1
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Villa J, Campbell DG, Parrish EM, Jeon ME, Robison M, Joiner T, Pinkham AE, Harvey PD, Depp CA. Associations between fearlessness about death and suicidal ideation in individuals with psychosis. Schizophr Res 2024; 269:96-102. [PMID: 38761436 DOI: 10.1016/j.schres.2024.05.006] [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: 09/22/2023] [Revised: 04/13/2024] [Accepted: 05/04/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Despite high rates of suicide among people with psychosis, relatively little is known about the mechanisms underlying the transition from suicidal ideation to behavior in this population. The Interpersonal Psychological Theory of Suicide (IPTS) proposes that fearlessness about death (FAD) may play a role in this relationship. The present study tested whether constructs of the IPTS [thwarted belongingness (TB), perceived burdensomeness (PB), and FAD] were associated with the severity of suicidal ideation in a sample of adults with histories of psychosis. METHOD 261 adults with histories of psychosis completed measures of IPTS constructs, current severity of suicidal ideation, and history of suicidal attempts. We examined differences between those with past suicide attempts and those without and conducted regression analyses to evaluate the associations among TB, PB, FAD and severity of current suicidal ideation. RESULTS Contrary to expectations, a history of suicidal behavior was not uniquely associated with FAD. Regression analyses revealed TB × PB and FAD × PB interactions emerged as significant correlates of the severity of suicidal ideation, with the relationship between PB and suicidal ideation more pronounced at higher levels of FAD and TB. Interestingly, positive symptoms of psychosis were positively associated with PB. IMPLICATIONS This study provides support for broadening the investigation of FAD as a contributor to suicidal ideation in individuals with psychotic symptoms. Future research investigating the role of other contributors that may influence capability for suicide (e.g., impulsivity) may add additional understanding of suicide in this population.
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Affiliation(s)
- Jennifer Villa
- Department of Psychology, University of Montana, Missoula, MT, United States of America.
| | - Duncan G Campbell
- Department of Psychology, University of Montana, Missoula, MT, United States of America
| | - Emma M Parrish
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States of America
| | - Min Eun Jeon
- Department of Psychology, Florida State University, Tallahassee, FL, United States of America
| | - Morgan Robison
- Department of Psychology, Florida State University, Tallahassee, FL, United States of America
| | - Thomas Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, United States of America
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States of America
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America; Research Service, Bruce W. Carter VA Medical Center, Miami, FL, United States of America
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States of America
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2
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Hours C. Pediatric Bipolar Disorder: A Practical Guide for Clinicians. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01534-9. [PMID: 37097506 DOI: 10.1007/s10578-023-01534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/26/2023]
Abstract
Pediatric bipolar disorder (PBD) is a controversial clinical entity and it still needs to be satisfactorily defined. Having a polymorphous presentation and associated with numerous symptoms of comorbid psychiatric illnesses often diagnosed during childhood and adolescence, including attention deficit hyperactivity disorder, its symptoms do not completely parallel those of bipolar disorder in adults. The clinician must be able to reach a diagnosis of PBD in the presence of fluctuating and atypical symptoms, especially in children, who tend to experience mixed episodes and very rapid cycles. Historically a key symptom for diagnosing PBD is episodic irritability. Proper diagnosis is critical due to the gravity of its prognosis. Clinicians may find supporting evidence for a diagnosis through careful study of the medical and developmental history of the young patient in addition to psychometric data. Treatment prioritizes psychotherapeutic intervention and assigns important roles to family involvement and a healthy lifestyle.
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3
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Veddum L, Gregersen M, Andreassen AK, Knudsen CB, Brandt JM, Krantz MF, Søndergaard A, Burton BK, Jepsen JRM, Hemager N, Thorup AAE, Nordentoft M, Mors O, Bliksted V, Greve AN. Social responsiveness in families with parental schizophrenia or bipolar disorder-The Danish High Risk and Resilience Study. Psychiatry Res 2023; 323:115140. [PMID: 36898170 DOI: 10.1016/j.psychres.2023.115140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023]
Abstract
Schizophrenia and bipolar disorder are highly heritable severe mental disorders associated with social impairments. Moreover, partners to individuals with one of these disorders display poorer functioning and more psychopathology, but their social skills and the transgenerational transmission remains uninvestigated. Therefore, we aimed to examine social responsiveness in families with parental schizophrenia or bipolar disorder. The cohort consists of 11-year-old children with at least one parent with schizophrenia (n = 179) or bipolar disorder (n = 105) and population-based controls (PBC, n = 181). Children and parents were assessed with The Social Responsiveness Scale, Second Edition. Duration of time each parent and child have lived together was ascertained through interviews. Parents with schizophrenia and parents with bipolar disorder exhibited poorer social responsiveness compared with PBC parents. Parents with schizophrenia displayed poorer social responsiveness compared with parents with bipolar disorder. Schizophrenia co-parents exhibited poorer social responsiveness compared with bipolar co-parents and PBC co-parents. We found significant positive associations between parents' and children's social responsiveness, with no interaction effect of duration of time living together. Considering that social impairments are suggested as a vulnerability marker, this knowledge calls for increased attention towards vulnerable families, particularly those where both parents have social impairments.
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Affiliation(s)
- Lotte Veddum
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark; The Psychosis Research Unit, Aarhus University Hospital Skejby - Psychiatry, Aarhus, Denmark; iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark.
| | - Maja Gregersen
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark; CORE - Copenhagen Research Center for Mental Health, Mental Health Center, Copenhagen University Hospital, Hellerup, Denmark
| | - Anna Krogh Andreassen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark; The Psychosis Research Unit, Aarhus University Hospital Skejby - Psychiatry, Aarhus, Denmark; iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark
| | - Christina Bruun Knudsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark; The Psychosis Research Unit, Aarhus University Hospital Skejby - Psychiatry, Aarhus, Denmark; iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark
| | - Julie Marie Brandt
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark; CORE - Copenhagen Research Center for Mental Health, Mental Health Center, Copenhagen University Hospital, Hellerup, Denmark; Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mette Falkenberg Krantz
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark; CORE - Copenhagen Research Center for Mental Health, Mental Health Center, Copenhagen University Hospital, Hellerup, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services Copenhagen, Copenhagen, Denmark
| | - Anne Søndergaard
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark; CORE - Copenhagen Research Center for Mental Health, Mental Health Center, Copenhagen University Hospital, Hellerup, Denmark; Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Klee Burton
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services Copenhagen, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Child and Adolescent Psychiatry, Copenhagen University Hospital, Psychiatry Region Zealand, Roskilde, Denmark
| | - Jens Richardt Møllegaard Jepsen
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark; CORE - Copenhagen Research Center for Mental Health, Mental Health Center, Copenhagen University Hospital, Hellerup, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services Copenhagen, Copenhagen, Denmark; Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center, Copenhagen University Hospital, Mental Health Services Copenhagen, Glostrup, Denmark
| | - Nicoline Hemager
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark; CORE - Copenhagen Research Center for Mental Health, Mental Health Center, Copenhagen University Hospital, Hellerup, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services Copenhagen, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services Copenhagen, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark; CORE - Copenhagen Research Center for Mental Health, Mental Health Center, Copenhagen University Hospital, Hellerup, Denmark; Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- The Psychosis Research Unit, Aarhus University Hospital Skejby - Psychiatry, Aarhus, Denmark; iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark
| | - Vibeke Bliksted
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark; The Psychosis Research Unit, Aarhus University Hospital Skejby - Psychiatry, Aarhus, Denmark; iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark
| | - Aja Neergaard Greve
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark; The Psychosis Research Unit, Aarhus University Hospital Skejby - Psychiatry, Aarhus, Denmark; iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark
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Weintraub MJ, Keenan-Miller D, Schneck CD, Forgey Borlik M, Suddath RL, Marvin SE, Singh MK, Chang KD, Miklowitz DJ. Social impairment in relation to clinical symptoms in youth at high risk for bipolar disorder. Early Interv Psychiatry 2022; 16:17-25. [PMID: 33559355 PMCID: PMC8492196 DOI: 10.1111/eip.13124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/11/2021] [Accepted: 01/21/2021] [Indexed: 01/11/2023]
Abstract
AIM Social impairment is common in individuals with bipolar disorder (BD), although its role in youths at high-risk for BD (i.e., mood symptoms in the context of a family history of BD) is not well understood. Social impairment takes many forms including social withdrawal, relational aggression, physical aggression, and victimization. The aim of this study was to explore the links between social impairment and clinical symptoms in youth at high-risk for BD. METHODS The sample included 127 youths with elevations in mood symptoms (depression or hypomania) and at least one first and/or second degree relative with BD. Measures of youths' current psychopathology (i.e., depressive and manic severity, suicidality, anxiety, and attention-deficit/hyperactivity disorder [ADHD]) were regressed onto youths' self-reports of social impairment (i.e., social withdrawal, relational aggression, physical aggression, and victimization). RESULTS Depressive symptoms, suicidal ideation, and anxiety symptoms were related to social withdrawal. Suicidal ideation was also related to reactive aggression. ADHD symptoms related to reactive and proactive aggression as well as relational victimization. Manic symptoms were not associated with social impairment in this sample. CONCLUSIONS Although cross-sectional, study findings point to potential treatment targets related to social functioning. Specifically, social withdrawal should be a target for treatment of childhood depressive and anxiety symptoms. Treatments that focus on social skills and cognitive functioning deficits associated with BD may also have clinical utility.
