (53.3%) had overall functional impairment. The overall functioning was associated with age, education level, professional activity, the number of manic and depressive episodes, the number of hospitalizations, a higher HDRS score as well as with the two self-esteem subscores: "self-confidence" and "self-deprecation".

CONCLUSION

Our results suggest that a paradigm shift in the treatment of bipolar disorders should happen and that the goals of therapy should be modified from symptomatic remission to functional remission.

Negative affect predicts social functioning across schizophrenia and bipolar disorder: Findings from an integrated data analysis

Most people with a serious mental illness experience significant functional impairment despite ongoing pharmacological treatment. Thus, in order to improve outcomes, a better understanding of functional predictors is needed. This study examined negative affect, a construct comprised of negative emotional experience, as a predictor of social functioning across serious mental illnesses. One hundred twenty-seven participants with schizophrenia, 113 with schizoaffective disorder, 22 with psychosis not otherwise specified, 58 with bipolar disorder, and 84 healthy controls (N=404) completed self-report negative affect measures. Elevated levels of negative affect were observed in clinical participants compared with healthy controls. For both clinical and healthy control participants, negative affect measures were significantly correlated with social functioning, and consistently explained significant amounts of variance in functioning. For clinical participants, this relationship persisted even after accounting for cognition and positive/negative symptoms. The findings suggest that negative affect is a strong predictor of outcome across these populations and treatment of serious mental illnesses should target elevated negative affect in addition to cognition and positive/negative symptoms.

Self-Esteem, Perceived Stress, and Gender During Adolescence: Interactive Links to Different Types of Interpersonal Relationships

The goal of this study was to analyze the relationships between self-esteem, perceived stress, the quality of different types of interpersonal relationships, and gender in adolescents. This study used a sample of 1614 adolescent high school students and robust data analytic techniques to test the proposed relationships. The results partially supported the initial hypothesis in that perceived stress mediated the relationships between self-esteem and four of the types of interpersonal relationships (i.e., same-sex peer relationships, opposite-sex peer relationships, parent-child relationships, and teacher-student relationships) and moderated the relationship between self-esteem and same-sex peer relationships. In addition, a moderated role of gender was also partially supported in that perceived stress mediated the relationships between self-esteem and same-sex peer relationships, opposite-sex peer relationships, and the parent-child relationship for girls, but not boys. On the basis of these findings, it was concluded that perceived stress plays an intervening role in the relationship between self-esteem and different types of interpersonal relationships and that gender seems to be a moderator for some of the patterns of the relationships between these variables. These findings are discussed in light of the possible mechanisms by which the variables could influence each other. Implications for theory and practice as well as some directions for future research were also suggested.

Multimodal emotion integration in bipolar disorder: an investigation of involuntary cross-modal influences between facial and prosodic channels

The ability to integrate information from different sensory channels is a vital process that serves to facilitate perceptual decoding in times of unimodal ambiguity. Despite its relevance to psychosocial functioning, multimodal integration of emotional information across facial and prosodic modes has not been addressed in bipolar disorder (BD). In light of this paucity of research we investigated multimodal processing in a BD cohort using a focused attention paradigm. Fifty BD patients and 52 healthy controls completed a task assessing the cross-modal influence of emotional prosody on facial emotion recognition across congruent and incongruent facial and prosodic conditions, where attention was directed to the facial channel. There were no differences in multi-modal integration between groups at the level of accuracy, but differences were evident at the level of response time; emotional prosody biased facial recognition latencies in the control group only, where a fourfold increase in response times was evident between congruent and incongruent conditions relative to patients. The results of this study indicate that the automatic process of integrating multimodal information from facial and prosodic sensory channels is delayed in BD. Given that interpersonal communication usually occurs in real time, these results have implications for social functioning in the disorder.

