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Douglas KM, Inder ML, Crowe MT, Jordan J, Carlye D, Lacey C, Beaglehole B, Mulder R, Eggleston K, Donovan KA, Frampton CMA, Bowie CR, Porter RJ. Randomised controlled trial of Interpersonal and Social Rhythm Therapy and group-based Cognitive Remediation versus Interpersonal and Social Rhythm Therapy alone for mood disorders: study protocol. BMC Psychiatry 2022; 22:115. [PMID: 35164720 PMCID: PMC8845377 DOI: 10.1186/s12888-022-03747-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with mood disorders frequently experience cognitive impairment, which impacts on the long-term trajectory of the disorders, including being associated with persisting difficulties in occupational and psychosocial functioning, residual mood symptoms, and relapse. Current first-line treatments for mood disorders do little to improve cognitive function. Targeting cognition in clinical research is thus considered a priority. This protocol outlines a prospectively-registered randomised controlled trial (RCT) which examines the impact of adding group-based Cognitive Remediation (CR) to Interpersonal and Social Rhythm Therapy (IPSRT-CR) for individuals with mood disorders. METHODS This is a pragmatic, two-arm, single-blinded RCT comparing IPSRT-CR with IPSRT alone for adults (n = 100) with mood disorders (Major Depressive Disorder or Bipolar Disorder) with subjective cognitive difficulties, on discharge from Specialist Mental Health Services in Christchurch, New Zealand. Both treatment arms will receive a 12-month course of individual IPSRT (full dose = 24 sessions). At 6 months, randomisation to receive, or not, an 8-week group-based CR programme (Action-based Cognitive Remediation - New Zealand) will occur. The primary outcome will be change in Global Cognition between 6 and 12 months (treatment-end) in IPSRT-CR versus IPSRT alone. Secondary outcomes will be change in cognitive, functional, and mood outcomes at 6, 12, 18, and 24 months from baseline and exploratory outcomes include change in quality of life, medication adherence, rumination, and inflammatory markers between treatment arms. Outcome analyses will use an intention-to-treat approach. Sub-group analyses will assess the impact of baseline features on CR treatment response. Participants' experiences of their mood disorder, including treatment, will be examined using qualitative analysis. DISCUSSION This will be the first RCT to combine group-based CR with an evidence-based psychotherapy for adults with mood disorders. The trial may provide valuable information regarding how we can help promote long-term recovery from mood disorders. Many issues have been considered in developing this protocol, including: recruitment of the spectrum of mood disorders, screening for cognitive impairment, dose and timing of the CR intervention, choice of comparator treatment, and choice of outcome measures. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry, ACTRN12619001080112 . Registered on 6 August 2019.
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Affiliation(s)
- Katie M. Douglas
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Maree L. Inder
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marie T. Crowe
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jennifer Jordan
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Dave Carlye
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Cameron Lacey
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.29980.3a0000 0004 1936 7830Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Ben Beaglehole
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Roger Mulder
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Kate Eggleston
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Katherine A. Donovan
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Christopher M. A. Frampton
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Christopher R. Bowie
- grid.410356.50000 0004 1936 8331Department of Psychology, Queen’s University, Kingston, ON Canada
| | - Richard J. Porter
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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Chumakov EM, Petrova NN, Limankin OV, Ashenbrenner YV. [Cognitive impairment in remitted patients with bipolar disorder]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:12-18. [PMID: 34037349 DOI: 10.17116/jnevro202112104112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the frequency and severity of cognitive impairment as well as its correlations with clinical characteristics in remitted patients with bipolar disorder (BD). MATERIAL AND METHODS Eighty-five patients with BD type I (64 patients) and BD type II (21 patients) in remission were examined (average age 36.6±5.7). Affective symptoms were assessed using the Hamilton Depression Rating Scale (HDRS) and Young's Mania Rating Scale (YMRS). Cognitive impairment was assessed using the Brief Neuropsychological Cognitive Examination (BNCE). RESULTS Cognitive impairment was revealed in 43.5% of the patients. The frequency and structure of cognitive impairment in patients with BD type I and type II did not differ. The patients with cognitive impairment were characterized by decreased speed of mental processes, decreased working memory and attention deficit. The correlation of the total BNCE score with the age of the patients, duration of the disease, total HDRS and YMRS scores was revealed. CONCLUSION The results demonstrate the affective nature of cognitive deficit in the patients. Cognitive impairment in remitted patients with BD is a significant therapeutic target.
