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Jupille J, Harscoet YA, Duval M, Grall-Bronnec M, Moret L, Chirio-Espitalier M. "What makes you well?" Supports of well-being in bipolar disorder. A qualitative study. Int J Qual Stud Health Well-being 2023; 18:2244763. [PMID: 37660342 PMCID: PMC10478622 DOI: 10.1080/17482631.2023.2244763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE Subjective experience of people living with bipolar disorder is gaining attention in the field of research. Improving well-being could be as important as symptom remission, but this constitutes a vague concept. This study aimed at exploring the boundaries and the determinants of the well-being of people living with bipolar disorder in a French context. METHODS Individual semi-structured interviews were conducted with 16 patients by three professionals. Interviews were transcribed and analysed using the thematic analysis method. RESULTS Various dimensions emerged as contributing to well-being: daily routines, connectedness, regaining a positive identity, and self-awareness for self-management. CONCLUSIONS In addition to those common to the general population, this study highlighted specific determinants of well-being: the construction of a positive identity through acceptance of the diagnosis, the importance of self-awareness and self-management. They are highly intertwined with those of personal recovery and could help caregivers design interventions that directly target these goals. This study aimed to identify specific components of well-being for people living with bipolar disorder. Understanding the determinants of well-being enable caregivers to design tailored interventions that directly target quality of life and help improve bipolar disorder outcomes.
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Affiliation(s)
- Julien Jupille
- CRehab’S, Support Center for Psychosocial Rehabilitation in the Loire Region, Nantes University Hospital and Angevin Mental Health Center, Sainte Gemmes sur Loire, France
| | | | - Mélanie Duval
- Nantes Université, CHU Nantes, UIC Psychiatrie Et Santé Mentale, Nantes, France
| | - Marie Grall-Bronnec
- Nantes Université, CHU Nantes, UIC Psychiatrie Et Santé Mentale, Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, France
| | - Leila Moret
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, France
- University Hospital Centre Nantes Department of Medical Information Evaluation and Public Health, Nantes, Pays de la Loire, France
| | - Marion Chirio-Espitalier
- Nantes Université, CHU Nantes, UIC Psychiatrie Et Santé Mentale, Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, France
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Ellouze S, Jenhani R, Bougacha D, Turki M, Aloulou J, Ghachem R. [Self-stigma and functioning in patients with bipolar disorder]. L'ENCEPHALE 2023; 49:34-40. [PMID: 36253184 DOI: 10.1016/j.encep.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 01/19/2023]
Abstract
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.
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Affiliation(s)
- S Ellouze
- Service de psychiatrie B, CHU de Hèdi Chaker de Sfax, Sfax 3000, Tunisie.
| | - R Jenhani
- Service de psychiatrie B, hôpital Razi, La Mannouba, Tunisie
| | - D Bougacha
- Service de psychiatrie B, hôpital Razi, La Mannouba, Tunisie
| | - M Turki
- Service de psychiatrie B, CHU de Hèdi Chaker de Sfax, Sfax 3000, Tunisie
| | - J Aloulou
- Service de psychiatrie B, CHU de Hèdi Chaker de Sfax, Sfax 3000, Tunisie
| | - R Ghachem
- Service de psychiatrie B, hôpital Razi, La Mannouba, Tunisie
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Sims R, Michaleff ZA, Glasziou P, Thomas R. Consequences of a Diagnostic Label: A Systematic Scoping Review and Thematic Framework. Front Public Health 2022; 9:725877. [PMID: 35004561 PMCID: PMC8727520 DOI: 10.3389/fpubh.2021.725877] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/29/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: To develop a thematic framework for the range of consequences arising from a diagnostic label from an individual, family/caregiver, healthcare professional, and community perspective. Design: Systematic scoping review of qualitative studies. Search Strategy: We searched PubMed, Embase, PsycINFO, Cochrane, and CINAHL for primary studies and syntheses of primary studies that explore the consequences of labelling non-cancer diagnoses. Reference lists of included studies were screened, and forward citation searches undertaken. Study Selection: We included peer reviewed publications describing the perceived consequences for individuals labelled with a non-cancer diagnostic label from four perspectives: that of the individual, their family/caregiver, healthcare professional and/or community members. We excluded studies using hypothetical scenarios. Data Extraction and Synthesis: Data extraction used a three-staged process: one third was used to develop a preliminary framework, the next third for framework validation, and the final third coded if thematic saturation was not achieved. Author themes and supporting quotes were extracted, and analysed from the perspective of individual, family/caregiver, healthcare professional, or community member. Results: After deduplication, searches identified 7,379 unique articles. Following screening, 146 articles, consisting of 128 primary studies and 18 reviews, were included. The developed framework consisted of five overarching themes relevant to the four perspectives: psychosocial impact (e.g., positive/negative psychological impact, social- and self-identity, stigma), support (e.g., increased, decreased, relationship changes, professional interactions), future planning (e.g., action and uncertainty), behaviour (e.g., beneficial or detrimental modifications), and treatment expectations (e.g., positive/negative experiences). Perspectives of individuals were most frequently reported. Conclusions: This review developed and validated a framework of five domains of consequences following diagnostic labelling. Further research is required to test the external validity and acceptability of the framework for individuals and their family/caregiver, healthcare professionals, and community.
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Affiliation(s)
- Rebecca Sims
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Zoe A Michaleff
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
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Jordan AL, Marczak M, Knibbs J. 'I Felt Like I was Floating in Space': Autistic Adults' Experiences of Low Mood and Depression. J Autism Dev Disord 2021; 51:1683-1694. [PMID: 32830302 PMCID: PMC8084765 DOI: 10.1007/s10803-020-04638-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
It is recognised that a high proportion of adults on the autism spectrum experience depressive symptoms. However, limited research has explored autistic peoples' experiences of low mood and depression. The aim of this study was to explore the lived experiences of low mood and depression for adults on the autism spectrum. The study employed Interpretive Phenomenological Analysis to investigate the experiences of 8 adults (7 males and 1 female), aged between 19 and 51, who had a diagnosis of autism without co-occurring learning disabilities, and experienced low mood or depression. All participants recorded their thoughts and feelings in a mood diary for 1 week and participated in a semi-structured interview. Three superordinate themes emerged from the data: 'Autism has made me the person I am', 'I can't function in the world' and 'It's like trying to do accounts on the futures market': Making sense of emotions. Findings highlight a need for specialist mental health provision for adults who are on the autism spectrum. Limitations of this study and implications for future research are discussed.
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Affiliation(s)
- Amy Louise Jordan
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
- Department of Psychology, University of Warwick, Coventry, UK.
| | - Magdalena Marczak
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Jacqueline Knibbs
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Chen GF, Mao MC, Feng K, Gan JC, Zhang XQ, Shen CY, Xu B, Liu XM, Ren XJ, Liu PZ, Wang Y. Brain activation during verbal fluency task in type II bipolar disorder patients: a near-infrared spectroscopy study. Psychiatry Res 2021; 298:113762. [PMID: 33545426 DOI: 10.1016/j.psychres.2021.113762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/24/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Previous studies have shown that BD patients exhibited impairment when performing a verbal fluency task (VFT) and abnormal prefrontal cortex activation during this task. However, no study has specifically examined whether patients with type II BD demonstrate difficulty in performing VFT and impairments in relevant neural correlates or whether these are related to psychotic symptoms, the present study aimed to examine these issues. METHODS Forty-nine patients with type II BD (21 patients with psychotic symptoms [BDIIp] and 28 patients without psychotic symptoms [BDIIn]) and 45 matched healthy controls (HCs) participated the study and completed the VFTs, while their brain activity was recorded with near-infrared spectroscopy (NIRS). RESULTS Both BDIIp and BDIIn patients showed poorer performance on VFTs than HCs. In addition, BDII patients showed lower brain activation than HCs in bilateral dorsolateral prefrontal cortex and right frontal pole, these results were mainly driven by BDIIn patients. Moreover, subjective psychotic symptoms were positively significantly correlated with left dorsolateral prefrontal cortex activation in BDII patients. CONCLUSIONS Type II BD patients showed significant impairment when performing VFTs and reduced activation in the prefrontal cortex, and subjective psychotic symptoms were associated with brain activation in left dorsolateral prefrontal cortex in BDII patients.
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Affiliation(s)
- Gui-Fang Chen
- YuQuan Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Meng-Chai Mao
- Shanghai University of Traditional Chinese Medicine, Shanghai, China; Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
| | - Kun Feng
- YuQuan Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jie-Chun Gan
- YuQuan Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xiao-Qian Zhang
- YuQuan Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Chen-Yu Shen
- YuQuan Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Bo Xu
- YuQuan Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xiao-Min Liu
- Department of Neurology and Psychiatry, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xia-Jin Ren
- YuQuan Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Po-Zi Liu
- YuQuan Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Ya Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Mousavi N, Norozpour M, Taherifar Z, Naserbakht M, Shabani A. Bipolar I disorder: a qualitative study of the viewpoints of the family members of patients on the nature of the disorder and pharmacological treatment non-adherence. BMC Psychiatry 2021; 21:83. [PMID: 33557797 PMCID: PMC7869228 DOI: 10.1186/s12888-020-03008-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Bipolar disorder is a common psychiatric disorder with a massive psychological and social burden. Research indicates that treatment adherence is not good in these patients. The families' knowledge about the disorder is fundamental for managing their patients' disorder. The purpose of the present study was to investigate the knowledge of the family members of a sample of Iranian patients with bipolar I disorder (BD-I) and to explore the potential reasons for treatment non-adherence. METHODS This study was conducted by qualitative content analysis. In-depth interviews were held and open-coding inductive analysis was performed. A thematic content analysis was used for the qualitative data analysis. RESULTS The viewpoints of the family members of the patients were categorized in five themes, including knowledge about the disorder, information about the medications, information about the treatment and the respective role of the family, reasons for pharmacological treatment non-adherence, and strategies applied by families to enhance treatment adherence in the patients. The research findings showed that the family members did not have enough information about the nature of BD-I, which they attributed to their lack of training on the disorder. The families did not know what caused the recurrence of the disorder and did not have sufficient knowledge about its prescribed medications and treatments. Also, most families did not know about the etiology of the disorder. CONCLUSION The lack of knowledge among the family members of patients with BD-I can have a significant impact on relapse and treatment non-adherence. These issues need to be further emphasized in the training of patients' families. The present findings can be used to re-design the guidelines and protocols in a way to improve treatment adherence and avoid the relapse of BD-I symptoms.
