The Role of Cognitive Behaviour Therapy in Bipolar Disorder

The Cognition Checklist for Mania-Revised (CCL-M-R): Factor-Analytic Structure and Links with Risk for Mania, Diagnoses of Mania, and Current Symptoms

We conducted two studies to examine the Cognition Checklist for Mania-Revised (CCL-M-R; Beck, Colis, Steer, Madrak, & Goldberg, 2006). In the first, we gathered data in an undergraduate sample (N = 208) to examine the factor structure of the measure and the correlations of the subscales with the Hypomanic Personality Scale (HPS; Eckblad & Chapman, 1986). Factor analyses refined subscales, and three of the original four subscales developed by Beck and colleagues (2006) were retained. Persons with higher stores on the HPS were likely to endorse manic cognitions associated with overconfidence and excitement-seeking. In a second study, we gathered data from 61 persons diagnosed with bipolar I disorder, 38 with major depressive disorder (MDD), and 33 with no history of mood disorder. Excitement-seeking scores were robustly related to current manic symptoms, as measured by the Internal State Scale (ISS; Bauer et al., 1991). Thus, CCL-M-R excitement-seeking scores appear to be related to risk for mania and to current symptoms of mania within a clinical sample. Other findings, though, suggest that problems with interpersonal relationships (feeling thwarted by others) may emerge among those clinically diagnosed with bipolar I disorder, even though not endorsed among those at risk. Moreover, difficulties with interpersonal relationships and diminished confidence in those with bipolar I disorder paralleled the difficulties observed among those with MDD. Findings suggest that cognitive profiles associated with mania may depend on mood state and course of the disorder.

O papel da equipe multidisciplinar no manejo do paciente bipolar

O transtorno de humor bipolar (THB) é uma patologia incurável, recorrente e crônica, sendo que inúmeros fatores de vida relacionados ao estresse demonstram influenciar o curso da doença. Devido a estes fatores, a doença está associada com grave disfunção familiar, social e ocupacional, especialmente quando o tratamento farmacológico não é realizado de forma continuada. O papel prioritário da equipe multidisciplinar no tratamento do pacientes com transtorno de humor bipolar é melhorar a aderência medicamentosa, diminuindo os riscos de recaída. Neste artigo, são apresentadas possíveis causas biopsicossociais envolvidas no surgimento e curso da doença, incluindo-se eventos de vida, meio familiar e refratariedade farmacológica. São descritas as funções da equipe multidisciplinar no tratamento da bipolaridade, avaliando-se, neste contexto, a eficácia terapêutica das diversas abordagens psicossociais em uso e as perspectivas neste campo de "intervenção preventiva".

Negative Cognitions Predict the Course of Bipolar Depression, Not Mania

Cognitive interventions for bipolar disorder have received increased attention, but very few prospective studies have focused on whether cognitive variables predict the course of bipolar disorder. Available studies have yielded conflicting results concerning the effects of negative cognitions on mania. In this study, 60 individuals with bipolar I disorder completed monthly symptom severity interviews. At a 6-month follow-up, they completed the Dysfunctional Attitudes Scale, the Negative Automatic Thoughts Questionnaire, and the Positive Automatic Thoughts Questionnaire. Participants then completed monthly symptom severity interviews for another 6 months. Cognitive scales were correlated with current depression and predicted increases in depression over time, but were not related to mania. Although results do not support negative cognitions as a predictor of mania, they do provide support for the increasingly common use of cognitive interventions to treat bipolar depression.