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Affiliation(s)
- E M Chumakov
- St. Petersburg State University, St. Petersburg, Russia.,Kashchenko Psychiatric Hospital No. 1, St. Petersburg, Russia
| | - N N Petrova
- St. Petersburg State University, St. Petersburg, Russia
| | - O V Limankin
- Kashchenko Psychiatric Hospital No. 1, St. Petersburg, Russia.,St. Petersburg Institute of Advanced Training of Medical Experts, St. Petersburg, Russia.,Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - Yu V Ashenbrenner
- St. Petersburg State University, St. Petersburg, Russia.,Kashchenko Psychiatric Hospital No. 1, St. Petersburg, Russia
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Yasin S, Hussain SA, Aslan S, Raza I, Muzammel M, Othmani A. EEG based Major Depressive disorder and Bipolar disorder detection using Neural Networks:A review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 202:106007. [PMID: 33657466 DOI: 10.1016/j.cmpb.2021.106007] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/11/2021] [Indexed: 05/23/2023]
Abstract
Mental disorders represent critical public health challenges as they are leading contributors to the global burden of disease and intensely influence social and financial welfare of individuals. The present comprehensive review concentrate on the two mental disorders: Major depressive Disorder (MDD) and Bipolar Disorder (BD) with noteworthy publications during the last ten years. There is a big need nowadays for phenotypic characterization of psychiatric disorders with biomarkers. Electroencephalography (EEG) signals could offer a rich signature for MDD and BD and then they could improve understanding of pathophysiological mechanisms underling these mental disorders. In this review, we focus on the literature works adopting neural networks fed by EEG signals. Among those studies using EEG and neural networks, we have discussed a variety of EEG based protocols, biomarkers and public datasets for depression and bipolar disorder detection. We conclude with a discussion and valuable recommendations that will help to improve the reliability of developed models and for more accurate and more deterministic computational intelligence based systems in psychiatry. This review will prove to be a structured and valuable initial point for the researchers working on depression and bipolar disorders recognition by using EEG signals.
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Affiliation(s)
- Sana Yasin
- Department of Computer Science, COMSATS University Islamabad, Lahore Campus Lahore,Pakistan; Department of Computer Science, University of Okara, Okara Pakistan
| | - Syed Asad Hussain
- Department of Computer Science, COMSATS University Islamabad, Lahore Campus Lahore,Pakistan
| | - Sinem Aslan
- Ca' Foscari University of Venice, DAIS & ECLT, Venice, Italy; Ege University, International Computer Institute, Izmir, Turkey
| | - Imran Raza
- Department of Computer Science, COMSATS University Islamabad, Lahore Campus Lahore,Pakistan
| | - Muhammad Muzammel
- Université Paris-Est Créteil (UPEC), LISSI, Vitry sur Seine 94400, France
| | - Alice Othmani
- Université Paris-Est Créteil (UPEC), LISSI, Vitry sur Seine 94400, France.
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Meyer N, Faulkner SM, McCutcheon RA, Pillinger T, Dijk DJ, MacCabe JH. Sleep and Circadian Rhythm Disturbance in Remitted Schizophrenia and Bipolar Disorder: A Systematic Review and Meta-analysis. Schizophr Bull 2020; 46:1126-1143. [PMID: 32154882 PMCID: PMC7505194 DOI: 10.1093/schbul/sbaa024] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Sleep and circadian rhythm disturbances in schizophrenia are common, but incompletely characterized. We aimed to describe and compare the magnitude and heterogeneity of sleep-circadian alterations in remitted schizophrenia and compare them with those in interepisode bipolar disorder. METHODS EMBASE, Medline, and PsycINFO were searched for case-control studies reporting actigraphic parameters in remitted schizophrenia or bipolar disorder. Standardized and absolute mean differences between patients and controls were quantified using Hedges' g, and patient-control differences in variability were quantified using the mean-scaled coefficient of variation ratio (CVR). A wald-type test compared effect sizes between disorders. RESULTS Thirty studies reporting on 967 patients and 803 controls were included. Compared with controls, both schizophrenia and bipolar groups had significantly longer total sleep time (mean difference [minutes] [95% confidence interval {CI}] = 99.9 [66.8, 133.1] and 31.1 [19.3, 42.9], respectively), time in bed (mean difference = 77.8 [13.7, 142.0] and 50.3 [20.3, 80.3]), but also greater sleep latency (16.5 [6.1, 27.0] and 2.6 [0.5, 4.6]) and reduced motor activity (standardized mean difference [95% CI] = -0.86 [-1.22, -0.51] and -0.75 [-1.20, -0.29]). Effect sizes were significantly greater in schizophrenia compared with the bipolar disorder group for total sleep time, sleep latency, and wake after sleep onset. CVR was significantly elevated in both diagnoses for total sleep time, time in bed, and relative amplitude. CONCLUSIONS In both disorders, longer overall sleep duration, but also disturbed initiation, continuity, and reduced motor activity were found. Common, modifiable factors may be associated with these sleep-circadian phenotypes and advocate for further development of transdiagnostic interventions that target them.