Implicit motives and cognitive variables: specific links to vulnerability for unipolar or bipolar disorder

Cognitive variables contribute to the etiology of affective disorders. With the differentiation between explicit and implicit measures some studies have indicated underlying depressogenic schemata even in bipolar disorders. We tested for differences in implicit motives and cognitive variables between patients with remitted unipolar and bipolar disorder compared to controls and in a high-risk sample. Additionally we investigated whether affective symptoms relate to those variables. We cross-sectionally examined N=164 participants (53 with bipolar disorder, 58 with major depression, and 53 without affective disorders) and a high-risk sample (N=49) of adolescent children of either parents with unipolar or bipolar disorder or of healthy parents. The Multi-Motive-Grid was used to measure the implicit motives achievement, affiliation, and power, in addition to the cognitive measures of self-esteem, dysfunctional attitudes, and perfectionism. Unipolar and bipolar groups did not differ from healthy controls in implicit motives but showed higher scores in the cognitive factors. Adolescents at high risk for unipolar disorder showed lower scores in the power and achievement motives compared to adolescents at low risk. Subsyndromal depressive symptoms were related to the cognitive variables in both samples. Our results underline the importance of cognitive-behavioral treatment for both unipolar and bipolar disorder.

The self-liking brain: a VBM study on the structural substrate of self-esteem

Abundant evidence suggests that self-esteem is an important personality resource for emotion regulation in response to stressful experiences. It was thus hypothesized that the relative grey matter volume of brain regions involved in responding to and coping with stress is related to individual differences in trait self-esteem. Using structural magnetic resonance imaging of 48 healthy adults in conjunction with voxel-based morphometry and diffeomorphic anatomical registration using exponentiated lie algebra (VBM-DARTEL), positive associations between self-esteem and regional grey matter volume were indeed found in the anterior cingulate cortex (ACC), right lateral prefrontal cortex (LPFC), right hippocampus, and left hypothalamus. In addition, self-esteem positively covaried with grey matter volume in the right temporo-parietal junction (TPJ), which has been implicated in pride and theory of mind. The results suggest that persons with low self-esteem have reduced grey matter volume in brain regions that contribute to emotion/stress regulation, pride, and theory of mind. The findings provide novel neuroanatomical evidence for the view that self-esteem constitutes a vital coping resource.

Phenomenological predictors of psychosocial function in bipolar disorder: is there evidence that social cognitive and emotion regulation abnormalities contribute?

OBJECTIVES

Neurocognitive ability and mood have often been discussed as contributing mechanisms to the severe psychosocial dysfunction experienced in bipolar disorder (BD). In contrast, there has been little discussion on the contribution of social cognition or emotion regulation. This paper aims to assert a potential role for these constructs in psychosocial functioning in BD, with an overarching goal to highlight the necessary importance of considering them in future research examining psychosocial outcomes in the disorder.

METHODS

This paper provides a theoretical synthesis of available and indirect evidence for an influence of (1) social cognition and (2) emotion regulation on psychosocial functioning; it acknowledges important clinical questions that need addressing, and discusses how current research might be translated to improve the treatment of psychosocial dysfunction in BD.

RESULTS

Given their assumed roles in facilitating social interactions and modulating behaviours, it is certainly plausible that abnormalities in social cognition and emotion regulation are detrimental to psychosocial functioning. Currently, there is only minimal direct evidence examining their influence, although existing BD studies are preliminarily supportive of relationships between these constructs.

CONCLUSIONS

There are reasonable theoretical grounds, supported by indirect and preliminary evidence, to suggest that social cognition and emotion regulation may be important in the prediction of psychosocial outcome in BD. However, this proposition is limited by the paucity of empirical research directly examining this matter.

Overgenerality memory style for past and future events and emotions related in bipolar disorder. What are the links with problem solving and interpersonal relationships?