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Affiliation(s)
- Nasim Mousavi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Marzieh Norozpour
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran.
| | - Zahra Taherifar
- Department of Psychology, Faculty of Psychology and Educational Sciences, University of Tehran, Tehran, Islamic Republic of Iran
| | - Morteza Naserbakht
- Faculty of Behavioral Sciences and Mental Health, Tehran Psychiatry Institute, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Amir Shabani
- Faculty of Behavioral Sciences and Mental Health, Tehran Psychiatry Institute, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
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AY R, KILINÇEL O. Hekimlerin Bipolar Afektif Bozukluğa Karşı Damgalayıcı Tutumların Değerlendirilmesi. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2021. [DOI: 10.33631/duzcesbed.830836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Chakrabarti S. Treatment Attitudes and Adherence Among Patients with Bipolar Disorder: A Systematic Review of Quantitative and Qualitative Studies. Harv Rev Psychiatry 2020; 27:290-302. [PMID: 31385812 DOI: 10.1097/hrp.0000000000000228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Systematic reviews about treatment attitudes of patients influencing adherence in bipolar disorder (BD) are rare. METHODS A systematic review was conducted according to the PRISMA guidelines and principles of thematic synthesis. Selectively identified quantitative and qualitative studies were used to examine the attitude-adherence relationship in BD, the types and correlates of treatment attitudes, and the impact of psychosocial interventions on attitudes. RESULTS The final list of 163 articles included 114 observational reports (incorporating 21 psychosocial intervention trials), 45 qualitative/descriptive studies, and 4 patient surveys. A positive association between treatment attitudes and adherence was found in most quantitative and qualitative studies, though the strength of the relationship was unclear. Thematic analysis of qualitative studies suggested that patient attitudes influencing adherence were based on perceived advantages and disadvantages of treatment. The principal correlates of patients' attitudes were family attitudes, the clinician-patient alliance, social support, and patients' knowledge of BD. Though negative attitudes such as denial, concerns about adverse treatment consequences, and stigmatizing effects of treatment were common, many patients believed treatment to be beneficial and necessary. The limited data on the effect of psychosocial interventions indicated that treatments selectively targeting attitudes enhanced adherence. LIMITATIONS The studies were heterogeneous in design; the quality was uneven (fair to poor); and the risk of bias moderate to high. CONCLUSIONS Despite these flaws, awareness of the existing evidence on the attitude-adherence association and other aspects of treatment attitudes in BD can help in efforts to address nonadherence in BD.
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Affiliation(s)
- Subho Chakrabarti
- From the Department of Psychiatry, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh (India)
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Smyth K, Salloum A, Herring J. Interpersonal functioning, support, and change in early-onset bipolar disorder: a transcendental phenomenological study of emerging adults. J Ment Health 2020; 30:121-128. [PMID: 31997686 DOI: 10.1080/09638237.2020.1713997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Early-onset bipolar disorder (EOBD) diagnoses have increased, yet much remains to be understood about its phenomenology. Research and treatment models developed for adult-onset bipolar disorder have largely overlooked qualitative inquiries and adolescent developmental considerations that influence course of illness. AIM The purpose of the current study was to obtain an understanding of the lived experience of interpersonal relationships and EOBD during adolescence through the retrospective report of emerging adults. METHODS This study utilized a transcendental phenomenological design. A purposive sample of eight participants ages 18-25 participated in semi-structured interviews that explored the experience of interpersonal relationships and EOBD throughout adolescence. RESULTS Participants described their experiences across three broad themes: managing and coping with EOBD; effect of EOBD on relationships; and change and uncertainty. Sub-themes include knowledge and denial of illness, involvement of others in treatment, support, difficulty maintaining social functioning, isolation and secrecy, and changes in relationships. CONCLUSIONS Participants characterized adolescence as a period of constant, simultaneous challenges in symptom management, maintaining social functioning, and concurrent changes in family and peer relationships that provide interpersonal support. Future qualitative studies should explore the implications of normative social development and family functioning for the course of illness and treatment outcomes.
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Affiliation(s)
- Kristin Smyth
- Department of Social Work, Western Carolina University, Cullowhee, NC, USA
| | - Alison Salloum
- Department of Social Work, University of South Florida, Tampa, FL, USA
| | - Jaclyn Herring
- Department of Social Work, Western Carolina University, Cullowhee, NC, USA
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Beentjes TAA, van Gaal BGI, van Achterberg T, Goossens PJJ. Self-Management Support Needs From the Perspectives of Persons With Severe Mental Illness: A Systematic Review and Thematic Synthesis of Qualitative Research. J Am Psychiatr Nurses Assoc 2020; 26:464-482. [PMID: 31578904 DOI: 10.1177/1078390319877953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: The development of de-hospitalization policies in mental health has resulted in a growing emphasis on self-management. In the chronic care model, self-management support is an essential element. Because of the episodic nature of severe mental illness (SMI) and its high relapse rates, we assume that the extent of self-management support needs of individuals with an SMI is considerable. However, a clear overview of the nature of the self-management support needs of persons with SMI is missing. AIMS: This study aimed to identify self-management support needs from the perspective of individuals with SMI. METHOD: A systematic review was conducted using the method of thematic synthesis of qualitative studies. After searching the databases MEDLINE, PsycINFO, CINAHL, and EMBASE, we screened the papers for the eligibility criteria: individuals with an SMI, adequately representing the voice of persons with SMI and describing their self-management support needs. Thirty-one papers were included. RESULTS: The main findings showed that participants in the studies described the need for informational support, emotional support, acknowledgment, encouragement, and guidance to make sense of their illness experiences, ease suffering, obtain validation and recognition, execute self-management tasks, and be led through unfamiliar territory. CONCLUSION: The perspectives of persons with SMI can provide a road map for constructing a self-management support intervention for persons with SMI. Important others have an essential role in fulfilling support needs. Independently managing an SMI is difficult. Therefore, it is preferable to let important others participate in self-management interventions and to introduce peer support.
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Affiliation(s)
- Titus A A Beentjes
- Titus A. A. Beentjes, MScN, APRN, RN, Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands; Dimence Group Mental Health Care Centre, Deventer, the Netherlands; Centre for Nursing Research, Saxion University of Applied Science, Deventer, the Netherlands
| | - Betsie G I van Gaal
- Betsie G. I. van Gaal, PhD, FEANS, Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands; HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
| | - Theo van Achterberg
- Theo van Achterberg, PhD, FEANS, KU Leuven, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Peter J J Goossens
- Peter J. J. Goossens, PhD, APRN, RN, FEANS, Dimence Group Mental Health Care Centre, Deventer, the Netherlands; University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Coadministration of lithium and celecoxib reverses manic-like behavior and decreases oxidative stress in a dopaminergic model of mania induced in rats. Transl Psychiatry 2019; 9:297. [PMID: 31723123 PMCID: PMC6853972 DOI: 10.1038/s41398-019-0637-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 06/10/2019] [Accepted: 06/20/2019] [Indexed: 12/24/2022] Open
Abstract
The present study intends to investigate the effect of lithium (Li) and celecoxib (Cel) coadministration on the behavioral status and oxidative stress parameters in a rat model of mania induced by dextroamphetamine (d-AMPH). Male Wistar rats were treated with d-AMPH or saline (Sal) for 14 days; on the 8th day of treatment, rats received lithium (Li), celecoxib (Cel), Li plus Cel, or water until day 14. Levels of oxidative stress parameters were evaluated in the serum, frontal cortex, and hippocampus. d-AMPH administration induced hyperlocomotion in rats, which was significantly reversed by Li and Cel coadministration. In addition, d-AMPH administration induced damage to proteins and lipids in the frontal cortex and hippocampus of rats. All these impairments were reversed by treatment with Li and/or Cel, in a way dependent on cerebral area and biochemical analysis. Li and Cel coadministration reversed the d-AMPH-induced decrease in catalase activity in cerebral structures. The activity of glutathione peroxidase was decreased in the frontal cortex of animals receiving d-AMPH, and treatment with Li, Cel, or a combination thereof reversed this alteration in this structure. Overall, data indicate hyperlocomotion and alteration in oxidative stress biomarkers in the cerebral structures of rats receiving d-AMPH. Li and Cel coadministration can mitigate these modifications, comprising a potential novel approach for BD therapy.