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Affiliation(s)
- Nicholas Meyer
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Robert A McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Toby Pillinger
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, University of Surrey, Guildford, Surrey, UK
- UK Dementia Research Institute, London, UK
| | - James H MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Crowe M, Porter R, Douglas K, Inder M, Lacey C, Jordan J, Wells H. Patients' experiences of cognitive functioning in recurrent depression: A qualitative study. J Psychiatr Ment Health Nurs 2020; 27:321-329. [PMID: 31981272 DOI: 10.1111/jpm.12603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Recurrent depressive episodes involve significant morbidity, suicide risk and recurrent hospitalizations. In both major depressive disorder and bipolar disorder, there are significant impairments in functioning following resolution of acute symptoms. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides an in-depth qualitative understanding of the subjective experience of cognitive impairment following a depressive episode in a recurrent mood disorder. It identifies descriptions of two types of experience (being stuck and being preoccupied with one's thoughts) that led to impairments in concentration, memory, organization and decision-making. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses need to develop an awareness of the impact of cognitive difficulties in the process of recovery from recurrent mood disorders. Mental health nurses need to provide knowledgeable reassurance, information and interventions to people who experience cognitive difficulties to provide a framework of understanding that promotes recovery. ABSTRACT: Introduction People who experience recurrent depressive episodes often have ongoing cognitive problems that impact on their functional recovery. These cognitive difficulties have been identified as impacting on social, interpersonal and occupational functioning and can result in vulnerability to relapse. Aim The aim of this qualitative study was to explore participants' subjective experiences of cognitive impairment after discharge from mental health services following treatment for recurrent depression. Methods The study was designed as a qualitative study in order to best capture participants' subjective experiences. Data were collected by semi-structured interviews and were analysed using a process of thematic analysis. Results Twenty participants took part in this study. All participants described experiences of either 1) "being stuck"; or 2) "being preoccupied with own thoughts"; however, all participants described the experiences in the third theme: "it stops you living to your potential." Implications for practice In order to promote recovery in a meaningful way, mental health nurses need to provide information about and strategies for managing cognitive difficulties associated with recurrent mood disorders.
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Affiliation(s)
- Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Katie Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Maree Inder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Hayley Wells
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Douglas KM, Milanovic M, Porter RJ, Bowie CR. Clinical and methodological considerations for psychological treatment of cognitive impairment in major depressive disorder. BJPsych Open 2020; 6:e67. [PMID: 32594951 PMCID: PMC7345587 DOI: 10.1192/bjo.2020.53] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cognitive impairment is considered a core feature of major depressive disorder (MDD) and research into psychological treatments aiming to address cognitive impairment are gaining momentum. Compared with the well-established research base of cognitive treatment trials in schizophrenia, including meta-analyses, mood disorder research is much more preliminary. AIMS To focus on identifying the important factors to consider in developing larger-scale psychological treatment trials targeting cognitive impairment in mood disorders. Trial design recommendations have been published for cognitive treatment trials in bipolar disorder. METHOD An in-depth discussion of methodological considerations in the development of cognitive treatment trials for MDD. RESULTS Methodological considerations include: screening for, and defining, cognitive impairment; mood state when cognitive intervention begins; medication monitoring during cognitive interventions; use of concomitant therapy; level of therapist involvement; duration and dose of treatment; choice of specific cognitive training exercises; home practice; improving adherence; appropriate comparison therapies in clinical trials; and choice of primary outcomes. CONCLUSIONS As well as guidance for clinical trial development, this review may be helpful for clinicians wanting to provide cognitive interventions for individuals with MDD.