This study investigated patients with Bipolar Disorder's abilities to generate specific past and future events in response to positive and negative cues words as well as emotional intensity related to these ones. The relationships between the number of generated specific events cognitive functioning, interpersonal problems and the ability to problem solving were investigated. Nineteen BD and nineteen healthy controls completed a French version of the AMT to evaluate the past and future events recall, in function of their valence, and emotions related. Furthermore, they completed the Optional Thinking Test, the Inventory of Interpersonal Problems and the neuropsychological measures. Compared to healthy controls, BD recollected (1) fewer specific past negative events and (2) fewer future specific positive and negative events furthermore, (3) they felt more emotional intensity related to future events. These results were explained in the light of theoretical models. Finally, specific past memories deficits in BD were linked with issues in problem solving but not with levels of distress arising from interpersonal problems. In view of AM functions in everyday life, all types of deficits should be taken into consideration, and AM remediation envisaged.

Variation in the HTR1A and HTR2A genes and social adjustment in depressed patients

BACKGROUND

Social adjustment is impaired in depressed patients. The difficulty to adjust to social circumstances has been hypothesized to be one of the causes of depression, as well as a consequence of the disorder. Genetic variation in the serotonin transporter gene has been previously associated with social adjustment levels in patients with mood disorders.

METHODS

We investigated whether variations on the HTR1A (rs6295) and HTR2A (rs7997012) genes were associated with levels of social adjustment using the Social Adjustment Scale in two samples of depressed patients (total n=156).

RESULTS

Patients carrying the GG genotype of the HTR2A-rs7997012 showed better social adjustment in areas of work and family unit bonding.

LIMITATIONS

These findings did not survive correction for multiple testing and should be interpreted with caution.

CONCLUSION

Our finding is in line with previous observations that have associated the G allele of the HTR2A-rs7997012 with higher rate of antidepressant response. The HTR2A-rs7997012 is worthy of further investigation in studies examining factors that are related to depression course and outcome.

Stigma and bipolar disorder: a review of the literature

BACKGROUND

Psychiatric stigma is pervasive injustice that complicates the course of illness and reduces quality of life for people with mental illnesses. This article reviews the research examining stigma towards bipolar disorder (BD) with a view to guiding the development of stigma reduction initiatives and ongoing research.

METHODS

PsychInfo, Medline, and Embase databases were searched for peer-reviewed studies addressing stigma in BD.

RESULTS

Stigma is a serious concern for individuals with BD and their families. Stigma occurs within affected individuals, families, social environments, work and school environments, and the healthcare industry. With stigma often come a loss of social support and occupational success, reduced functioning, higher symptom levels and lower quality of life. BD stigma is comparable to that of other severe mental illnesses, such as schizophrenia. Few interventions are available to specifically target stigma against BD.

LIMITATIONS

Most studies have used explicit, attitude-based measures of stigma without controlling for social desirability, which may not translate into real-world stigmatizing behaviors. Furthermore, many studies have not clearly delineated results in a manner consistent with the conceptual framework of stigmatization.

CONCLUSIONS

Stigma toward BD is ubiquitous and has insidious consequences for affected individuals and their families. Stigma reduction initiatives should target individuals living with BD, their families, workplaces, and the healthcare industry, taking into account the experiences and impacts of BD stigma to improve social support, course of illness, and quality of life.

Early maladaptive schemas and functional impairment in remitted bipolar disorder patients

BACKGROUND AND OBJECTIVES

Previous research indicates that low self-esteem is associated with functional impairment in remitted bipolar disorder patients. The present study aimed to elucidate this area further by exploring the relationship between different self-schemas and key functional outcome domains.

METHODS

The study consisted of 49 remitted bipolar disorders patients who completed the Young Schema Questionnaire-Short Version (YSQ-S3) and the Work and Social Adjustment Scale (WSAS).

RESULTS

A hierarchical regression analysis revealed that the schemas Social Isolation, Failure to Achieve, Dependence, Vulnerability to Harm and Illness, Emotional Inhibition, Insufficient Self-Control, and Pessimism accounted for 28% of the variance in functional impairment when controlling for length of remission and subsyndromal depressive symptoms.

LIMITATIONS

The WSAS as a self-report scale measures the patients' perception of own functioning and is therefore not an objective measure of functioning.