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Affiliation(s)
- Marc J Weintraub
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | | | - Christopher D Schneck
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marcy Forgey Borlik
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Robert L Suddath
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Sarah E Marvin
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Manpreet K Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | | | - David J Miklowitz
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA.,Department of Psychology, University of California, Los Angeles, California, USA
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5
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Roybal DJ, Cosgrove VE, Kelley R, Smallwood Shoukry R, Larios RM, Novy B, Chang KD, Garrett AS. Aberrant Neural Response to Social Exclusion Without Significantly Greater Distress in Youth With Bipolar Disorder: Preliminary Findings. Front Psychiatry 2022; 13:687052. [PMID: 35432046 PMCID: PMC9011186 DOI: 10.3389/fpsyt.2022.687052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about the effects of social exclusion on youth with bipolar disorder (BD). Understanding these effects and the functional neural correlates of social exclusion in youth with BD may establish differences from healthy youth and help identify areas of intervention. METHODS We investigated brain function in 19 youth with BD and 14 age and gender matched healthy control (HC) participants while performing Cyberball, an fMRI social exclusion task. Whole brain activation, region-of-interest, and functional connectivity were compared between groups and examined with behavioral measures. RESULTS Compared with the HC group, youth with BD exhibited greater activation in the left fusiform gyrus (FFG) during social exclusion. Functional connectivity between the left FFG and the posterior cingulate/precuneus was significantly greater in the HC compared with the BD group. For the HC group only, age and subjective distress during Cyberball significantly predicted mean FFG activation. No significant differences in distress during social exclusion were found between groups. CONCLUSION Although preliminary due to small sample size, these data suggest that youth with BD process social exclusion in a manner that focuses on basic visual information while healthy youth make use of past experiences to interpret current social encounters. This difference may account for the social cognitive issues experienced by youth with BD, which can lead to more severe anxiety and mood symptoms.
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Affiliation(s)
- Donna J Roybal
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States.,Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States.,Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX, United States.,Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX, United States
| | - Victoria E Cosgrove
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Ryan Kelley
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Rachel Smallwood Shoukry
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX, United States
| | - Rose Marie Larios
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX, United States.,Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX, United States
| | - Blake Novy
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX, United States.,Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX, United States
| | - Kiki D Chang
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Amy S Garrett
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States.,Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX, United States.,Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX, United States
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6
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Abstract
Although autism spectrum disorder (ASD) is the prototypical psychiatric disorder of social impairment, several if not most psychiatric disorders are characterized by prominent impairments in social functioning. A challenge in clinically assessing and describing social impairment is that it has been variably defined and can be difficult to measure. In this article we consider the psychiatric differential diagnosis of social impairment within the DSM-5 framework. We describe the features of social impairment in 13 DSM-5 disorders from a developmental perspective and highlight diagnostic factors that differentiate among the disorders, including the main features of social impairment, verbal communication, nonverbal communication, course of social impairment, social cognition, and key features of accompanying neuropsychiatric symptoms. We conclude by describing an approach for assessing social impairment across the lifespan.
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7
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Miller ML, Strassnig MT, Bromet E, Depp CA, Jonas K, Lin W, Moore RC, Patterson TL, Penn DL, Pinkham AE, Kotov RA, Harvey PD. Performance-based assessment of social skills in a large sample of participants with schizophrenia, bipolar disorder and healthy controls: Correlates of social competence and social appropriateness. Schizophr Res 2021; 236:80-86. [PMID: 34425381 PMCID: PMC10857848 DOI: 10.1016/j.schres.2021.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/30/2021] [Accepted: 08/13/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Performance-based assessments of social skills have detected impairments in people with severe mental illness and are correlated with functional outcomes in people with schizophrenia and bipolar disorder. The most common of these assessments, the Social Skills Performance Assessment (SSPA), has two communication scenarios and items measuring both social competence and appropriateness. As real-world competence and appropriateness appear to have different correlates, we hypothesized that SSPA Items measuring competence and appropriateness would be distinct and have different correlations with other outcomes. METHODS We aggregated data from 557 people with schizophrenia, 106 with bipolar disorder, and 378 well controls from 4 separate research studies. All participants were assessed with both SSPA scenarios and other performance based and clinician-rated measures. A single expert rated the SSPA interactions for competence and appropriateness while blind to participant diagnoses. RESULTS Participants with bipolar disorder and schizophrenia performed more poorly on every item of the SSPA than healthy controls. Items measuring social competence and appropriateness in communication were intercorrelated across scenarios, as were elements of socially competent communication, although the items measuring competence did not correlate substantially with appropriateness. Items assessing social competence, but not social appropriateness, correlated with better cognitive and functional performance and residential and financial independence. DISCUSSION Social competence and social appropriateness were distinct elements of performance-based social skills with potential differences in their functional correlates. As both social competence and appropriateness impact functional outcomes, improvement in the measurement and treatment of appropriate communication seems to be an important goal.
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Affiliation(s)
- Michelle L Miller
- Department of Psychiatry, University of Miami Miller School of Medicine, USA
| | - Martin T Strassnig
- Department of Psychiatry, University of Miami Miller School of Medicine, USA
| | - Evelin Bromet
- Department of Psychiatry, Stony Brook University Medical Center, USA
| | - Colin A Depp
- Department of Psychiatry UCSD Medical Center, USA; San Diego VA Healthcare System, USA
| | - Katherine Jonas
- Department of Psychiatry, Stony Brook University Medical Center, USA
| | - Wenxuan Lin
- Department of Psychiatry, Stony Brook University Medical Center, USA
| | | | | | - David L Penn
- Department of Psychology, University of North Carolina at Chapel Hill, USA; School of Psychology, Australian Catholic University, Australia
| | - Amy E Pinkham
- Department of Psychology, University of Texas at Dallas, USA; Department of Psychiatry, UT Southwestern Medical Center, USA
| | - Roman A Kotov
- Department of Psychiatry, Stony Brook University Medical Center, USA
| | - Philip D Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine, USA; Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA.