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Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, New Zealand
| | | | - Richard J Porter
- Department of Psychological Medicine, University of Otago; and Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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Munuera C, Weil F, Minois I, Zanouy L, Gard S, Roux P, M'Bailara K. [Exploring Early Maladaptative Schema (EMS) in adults with bipolar disorder: A systematic review of the scientific literature]. Encephale 2019; 46:65-77. [PMID: 31767255 DOI: 10.1016/j.encep.2019.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/10/2019] [Accepted: 09/16/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Clinical heterogeneity during euthymic states is a crucial issue in bipolar disorders. Indeed, actual data are not sufficient to understand why some patients are unharmed by subthreshold symptoms and have functional impairments whereas others have a functional remission but have subthreshold symptoms. Based on the Ball model, cognitive and schematic vulnerability interact with genetic vulnerability and trigger affective symptoms with the intervention of stressful life events. Furthermore, according to this model, adjustment and adaptation to illness assessed by functional outcome and illness experience are associated with this cognitive and schematic vulnerability. So, theoretical arguments support that childhood adversity and temperamental deregulation characterize patients with bipolar disorders. Thus, the aim of this study is to systematically review studies of Early Maladaptive Schemas in bipolar disorder, to determine whether Early Maladaptive Schemas have specificity in bipolar disorder in comparison with other populations, and to identify which Early Maladaptive Schemas could be activated. The challenge of this review is to identify if the taking of early maladaptive schemas into account could allow us to better identify, understand and manage bipolar disorders. METHODS This systematic review was led according to the Preferred Reporting Items for Systematic review and Meta-Analysis statement on the electronic databases Cochrane, PsycArticles, Psychology and Behavioral Sciences Collection, PsycInfo, PubMed, ScienceDirect and Scopus with « early maladaptive schemas » AND « bipolar disorder » as keywords. Only studies meeting eligibility criteria concerning publication status, language, population and outcomes were included after several screenings on basis of title, abstract and full-text. Then, we carried out data extraction in accordance with criteria defined in principle (about characteristics of participants, objectives, materiel and methods, principle results and bias). RESULTS Among 39 records identified, a total of 10 studies met eligibility criteria for inclusion in this review. Synthesizing findings across the studies revealed three important topics. First, early maladaptive schemas appear as potential cognitive characteristics that clinicians have to investigate in clinical practice. Indeed, patients with bipolar disorders present greater activation of the early maladaptive schemas in comparison with people who have no disorder. This point supports the first part of Ball's theoretical model that considers schemas as a vulnerability to bipolarity. Secondly, early maladaptive schemas are relevant to distinguish bipolar disorders from unipolar depression and borderline personality disorder. A greater and a lower activation are respectively identified among bipolar disorders. Thirdly, supporting the second part of Ball's model, early maladaptive schemas play a key role in recovery regarding their impact on the course of bipolarity, in particular on suicidality and functional impairment. Finally, these dysfunctional schemas allow us to understand the clinical heterogeneity of bipolar disorder, and among others, about the type of bipolarity. These results have several implications, but there are some limits in this systematic review. First, no French study has been done. Then, reduced sample sizes in these studies increased the risk to conclude wrongly to an activation difference between groups. Furthermore, probably due to the variety of methods and populations, we could not identify an homogeneous pattern of early activated maladaptive schemas. Overall, scientific approaches used in these studies are based on statistical models using mean and standard deviation. These types of statistical analyses are the main limit because they cannot represent the heterogeneity of early maladaptive schemas profiles. CONCLUSIONS Schema theory proves to be a relevant approach in bipolar disorders, and early maladaptive schemas appear to be important to take into account in clinical practice. Nevertheless, in order to propose schemas therapy appropriately, it is necessary to specify if early maladaptive schemas are activated and to specify therapeutic indications because of clinical heterogeneity. Moreover, data do not yet allow us to understand the disparity of profiles during the inter-episode period. Indeed, a French research perspective is being considered that will prefer a person-oriented approach.