CONCLUSIONS

The findings delineate specific psychological vulnerabilities which are likely to be implicated in functional impairment in bipolar disorder and as such warrant further examination in terms of their causal mechanisms and therapeutic implications.

Clinical correlates of social adjustment in patients with obsessive-compulsive disorder

BACKGROUND

Patients with obsessive-compulsive disorder (OCD) frequently show poor social adjustment, which has been associated with OCD severity. Little is known about the effects that age at symptom onset, specific OCD symptoms, and psychiatric comorbidities have on social adjustment. The objective of this study was to investigate the clinical correlates of social functioning in OCD patients.

METHODS

Cross-sectional study involving 815 adults with a primary DSM-IV diagnosis of OCD participating in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. Patients were assessed with the Social Adjustment Scale, the Medical Outcomes Study 36-item Short-Form Health Survey, the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Clinical correlates of social adjustment were assessed with generalized linear models with gamma distribution.

RESULTS

Poor overall social functioning was associated with greater OCD severity (p = 0.02); hoarding symptoms (p = 0.004); sexual/religious obsessions (p = 0.005); current major depressive disorder (p = 0.004); current post-traumatic stress disorder (p = 0.002); and current eating disorders (p = 0.02). Poor social adjustment was also associated with impaired quality of life.

CONCLUSIONS

Patients with OCD have poor social functioning in domains related to personal relationships and professional performance. Hoarding symptoms and sexual/religious obsessions seem to have the strongest negative effects on social functioning. Early age at OCD symptom onset seems to be associated with professional and academic underachievement and impairment within the family unit, whereas current psychiatric comorbidity worsen overall social functioning. In comparison with quality of life, social adjustment measures seem to provide a more comprehensive overview of the OCD-related burden.

Theory of mind and functionality in bipolar patients with symptomatic remission

INTRODUCTION

Functional deficits are commonly observed in bipolar disorder after symptomatic remission. Social cognition deficits have also been reported, which could contribute to dysfunction in patients with bipolar disorder in remission.

MATERIAL AND METHODS

Twelve bipolar disorder patients in symptomatic remission (7 patients with bipolar disorder type I and 5 with bipolar disorder type II) and 12 healthy controls completed the Reading the Mind in the Eyes Test and the Faux Pas Test to evaluate theory of mind (ToM). Both groups also completed the Functional Assessment Short Test (FAST).

RESULTS

The performance of the bipolar patients in the cognitive component of ToM was below normal, although the difference between the control group was not statistically significant (P=.078), with a trend to a worse performance associated with a higher number of depressive episodes (P=.082). There were no statistically significant differences between groups for the emotional component of ToM. Global functionality was significantly lower in bipolar patients compared to the control group (P=.001). Significant differences were also observed between both groups in five of the six dimensions of functionality assessed. No significant correlation was found between functionality and theory of mind.

CONCLUSIONS

Bipolar patients in symptomatic remission exhibit impairments in several areas of functioning. Cognitive ToM appears more affected than emotional ToM. Deficits in ToM were not related to functional impairment.

Early maladaptive schemas in bipolar disorder

OBJECTIVE

According to the cognitive model of depression, negative schemas, formed in early life, increase susceptibility to depression. The objective of this study was to investigate schemas that are proposed to increase susceptibility of depression in bipolar disorder patients who have had depressive episodes.

METHOD

Eighteen patients diagnosed with bipolar disorder according to DSM-IV and a healthy control group (N= 20) constituted the sample of the study. The Beck Depression Inventory, Young Mania Rating Scale, and Young Schema Scale were applied to patients in order to determine the level of symptoms and schemas.

RESULTS

When the scores obtained from Young Schema Scale were compared between groups, significant differences were observed between bipolar patients and control group on all the schemas except abandonment, emotional deprivation, defectiveness, vulnerability to harm or illness, and approval seeking. The negative schema scores of bipolar patients were significantly higher than those of the control group.