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8
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Bralten J, Mota NR, Klemann CJHM, De Witte W, Laing E, Collier DA, de Kluiver H, Bauduin SEEC, Arango C, Ayuso-Mateos JL, Fabbri C, Kas MJ, van der Wee N, Penninx BWJH, Serretti A, Franke B, Poelmans G. Genetic underpinnings of sociability in the general population. Neuropsychopharmacology 2021; 46:1627-1634. [PMID: 34054130 PMCID: PMC8280100 DOI: 10.1038/s41386-021-01044-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/30/2021] [Accepted: 05/11/2021] [Indexed: 02/03/2023]
Abstract
Levels of sociability are continuously distributed in the general population, and decreased sociability represents an early manifestation of several brain disorders. Here, we investigated the genetic underpinnings of sociability in the population. We performed a genome-wide association study (GWAS) of a sociability score based on four social functioning-related self-report questions from 342,461 adults in the UK Biobank. Subsequently we performed gene-wide and functional follow-up analyses. Robustness analyses were performed in the form of GWAS split-half validation analyses, as well as analyses excluding neuropsychiatric cases. Using genetic correlation analyses as well as polygenic risk score analyses we investigated genetic links of our sociability score to brain disorders and social behavior outcomes. Individuals with autism spectrum disorders, bipolar disorder, depression, and schizophrenia had a lower sociability score. The score was significantly heritable (SNP h2 of 6%). We identified 18 independent loci and 56 gene-wide significant genes, including genes like ARNTL, DRD2, and ELAVL2. Many associated variants are thought to have deleterious effects on gene products and our results were robust. The sociability score showed negative genetic correlations with autism spectrum, disorders, depression, schizophrenia, and two sociability-related traits-loneliness and social anxiety-but not with bipolar disorder or Alzheimer's disease. Polygenic risk scores of our sociability GWAS were associated with social behavior outcomes within individuals with bipolar disorder and with major depressive disorder. Variation in population sociability scores has a genetic component, which is relevant to several psychiatric disorders. Our findings provide clues towards biological pathways underlying sociability.
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Grants
- MC_PC_17228 Medical Research Council
- MC_QA137853 Medical Research Council
- Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 115916. The research programme Computing Time National Computing Facilities Processing Round pilots 2018 with project number 17666, which is (partly) financed by the Dutch Research Council (NWO). And lastly, the Dutch national e-infrastructure with the support of SURF Cooperative.
- EU H2020 Program under the Innovative Medicines Initiative 2 Joint Undertaking with grant agreement 777394 (AIMS-2-TRIALS), the Spanish Ministry of Science, Innovation and Universities, Instituto de Salud Carlos III (PI14/00397, PI14/02103, PIE16/00055, PI17/00819, PI17/00481), co-financed by ERDF Funds from the European Commission, “A way of making Europe”, CIBERSAM, Madrid Regional Government (B2017/BMD-3740 AGES-CM-2), EU Structural Funds, EU Seventh Framework Program under grant agreement FP7-HEALTH-2013-2.2.1-2-603196 (Project PSYSCAN), Fundación Familia Alonso, Fundación Alicia Koplowitz.
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Affiliation(s)
- Janita Bralten
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Nina R Mota
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | | | - Ward De Witte
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Emma Laing
- Lilly Research Centre, Eli Lilly and Company, Surrey, UK
| | | | - Hilde de Kluiver
- Department of Psychiatry, Amsterdam University Medical Center/GGZ in Geest, Vrije Universiteit, Amsterdam, The Netherlands
| | - Stephanie E E C Bauduin
- Department of Psychiatry, Leiden Institute for Brain and Cognition/Psychiatric Neuroimaging, Leiden University Medical Center, Leiden, The Netherlands
| | - Celso Arango
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Jose L Ayuso-Mateos
- Department of Psychiatry, Instituto de Investigación Sanitaria La Princesa (IIS-IP), CIBERSAM, Universidad Autónoma de Madrid, Madrid, Spain
| | - Chiara Fabbri
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Martien J Kas
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
| | - Nic van der Wee
- Department of Psychiatry, Leiden Institute for Brain and Cognition/Psychiatric Neuroimaging, Leiden University Medical Center, Leiden, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam University Medical Center/GGZ in Geest, Vrije Universiteit, Amsterdam, The Netherlands
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Barbara Franke
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geert Poelmans
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.
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Whitmore A, Hudson S, West AE. Adapting psychosocial treatment to target parenting stress and parent–child relationships associated with transdiagnostic emotional and behavioural dysregulation in a culturally diverse population. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1883403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Alina Whitmore
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Sharon Hudson
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Amy E. West
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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10
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Figueiredo T, Sudo FK, Serra-Pinheiro MA, Mattos P. Interpersonal negotiation impairment in ADHD: The critical role of comprehension processing. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01767-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Khafif TC, Rotenberg LDS, Nascimento C, Beraldi GH, Lafer B. Emotion regulation in pediatric bipolar disorder: A meta-analysis of published studies. J Affect Disord 2021; 285:86-96. [PMID: 33639359 DOI: 10.1016/j.jad.2021.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/14/2021] [Accepted: 02/01/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Emotion regulation is a relatively recent topic in psychiatry, and has only recently begun to be tested across Pediatric Bipolar Disorder (PBD). To date, no meta-analysis has investigated the presence of emotion regulation deficits in PBD patients. OBJECTIVES The aim of this study is to understand where the literature stands on this topic, as well as how different researchers are measuring and grasping the concept of emotion regulation in pediatric bipolar disorders. METHODS A systematic search of trials using the terms ("Pediatric Bipolar Disorder") AND ("Emotion Regulation" OR "Affect Regulation" OR "Mood Lability" OR "Mood Instability" OR "Irritability") was conducted using PubMed, Google Scholar, ResearchGate, Web of Science and Psych Info databases. Of the initial 366 articles identified, 8 met eligibility criteria for the meta-analysis and were included in this study. RESULTS There is a statistically significant difference in Accuracy in Emotion Regulation tasks, with a tendency for lower accuracy in PBD patients; however, both groups did not differ statistically regarding Response Time. CONCLUSION Our data suggests that PBD patients do present emotion regulation deficits, particularly regarding facial emotion recognition and affective language interference tasks mediated by cognitive assignments. These results have important implications in developing novel psychotherapeutic interventions for this population.
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Affiliation(s)
- Tatiana Cohab Khafif
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, Brazil.
| | - Luisa de Siqueira Rotenberg
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, Brazil
| | - Camila Nascimento
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, Brazil
| | - Gabriel Henrique Beraldi
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, Brazil
| | - Beny Lafer
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, Brazil
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12
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Van Meter A, Stoddard J, Penton-Voak I, Munafò MR. Interpretation bias training for bipolar disorder: A randomized controlled trial. J Affect Disord 2021; 282:876-884. [PMID: 33601731 DOI: 10.1016/j.jad.2020.12.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/19/2020] [Accepted: 12/23/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with emotion interpretation biases that can exacerbate depressed mood. Interpretation bias training (IBT) may help; according to the "virtuous cycle" hypothesis, interpreting others' emotions as positive can lead to interactions that improve mood. Our goals were to determine whether IBT can shift emotion interpretation biases and demonstrate clinical benefits (lower depressed mood, improved social function) in people with BD. METHOD Young adults with BD were recruited for three sessions of computer-based IBT. Active IBT targets negative emotion bias by training judgments of ambiguous face emotions towards happy judgments. Participants were randomized to active or sham IBT. Participants reported on mood and functioning at baseline, intervention end (week two), and week 10. RESULTS Fifty participants (average age 22, 72% female) enrolled, 38 completed the week 10 follow-up. IBT shifted emotion interpretations (Hedges g = 1.63). There was a group-by-time effect (B = -13.88, p < .0001) on self-reported depression; the IBT group had a larger decrease in depressed mood. The IBT group also had a larger increase in perceived familial support (B = 3.88, p < .0001). Baseline learning rate (i.e., how quickly emotion judgments were updated) was associated with reduced clinician- (B = -54.70, p < 0.001) and self-reported depression (B = -58.20, p = 0.009). CONCLUSION Our results converge with prior work demonstrating that IBT may reduce depressed mood. Additionally, our results provide support for role of operant conditioning in the treatment of depression. People with BD spend more time depressed than manic; IBT, an easily disseminated intervention, could augment traditional forms of treatment without significant expense or side effects.