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Hackmann C, Wilson J, Perkins A, Zeilig H. Collaborative diagnosis between clinician and patient: why to do it and what to consider. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYThis article discusses findings from the literature and our own research related to the experience of the diagnostic process in mental healthcare, primarily from the perspective of patients, and it focuses on the benefits of collaboration. A common finding throughout our research is that, if a diagnostic process is undertaken, the majority of patients want to be actively involved and feel valued in it. This helps ensure that they find the process and the resulting diagnosis to be meaningful, informative and useful. We believe that collaboration could also mitigate some of the reported negative unintended consequences of diagnosis, including feeling stigmatised, labelled and disempowered. Our work has led us to conceive of diagnosis as having two overarching elements: the diagnostic process and the resulting diagnostic label. This article focuses specifically on the diagnostic process; we do not consider here the debate surrounding the evidence base for the validity of psychiatric classification.LEARNING OBJECTIVESAfter reading this article you will be able to:
•understand patients' experiences of the diagnostic process•achieve a shared and collaborative diagnostic process with patients•reflect on potential barriers and facilitators to collaborative diagnosis in your own practice.DECLARATION OF INTERESTNone.
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Eisner E, Drake RJ, Berry N, Barrowclough C, Emsley R, Machin M, Bucci S. Development and Long-Term Acceptability of ExPRESS, a Mobile Phone App to Monitor Basic Symptoms and Early Signs of Psychosis Relapse. JMIR Mhealth Uhealth 2019; 7:e11568. [PMID: 30924789 PMCID: PMC6460313 DOI: 10.2196/11568] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/25/2018] [Accepted: 12/10/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Schizophrenia relapses are common, have profound, adverse consequences for patients and are costly to health services. Early signs interventions aim to use warning signs of deterioration to prevent full relapse. Such interventions show promise but could be further developed. This study addresses 2 developments: adding basic symptoms to checklists of conventional early signs and using a mobile phone app ExPRESS to aid early signs monitoring. OBJECTIVE This study aimed to (1) design a pool of self-report items assessing basic symptoms (Basic Symptoms Checklist, BSC); (2) develop and beta test a mobile phone app (ExPRESS) for monitoring early signs, basic symptoms, and psychotic symptoms; and (3) evaluate the long-term acceptability of ExPRESS via qualitative feedback from participants in a 6-month feasibility study. METHODS The BSC items and ExPRESS were developed and then adjusted following feedback from beta testers (n=5) with a schizophrenia diagnosis. Individuals (n=18) experiencing a relapse of schizophrenia within the past year were asked to use ExPRESS for 6 months to answer weekly questions about experiences of early signs, basic symptoms, and psychotic symptoms. At the end of follow-up, face-to-face qualitative interviews (n=16; 2 were uncontactable) explored experiences of using ExPRESS. The topic guide sought participants' views on the following a priori themes regarding app acceptability: item content, layout, and wording; app appearance; length and frequency of assessments; worries about app use; how app use fitted with participants' routines; and the app's extra features. Interview transcripts were analyzed using the framework method, which allows examination of both a priori and a posteriori themes, enabling unanticipated aspects of app use experiences to be explored. RESULTS Participants' mean age was 38 years (range 22-57 years). Responses to a priori topics indicated that long-term use of ExPRESS was acceptable; small changes for future versions of ExPRESS were suggested. A posteriori themes gave further insight into individuals' experiences of using ExPRESS. Some reported finding it more accessible than visits from a clinician, as assessments were more frequent, more anonymous, and did not require the individual to explain their feelings in their own words. Nevertheless, barriers to app use (eg, unfamiliarity with smartphones) were also reported. Despite ExPRESS containing no overtly therapeutic components, some participants found that answering the weekly questions prompted self-reflection, which had therapeutic value for them. CONCLUSIONS This study suggests that apps are acceptable for long-term symptom monitoring by individuals with a schizophrenia diagnosis across a wide age range. If the potential benefits are understood, patients are generally willing and motivated to use a weekly symptom-monitoring app; most participants in this study were prepared to do so for more than 6 months. TRIAL REGISTRATION ClinicalTrials.gov NCT03558529; https://clinicaltrials.gov/ct2/show/NCT03558529 (Archived by WebCite at http://www.webcitation.org/70qvtRmZY).
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Affiliation(s)
- Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Richard James Drake
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, United Kingdom
| | - Natalie Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Christine Barrowclough
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom
| | - Matthew Machin
- Division of Informatics, Imaging & Data Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, United Kingdom
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14
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Ironside ML, Johnson SL, Carver CS. Identity in bipolar disorder: Self-worth and achievement. J Pers 2019; 88:45-58. [PMID: 30714166 DOI: 10.1111/jopy.12461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/10/2018] [Accepted: 01/27/2019] [Indexed: 12/17/2022]
Abstract
This article considers self and self-concept in bipolar disorder. Bipolar disorder, defined on the basis of manic symptoms, is a highly debilitating psychopathology. It is heavily grounded in biology but symptom course is still very responsive to psychological and social forces in the lives of persons who have the disorder. This review assumes an overall view of the self that is typical of personality psychology: self as traits, self as goals and aspirations, and ongoing efforts to attain those goals. In this review, we will discuss two different facets of self and identity in bipolar disorder. First, we review a body of goal pursuit literature suggesting that persons with bipolar disorder endorse heightened ambitions for attaining goals and recognition from others. Second, we will review multiple findings which suggest that among persons with bipolar disorder, self-worth depends on measurable success in an extreme way. We will consider how the intersection of these two themes may lead to unique identity challenges for people with bipolar disorder, drawing from self-report, behavioral, and neuroscience findings to critically examine this viewpoint.
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Affiliation(s)
- Manon L Ironside
- Department of Psychology, University of California, Berkeley, Berkeley, California
| | - Sheri L Johnson
- Department of Psychology, University of California, Berkeley, Berkeley, California
| | - Charles S Carver
- Department of Psychology, University of Miami, Coral Gables, Florida
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15
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Vallarino M, Rapisarda F, Scott J, Vecchi T, Barbato A, D'Avanzo B. Experiences of Mental Healthcare Reported by Individuals Diagnosed with Bipolar Disorder: An Italian Qualitative Study. Community Ment Health J 2019; 55:129-136. [PMID: 30074118 DOI: 10.1007/s10597-018-0311-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 07/28/2018] [Indexed: 01/06/2023]
Abstract
This qualitative study explores experiences of mental health care by nine Italian users with a diagnosis of bipolar disorder. The findings from semi-structured interviews carried by professional researchers highlighted the following themes: mixed feelings about the diagnosis; lack of access to psychological interventions despite preferences of users; positive view of peer support, job as a safe haven, traumatic experiences of compulsory hospital admissions; need for crisis interventions as alternative to hospital admission. Most users' views look in accordance with evidence-based recommendations seldom implemented in practice. Future research directions, implications of users' expectations and experiences for service planning and quality improvement, are presented and discussed in the light of the qualitative available literature.
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Affiliation(s)
- Martine Vallarino
- Department of Brain and Behavioral Sciences, University of Pavia, Piazza Botta 6, 27100, Pavia, Italy.
| | - Filippo Rapisarda
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Tomaso Vecchi
- Department of Brain and Behavioral Sciences, University of Pavia, Piazza Botta 6, 27100, Pavia, Italy
- Brain Connectivity Center, National Neurological Institute C. Mondino, Pavia, Italy
| | - Angelo Barbato
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Barbara D'Avanzo
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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16
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Experiencing mental health diagnosis: a systematic review of service user, clinician, and carer perspectives across clinical settings. Lancet Psychiatry 2018; 5:747-764. [PMID: 29680468 DOI: 10.1016/s2215-0366(18)30095-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 11/23/2022]
Abstract
Receiving a mental health diagnosis can be pivotal for service users, and it has been described in both positive and negative terms. What influences service-user experience of the diagnostic process is unclear; consequently, clinicians report uncertainty regarding best practice. This Review aims to understand and inform diagnostic practice through a comprehensive synthesis of qualitative data on views and experiences from key stakeholders (service users, clinicians, carers, and family). We searched five databases and identified 78 papers for inclusion, originating from 13 countries and including 2228 participants. Eligible papers were assessed for quality, and data were coded and then developed into themes, which generated a model representing factors to consider for clinicians conveying, and individuals receiving, mental health diagnoses. Themes included disclosure, information provision, collaboration, timing, stigma, and functional value of diagnosis for recovery. Variations between different stakeholders and clinical contexts are explored. Findings support an individualised, collaborative, and holistic approach to mental health diagnosis.
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17
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Forgione FA. Diagnostic Dissent: Experiences of Perceived Misdiagnosis and Stigma in Persons Diagnosed With Schizophrenia. JOURNAL OF HUMANISTIC PSYCHOLOGY 2018. [DOI: 10.1177/0022167818777151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is not uncommon for individuals to disagree with their psychiatric diagnosis. The experience of perceived misdiagnosis can be challenging for service users, as mainstream psychiatric theory often views this disagreement as an indication of “poor insight” into their putative illness. Some researchers have suggested that labeling a service user as lacking insight can be detrimental to the service user’s recovery. Regardless of whether a person agrees with his or her diagnosis, persons labeled with “mental illness” sometimes internalize the discrimination and stigma that they encounter. However, few studies have examined the lived experience of disagreeing with a diagnosis. The present study investigated the first-person experiences of three individuals who believed that they were misdiagnosed with a psychotic disorder. As part of a larger study, participants completed in-depth interviews about their life history and experiences in psychiatric hospitals. Data were analyzed using phenomenological methods. Participants felt that their clinicians assigned an erroneous and stigmatizing label that did not match their self-experience. Diagnostic dissent, a form of perceived misdiagnosis, was a way for individuals to assert their self-experience against perceived invalidation and stigmatizing labels.