CONCLUSION

Of all schemas included in the Young Schema Scale, the scores of bipolar group were higher than the scores of the control group. These findings suggest that, in cognitive-based psychotherapeutic approaches for patients with bipolar disorder, it would be more effective to focus on schemas related to the perception and allowance of feelings at the proper time and the instability of self-perceptions.

Mindfulness-based stress reduction, mindfulness-based cognitive therapy, and Zen meditation for depression, anxiety, pain, and psychological distress

Mindfulness has been described as a practice of learning to focus attention on moment-bymoment experience with an attitude of curiosity, openness, and acceptance. Mindfulness practices have become increasingly popular as complementary therapeutic strategies for a variety of medical and psychiatric conditions. This paper provides an overview of three mindfulness interventions that have demonstrated effectiveness for psychiatric symptoms and/or pain. The goal of this review is to provide a synopsis that practicing clinicians can use as a clinical reference concerning Zen meditation, mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT). All three approaches originated from Buddhist spiritual practices, but only Zen is an actual Buddhist tradition. MBSR and MBCT are secular, clinically based methods that employ manuals and standardized techniques. Studies indicate that MBSR and MBCT have broad-spectrum antidepressant and antianxiety effects and decrease general psychological distress. MBCT is strongly recommended as an adjunctive treatment for unipolar depression. The evidence suggests that both MBSR and MBCT have efficacy as adjunctive interventions for anxiety symptoms. MBSR is beneficial for general psychological health and stress management in those with medical and psychiatric illness as well as in healthy individuals. Finally, MBSR and Zen meditation have a role in pain management.

Self-referential thinking, suicide, and function of the cortical midline structures and striatum in mood disorders: possible implications for treatment studies of mindfulness-based interventions for bipolar depression

Bipolar depression is often refractory to treatment and is frequently associated with anxiety symptoms and elevated suicide risk. There is a great need for adjunctive psychotherapeutic interventions. Treatments with effectiveness for depressive and anxiety symptoms as well as suicide-related thoughts and behaviors would be particularly beneficial. Mindfulness-based interventions hold promise, and studies of these approaches for bipolar disorder are warranted. The aim of this paper is to provide a conceptual background for such studies by reviewing key findings from diverse lines of investigation. Results of that review indicate that cortical midline structures (CMS) appear to link abnormal self-referential thinking to emotional dysregulation in mood disorders. Furthermore, CMS and striatal dysfunction may play a role in the neuropathology underlying suicide-related thoughts and behaviors. Thus, combining studies of mindfulness interventions targeting abnormal self-referential thinking with functional imaging of CMS and striatal function may help delineate the neurobiological mechanisms of action of these treatments.

Extreme positive and negative appraisals of activated states interact to discriminate bipolar disorder from unipolar depression and non-clinical controls

BACKGROUND

This research aimed to test whether positive, negative, or conflicting appraisals about activated mood states (e.g., energetic and high states) predicted bipolar disorder.

METHODS

A sample of individuals from clinical and control groups (171 with bipolar disorder, 42 with unipolar depression, and 64 controls) completed a measure of appraisals of internal states.

RESULTS

High negative appraisals related to a higher likelihood of bipolar disorder irrespective of positive appraisals. High positive appraisals related to a higher likelihood of bipolar disorder only when negative appraisals were also high. Individuals were most likely to have bipolar disorder, as opposed to unipolar depression or no diagnosis, when they endorsed both extremely positive and extremely negative appraisals of the same, activated states.

LIMITATIONS

Appraisals of internal states were based on self-report.

CONCLUSIONS

The results indicate that individuals with bipolar disorder tend to appraise activated, energetic internal states in opposing or conflicting ways, interpreting these states as both extremely positive and extremely negative. This may lead to contradictory attempts to regulate these states, which may in turn contribute to mood swing symptoms. Psychological therapy for mood swings and bipolar disorder should address extreme and conflicting appraisals of mood states.