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Affiliation(s)
- Anna Van Meter
- Feinstein Institutes for Medical Research, Institute of Behavioral Science; The Zucker Hillside Hospital, Department of Psychiatry Research; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, New York.
| | - Joel Stoddard
- Pediatric Mental Health Institute, Children's Hospital Colorado, Department of Psychiatry & Neuroscience Program, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Ian Penton-Voak
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit, School of Psychological Science, University of Bristol, Bristol, United Kingdom
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13
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Dryburgh NSJ, Khullar TH, Sandre A, Persram RJ, Bukowski WM, Dirks MA. Evidence Base Update for Measures of Social Skills and Social Competence in Clinical Samples of Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 49:573-594. [PMID: 32697122 DOI: 10.1080/15374416.2020.1790381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Social skills and social competence are key transdiagnostic processes in developmental psychopathology and are the focus of an array of clinical interventions. In this Evidence Base Update, we evaluated the psychometric properties of measures of social skills and social competence used with clinical samples of children and adolescents. A systematic literature search yielded eight widely used measures of social skills and one measure of social competence. Applying the criteria identified by Youngstrom et al. (2017), we found that, with some exceptions, these measures had adequate to excellent norms, internal consistency, and test-retest reliability. There was at least adequate evidence of construct validity and treatment sensitivity in clinical samples for nearly all measures assessed. Many of the scales included items assessing constructs other than social skills and competence (e.g., emotion regulation). Development of updated tools to assess youth's effectiveness in key interpersonal situations, including those occurring online, may yield clinical dividends.
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14
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Millard H, Parke S, Wilson C, Qayyum Z, Kim HJ, Van Deusen T. Inpatient Milieu Therapy: Considerations for Adolescent and Transitional Age Youth. ADOLESCENT PSYCHIATRY 2020. [DOI: 10.2174/2210676609666190617150025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background and Goals:
The role of milieu therapy on inpatient treatment has become
more prominent due to the changing landscape of hospital care, with shorter length of
stay, higher patient acuity, and rapid turnover. The modern inpatient unit promotes less individual
psychotherapy with the psychiatrist or therapist, and more milieu and group based
treatment that emphasizes acute stabilization.
Methods:
The authors share some of the core domains that provide the basic framework for
milieu treatment within an acute care setting when working with adolescents and transitional
age youth (TAY), with the aim to share clinical considerations for milieu therapy and offer
practical ideas for implementation in clinical practice.
Discussion:
The therapeutic milieu and collaboration of an interdisciplinary team has a significant
impact on hospital treatment. Considerations for milieu therapy implementation in
an inpatient unit include developmentally informed concepts related to milieu treatment of
adolescents and TAY patients in a hospital setting.
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Affiliation(s)
- Hun Millard
- Yale University School of Medicine, Psychiatry, New Haven, CT, United States
| | - Susan Parke
- Yale University School of Medicine, Psychiatry, New Haven, CT, United States
| | - Cynthia Wilson
- Yale University School of Medicine, Psychiatry, New Haven, CT, United States
| | - Zheala Qayyum
- Yale University School of Medicine, Psychiatry, New Haven, CT, United States
| | - Hyun Jung Kim
- Harvard Medical School, Psychiatry, Boston, MA, United States
| | - Timothy Van Deusen
- Yale University School of Medicine, Psychiatry, New Haven, CT, United States
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15
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Sewall CJR, Goldstein TR, Salk RH, Merranko J, Gill MK, Strober M, Keller MB, Hafeman D, Ryan ND, Yen S, Hower H, Liao F, Birmaher B. Interpersonal Relationships and Suicidal Ideation in Youth with Bipolar Disorder. Arch Suicide Res 2020; 24:236-250. [PMID: 31159677 PMCID: PMC6940551 DOI: 10.1080/13811118.2019.1616018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study examines how relationship quality in family and peer domains are associated with suicidal ideation (SI) in youth with bipolar disorder (BP). We assessed 404 Course and Outcome of Bipolar Youth study participants for psychiatric disorders and SI at intake and for family/peer relationships the month after intake. Multivariate logistic regression examined associations between relationships and SI, controlling for significant covariates. There were 144 youth (36%) who reported SI at intake; bivariate analyses indicated they had significantly worse family/peer relationships. Multivariate analyses showed that family/peer relationships were associated with current SI, controlling for significant covariates. Results support associations between poor relationships and SI in BP youth, regardless of current mood symptom severity. Clinicians should assess relationships when completing risk assessments with BP youth.
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16
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Bartholomew ME, Smith B, Johnson SL. Explaining interpersonal difficulty via implicit and explicit personality correlates of mania risk. J Affect Disord 2019; 246:248-251. [PMID: 30590287 DOI: 10.1016/j.jad.2018.12.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/09/2018] [Accepted: 12/16/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mania is associated with social conflict, reduced social support, and reduced social interaction quality (Breyer et al., 2003; Coryell et al., 1998; Morriss et al., 2007). Chronic stress in interpersonal relationships is related to the worsening of mood symptoms (Kim et al., 2007), suggesting the importance of characterizing the mechanism of interpersonal relationship disruption in bipolar disorder. The current study was designed to investigate exaggerated dominance tendencies present in at-risk individuals (Gardner, 1982; Wilson and Price, 2006), which may represent one such mechanism. METHODS Sixty-nine University undergraduate participants (50.7% female, 22 categorized as high mania risk) completed an implicit measure of power motivation and series of self-report questionnaires designed to assess dominance-relevant traits. RESULTS Risk for mania was related to a tendency to experience contempt, and an implicit index of dominance tendencies, and also to trait-like tendencies to experience pride, perceptions of being more powerful and influential across relationships,. LIMITATIONS Use of an undergraduate population and a dimensional measure of mania risk (rather than diagnosed individuals) are limitations. CONCLUSIONS Mania risk is tied not only to the pursuit of dominance, but also to beliefs and actions consistent with a sense of power. Current findings provide evidence that the dominance system profile observed in those at risk for mania could be one source of interpersonal problems.