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18
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Valvassori SS, Dal-Pont GC, Resende WR, Varela RB, Peterle BR, Gava FF, Mina FG, Cararo JH, Carvalho AF, Quevedo J. Lithium and Tamoxifen Modulate Behavior and Protein Kinase C Activity in the Animal Model of Mania Induced by Ouabain. Int J Neuropsychopharmacol 2017; 20:877-885. [PMID: 29020306 PMCID: PMC5737643 DOI: 10.1093/ijnp/pyx049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/04/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The intracerebroventricular injection of ouabain, a specific inhibitor of the Na+/K+-adenosine-triphosphatase (Na+/K+-ATPase) enzyme, induces hyperactivity in rats in a putative animal model of mania. Several evidences have suggested that the protein kinase C signaling pathway is involved in bipolar disorder. In addition, it is known that protein kinase C inhibitors, such as lithium and tamoxifen, are effective in treating acute mania. METHODS In the present study, we investigated the effects of lithium and tamoxifen on the protein kinase C signaling pathway in the frontal cortex and hippocampus of rats submitted to the animal model of mania induced by ouabain. We showed that ouabain induced hyperlocomotion in the rats. RESULTS Ouabain increased the protein kinase C activity and the protein kinase C and MARCKS phosphorylation in frontal cortex and hippocampus of rats. Lithium and tamoxifen reversed the behavioral and protein kinase C pathway changes induced by ouabain. These findings indicate that the Na+/K+-ATPase inhibition can lead to protein kinase C alteration. CONCLUSIONS The present study showed that lithium and tamoxifen modulate changes in the behavior and protein kinase C signalling pathway alterations induced by ouabain, underlining the need for more studies of protein kinase C as a possible target for treatment of bipolar disorder.
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Affiliation(s)
- Samira S Valvassori
- Laboratory of Neuronal Signaling and Psychopharmacology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, and Ms Gava); Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, Ms Gava, Ms Mina, and Dr Quevedo); Laboratory of Inborn Errors of Metabolism, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Cararo); Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil(Dr Carvalho); Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo);Center of Excellence on Mood Disorders, Department of Psychiatry and BehavioralSciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo); Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas (Dr Quevedo).,Correspondence: S. S. Valvassori, PhD, Laboratório de Sinalização Neural e Psicofarmacologia, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brasil, CEP 88806-000 ()
| | - Gustavo C Dal-Pont
- Laboratory of Neuronal Signaling and Psychopharmacology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, and Ms Gava); Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, Ms Gava, Ms Mina, and Dr Quevedo); Laboratory of Inborn Errors of Metabolism, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Cararo); Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil(Dr Carvalho); Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo);Center of Excellence on Mood Disorders, Department of Psychiatry and BehavioralSciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo); Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas (Dr Quevedo)
| | - Wilson R Resende
- Laboratory of Neuronal Signaling and Psychopharmacology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, and Ms Gava); Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, Ms Gava, Ms Mina, and Dr Quevedo); Laboratory of Inborn Errors of Metabolism, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Cararo); Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil(Dr Carvalho); Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo);Center of Excellence on Mood Disorders, Department of Psychiatry and BehavioralSciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo); Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas (Dr Quevedo)
| | - Roger B Varela
- Laboratory of Neuronal Signaling and Psychopharmacology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, and Ms Gava); Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, Ms Gava, Ms Mina, and Dr Quevedo); Laboratory of Inborn Errors of Metabolism, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Cararo); Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil(Dr Carvalho); Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo);Center of Excellence on Mood Disorders, Department of Psychiatry and BehavioralSciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo); Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas (Dr Quevedo)
| | - Bruna R Peterle
- Laboratory of Neuronal Signaling and Psychopharmacology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, and Ms Gava); Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, Ms Gava, Ms Mina, and Dr Quevedo); Laboratory of Inborn Errors of Metabolism, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Cararo); Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil(Dr Carvalho); Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo);Center of Excellence on Mood Disorders, Department of Psychiatry and BehavioralSciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo); Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas (Dr Quevedo)
| | - Fernanda F Gava
- Laboratory of Neuronal Signaling and Psychopharmacology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, and Ms Gava); Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, Ms Gava, Ms Mina, and Dr Quevedo); Laboratory of Inborn Errors of Metabolism, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Cararo); Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil(Dr Carvalho); Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo);Center of Excellence on Mood Disorders, Department of Psychiatry and BehavioralSciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo); Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas (Dr Quevedo)
| | - Francielle G Mina
- Laboratory of Neuronal Signaling and Psychopharmacology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, and Ms Gava); Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, Ms Gava, Ms Mina, and Dr Quevedo); Laboratory of Inborn Errors of Metabolism, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Cararo); Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil(Dr Carvalho); Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo);Center of Excellence on Mood Disorders, Department of Psychiatry and BehavioralSciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo); Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas (Dr Quevedo)
| | - José H Cararo
- Laboratory of Neuronal Signaling and Psychopharmacology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, and Ms Gava); Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, Ms Gava, Ms Mina, and Dr Quevedo); Laboratory of Inborn Errors of Metabolism, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Cararo); Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil(Dr Carvalho); Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo);Center of Excellence on Mood Disorders, Department of Psychiatry and BehavioralSciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo); Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas (Dr Quevedo)
| | - André F Carvalho
- Laboratory of Neuronal Signaling and Psychopharmacology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, and Ms Gava); Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, Ms Gava, Ms Mina, and Dr Quevedo); Laboratory of Inborn Errors of Metabolism, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Cararo); Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil(Dr Carvalho); Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo);Center of Excellence on Mood Disorders, Department of Psychiatry and BehavioralSciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo); Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas (Dr Quevedo)
| | - João Quevedo
- Laboratory of Neuronal Signaling and Psychopharmacology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, and Ms Gava); Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Valvassori, Mr Dal-Pont, Dr Resende, Mr Varela, Ms Peterle, Ms Gava, Ms Mina, and Dr Quevedo); Laboratory of Inborn Errors of Metabolism, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil (Dr Cararo); Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil(Dr Carvalho); Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo);Center of Excellence on Mood Disorders, Department of Psychiatry and BehavioralSciences, The University of Texas Health Science Center at Houston Medical School, Houston, Texas (Dr Quevedo); Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas (Dr Quevedo)
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Grover S, Hazari N, Aneja J, Chakrabarti S, Avasthi A. Stigma and its correlates among patients with bipolar disorder: A study from a tertiary care hospital of North India. Psychiatry Res 2016; 244:109-16. [PMID: 27479100 DOI: 10.1016/j.psychres.2016.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 07/03/2016] [Accepted: 07/04/2016] [Indexed: 02/05/2023]
Abstract
This study aimed to assess stigma and its sociodemographic and clinical correlates among patients with bipolar disorder while in remission. 185 patients currently in remission were assessed on Internalized Stigma of Mental Illness Scale (ISMIS) for internalized stigma, Explanatory Model Interview Catalogue Stigma Scale for perceived stigma and Participation scale for restriction of activities. About 28% patients reported moderate to high level of self stigma as assessed by ISMIS total score. Discrimination experience (38.9%) was reported to be the most commonly experienced self stigma followed by alienation (28.6%) and social withdrawal (28.6%). On the participation scale, about two-fifth (42%) of the participants had severe restriction of activities. Internalized stigma was higher among those with lower age and lesser income. Higher level of stigma was associated with shorter mean duration of remission, income, mean duration of depressive episodes, higher severity of residual depressive symptoms and current level of functioning. Higher internalized stigma was associated with greater restriction in participation of activities. To conclude, present study suggests that self stigma is highly prevalent among patients with bipolar disorder in India and is associated with clinical variables like duration of depressive episodes and level of functioning.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Nandita Hazari
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Jitender Aneja
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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20
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Haarig F, Berndt C, Kühnert M, Fuchs S, Bräunig P, Mühlig S. Was ist Betroffenen wichtig? Bestimmung patientennaher Therapiezieldimensionen in der Behandlung von bipolaren Störungen. ACTA ACUST UNITED AC 2016. [DOI: 10.1024/1661-4747/a000269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Patientenorientierung schließt die Berücksichtigung von Therapiezielpräferenzen ein. Shared decision making kann dazu beitragen, die Therapiezufriedenheit und -mitarbeit zu verbessern. Fragestellungen: 1) Bestimmung, der von Patienten priorisierten Therapieziele in der Behandlung bipolarer Störungen, 2) Extraktion der wichtigsten Therapiezieldimensionen, 3) Darstellung von Unterschieden in der Wichtigkeit abhängig von Geschlecht, Alter und Behandlungsstatus. Im Rahmen einer BMBF-geförderten Studie wurde die Wichtigkeit (1 = unwichtig bis 5 = sehr wichtig) von 73 Therapiezielen in der Behandlung bipolarer Störungen aus Betroffenensicht (N = 333) untersucht. Störungsbewältigung (R2 = 29 %), Lebensqualität (R2 = 9 %), Beteiligung am therapeutischen Geschehen (R2 = 7 %) und Nebenwirkungen von Medikamenten (R2 = 5 %) stellten die bedeutsamsten Zieldimensionen dar. Morbiditätsparameter (Symptome, Episoden) hatten dagegen einen geringeren Stellwert (R2 = 3,6 %). Die Wichtigkeitseinschätzungen variierten in Abhängigkeit von Geschlecht, Alter und Behandlungsstatus. In der Behandlung von bipolaren Störungen legen Patienten vor allem Wert auf die Bearbeitung störungsbezogener Probleme sowie die Verbesserung von Lebensqualität. Durch eine verstärkte Orientierung an Bedürfnissen von bipolar Betroffenen auf Seiten ihrer Behandler lassen sich Prozesse des shared decision making optimieren.