Self-esteem is associated with premorbid adjustment and positive psychotic symptoms in early psychosis

BACKGROUND

Low levels of self-esteem have been implicated as both a cause and a consequence of severe mental disorders. The main aims of the study were to examine whether premorbid adjustment has an impact on the subject's self-esteem, and whether lowered self-esteem contributes to the development of delusions and hallucinations.

METHOD

A total of 113 patients from the Thematically Organized Psychosis research study (TOP) were included at first treatment. The Positive and Negative Syndrome Scale (PANSS) was used to assess present symptoms. Premorbid adjustment was measured with the Premorbid Adjustment Scale (PAS) and self-esteem by the Rosenberg Self-Esteem Scale (RSES).

RESULTS

Premorbid social adjustment was significantly related to lower self-esteem and explained a significant proportion of the variance in self-esteem. Self-esteem was significantly associated with the levels of persecutory delusions and hallucinations experienced by the patient and explained a significant proportion of the variance even after adjusting for premorbid functioning and depression.

CONCLUSION

There are reasons to suspect that premorbid functioning is an important aspect in the development of self- esteem, and, furthermore, that self-esteem is associated with the development of delusions and hallucinations.

Aberrant emotional processing in posterior cortical midline structures in bipolar II depression

Bipolar II depression is a serious and disabling illness associated with significant impairment and high rates of suicide attempts. However, mechanisms underlying emotional dysregulation in this condition are poorly characterized. The goal of this work was to investigate one component of emotional processing in this disorder, brain activation associated with exposure to emotional faces. Functional MRI was used to study 16 unmedicated male subjects with bipolar II depression and 19 healthy male controls. The activation paradigm exposed subjects to happy, fearful and neutral faces. The two key findings of this study were as follows. First, bipolar subjects demonstrated significantly decreased activation in response to happy facial expression in the left posterior cortical midline structures (CMS) and frontal cortex. Second, depression severity was positively correlated with activation of the posterior CMS and other regions. Our results suggest that mechanisms involving CMS dysfunction may play a role in the neurobiology of bipolar II depression as has been demonstrated for unipolar illness. Further investigations of CMS function in bipolar spectrum disorders are warranted.

Experience of living with a family member with bipolar disorder

Bipolar disorder (BD) is a severe illness that has a serious impact on the lives of those affected and on their families. The aim of this study was to elucidate what it means for family members to live with an adult person who has BD, with reference to their views concerning the condition of the person affected and the future. During 2005, 17 family members of people with the disorder were interviewed, and the data obtained were subjected to a qualitative content analysis. The findings showed that family members felt alone with their experiences and struggled to make sense of and to maintain normality, as their life was encroached on by the condition. Bearing the burden of responsibility and control made it difficult for family members to focus on their own future. To build hope, they needed opportunities to share their experiences with others, increased understanding of the condition, and relief from the burden they bore. This study underlines the importance of strengthening support holistically for family members living with an adult person with BD. Support and interventions concerning these families' needs have to be developed and should be provided by all mental health-care services.

Presence of co-morbid substance use disorder in bipolar patients worsens their social functioning to the level observed in patients with schizophrenia

Bipolar disorder has been considered to have a better prognosis than schizophrenia at the very beginning of its definition. However, psychosocial functioning may vary not only because of the characteristics of the disorder, but also of co-morbid conditions, especially regarding substance use disorder (SUD). The purpose of this study was to compare the social adjustment level of patients with bipolar disorder with that observed in patients with schizophrenia, taking into account substance use disorder (SUD). Forty subjects with schizophrenia and 40 subjects with bipolar disorder, in the stable phase of the disorder, were matched for age, gender and presence of SUD (DSM-IV criteria). The social adjustment scale was completed with socio-demographic and clinical characteristics of illness. The global adaptation score of bipolar patients with SUD was poorer than bipolar patients without SUD, but was not observed as being significantly different from that of patients with schizophrenia, with or without associated SUD. Suicide attempts, poor compliance, longer hospitalisation, shorter remissions and criminal activity were also more frequently observed in the group of patients with bipolar disorder and SUD. Presence of substance use disorder seems to have a greater weight than the main diagnostic (schizophrenia versus bipolar disorder) to predict worse social adjustment and poorer outcome.