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Affiliation(s)
- Morgan E Bartholomew
- Department of Psychology, University of California, Franz Hall, 502 Portola Plz, Los Angeles, CA, United States.
| | - Bruce Smith
- Department of Psychology, University of California, Berkeley, CA, United States
| | - Sheri L Johnson
- Department of Psychology, University of California, Berkeley, CA, United States
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17
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Zhao C, Gammie SC. The circadian gene Nr1d1 in the mouse nucleus accumbens modulates sociability and anxiety-related behaviour. Eur J Neurosci 2018; 48:1924-1943. [PMID: 30028550 DOI: 10.1111/ejn.14066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/11/2018] [Accepted: 07/14/2018] [Indexed: 12/17/2022]
Abstract
Nuclear receptor subfamily 1, group D, member 1 (Nr1d1) (also known as Rev-erb alpha) has been linked to circadian rhythm regulation, mood-related behaviour and disorders associated with social deficits. Recent work from our laboratory found striking decreases in Nr1d1 in the nucleus accumbens (NAc) in the maternal condition and indirect evidence that Nr1d1 was interacting with numerous addiction and reward-related genes to modulate social reward. In this study, we applied our insights from the maternal state to nonparental adult mice to determine whether decreases in Nr1d1 expression in the NAc via adeno-associated viral (AAV) vectors and short hairpin RNA (shRNA)-mediated gene knockdown were sufficient to modulate social behaviours and mood-related behaviours. Knockdown of Nr1d1 in the NAc enhanced sociability and reduced anxiety, but did not affect depressive-like traits in female mice. In male mice, Nr1d1 knockdown had no significant behavioural effects. Microarray analysis of Nr1d1 knockdown in females identified changes in circadian rhythm and histone deacetylase genes and suggested possible drugs, including histone deacetylase inhibitors, that could mimic actions of Nr1d1 knockdown. Quantitative real-time PCR (qPCR) analysis confirmed expression upregulation of gene period circadian clock 1 (Per1) and period circadian clock 2 (Per2) with Nr1d1 knockdown. The evidence for roles for opioid-related genes opioid receptor, delta 1 (Oprd1) and preproenkephalin (Penk) was also found. Together, these results suggest that Nr1d1 in the NAc modulates sociability and anxiety-related behaviour in a sex-specific manner, and circadian, histone deacetylase and opioid-related genes may be involved in the expression of these behavioural phenotypes.
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Affiliation(s)
- Changjiu Zhao
- Department of Integrative Biology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Stephen C Gammie
- Department of Integrative Biology, University of Wisconsin-Madison, Madison, Wisconsin.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, Wisconsin
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18
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Campos JR, Prette ZAPD, Prette AD. Relações entre depressão, habilidades sociais, sexo e nível socioeconômico em grandes amostras de adolescentes. PSICOLOGIA: TEORIA E PESQUISA 2018. [DOI: 10.1590/0102.3772e3446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Ainda não se têm claras as relações entre presença de indicadores de depressão, habilidades sociais, sexo e nível socioeconômico em adolescentes. Este estudo comparou uma amostra geral de 642 adolescentes em relação à mesma amostra, porém, sem os participantes com indicadores de depressão (539 adolescentes), buscando verificar o impacto desse controle no que se refere as habilidades sociais, o sexo e o nível socioeconômico. Houve rebaixamento do escore global, das habilidades sociais de empatia e autocontrole, na amostra feminina. Não houve diferença estatisticamente significativa quanto ao nível socioeconômico. Conclui-se sobre a importância de prover os manuais de testes com informações sobre as variáveis controladas e não controladas nas amostras utilizadas para o estabelecimento de padrões normativos.
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19
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Fernandes FBF, Rocca CC, Gigante AD, Dottori-Silva PR, Gerchmann L, Rossini D, Sato R, Lafer B, Nery FG. The association between social skills deficits and family history of mood disorder in bipolar I disorder. BRAZILIAN JOURNAL OF PSYCHIATRY 2018; 40:244-248. [PMID: 29590265 PMCID: PMC6899394 DOI: 10.1590/1516-4446-2017-2313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/28/2017] [Indexed: 11/21/2022]
Abstract
Objective: To compare social skills and related executive functions among bipolar disorder (BD) patients with a family history of mood disorders (FHMD), BD patients with no FHMD and healthy control (HCs). Methods: We evaluated 20 euthymic patients with FHMD, 17 euthymic patients without FHMD, and 31 HCs using the Social Skills Inventory (SSI) and a neuropsychological battery evaluating executive function, inhibitory control, verbal fluency and estimated intelligence. Results: Both BD groups had lower SSI scores than controls. Scores for one subfactor of the social skills questionnaire, conversational skills and social performance, were significantly lower among patients with FHMD than among patients without FHMD (p = 0.019). Both groups of BD patients exhibited significant deficits in initiation/inhibition, but only BD patients with FHMD had deficits in verbal fluency, both compared to HC. There were no associations between social skills questionnaire scores and measures of cognitive function. Conclusion: Euthymic BD patients have lower social skills and executive function performance than HC. The presence of FHMD among BD patients is specifically associated with deficits in conversational and social performance skills, in addition to deficits in verbal fluency. Both characteristics might be associated with a common genetically determined pathophysiological substrate.
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Affiliation(s)
- Francy B F Fernandes
- Programa de Transtorno Bipolar (PROMAN), Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Serviço de Psicologia e Neuropsicologia, Instituto de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Cristiana C Rocca
- Programa de Transtorno Bipolar (PROMAN), Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Serviço de Psicologia e Neuropsicologia, Instituto de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Alexandre D Gigante
- Programa de Transtorno Bipolar (PROMAN), Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Paola R Dottori-Silva
- Programa de Transtorno Bipolar (PROMAN), Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Luciana Gerchmann
- Programa de Transtorno Bipolar (PROMAN), Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Danielle Rossini
- Programa de Transtorno Bipolar (PROMAN), Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Rodrigo Sato
- Programa de Transtorno Bipolar (PROMAN), Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Beny Lafer
- Programa de Transtorno Bipolar (PROMAN), Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Institute & Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Fabiano G Nery
- Programa de Transtorno Bipolar (PROMAN), Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Institute & Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Ohio, USA
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20
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Best MW, Bowie CR, Naiberg MR, Newton DF, Goldstein BI. Neurocognition and psychosocial functioning in adolescents with bipolar disorder. J Affect Disord 2017; 207:406-412. [PMID: 27770733 DOI: 10.1016/j.jad.2016.09.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/06/2016] [Accepted: 09/05/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Adults with bipolar disorder demonstrate significantly poorer psychosocial functioning and neurocognition compared to controls. In adult bipolar disorder neurocognition predicts a substantial portion of variance in functioning. Adolescents with bipolar disorder have reducedpsychosocial functioning, but less is known about neurocognitive impairments, and no studies have examined the relationship between neurocognition and functioning in an adolescent sample. METHODS 38 adolescents with bipolar disorder and 49 healthy controls under 20 years of age completed assessments of psychosocial functioning, neurocognitive ability, and psychiatric symptoms. RESULTS Adolescents with bipolar disorder had significantly poorer psychosocial functioning in domains of daily activities, social functioning, and satisfaction with functioning, ps<.006, compared to healthy controls. They also had poorer general neurocognitive functioning than controls, p=.004, with the greatest impairment on a test of sustained attention. Neurocognition was not a significant predictor of psychosocial functioning in this sample, but depressive symptoms significantly predicted functioning in all domains, p<.033. LIMITATIONS Limited sample size did not allow for complex statistical analyses. Differences in demographic characteristics of the clinical and control groups may limit generalization of these results. CONCLUSIONS This adolescent sample with bipolar disorder experiences significantly poorer neurocognitive and psychosocial functioning compared to controls; however, psychosocial functioning appears to be more strongly related to mood symptoms than to neurocognition. Future work is needed to delineate the time course of neurocognitive functioning and its relation to psychosocial functioning across the course of illness. Adolescence may provide an ideal time for cognitive enhancement and intensive psychosocial intervention.