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Affiliation(s)
| | | | | | - Stefanie Fuchs
- Institut für Psychologie, Technische Universität Chemnitz
| | - Peter Bräunig
- Institut für Psychologie, Technische Universität Chemnitz
| | - Stephan Mühlig
- Institut für Psychologie, Technische Universität Chemnitz
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Gliddon E, Lauder S, Berk L, Cosgrove V, Grimm D, Dodd S, Suppes T, Berk M. Evaluating discussion board engagement in the MoodSwings online self-help program for bipolar disorder: protocol for an observational prospective cohort study. BMC Psychiatry 2015; 15:243. [PMID: 26462799 PMCID: PMC4604761 DOI: 10.1186/s12888-015-0630-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Online, self-guided programs exist for a wide range of mental health conditions, including bipolar disorder, and discussion boards are often part of these interventions. The impact engagement with these discussion boards has on the psychosocial well-being of users is largely unknown. More specifically we need to clarify the influence of the type and level of engagement on outcomes. The primary aim of this exploratory study is to determine if there is a relationship between different types (active, passive or none) and levels (high, mid and low) of discussion board engagement and improvement in outcome measures from baseline to follow up, with a focus on self-reported social support, stigma, quality of life and levels of depression and mania. The secondary aim of this study is to identify any differences in demographic variables among discussion users. METHODS/DESIGN The present study is a sub-study of the MoodSwings 2.0 3-arm randomised controlled trial (discussion board only (arm 1), discussion board plus psychoeducation (arm 2), discussion board, psychoeducation plus cognitive behavioural therapy-based tools (arm 3)). Discussion engagement will be measured via online participant activity monitoring. Assessments include online self-report as well as blinded phone interviews at baseline, 3, 6, 9 and 12 months follow up. DISCUSSION The results of this study will help to inform future programs about whether or not discussion boards are a beneficial inclusion in online self-help interventions. It will also help to determine if motivating users to actively engage in online discussion is necessary, and if so, what level of engagement is optimal to produce the most benefit. Future programs may benefit through being able to identify those most likely to poorly engage, based on demographic variables, so motivational strategies can be targeted accordingly. TRIAL REGISTRATION ClinicalTrials.gov NCT02118623 registered April 15 2014 and NCT02106078 registered May 16 2013.
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Affiliation(s)
- Emma Gliddon
- IMPACT Strategic Research Centre, Deakin University, Geelong, Australia. .,The Department of Psychiatry, The University of Melbourne, Parkville, Australia.
| | - Sue Lauder
- The Department of Psychiatry, The University of Melbourne, Parkville, Australia. .,The Collaborative Research Network, Federation University, Ballarat, Australia.
| | - Lesley Berk
- The Department of Psychiatry, The University of Melbourne, Parkville, Australia. .,Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, Australia. .,School of Psychology, Deakin University, Burwood, Australia.
| | - Victoria Cosgrove
- VA Palo Alto Health Care System, Palo Alto, California, USA. .,Stanford University School of Medicine, Stanford, California, USA.
| | - David Grimm
- VA Palo Alto Health Care System, Palo Alto, California, USA.
| | - Seetal Dodd
- IMPACT Strategic Research Centre, Deakin University, Geelong, Australia. .,The Department of Psychiatry, The University of Melbourne, Parkville, Australia.
| | - Trisha Suppes
- VA Palo Alto Health Care System, Palo Alto, California, USA. .,Stanford University School of Medicine, Stanford, California, USA.
| | - Michael Berk
- IMPACT Strategic Research Centre, Deakin University, Geelong, Australia. .,The Department of Psychiatry, The University of Melbourne, Parkville, Australia. .,Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, Australia. .,Florey Institute for Neuroscience and Mental Health, Parkville, Australia.
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'You just lose the people you know': relationship loss and mental illness. Arch Psychiatr Nurs 2015; 29:96-101. [PMID: 25858201 DOI: 10.1016/j.apnu.2014.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 11/05/2014] [Accepted: 11/27/2014] [Indexed: 11/21/2022]
Abstract
The purpose of this qualitative study was to explore the nature, scope and consequences of losses resulting from mental illness. This paper presents findings from a key theme of this study-the loss of relationships. Thematic analysis revealed two categories: loss of intimate relationships, which included subcategories of (i) spouses/partners, (ii) children/parenthood, (iii) family, and (iv) friends; and (2) people within the community, such as people at church and support groups. Relationships are seen as one of the most crucial yet challenging elements to recovery and wellbeing for people affected by mental illness.
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Leitan ND, Michalak EE, Berk L, Berk M, Murray G. Optimizing delivery of recovery-oriented online self-management strategies for bipolar disorder: a review. Bipolar Disord 2015; 17:115-27. [PMID: 25238632 DOI: 10.1111/bdi.12258] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 06/27/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Self-management is emerging as a viable alternative to difficult-to-access psychosocial treatments for bipolar disorder (BD), and has particular relevance to recovery-related goals around empowerment and personal meaning. This review examines data and theory on BD self-management from a recovery-oriented perspective, with a particular focus on optimizing low-intensity delivery of self-management tools via the web. METHODS A critical evaluation of various literatures was undertaken. Literatures on recovery, online platforms, and self-management in mental health and BD are reviewed. RESULTS The literature suggests that the self-management approach aligns with the recovery framework. However, studies have identified a number of potential barriers to the utilization of self-management programs for BD and it has been suggested that utilizing an online environment may be an effective way to surmount many of these barriers. CONCLUSIONS Online self-management programs for BD are rapidly developing, and in parallel the recovery perspective is becoming the dominant paradigm for mental health services worldwide, so research is urgently required to assess the efficacy and safety of optimization methods such as professional and/or peer support, tailoring and the development of 'online communities'.
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Affiliation(s)
- Nuwan D Leitan
- Faculty of Life and Social Sciences, Swinburne University of Technology, Hawthorn, Vic., Australia
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Bonnington O, Rose D. Exploring stigmatisation among people diagnosed with either bipolar disorder or borderline personality disorder: A critical realist analysis. Soc Sci Med 2014; 123:7-17. [DOI: 10.1016/j.socscimed.2014.10.048] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 10/22/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
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Fernandez ME, Breen LJ, Simpson TA. Renegotiating Identities: Experiences of Loss and Recovery for Women With Bipolar Disorder. QUALITATIVE HEALTH RESEARCH 2014; 24:890-900. [PMID: 24970246 DOI: 10.1177/1049732314538550] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Along with major changes in mood, people living with bipolar disorder (BD) often experience recurrent hospital admissions, feelings of failure and hopelessness, social stigma, underemployment, and a loss of independence. In this study we explored the experiences of loss, coping, and recovery in a community sample of women living with BD. Ten women each participated in a semistructured interview. We used the constant comparative method to analyze the data. We identified three themes from the data: identity bound by the diagnostic label, multidimensional effects of the bipolar disorder identity, and strategies for renegotiating identity. For these women, recovery involved an ongoing process of balancing their sick self with their healthy self. The findings contribute to conceptualizations of loss, coping mechanisms for dealing with loss, and the relevance of loss in recovery for people living at the margins with BD.
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Affiliation(s)
- Maria E Fernandez
- Department for Child Protection and Family Support, Geraldton, Western Australia, Australia
| | - Lauren J Breen
- Curtin University, Bentley, Western Australia, Australia
| | - Terry A Simpson
- Edith Cowan University, Joondalup, Western Australia, Australia
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Shah LBI, Klainin-Yobas P, Torres S, Kannusamy P. Efficacy of psychoeducation and relaxation interventions on stress-related variables in people with mental disorders: a literature review. Arch Psychiatr Nurs 2014; 28:94-101. [PMID: 24673782 DOI: 10.1016/j.apnu.2013.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 11/02/2013] [Indexed: 10/26/2022]
Abstract
This paper aimed to critically review and summarize empirical evidence concerning the efficacy of psychoeducation or relaxation-based stress management interventions on stress-related variables in people with mental disorders. Electronic databases were used during the literature search. Thirteen articles that fulfilled the preset eligible criteria were included in the review. Findings indicated that psychoeducation and relaxation-based interventions mitigated stress and depression; and enhanced relaxation intensity and knowledge on stress management. However, mixed results were obtained on anxiety. In addition, interventions using virtual reality technology revealed positive effects on depression, relaxation intensity and anxiety. Limitations and recommendations for future research are discussed.
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Affiliation(s)
| | | | - Samantha Torres
- Faculty of Health and Social Care, Dearne Building, University Of Hull, UK.
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Bilderbeck AC, Saunders KEA, Price J, Goodwin GM. Psychiatric assessment of mood instability: qualitative study of patient experience. Br J Psychiatry 2014; 204:234-9. [PMID: 24357573 DOI: 10.1192/bjp.bp.113.128348] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mood instability is a common reason for psychiatric referral. Very little is known about how patients with unstable mood experience assessment and diagnosis. AIMS To investigate the experiences of assessment and diagnosis among patients with mood instability and to suggest improvements to this process. METHOD Qualitative study, gathering data through individual interviews with 28 people experiencing mood instability and receiving a psychiatric assessment in secondary care. RESULTS Participants described the importance of receiving an explanation for their symptoms; the value of a good interpersonal relationship with their clinician(s); being listened to and acknowledged; and being involved in and informed about clinical decisions. These needs were not, however, consistently met. Receiving a psychiatric diagnosis, including a diagnosis of bipolar disorder or borderline personality disorder, evoked both positive and negative responses among participants, relating to stigma, personal understanding and responsibility, prognosis and treatment. CONCLUSIONS Patients with mood instability seek explanation for their symptoms and difficulties, empathetic care and consistent support as much as cure. Clinicians may incorrectly assume what patients' attitudes towards diagnosis are, a mismatch which may hamper the development of a strong therapeutic relationship. Clear, patient-centred communication, which acknowledges the patient's experience, may result in greater patient engagement and satisfaction.