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Affiliation(s)
- C Munuera
- Laboratoire de psychologie, EA4139, Université de Bordeaux, 3(ter) place de la Victoire, 33076 Bordeaux, France
| | - F Weil
- Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France; Service Universitaire de Psychiatrie d'Adultes, Centre Hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France; Laboratoire HANDIReSP, EA4047, Université de Versailles Saint-Quentin-En-Yvelines, 2, avenue de la Source de la Bièvre, 78180, Montigny-le-Bretonneux, France
| | - I Minois
- Centre Hospitalier Charles Perrens, Pôle 3-4-7, Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France; Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France
| | - L Zanouy
- Centre Hospitalier Charles Perrens, Pôle 3-4-7, Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France; Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France
| | - S Gard
- Centre Hospitalier Charles Perrens, Pôle 3-4-7, Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France; Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France
| | - P Roux
- Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France; Service Universitaire de Psychiatrie d'Adultes, Centre Hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France; Laboratoire HANDIReSP, EA4047, Université de Versailles Saint-Quentin-En-Yvelines, 2, avenue de la Source de la Bièvre, 78180, Montigny-le-Bretonneux, France
| | - K M'Bailara
- Laboratoire de psychologie, EA4139, Université de Bordeaux, 3(ter) place de la Victoire, 33076 Bordeaux, France; Centre Hospitalier Charles Perrens, Pôle 3-4-7, Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France; Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France.
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Faulkner SM, Bee PE, Meyer N, Dijk DJ, Drake RJ. Light therapies to improve sleep in intrinsic circadian rhythm sleep disorders and neuro-psychiatric illness: A systematic review and meta-analysis. Sleep Med Rev 2019; 46:108-123. [DOI: 10.1016/j.smrv.2019.04.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 04/02/2019] [Accepted: 04/23/2019] [Indexed: 12/12/2022]
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Inder M, Lacey C, Crowe M. Participation in decision-making about medication: A qualitative analysis of medication adherence. Int J Ment Health Nurs 2019; 28:181-189. [PMID: 29956441 DOI: 10.1111/inm.12516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2018] [Indexed: 12/28/2022]
Abstract
Rates of relapse in BD are high with medication nonadherence identified as an important contributor to relapse. Psychopharmacology remains a key component to the treatment of BD; therefore, increased understanding of medication use and ways to promote greater adherence is essential. The aim of the study was to identify how participants with BD experience taking prescribed medication. Participants had BD I or BD II, were users of specialist mental health services, aged 18-64 years, euthymic, mildly hypomanic or depressed, and on any combination of medication. Exclusion criteria were minimal. A semistructured interview was completed exploring patients' views of BD and factors influencing adherence based on the Subjective Experience of Medication Interview. An inductive thematic analysis was used to identify themes. The study participants (n = 36) had predominantly bipolar I (78%) and were female (69%), and of New Zealand European ethnicity (67%) with 14% Maori. The mean age was 41 years (SD: 12.0). Findings from the thematic analysis generated three themes: Learning about the clinical meaning of having BD, Understanding how to use medication, and Understanding what works for me. The qualitative nature of our study limits the generalizability of our findings to a broader population of individuals with BD. The participants developed confidence in being in charge of their BD through a process of learning about BD and medication and understanding what this meant for them. The findings support greater emphasis on collaborative approaches that recognize the expertise of the individual with BD and the clinician.
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Affiliation(s)
- Maree Inder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Ralat SI, Depp CA, Bernal G. Reasons for Nonadherence to Psychiatric Medication and Cardiovascular Risk Factors Treatment Among Latino Bipolar Disorder Patients Living in Puerto Rico: A Qualitative Study. Community Ment Health J 2018; 54:707-716. [PMID: 29127563 PMCID: PMC5945339 DOI: 10.1007/s10597-017-0202-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/04/2017] [Indexed: 10/18/2022]
Abstract
Latinos with bipolar disorder (BD) have a high rate of nonadherence to psychiatric medication and treatment for other medical conditions such as cardiovascular disease (CVD) risk factors than non-Latinos with BD. The aim of this study is to identify patients' perspectives on the reasons for nonadherence to psychiatric medication and for CVD risk factors conditions in outpatients with BD. Three focus group sessions were held for a total of 22 adults ranging from 23 to 60 years old. Participants had BD, Type I/II and CVD risk factors. Audio-recordings of focus groups were transcribed and a content analysis was performed. Reasons identified as barriers to adherence were somewhat different for BD medications in comparison to CVD risk factors suggesting the need for integrated interventions targeting these barriers to adherence for both BD and CVD risk factors.