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Affiliation(s)
- Michael W Best
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | | | - Melanie R Naiberg
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Dwight F Newton
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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21
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Gammie SC, Driessen TM, Zhao C, Saul MC, Eisinger BE. Genetic and neuroendocrine regulation of the postpartum brain. Front Neuroendocrinol 2016; 42:1-17. [PMID: 27184829 PMCID: PMC5030130 DOI: 10.1016/j.yfrne.2016.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/11/2016] [Accepted: 05/13/2016] [Indexed: 12/11/2022]
Abstract
Changes in expression of hundreds of genes occur during the production and function of the maternal brain that support a wide range of processes. In this review, we synthesize findings from four microarray studies of different maternal brain regions and identify a core group of 700 maternal genes that show significant expression changes across multiple regions. With those maternal genes, we provide new insights into reward-related pathways (maternal bonding), postpartum depression, social behaviors, mental health disorders, and nervous system plasticity/developmental events. We also integrate the new genes into well-studied maternal signaling pathways, including those for prolactin, oxytocin/vasopressin, endogenous opioids, and steroid receptors (estradiol, progesterone, cortisol). A newer transcriptional regulation model for the maternal brain is provided that incorporates recent work on maternal microRNAs. We also compare the top 700 genes with other maternal gene expression studies. Together, we highlight new genes and new directions for studies on the postpartum brain.
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Affiliation(s)
- Stephen C Gammie
- Department of Zoology, University of Wisconsin-Madison, Madison, WI, USA; Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA.
| | - Terri M Driessen
- Department of Zoology, University of Wisconsin-Madison, Madison, WI, USA
| | - Changjiu Zhao
- Department of Zoology, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael C Saul
- Department of Zoology, University of Wisconsin-Madison, Madison, WI, USA
| | - Brian E Eisinger
- Department of Zoology, University of Wisconsin-Madison, Madison, WI, USA
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22
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Impaired down-regulation of negative emotion in self-referent social situations in bipolar disorder: A pilot study of a novel experimental paradigm. Psychiatry Res 2016; 238:318-325. [PMID: 27086251 DOI: 10.1016/j.psychres.2016.02.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 02/18/2016] [Accepted: 02/21/2016] [Indexed: 12/11/2022]
Abstract
Emotion dysregulation is a core feature of bipolar disorder (BD) that persists into periods of remission. Neuroimaging studies show aberrant neural responses during emotion regulation (ER) in patients with BD relative to healthy controls, but behavioural evidence for ER deficits is sparse and conflicting. This study aimed to explore ER in BD using a novel, personally relevant experimental paradigm. Twenty patients with BD and 20 patients with unipolar disorder (UD), in full or partial remission, and 20 healthy controls were given a novel computerised test. Participants were instructed to react naturally or dampen their emotional response to positive and negative social scenarios and associated self-beliefs. They were also given an established experimental task for comparison, involving reappraisal of negative affective picture stimuli, as well as a questionnaire of habitual ER strategies. BD patients showed reduced ability to down-regulate emotional responses in negative, but not positive, social scenarios relative to healthy controls and UD patients. In contrast, there were no between-group differences in the established ER task or in self-reported habitual reappraisal strategies. Findings highlight the novel social scenario paradigm as a sensitive test for detection of ER difficulties in BD.
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23
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Van Meter A, Youngstrom E, Freeman A, Feeny N, Youngstrom JK, Findling RL. Impact of Irritability and Impulsive Aggressive Behavior on Impairment and Social Functioning in Youth with Cyclothymic Disorder. J Child Adolesc Psychopharmacol 2016; 26:26-37. [PMID: 26835744 PMCID: PMC4779275 DOI: 10.1089/cap.2015.0111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Research on adults with cyclothymic disorder (CycD) suggests that irritability and impulsive aggression (IA) are highly prevalent among this population. Less is known about whether these behaviors might also distinguish youth with CycD from youth without CycD. Additionally, little is known about how irritability and IA relate to one another, and whether they are associated with different outcomes. This study aimed to compare irritability and IA across diagnostic subtypes to determine whether CycD is uniquely associated with these behaviors, and to assess how irritability and IA relate to youth social and general functioning. METHODS Participants (n = 459), 11-18 years of age, were recruited from an urban community mental health center and an academic outpatient clinic; 25 had a diagnosis of CycD. Youth and caregivers completed measures of IA and irritability. Youth and caregivers also completed an assessment of youth friendship quality. Clinical interviewers assessed youth social, family, and school functioning. RESULTS Youth with CycD had higher scores on measures of irritability and IA than youth with nonbipolar disorders, but scores were not different from other youth with bipolar spectrum disorders. Measures of irritability and IA were correlated, but represented distinct constructs. Regression analyses indicated that irritability was related to friendship quality (p < 0.005). Both IA and irritability were related to social impairment (ps < 0.05-0.0005) and Child Global Assessment Scale (C-GAS) scores (ps = 0.05-0.005). CycD diagnosis was associated with poorer caregiver-rated friendship quality and social functioning (ps < 0.05). CONCLUSIONS We found that irritability and aggression were more severe among youth with CycD than among youth with nonbipolar diagnoses, but did not differ across bipolar disorder subtypes. Among youth seeking treatment for mental illness, irritability and IA are prevalent and nonspecific. Irritability and IA were uniquely related to our outcomes of social and general functioning, suggesting that it is worthwhile to assess each separately, in order to broaden our understanding of the characteristics and correlates of each.
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Affiliation(s)
- Anna Van Meter
- Ferkauf Graduate School, Yeshiva University, Bronx, New York
| | - Eric Youngstrom
- Department of Psychology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andrew Freeman
- Department of Psychology,The University of Nevada at Las Vegas, Las Vegas, Nevada
| | - Norah Feeny
- Department of Psychology, Case Western Reserve University, Cleveland, Ohio
| | - Jennifer Kogos Youngstrom
- Department of Psychology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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24
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Benarous X, Mikita N, Goodman R, Stringaris A. Distinct relationships between social aptitude and dimensions of manic-like symptoms in youth. Eur Child Adolesc Psychiatry 2016; 25:831-42. [PMID: 26650482 PMCID: PMC4967092 DOI: 10.1007/s00787-015-0800-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 11/17/2015] [Indexed: 01/28/2023]
Abstract
Difficulties with interpersonal relationships have been reported in children and adolescents with manic symptoms, even if they do not fulfil criteria for a manic episode. The role of social aptitude (SA) in youths with manic symptoms has never been examined in the general population. Moreover, no study has examined whether SA is differentially associated with dimensions of manic symptoms. We hypothesised that youth with predominantly undercontrol manic symptoms (characterised by irritability) would show lower levels of SA; conversely, youth with predominantly exuberant symptoms would show better than average social skills. Our sample comprised 5325 participants from the 2004 British Child and Adolescent Mental Health Survey (B-CAMHS04), mean age 10.3 years, SD = 3.3, 48 % girls. Manic symptoms were assessed with the Development and Wellbeing Assessment by interviewing parents and young people. Children and adolescents with manic symptoms had a lower SA score, compared to the general population by parent report, but not by self-report. SA score was higher in youths with predominantly exuberant manic symptoms compared to the general population; whereas the youths with predominantly undercontrol manic symptoms had lower SA scores by parent and self-report. Our results provide further evidence for the distinction between exuberant and undercontrol manic symptoms and highlight the need to focus on SA in future research.