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Affiliation(s)
- Amy C Bilderbeck
- Amy C. Bilderbeck, BA, MA, DPhil, Kate E. A. Saunders, BM, BCh, MA, MRCPsych, Jonathan Price, DPhil, MRCPsych, Guy M. Goodwin, FMedSci, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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Dudas RB. What is it like to be diagnosed with bipolar illness, borderline personality disorder or another diagnosis with mood instability? Br J Psychiatry 2014; 204:178-9. [PMID: 24590973 DOI: 10.1192/bjp.bp.113.132340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patients with mood instability represent a significant proportion of patients with mental illness. Important lessons need to be learnt about how current assessment processes do not meet their expectations. Changes at various levels, including medical and nursing education, service provision and research priorities, appear necessary if we are to help our patients better.
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Affiliation(s)
- Robert B Dudas
- Robert B. Dudas, MD, PhD (Cantab), MRCPsych, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH and Complex Cases Service, Cambridgeshire and Peterborough Mental Health NHS Foundation Trust, Cambridge, UK.
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Russell L, Moss D. High and happy? Exploring the experience of positive states of mind in people who have been given a diagnosis of bipolar disorder. Psychol Psychother 2013; 86:431-46. [PMID: 24217867 DOI: 10.1111/j.2044-8341.2012.02064.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To approach the experience of 'happiness' and 'mania' for people who have been given a diagnosis of 'bipolar disorder' and to explore how they might differentiate or associate between these experiences. DESIGN A qualitative design was used in which four participants who had been given a diagnosis of 'bipolar disorder' were interviewed individually regarding their experiences and ideas about 'mania' and 'happiness'. METHODS Transcriptions from the interviews were analysed using the iterative process of interpretative phenomenological analysis. RESULTS Four superordinate themes were identified. Two highlighted the conceptual fluidity and similarities between their ideas about and experiences of 'happiness' and 'mania'. Two emphasized the differences between these notions for the participants, which reflected the destruction, disruption, and chaos of 'mania' in contrast to the importance of self-acceptance, peacefulness, and social connection for 'happiness'. CONCLUSION There may be benefit in maintaining an active dialogue or 'poly-vocality' about the meanings of 'happiness' in clinical work with people who experience 'positive states' of mind, which are personally problematic. This can be supported by drawing on ideas and narratives about 'happiness' from the field of positive psychology.
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Affiliation(s)
- Leo Russell
- Clinical Psychology Service, Somerset Partnership NHS Foundation Trust, UKDepartment of Clinical Psychology, University of Plymouth, Devon, UK
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McCraw S, Parker G, Fletcher K, Friend P. Self-reported creativity in bipolar disorder: prevalence, types and associated outcomes in mania versus hypomania. J Affect Disord 2013; 151:831-6. [PMID: 24084622 DOI: 10.1016/j.jad.2013.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/24/2013] [Accepted: 07/24/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Bipolar (BP) disorder has been linked to creativity following investigation of prominent artists and controlled trials of creativity in BP disorder patients. However, it is unclear whether creativity is differentially expressed across the BP I and BP II subtypes. METHODS 219 patients (aged 19-63 years) diagnosed with BP disorder by clinical interview and DSM-IV criteria were asked whether they tended to be more creative during hypo/manic episodes, and answered five questions about personality styles associated with creativity. Qualitative analyses were performed on a smaller subset of 69 BP patients (n=19 BP I, n=50 BP II) who provided written responses of the types of creative activities engaged in when hypo/manic and any perceived advantages or disadvantages of their creative pursuits. RESULTS 82% of BP patients affirmed being creative when hypo/manic, with comparable results for the BP I and BP II subtypes (84% and 81% respectively). Both BP subtypes engaged mostly in writing, painting, work or business ideas and 'other' forms of art; however BP II patients were more likely to draw and be musical. Both subgroups reported the consequences of feeling good, being productive or quitting their project. BP I patients were more likely to overspend during their creative highs while BP II patients were more likely to experience improved focus and clarity. BP patients affirming creative highs were significantly more likely to report creative personality styles more generally outside of a mood episode. LIMITATIONS BP patients' self-reported creative activities were not retrospectively judged for quality or originality and so may reflect common creative abilities rather than exceptional quality. The impact of depressive episodes on creativity was not assessed. Uneven sample sizes in the BP I and BP II subgroups may have compromised statistical power. CONCLUSION Creativity during hypo/manic episodes was extremely common in both BP subtypes. While some nuances in activity type and outcomes were observed, no significant creative phenotype specific to BP I or BP II disorder emerged.
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Affiliation(s)
- Stacey McCraw
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia.
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Abstract
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.
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Russell L, Moss D. A Meta-Study of Qualitative Research Into the Experience of ‘Symptoms’ and ‘Having a Diagnosis’ for People Who Have Been Given a Diagnosis of Bipolar Disorder. EUROPES JOURNAL OF PSYCHOLOGY 2013. [DOI: 10.5964/ejop.v9i3.675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Russell L, Moss D. A Meta-Study of Qualitative Research Into the Experience of ‘Symptoms’ and ‘Having a Diagnosis’ for People Who Have Been Given a Diagnosis of Bipolar Disorder. EUROPES JOURNAL OF PSYCHOLOGY 2013. [DOI: 10.5964/ejop.v9i2.560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lauder S, Chester A, Castle D, Dodd S, Berk L, Klein B, Austin D, Gilbert M, Chamberlain JA, Murray G, White C, Piterman L, Berk M. Development of an online intervention for bipolar disorder. www.moodswings.net.au. PSYCHOL HEALTH MED 2013; 18:155-65. [DOI: 10.1080/13548506.2012.689840] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Michalak EE, Torres IJ, Bond DJ, Lam RW, Yatham LN. The relationship between clinical outcomes and quality of life in first-episode mania: a longitudinal analysis. Bipolar Disord 2013; 15:188-98. [PMID: 23437962 DOI: 10.1111/bdi.12049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Despite growing attention to the relationship between bipolar disorder (BD) and quality of life (QoL), there remains a lack of information about QoL in the early stages of BD, and about the course of QoL in people with BD over time. Here, we report on QoL and symptomatic outcomes over a 1.5-year period in a Canadian sample of first-episode mania patients. METHODS Patients (n = 63) with DSM-IV-TR BD type I recovering from a recent episode of mania were recruited from a university-based hospital setting in Vancouver, BC, Canada and assessed at six monthly intervals for 18 months. In addition to symptomatic and cognitive assessments, two self-report QoL scales [the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Medical Outcomes Study Short Form 36 (SF-36)] were administered. RESULTS Baseline QoL scores were high, with mean Q-LES-Q scores at 70% of the maximum possible score; QoL continued to show a trend towards improvement over time. Multiple hierarchical regressions were used to explore predictors of QoL over time, finding that: (i) length of illness and severity of depressive symptoms at baseline predicted Q-LES-Q scores at both baseline and six months; (ii) the number of previous depressive episodes and severity of depression at baseline and 12 months all predicted QoL at 12 months; and (iii) only severity of depressive symptoms at 12 months predicted QoL at 18 months. CONCLUSIONS Our observation that QoL in patients who have recently experienced an episode of mania can be relatively preserved offers hope, both for healthcare providers and for those newly diagnosed. Further, that severity of depressive symptoms even in the early stages of the disease was the consistent predictor of QoL suggests that depressive symptoms need to be aggressively treated to improve QoL.
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Affiliation(s)
- Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Abstract
The Diagnostic and Statistical Manual of Mental Disorders (DSM) offers a biomedical framing of people’s experiences of distress and impairment, and despite decades of criticism, it remains the dominant approach. This dominance is maintained not only by powerful corporate interests such as the pharmaceutical industry, but also through the everyday talk of people as they attempt to make meaning of themselves and their experiences. This paper explores how and why the DSM holds such cultural currency for individual speakers, and unpacks what is being accomplished in their taking up the language of psychiatric diagnosis. In particular, we argue that a biomedical construction of distress offers the lure, or promise, of validating persons’ pain and legitimizing their identities. However, we also argue that the very assumptions of biomedicine ensure that this promise can never entirely be fulfilled and, despite its lure, a biomedical construction of ‘mental illness’ all too frequently fails to protect individuals from delegitimation and stigma.
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Abstract
Constructed as a barrier to treatment adherence, ambivalence is typically pathologized in qualitative research on “bipolar disorder”—seen as something to be feared and eradicated. Here, I critically review this position, arguing that it is constructed through a “lens of risk” that problematically presumes people have a chronic mental illness that requires lifelong pharmaceutical intervention. I then draw on the accounts of three young women who have been diagnosed with bipolar disorder to demonstrate how people’s concerns, questions, and dreams could instead be seen as a site of expertise about diagnostic and treatment practices; in turn using their ambivalence to stitch together an alternative analytic “lens of desire” through which to re-view accounts of bipolar disorder. Overall this article is thus both a commentary on mainstream research practices in psychology and an experiment with how we might look differently; believing that perhaps the real risk associated with people’s ambivalence is its ability to force us—psychologists and psychiatrists—to question the ways in which we do madness.