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Affiliation(s)
- Sandra I Ralat
- Department of Psychiatry, School of Medicine, University of Puerto Rico, Medical Sciences Campus, P.O. Box 365067, San Juan, PR, 00936-5067, USA.
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego, USA
| | - Guillermo Bernal
- Department of Psychology, University of Puerto Rico, Rio Piedras Campus, San Juan, PR, USA
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Faulkner S, Bee P. Experiences, perspectives and priorities of people with schizophrenia spectrum disorders regarding sleep disturbance and its treatment: a qualitative study. BMC Psychiatry 2017; 17:158. [PMID: 28464848 PMCID: PMC5414297 DOI: 10.1186/s12888-017-1329-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 04/24/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Sleep problems are very common in people with schizophrenia spectrum disorders, and impact negatively on functioning and wellbeing. Research regarding interventions to improve sleep in this population has been lacking. Little is known regarding these patient's perspectives on sleep problems and their treatment, providing very little foundation on which to develop acceptable and patient-centred treatments. METHODS This study aims to explore perspectives and priorities of participants with schizophrenia spectrum disorders regarding sleep and sleep disturbance, and their perspectives on existing treatments. An Interpretive Phenomenological Analysis (IPA) study was conducted; data were gathered through in depth interviews with 15 people with schizophrenia spectrum disorders and varying degrees of self-reported sleep disturbance, each case was analysed individually before cross-case comparisons were made. RESULTS Sleep maintenance and sleep quality were universally valued. Changes to sleep were interpreted as part of a perceived loss of normality relating to diagnosis. Participants differed in the extent of any hopes that sleep would improve. Sleep disturbances were linked to a reduced ability or opportunity to participate in valued activities, and were entangled with self-image due to a wish to be perceived as alert and in control. During difficult times, sleep could be seen as an escape. Concerns were expressed regarding the negative effects of using hypnotics or anti-psychotics to aid sleep, although typically antipsychotics were deemed more acceptable than hypnotics. Concerns regarding barriers to adherence and effectiveness of self-help approaches were common. Non-pharmacological interventions were noted to require a personalised whole-lifestyle approach. CONCLUSIONS This is the first study to explore sleep perspectives in participants with established schizophrenia spectrum disorders, recruited from a population receiving usual care. Findings re-enforce the importance of considering sleep within recovery focused practice. In developing and adapting interventions routine-based approaches should be considered. Approaches should attempt to make gradual changes more easily perceptible, should support motivation for behaviour change, and should consider the impact of regular psychotropic medications.
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Affiliation(s)
- Sophie Faulkner
- The School of Health Sciences, Oxford Road, Manchester, M13 9PL UK
- Greater Manchester Mental Health NHS Foundation Trust, Trust Headquarters, Bury New Road, Prestwich, Manchester, M25 3BL UK
| | - Penny Bee
- The School of Health Sciences, Oxford Road, Manchester, M13 9PL UK
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Grover S, Hazari N, Aneja J, Chakrabarti S, Sharma S, Avasthi A. Recovery and its correlates among patients with bipolar disorder: A study from a tertiary care centre in North India. Int J Soc Psychiatry 2016; 62:726-736. [PMID: 27815514 DOI: 10.1177/0020764016676214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM The goal of treatment in mental illness has evolved from a symptom-based approach to a personal recovery-based approach. The aim of this study was to evaluate the predictors of personal recovery among patients with bipolar disorder. METHODOLOGY A total of 185 patients with bipolar disorder, currently in remission, were evaluated on Recovery Assessment Scale (RAS), Internalized Stigma of Mental Illness Scale (ISMIS), Brief Religious coping scale (RCOPE), Duke University Religiosity Index (DUREL), Religiousness Measures Scale, Hamilton depression rating scale (HDRS), Young Mania rating scale (YMRS) and Global Assessment of Functioning (GAF) scale. RESULTS The mean age of the sample was 40.5 (standard deviation (SD), 11.26) years. Majority of the participants were male, married, working, Hindu by religion and belonged to extended/joint families of urban background. In the regression analysis, RAS scores were predicted significantly by discrimination experience, stereotype endorsement and alienation domains of ISMIS, level of functioning as assessed by GAF, residual depressive symptoms as assessed by HDRS and occupational status. The level of variance explained for total RAS score and various RAS domains ranged from 36.2% to 46.9%. CONCLUSION This study suggests that personal recovery among patients with bipolar disorder is affected by stigma, level of functioning, residual depressive symptoms and employment status of patients with bipolar disorder.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Nandita Hazari