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Affiliation(s)
- Xavier Benarous
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box P085, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK. .,Department of Child and Adolescent Psychiatry, Hôpital Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75013, Paris, France. .,, 19 rue de Turenne, 75004, Paris, France.
| | - Nina Mikita
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Box P085, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Robert Goodman
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Box P085, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Argyris Stringaris
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Box P085, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
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Silva C, Ribeiro JD, Joiner TE. Mental disorders and thwarted belongingness, perceived burdensomeness, and acquired capability for suicide. Psychiatry Res 2015; 226:316-27. [PMID: 25650048 DOI: 10.1016/j.psychres.2015.01.008] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 01/06/2015] [Accepted: 01/10/2015] [Indexed: 11/17/2022]
Abstract
Nearly all mental disorders increase suicide risk; however, some better predict ideation versus attempts. The interpersonal theory of suicide provides a framework to understand these relationships, via the constructs of thwarted belongingness, perceived burdensomeness, and acquired capability. The current study examined the relationships between various mental disorders and theory constructs among 997 adult outpatients, controlling for sex and age. Disorders generally symptomatically associated with social withdrawal or potential liability to others (i.e., depressive and bipolar disorders, social phobia, borderline personality disorder, schizophrenia and other psychotic disorders, certain drug dependence) were uniquely positively associated with thwarted belongingness and perceived burdensomeness. Disorders associated with potential exposure to painful and provocative events (i.e., posttraumatic stress disorder, schizophrenia and other psychotic disorders, certain drug use) were associated with increased acquired capability. Notably, alcohol use disorders, attention-deficit/hyperactivity disorder subtypes, and panic/agoraphobia were negatively associated with thwarted belongingness or perceived burdensomeness; avoidant personality disorder, and certain anxiety disorders and drug use disorders, were associated with decreased acquired capability. Importantly, disorders associated with both thwarted belongingness and perceived burdensomeness may place individuals at greatest risk for suicide if acquired capability develops. Implications for comorbidity and suicide risk assessment and treatment are discussed.
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Siegel RS, Freeman AJ, La Greca AM, Youngstrom EA. Peer relationship Difficulties in Adolescents with Bipolar Disorder. CHILD & YOUTH CARE FORUM 2014. [DOI: 10.1007/s10566-014-9291-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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West AE, Weinstein SM, Peters AT, Katz A, Henry D, Cruz R, Pavuluri M. Child- and family-focused cognitive-behavioral therapy for pediatric bipolar disorder: a randomized clinical trial. J Am Acad Child Adolesc Psychiatry 2014; 53:1168-78, 1178.e1. [PMID: 25440307 PMCID: PMC4254579 DOI: 10.1016/j.jaac.2014.08.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/28/2014] [Accepted: 09/04/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Previous studies have found that family-based psychosocial treatments are effective adjuncts to pharmacotherapy among adults and adolescents with bipolar disorder (BD). The objective of this study was to compare the efficacy of adjunctive child- and family-focused cognitive-behavioral therapy (CFF-CBT) to psychotherapy as usual (control) for mood symptom severity and global functioning in children with BD. METHOD Sixty-nine youth, aged 7 to 13 years (mean = 9.19, SD = 1.61) with DSM-IV-TR bipolar I, II, or not otherwise specified (NOS) disorder were randomly assigned to CFF-CBT or control groups. Both treatments consisted of 12 weekly sessions followed by 6 monthly booster sessions delivered over a total of 9 months. Independent evaluators assessed participants at baseline, week 4, week 8, week 12 (posttreatment), and week 39 (6-month follow-up). RESULTS Participants in CFF-CBT attended more sessions, were less likely to drop out, and reported greater satisfaction with treatment than controls. CFF-CBT demonstrated efficacy compared to the control treatment in reducing parent-reported mania at posttreatment and depression symptoms at posttreatment and follow-up. Global functioning did not differ at posttreatment but was higher among CFF-CBT participants at follow-up. CONCLUSION CFF-CBT may be efficacious in reducing acute mood symptoms and improving long-term psychosocial functioning among children with BD.
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Benti L, Manicavasagar V, Proudfoot J, Parker G. Identifying early indicators in bipolar disorder: a qualitative study. Psychiatr Q 2014; 85:143-53. [PMID: 24174009 DOI: 10.1007/s11126-013-9279-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The identification of early markers has become a focus for early intervention in bipolar disorder. Using a retrospective, qualitative methodology, the present study compares the early experiences of participants with bipolar disorder to those with unipolar depression up until their first diagnosed episode. The study focuses on differences in early home and school environments as well as putative differences in personality characteristics between the two groups. Finally we a compare and contrast prodromal symptoms in these two populations. Thirty-nine participants, 20 diagnosed with unipolar depression and 19 diagnosed with bipolar disorder, took part in the study. A semi-structured interview was developed to elicit information about participants' experiences prior to their first episode. Participants with bipolar disorder reported disruptive home environments, driven personality features, greater emotion dysregulation and adverse experiences during the school years, whereas participants with depression tended to describe more supportive home environments, and more compliant and introvert personality traits. Retrospective data collection and no corroborative evidence from other family members. No distinction was made between bipolar I and bipolar II disorder nor between melancholic and non-melancholic depression in the sample. Finally the study spanned over a 12-month period which does not allow for the possibility of diagnostic reassignment of some of the bipolar participants to the unipolar condition. These findings indicate that there may be benefits in combining both proximal and distal indicators in identifying a bipolar disorder phenotype which, in turn, may be relevant to the development of early intervention programs for young people with bipolar disorder.
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Affiliation(s)
- Liliane Benti
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia,
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Multimodal emotion integration in bipolar disorder: an investigation of involuntary cross-modal influences between facial and prosodic channels. J Int Neuropsychol Soc 2014; 20:525-33. [PMID: 24725656 DOI: 10.1017/s1355617714000253] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The ability to integrate information from different sensory channels is a vital process that serves to facilitate perceptual decoding in times of unimodal ambiguity. Despite its relevance to psychosocial functioning, multimodal integration of emotional information across facial and prosodic modes has not been addressed in bipolar disorder (BD). In light of this paucity of research we investigated multimodal processing in a BD cohort using a focused attention paradigm. Fifty BD patients and 52 healthy controls completed a task assessing the cross-modal influence of emotional prosody on facial emotion recognition across congruent and incongruent facial and prosodic conditions, where attention was directed to the facial channel. There were no differences in multi-modal integration between groups at the level of accuracy, but differences were evident at the level of response time; emotional prosody biased facial recognition latencies in the control group only, where a fourfold increase in response times was evident between congruent and incongruent conditions relative to patients. The results of this study indicate that the automatic process of integrating multimodal information from facial and prosodic sensory channels is delayed in BD. Given that interpersonal communication usually occurs in real time, these results have implications for social functioning in the disorder.
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Van Rheenen TE, Rossell SL. Phenomenological predictors of psychosocial function in bipolar disorder: is there evidence that social cognitive and emotion regulation abnormalities contribute? Aust N Z J Psychiatry 2014; 48:26-35. [PMID: 24126607 DOI: 10.1177/0004867413508452] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Neurocognitive ability and mood have often been discussed as contributing mechanisms to the severe psychosocial dysfunction experienced in bipolar disorder (BD). In contrast, there has been little discussion on the contribution of social cognition or emotion regulation. This paper aims to assert a potential role for these constructs in psychosocial functioning in BD, with an overarching goal to highlight the necessary importance of considering them in future research examining psychosocial outcomes in the disorder. METHODS This paper provides a theoretical synthesis of available and indirect evidence for an influence of (1) social cognition and (2) emotion regulation on psychosocial functioning; it acknowledges important clinical questions that need addressing, and discusses how current research might be translated to improve the treatment of psychosocial dysfunction in BD. RESULTS Given their assumed roles in facilitating social interactions and modulating behaviours, it is certainly plausible that abnormalities in social cognition and emotion regulation are detrimental to psychosocial functioning. Currently, there is only minimal direct evidence examining their influence, although existing BD studies are preliminarily supportive of relationships between these constructs. CONCLUSIONS There are reasonable theoretical grounds, supported by indirect and preliminary evidence, to suggest that social cognition and emotion regulation may be important in the prediction of psychosocial outcome in BD. However, this proposition is limited by the paucity of empirical research directly examining this matter.