Self-esteem in remitted bipolar disorder patients: a meta-analysis

OBJECTIVES

Low self-esteem has been found to be a risk factor for depression in major depressive disorder (MDD). In contrast, the role of self-esteem in bipolar disorder (BD) is still uncertain. In order to examine the characteristics of self-esteem in BD, we synthesized studies comparing self-esteem in BD patients with self-esteem in MDD patients and in normal controls.

METHODS

Database searches and identification of studies were conducted by two of the authors independently. Remission of BD and MDD was a major selection criterion. The results were generated through meta-analyses.

RESULTS

Random-effects models of 19 between-group comparisons (N= 1,838) suggested that the self-esteem of remitted BD patients was significantly lower than that of normal controls (Cohen's d= -0.83), while significantly higher than that of remitted MDD patients (Cohen's d= 0.54). Fail-safe numbers and tests for funnel plot asymmetry indicated that the results were robust and unlikely to reflect publication biases. Additional studies indicated that self-esteem may take a fluctuating course during remission of BD.

CONCLUSIONS

By revealing that BD patients do experience low self-esteem, the findings implicate a need for further understanding the causes and therapeutic impact of such abnormality in BD.

Altered self-report of empathic responding in patients with bipolar disorder

Despite evidence of impairments in social cognition in patients with bipolar disorder (BD), systematic investigations of empathic responding in this population have not been conducted. The objectives of the current study were to investigate empathic responding in patients with BD in varying states of illness and to determine whether course of illness variables and symptom severity predicted responding. Twenty well-characterized patients with BD and 20 matched healthy control subjects completed the Interpersonal Reactivity Index (IRI) and the Social Adjustment Scale Self-Report (SAS-SR), self-report measures of cognitive and emotional empathy and of psychosocial functioning, respectively. Patients with BD reported significantly reduced levels of cognitive empathy ('Perspective Taking') and higher levels of personal distress in response to others' negative experiences than did controls. Altered affective empathic abilities correlated significantly with reduced psychosocial functioning in family, social and occupational domains and with increased symptom severity. This study provides preliminary evidence of alterations in empathic responding in patients with BD. Alterations in the ability to adopt the perspective of others may contribute to the difficulties in social communication inherent in this patient population. Additional studies, involving larger samples, are required to determine the contribution of social cognitive performance to impaired social functioning in BD.

Relationship between psychosocial adjustment and executive function in patients with bipolar disorder and schizophrenia in remission: the mediating and moderating effects of insight

OBJECTIVES

The aims of this study were to examine the relationships between executive function and psychosocial adjustment, and the mediating and moderating effects of insight on the association between executive function and psychosocial adjustment in patients with bipolar disorder and schizophrenia in clinical remission.

METHODS

The level of psychosocial adjustment was assessed in 96 subjects with bipolar disorder and 96 subjects with schizophrenia who were in remitted state. The association between executive function and psychosocial adjustment and the mediating and moderating effects of insight were examined by multiple regression analysis models and the Goodman test.

RESULTS

The results indicated that executive function had direct effect on psychosocial adjustment in both subjects with bipolar disorder and schizophrenia. However, the mediating effect of insight on the association between executive function and psychosocial adjustment was only found in subjects with schizophrenia, but not in subjects with bipolar disorder. No moderating effect of insight on the association between executive function and psychosocial adjustment was found in subjects with schizophrenia or bipolar disorder.

CONCLUSIONS

The results of this study indicated that executive function has an important role in psychosocial adjustment in both patients with bipolar disorder and schizophrenia. Meanwhile, insight has a different role in the association between executive function and psychosocial adjustment between patients with bipolar disorder and schizophrenia.