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Jitender Aneja
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sunil Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Faulkner S, Bee P. Perspectives on Sleep, Sleep Problems, and Their Treatment, in People with Serious Mental Illnesses: A Systematic Review. PLoS One 2016; 11:e0163486. [PMID: 27657927 PMCID: PMC5033349 DOI: 10.1371/journal.pone.0163486] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 09/10/2016] [Indexed: 01/11/2023] Open
Abstract
Sleep problems are common in people with serious mental illness, and impact negatively on functioning and wellbeing. To understand the development of sleep problems, their maintenance, and their treatment, an in depth understanding of patient perspectives is crucial. A systematic literature review was conducted using Medline, AMED, PsychInfo, Embase and CINAHL. Qualitative and quantitative studies were included if they explored or measured patient perspectives on sleep, sleep problems or sleep treatments in people with serious mental illness. Of the 2,067 hits, only 22 met review inclusion criteria, and high quality evidence was sparse. The limited findings suggested sleep was seen as highly interlinked with mental health. Evaluations of treatments varied, however perceived efficacy and personalisation of treatments were valued. Some evidence suggested patient priorities and conceptualisations regarding sleep may diverge from those of validated screening tools developed in general population and sleep medicine samples. More rigorous research is needed to support adaptation and development of interventions and outcome measures for use in specialist mental health settings. Qualitative studies exploring the experience of sleep disturbance in particular diagnostic groups and contexts are urgently required, as are patient perspectives on sleep interventions.
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Affiliation(s)
- Sophie Faulkner
- The School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
- Manchester Mental Health and Social Care Trust, Manchester, United Kingdom
| | - Penny Bee
- The School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
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Samalin L, de Chazeron I, Vieta E, Bellivier F, Llorca PM. Residual symptoms and specific functional impairments in euthymic patients with bipolar disorder. Bipolar Disord 2016; 18:164-73. [PMID: 26946486 DOI: 10.1111/bdi.12376] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/16/2015] [Accepted: 12/30/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aims of the present study were to confirm the impact of residual symptoms on overall functioning in a large sample of euthymic patients with bipolar disorder in real-life conditions and to explore the relationship between residual symptoms and specific areas of functional impairment. METHODS This was a multicenter, cross-sectional, non-interventional study of euthymic outpatients with bipolar disorder. The Functioning Assessment Short Test was used to assess overall and specific domains of functioning (autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time). Various residual symptoms were assessed (residual mood symptoms, emotional dysregulation, sleep and sexual disorders, stigma, and perceived cognitive impairment). Logistic regression was used to determine the best model of association between functional domains and residual symptoms. RESULTS Almost half of the 468 patients included (42%) had poor overall functioning. Residual depressive symptoms appeared to have an impact on overall functioning and in nearly all areas of functioning. In addition, specific residual symptoms had significantly more negative effects on some domains of functioning in euthymic patients with bipolar disorder (residual manic symptoms and occupational stigma on autonomy, emotional inhibition on occupational functioning, residual manic symptoms on financial issues, family stigma on interpersonal relationships, and sexual function and occupational stigma on leisure time). CONCLUSIONS Our findings highlight the importance of evaluating overall functioning in clinical practice as well as functional domains. They also indicate that some residuals symptoms in patients with bipolar disorder should be targeted in personalized treatment plans, in order to improve functioning in the domains in which the patient is most impaired.
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Affiliation(s)
- Ludovic Samalin
- CHU Clermont-Ferrand, University of Auvergne, Clermont-Ferrand, France
| | | | - Eduard Vieta
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Frank Bellivier
- AP-HP, CHU Saint-Louis Lariboisière, Hôpital Fernand Widal, INSERM UMRS 1144, Paris, France
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