Early intervention for bipolar disorder in adolescents: A psychosocial perspective

Study of the different sleep disturbances during the prodromal phase of depression and mania in bipolar disorders

BACKGROUND

One of the challenges in bipolar disorder (BD) lies in early detection of the illness and its recurrences, to improve prognosis. Sleep disturbances (SD) have been proposed as reliable predictive markers of conversion. While preliminary studies have explored the relationship between SD and the onset of mood episodes, the results remain heterogeneous and a few have specifically examined patients' perception of prodromal symptoms and their progression until the episode occurs. Identifying prodromes represents a crucial clinical challenge, as it enables early intervention, thereby reducing the severity of BD. Therefore, the objective of this study is to better characterize and evaluate the progressive nature of SD as prodromal symptoms of mood episodes, and patients' perception of it.

METHODS

Patients diagnosed with BD, either hospitalized or seeking treatment for a (hypo)manic or depressive episode benefited from standardized questionnaires, structured interviews, and self-report questionnaires to evaluate SD prior to the current episode, as well as sociodemographic and clinical information.

RESULTS

Out of the 41 patients included, 59% spontaneously reported SD prior to the episode, appearing 90 days before depression and 35 days before mania (pre-indexed/spontaneous reports: 51.22% insomnia complaints, 4.88% hypersomnolence complaints, 7.32% parasomnias, 2.44% sleep movements). After inquiry about specific SD, the percentage of patients reporting prodromal SD increased significantly to 83%, appearing 210 days before depression and 112.5 days before mania (post-indexed reports: 75.61% presented with insomnia complaints appearing 150 days before depression and 20 days before mania, 46.34% had hypersomnolence complaints appearing 60 days before depression, 43.9% had parasomnias appearing 210 days before depression and 22.5 days before mania, 36.59% had sleep movements appearing 120 days before depression and 150 days before mania). Of note, bruxism appeared in 35% of patients before mania, and restless legs syndrome in 20% of patients before depression.

CONCLUSION

This study highlights the very high prevalence of SD prior to a mood episode in patients with BD with differences between depressive and manic episodes. The more systematic screening of sleep alterations of the prodromal phase improved the recognition and characterization of different symptoms onset by patients. This underscores the need for precise questioning regarding sleep patterns in patients, to better identify the moment of transition toward a mood episode, referred to as "Chronos syndrome". The study emphasizes the importance of educating patients about the disorder and its sleep prodromal symptoms to facilitate early intervention and prevent recurrences.

Performance of a measure to assess distress in bipolar disorder

INTRODUCTION

Bipolar disorder is a condition that causes distress even for euthymic patients, having an impact on functional capabilities and quality of life. Personal and social variables are potential sources of distress. Yet, there is a lack of measures to identify specific distress in bipolar disorder. This study describes the development and evaluation of a brief measure for assessing distress in patients with bipolar disorder. We also identify associations with related constructs such as functioning, stigma, and personal beliefs regarding mental illness.

MATERIAL AND METHODS

We used a sample of 101 euthymic bipolar outpatients. Psychological assessment consisted of the Young Mania Rating Scale (YMRS) and the Hamilton Depression Scale (HAM-D) to establish euthymia. Distress was assessed with Distress on Bipolar Patients-Short (DISBIP-S); associated variables were assessed with the Functioning Assessment Short Scale (FAST), the Internalized Stigma of Mental Illness (ISMI), and the Personal Beliefs about Illness Questionnaire (PBIQ).

RESULTS

The DISBIP-S has strong internal consistency (Cronbach's alpha=0.90), and medium-high correlation coefficients with the time since last relapse (r=-0.401), predominant polarity (r=0.309), HDRS (r=-0.644), FAST (r=0.453), ISMI (r=0.789), and PBIQ (r=-0.796). Taken together, the scores on the ISMI, and PBIQ and the time since last relapse together explain 69.2% of the variability in distress.

CONCLUSIONS

The DISBIP-S can be used as a first step to develop interventions aimed at dealing with problematic personal beliefs and interpersonal sources of distress. Reducing distress experienced by bipolar disorder patients could help improve their quality of life and daily functioning.

Patients' perspectives of the effects of a group-based therapeutic patient education program for bipolar disorder: a qualitative analysis

BACKGROUND

Few qualitative studies have explored the impact of group-based psychoeducation programs from the perspective of patients with bipolar disorder, and no studies to date have examined the effects of such programs on patients' personal recovery. The aim of this study was to explore the effects of a group therapeutic education program on the personal recovery of people with bipolar disorder and its determinants.

METHODS

Three professionals conducted semistructured interviews with 16 patients who participated in 9 weekly sessions of four separate bipolar therapeutic education programs. The interviews were transcribed verbatim and analyzed inductively by two of the professionals using the thematic analysis method.

RESULTS

Three main themes emerged from the interviews: the elements of therapeutic education, the experience of therapeutic education and the changes facilitated by therapeutic education. The changes reported by the participants included the evolution of the patient's relationship with the disorder, improvement in the patient's knowledge of the disorder, improvement in disorder management throughout daily life in general, and development of psycho-social skills and social relationships.

CONCLUSIONS

This study provides support for the beneficial impact of group therapeutic education programs on the personal recovery of people with bipolar disorder. These programs improve all dimensions of recovery according to the CHIME model, with connectedness, hope and empowerment being the main dimensions impacted. Our results indicate that therapeutic group education programs can be beneficial for people with bipolar disorder at any point during their experience of the disorder, with the potential exception of periods of thymic decompensation.