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Proudfoot J, Parker G, Manicavasagar V, Hadzi-Pavlovic D, Whitton A, Nicholas J, Smith M, Burckhardt R. Effects of adjunctive peer support on perceptions of illness control and understanding in an online psychoeducation program for bipolar disorder: a randomised controlled trial. J Affect Disord 2012; 142:98-105. [PMID: 22858215 DOI: 10.1016/j.jad.2012.04.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/04/2012] [Accepted: 04/04/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine the comparative effectiveness of an online psychoeducation program for people diagnosed with bipolar disorder within the previous 12 months, completed alone or with adjunctive peer support, on symptoms and perceived control over the illness. METHOD Participants were randomly allocated to an eight-week online psychoeducation program (n=139), a psychoeducation program plus online peer support (n=134) or an attentional control condition (n=134). RESULTS Increased perceptions of control, decreased perceptions of stigmatisation and significant improvements in levels of anxiety and depression, from pre- to post-intervention were found across all groups. There were no significant differences between groups on outcome measures, although a small clinical difference was found between the supported and unsupported conditions in depression symptoms and in functional impairment at the six-month follow-up. Adherence to the treatment program was significantly higher in the supported intervention than in the unsupported program. Gender and age were also significant predictors of adherence, with females and those over the age of 30 showing greater adherence. LIMITATIONS Mood state at study entry was measured by self-report rather than by clinical interview. CONCLUSIONS The pattern of outcomes suggests a primary influence of non-specific or common therapeutic factors across all three intervention groups. A personally tailored intervention may be more suitable for individuals recently diagnosed with bipolar disorder, and longer term coaching may increase program adherence and long-term improvement in symptoms and functioning.
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Affiliation(s)
- Judith Proudfoot
- School of Psychiatry, University of NSW and Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, NSW 2031, Australia.
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Parker G, Paterson A, Fletcher K, Hyett M, Blanch B. Out of the darkness: the impact of a mood disorder over time. Australas Psychiatry 2012; 20:487-91. [PMID: 23125400 DOI: 10.1177/1039856212466160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Being diagnosed with depression or bipolar disorder has a significant impact on an individual's life. This paper reports data examining how patients view having had such a condition. METHOD Patients attending the Black Dog Institute Depression Clinic were asked to complete questionnaires examining the impact of being diagnosed with a mood disorder and dealing with that condition over time. RESULTS Patient responses were analysed qualitatively (in terms of positive, negative and neutral responses) and their quantitative distribution was examined. Themes were relatively consistent across unipolar and bipolar patients. Negative themes included family and work consequences, social impairment and a loss of self-confidence. Positive themes included the development of stronger familial bonds, the provision of relief and hope, positive treatment outcomes and the explanatory benefits of receiving a diagnosis. CONCLUSIONS Findings indicate quite contrasting courses reported by patients with mood disorders (irrespective of polarity), ranging from negative to very positive evaluations.
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Affiliation(s)
- Gordon Parker
- School of Psychiatry, University of New South Wales, Randwick, NSW, Australia.
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Proudfoot JG, Jayawant A, Whitton AE, Parker G, Manicavasagar V, Smith M, Nicholas J. Mechanisms underpinning effective peer support: a qualitative analysis of interactions between expert peers and patients newly-diagnosed with bipolar disorder. BMC Psychiatry 2012; 12:196. [PMID: 23140497 PMCID: PMC3549948 DOI: 10.1186/1471-244x-12-196] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 11/07/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The increasing burden on mental health services has led to the growing use of peer support in psychological interventions. Four theoretical mechanisms have been proposed to underpin effective peer support: advice grounded in experiential knowledge, social support, social comparison and the helper therapy principle. However, there has been a lack of studies examining whether these mechanisms are also evident in clinical populations in which interpersonal dysfunction is common, such as bipolar disorder. METHOD This qualitative study, conducted alongside a randomized controlled trial, examined whether the four mechanisms proposed to underpin effective peer support were expressed in the email exchange between 44 individuals newly-diagnosed with bipolar disorder and their Informed Supporters (n = 4), over the course of a supported online psychoeducation program for bipolar disorder. A total of 104 text segments were extracted and coded. The data were complemented by face-to-face interviews with three of the four Informed Supporters who participated in the study. RESULTS Qualitative analyses of the email interchange and interview transcripts revealed rich examples of all four mechanisms. The data illustrated how the involvement of Informed Supporters resulted in numerous benefits for the newly-diagnosed individuals, including the provision of practical strategies for illness management as well as emotional support throughout the intervention. The Informed Supporters encouraged the development of positive relationships with mental health services, and acted as role models for treatment adherence. The Informed Supporters themselves reported gaining a number of benefits from helping, including a greater sense of connectedness with the mental health system, as well as a broader knowledge of illness management strategies. CONCLUSIONS Examples of the mechanisms underpinning effective peer support were found in the sample of emails from individuals with newly-diagnosed bipolar disorder and their Informed Supporters. Experiential knowledge, social support, social comparison and helper therapy were apparent, even within a clinical population for whom relationship difficulties are common. Trial registration number ACTRN12608000411347.
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Affiliation(s)
- Judith G Proudfoot
- Black Dog Institute and School of Psychiatry, University of New South Wales, Randwick, NSW, Australia.
| | - Amisha Jayawant
- Black Dog Institute and School of Psychiatry, University of New South Wales, Hospital Road, Randwick, NSW, Australia
| | - Alexis E Whitton
- Black Dog Institute and School of Psychiatry, University of New South Wales, Hospital Road, Randwick, NSW, Australia
| | - Gordon Parker
- Black Dog Institute and School of Psychiatry, University of New South Wales, Hospital Road, Randwick, NSW, Australia
| | - Vijaya Manicavasagar
- Black Dog Institute and School of Psychiatry, University of New South Wales, Hospital Road, Randwick, NSW, Australia
| | - Meg Smith
- School of Social Sciences, University of Western Sydney, Penrith South, NSW, Australia
| | - Jennifer Nicholas
- Black Dog Institute and School of Psychiatry, University of New South Wales, Hospital Road, Randwick, NSW, Australia
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41
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Goldberg SG. Becoming the denigrated other: group relations perspectives on initial reactions to a bipolar disorder diagnosis. Front Psychol 2012; 3:347. [PMID: 23049521 PMCID: PMC3446808 DOI: 10.3389/fpsyg.2012.00347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 08/29/2012] [Indexed: 11/17/2022] Open
Abstract
The initial reactions to a bipolar disorder diagnosis of research participants in a small, qualitative study consisted of astonishment, dread of being “mad,” and extremely negative associations. All had prior mental health diagnoses, including episodes of severe depression (all but one) and alcoholism (one). All participants reported mental health histories prediagnosis and most had spent years contending with mental health labels, medications, symptoms, and hospitalizations. In addition, most participants were highly educated health professionals, quite familiar with the behaviors that the medical system considered to comprise bipolar disorder. Their negative associations to the initial bipolar disorder diagnosis, therefore, appeared inconsistent with their mental health histories and professional knowledge. This article contextualizes these initial reactions of shock and distress and proposes interpretations of these findings from societal and psychodynamic group relations perspectives. The participants’ initial negative reactions are conceptualized as involving the terror of being transported from the group of “normal” people into the group of “mad” or “crazy” people, i.e., people with mental illnesses, who may constitute a societal “denigrated other.”
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Affiliation(s)
- Susan G Goldberg
- Department of Psychology, Duquesne University, Pittsburgh PA, USA ; Fielding Graduate University Santa Barbara, CA, USA
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42
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Thomé ES, Dargél AA, Migliavacca FM, Potter WA, Jappur DMC, Kapczinski F, Ceresér KM. Stigma experiences in bipolar patients: the impact upon functioning. J Psychiatr Ment Health Nurs 2012; 19:665-71. [PMID: 22093281 DOI: 10.1111/j.1365-2850.2011.01849.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate the impact of self-rated stigma and functioning in patients with bipolar disorder in South Brazil. This is a cross-sectional study. Sixty participants with bipolar disorder were recruited from an outpatient Bipolar Disorder Program. Experiences with and impact of perceived stigma were evaluated using the Inventory of Stigmatizing Experiences. Functional impairment was assessed with the Functioning Assessment Short Test (FAST). Higher scores of self-perceived stigma were correlated with higher FAST scores, indicating more disability. After linear correlation analysis, current depressive symptoms, age at onset of treatment, age at diagnosis and functioning were correlated with self-perceived stigma. The study demonstrated a correlation between stigma and poor functioning in bipolar disorder. Perceived stigma is really important to individuals with bipolar disorder, both to how they experience their illness and to its results on functioning. Potential consequences of such results for mental health care professionals are discussed. Differential clinical features, sociocultural factors and the sample size limit the generalization of the present findings.
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Affiliation(s)
- E S Thomé
- Hospital das Clínicas de Porto Alegre and Post-Graduate Medical Sciences Program, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Crowe M, Inder M, Carlyle D, Wilson L, Whitehead L, Panckhurst A, O'Brien A, Joyce P. Feeling out of control: a qualitative analysis of the impact of bipolar disorder. J Psychiatr Ment Health Nurs 2012; 19:294-302. [PMID: 22074414 DOI: 10.1111/j.1365-2850.2011.01786.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bipolar disorder is a chronic and recurrent disorder with fluctuating symptoms. Few patients with bipolar disorder experience a simple trajectory of clear-cut episodes, with recovery typically occurring slowly over time. The chronic and disabling course of the disorder has a marked impact on the person's functioning and relationships with others. The objectives of this study were to investigate the impact of bipolar disorder on the lives of people diagnosed with this disorder. The method used was a general inductive qualitative approach. Twenty-one participants were interviewed between 2008 and 2009 about how they had experienced the impact of bipolar disorder. The interviews were audio-taped and transcribed. The core theme that emerged was the participants were feeling out of control. Their own reactions and the reactions of others to the symptoms of bipolar disorder contributed to this core theme. The core theme was constituted by feeling overwhelmed, a loss of autonomy and felling flawed. Mental health nurses can help facilitate a sense of personal control for people with bipolar disorder by exploring what the symptoms mean for that person and implementing strategies to manage the symptoms, address social stigma and facilitate active involvement in treatment.
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Affiliation(s)
- M Crowe
- Department of Psychological Medicine, Centre for Postgraduate Nursing, University of Otago, Christchurch, New Zealand.
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44
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Chouinard V. Mapping bipolar worlds: Lived geographies of ‘madness’ in autobiographical accounts. Health Place 2012; 18:144-51. [DOI: 10.1016/j.healthplace.2011.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 08/15/2011] [Accepted: 08/24/2011] [Indexed: 11/16/2022]
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45
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Inder M, Crowe M, Moor S, Carter J, Luty S, Joyce P. ‘It wouldn’t be me if I didn’t have bipolar disorder’: managing the shift in self-identity with bipolar disorder. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1752-9824.2011.01117.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Proudfoot J, Doran J, Manicavasagar V, Parker G. The precipitants of manic/hypomanic episodes in the context of bipolar disorder: a review. J Affect Disord 2011; 133:381-7. [PMID: 21106249 DOI: 10.1016/j.jad.2010.10.051] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 10/28/2010] [Accepted: 10/28/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Mania/hypomania is the hallmark feature of bipolar disorder. This paper aims to review the current evidence in relation to factors hypothesised to precipitate bipolar mania/hypomania, and suggest areas for future research. METHODS A selective review of original and review papers was conducted. The electronic databases 'PsycINFO' and 'PubMed' were searched using the following search strings: "bipolar disorder" or "mania" or "hypomania" or "manic-depression" with "triggers" or "precipitants" or "precedents" or "predictors". RESULTS There is evidence that goal attainment events, antidepressant medication, disrupted circadian rhythms, spring/summer seasonal conditions, and more tentatively, stressful life events and high emotional expression, may precipitate bipolar mania/hypomania in susceptible individuals. Evidence from case reports and clinical observations are also reported. DISCUSSION The pathways to bipolar mania/hypomania may be many and varied, and many of these pathways may be outside the awareness of individuals with bipolar disorder. Greater awareness of the broad number of precipitating factors is needed to inform self-management and psycho-educational programs to build resilience to further episodes. Future research is needed to explore what other factors may precipitate bipolar mania/hypomania, and to determine why some factors may precipitate mania/hypomania in some individuals with bipolar I or II disorder but not in others.
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Affiliation(s)
- Judith Proudfoot
- School of Psychiatry, University of NSW and Black Dog Institute, Australia.
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Michalak E, Livingston JD, Hole R, Suto M, Hale S, Haddock C. 'It's something that I manage but it is not who I am': reflections on internalized stigma in individuals with bipolar disorder. Chronic Illn 2011; 7:209-24. [PMID: 21357643 DOI: 10.1177/1742395310395959] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bipolar disorder (BD) is a complex chronic condition associated with substantial costs, both at a personal and societal level. Growing research indicates that experiences with stigma may play a significant role in contributing to the distress, disability, and poor quality of life (QoL) often experienced in people with BD. Here, we present a sub-set of findings from a qualitative study of self-management strategies utilized by high functioning Canadian individuals with BD. Specifically, we describe a theme relating to participants' experiences and understandings of internalized stigma. Descriptive qualitative methods were used including purposeful sampling and thematic analysis. High functioning individuals with BD type I or II (N = 32) completed quantitative scales to assess symptoms, functioning and QoL, and participated in an individual interview or focus group to discuss the self-management strategies that they use to maintain or regain wellness. Thematic analysis identified several themes, including one relating to internalized stigma. Within this, four additional themes were identified: stigma expectations and experiences, sense of self/identity, judicious disclosure, and moving beyond internalised stigma. One of the more unique aspects of the study is that it involves a participant sample that is managing well with their illness, which differs from the norm in biomedical research that typically focuses on pathology, problems and dysfunction.
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Affiliation(s)
- Erin Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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Recoding past experiences: a qualitative study of how patients and family members adjust to the diagnosis of bipolar disorder. J Nerv Ment Dis 2011; 199:136-9. [PMID: 21278544 DOI: 10.1097/nmd.0b013e3182083175] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Few studies have investigated the processes associated with patients' reactions to the diagnosis of bipolar disorder, yet assisting patients to develop an acceptance of the condition is a core component of effective psychosocial interventions. This study explored the views and experiences of patients and family members about receiving a diagnosis of bipolar disorder and its implications for the future. We interviewed 17 people with bipolar disorder (7 diagnosed within the previous 12 months, 10 diagnosed 3-5 years ago), as well as 9 family members. Using the Phenomenology and Lived Experience framework to analyze the interview transcripts, we identified 3 key themes: (1) Misdiagnosis and growing awareness; (2) Accepting the diagnosis (including initial reactions and adjusting to the diagnosis); and (3) Factors that may have facilitated an earlier acceptance. From the findings, we draw implications for clinicians.
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49
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Positive aspects of mental illness: a review in bipolar disorder. J Affect Disord 2011; 128:185-90. [PMID: 20471692 DOI: 10.1016/j.jad.2010.03.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 02/16/2010] [Accepted: 03/23/2010] [Indexed: 11/22/2022]
Abstract
INTRODUCTION There is growing interest to understand the role of positive psychological features on the outcomes of medical illnesses. Unfortunately this topic is less studied in relation to mental health, and almost completely neglected in relation to one of the most common severe psychiatric illnesses, bipolar disorder. Certain specific psychological characteristics, that are generally viewed as valuable and beneficial morally or socially, may grow out of the experience of having this affective disorder. OBJECTIVE We describe the sources, research and impact of these positive psychological traits in the lives of persons with bipolar disorder based on the few published literature available to date. These include, but are not limited to: spirituality, empathy, creativity, realism, and resilience. METHODS After an extensive search in the literature, we found 81 articles that involve descriptions of positive psychological characteristics of bipolar disorder. RESULTS We found evidence for enhancement of the five above positive psychological traits in persons with bipolar disorder. CONCLUSIONS Bipolar disorder is associated with the positive psychological traits of spirituality, empathy, creativity, realism, and resilience. Clinical and research attention to preserving and enhancing these traits may improve outcomes in bipolar disorder.
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Nicholas J, Proudfoot J, Parker G, Gillis I, Burckhardt R, Manicavasagar V, Smith M. The ins and outs of an online bipolar education program: a study of program attrition. J Med Internet Res 2010; 12:e57. [PMID: 21169169 PMCID: PMC3057316 DOI: 10.2196/jmir.1450] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 05/21/2010] [Accepted: 05/26/2010] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The science of eHealth interventions is rapidly evolving. However, despite positive outcomes, evaluations of eHealth applications have thus far failed to explain the high attrition rates that are associated with some eHealth programs. Patient adherence remains an issue, and the science of attrition is still in its infancy. To our knowledge, there has been no in-depth qualitative study aimed at identifying the reasons for nonadherence to-and attrition from- online interventions. OBJECTIVE This paper explores the predictors of attrition and participant-reported reasons for nonadherence to an online psycho-education program for people newly diagnosed with a bipolar disorder. METHODS As part of an ongoing randomized controlled trial (RCT) evaluating an online psycho-education program for people newly diagnosed with a bipolar disorder, we undertook an in-depth qualitative study to identify participants' reasons for nonadherence to, and attrition from, the online intervention as well as a quantitative study investigating predictors of attrition. Within the RCT, 370 participants were randomly allocated to 1 of 2 active interventions or an attention control condition. Descriptive analyses and chi-square tests were used to explore the completion rates of 358 participants, and standard regression analysis was used to identify predictors of attrition. The data from interviews with a subsample of 39 participants who did not complete the online program were analyzed using "thematic analysis" to identify patterns in reported reasons for attrition. RESULTS Overall, 26.5% of the sample did not complete their assigned intervention. Standard multiple regression analysis revealed that young age (P= .004), male gender (P= .001), and clinical recruitment setting (P= .001) were significant predictors of attrition (F(7,330)= 8.08, P< .001). Thematic analysis of interview data from the noncompleter subsample revealed that difficulties associated with the acute phases of bipolar disorder, not wanting to think about one's illness, and program factors such as the information being too general and not personally tailored were the major reasons for nonadherence. CONCLUSIONS The dropout rate was equivalent to other Internet interventions and to face-to-face therapy. Findings from our qualitative study provide participant-reported reasons for discontinuing the online intervention, which, in conjunction with the quantitative investigations about predictors, add to understanding about Internet interventions. However, further research is needed to determine whether there are systematic differences between those who complete and those who do not complete eHealth interventions. Ultimately, this may lead to the identification of population subgroups that most benefit from eHealth interventions and to informing the development of strategies to improve adherence. TRIAL REGISTRATION ACTRN12608000411347; http://www.anzctr.org.au/ACTRN12608000411347.aspx (Archived by WebCite at http://www.webcitation.org/5uX4uYwVN).
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Affiliation(s)
- Jennifer Nicholas
- School of Psychiatry, University of New South Wales and Black Dog Institute, Sydney, Australia
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