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Affiliation(s)
- Tamsyn E Van Rheenen
- 1Brain and Psychological Sciences Research Centre (BPsyC), Faculty of Life and Social Sciences, Swinburne University, Melbourne, Australia
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Weinstein SM, West AE, Pavuluri M. Psychosocial intervention for pediatric bipolar disorder: current and future directions. Expert Rev Neurother 2013; 13:843-50. [PMID: 23898854 DOI: 10.1586/14737175.2013.811985] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pediatric bipolar disorder (PBD) affects approximately 2% of the population and disrupts mood regulation, psychosocial functioning and quality of life among affected youths and families. Given the significant psychosocial impairment and poor long-term prognosis associated with PBD, psychosocial intervention is considered to be an essential component of a multimodal treatment approach. This relatively young field of research has witnessed significant growth in the evidence base for psychosocial treatments targeting youths in the past decade, particularly family-based interventions grounded in a biopsychosocial framework. This article reviews existing empirically supported interventions for children and adolescents with PBD. Common elements of successful interventions are identified, and future research directions to address current limitations in the field and advance understanding of treatment for PBD are discussed.
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Affiliation(s)
- Sally M Weinstein
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, 1747 W Roosevelt Road, Room 155, Chicago, IL 60608, USA.
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Van Rheenen TE, Rossell SL. Is the non-verbal behavioural emotion-processing profile of bipolar disorder impaired? A critical review. Acta Psychiatr Scand 2013; 128:163-78. [PMID: 23550737 DOI: 10.1111/acps.12125] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Growing evidence suggests that patients with bipolar disorder (BD) are impaired in their ability to process non-verbal emotion, although few comprehensive reviews of the behavioural literature exist, and there has been little consideration of methodological issues that may account for discrepant empirical findings. This review examines the behavioural facial, prosodic and multimodal processing literature in BD and discusses methodological issues in the context of this evidence. METHOD Major computer databases including Google Scholar and PsychINFO were consulted to conduct a comprehensive review of quantitative behavioural differences in the emotion-processing literature in BD. Articles were accepted only if the target population sample met criteria for a DSM-III, DSM-IV or ICD-10 diagnosis, and they contained a healthy control group. RESULTS The current literature suggests that facial emotion processing is impaired, and there is preliminary evidence for some behavioural impairment in the processing of emotional prosody. CONCLUSION The specificity or generalisability of impairments in facial emotion processing and the effects of mood state are unclear. Similarly, the lack of clarity around the impact of auditory processes on emotional prosody processing warrants a comprehensive examination of the auditory profile in BD.
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Affiliation(s)
- T E Van Rheenen
- Brain and Psychological Sciences Research Centre, Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Vic., Australia.
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Seymour KE, Pescosolido MF, Reidy BL, Galvan T, Kim KL, Young M, Dickstein DP. Emotional face identification in youths with primary bipolar disorder or primary attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2013; 52:537-546.e3. [PMID: 23622855 PMCID: PMC4418014 DOI: 10.1016/j.jaac.2013.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 02/28/2013] [Accepted: 03/15/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD) are often comorbid or confounded; therefore, we evaluated emotional face identification to better understand brain/behavior interactions in children and adolescents with either primary BD, primary ADHD, or typically developing controls (TDC). METHOD Participants included individuals 7 to 17 years of age (overall sample mean age 12.40 ± 3.01 years), with "narrow-phenotype" pediatric BD (n = 30) or ADHD (n = 38), or typically developing controls (TDC) with no psychiatric disorders themselves or in their first-degree relatives (n = 41). In the BD group, comorbid diagnoses were allowed; however, youth in the ADHD group were excluded for comorbid mood or anxiety disorders. Patient groups were not excluded for psychotropic medication use. Emotional face identification was assessed using the computerized Diagnostic Analysis of Non-Verbal Accuracy (DANVA). RESULTS Participants with BD made significantly more identification errors on child happy faces than either TDCs (p = .03) or participants with ADHD (p = .01). Furthermore, youth with BD (0.33 ± 0.55) were more likely than youth with ADHD (0.11 ± 0.31) to make errors on low-intensity child happy faces (p = .05) but not high-intensity happy faces (p = NS). Participants with BD and ADHD made significantly more total errors in child face labeling than did TDCs, although participants with BD and ADHD did not differ from one another. CONCLUSION Our data suggest that youths with BD have specific alterations in emotional face identification of happy faces, an important finding that supports theories that response to positively valenced emotional stimuli may be especially salient in BD. Clinical trial registration information-Brain Imaging and Computer Games in Children With Either Bipolar Disorder, ADHD, Anxiety or Healthy Controls (BBPP); http://clinicaltrials.gov/; NCT01570426.
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Affiliation(s)
- Karen E Seymour
- Bradley Hospital's Pediatric Mood, Imaging, and NeuroDevelopmental (PediMIND) Program and the Alpert Medical School of Brown University, RI 02915, USA.
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Baez S, Herrera E, Villarin L, Theil D, Gonzalez-Gadea ML, Gomez P, Mosquera M, Huepe D, Strejilevich S, Vigliecca NS, Matthäus F, Decety J, Manes F, Ibañez AM. Contextual social cognition impairments in schizophrenia and bipolar disorder. PLoS One 2013; 8:e57664. [PMID: 23520477 PMCID: PMC3592887 DOI: 10.1371/journal.pone.0057664] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 01/23/2013] [Indexed: 01/09/2023] Open
Abstract
Background The ability to integrate contextual information with social cues to generate social meaning is a key aspect of social cognition. It is widely accepted that patients with schizophrenia and bipolar disorders have deficits in social cognition; however, previous studies on these disorders did not use tasks that replicate everyday situations. Methodology/Principal Findings This study evaluates the performance of patients with schizophrenia and bipolar disorders on social cognition tasks (emotional processing, empathy, and social norms knowledge) that incorporate different levels of contextual dependence and involvement of real-life scenarios. Furthermore, we explored the association between social cognition measures, clinical symptoms and executive functions. Using a logistic regression analysis, we explored whether the involvement of more basic skills in emotional processing predicted performance on empathy tasks. The results showed that both patient groups exhibited deficits in social cognition tasks with greater context sensitivity and involvement of real-life scenarios. These deficits were more severe in schizophrenic than in bipolar patients. Patients did not differ from controls in tasks involving explicit knowledge. Moreover, schizophrenic patients’ depression levels were negatively correlated with performance on empathy tasks. Conclusions/Significance Overall performance on emotion recognition predicted performance on intentionality attribution during the more ambiguous situations of the empathy task. These results suggest that social cognition deficits could be related to a general impairment in the capacity to implicitly integrate contextual cues. Important implications for the assessment and treatment of individuals with schizophrenia and bipolar disorders, as well as for neurocognitive models of these pathologies are discussed.
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Affiliation(s)
- Sandra Baez
- Institute of Cognitive Neurology (INECO) & Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Pontifical Catholic University of Argentina, Buenos Aires, Argentina
| | - Eduar Herrera
- Universidad Autónoma del Caribe, Barranquilla, Colombia
| | - Lilian Villarin
- Interdisciplinary Center for Scientific Computing, University of Heidelberg, Heidelberg, Germany
| | | | - María Luz Gonzalez-Gadea
- Institute of Cognitive Neurology (INECO) & Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Pedro Gomez
- CARI University Hospital, Barranquilla, Colombia
| | | | - David Huepe
- Laboratory of Cognitive and Social Neuroscience, Universidad Diego Portales, Santiago, Chile
| | - Sergio Strejilevich
- Institute of Cognitive Neurology (INECO) & Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina
| | - Nora Silvana Vigliecca
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Instituto de Humanidades (IDH) de la Facultad de Filosofía y Humanidades, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Franziska Matthäus
- Interdisciplinary Center for Scientific Computing, University of Heidelberg, Heidelberg, Germany
| | - Jean Decety
- Departments of Psychology and Psychiatry, and Center for Cognitive and Social Neuroscience, University of Chicago, Chicago, Illinois, United States of America
| | - Facundo Manes
- Institute of Cognitive Neurology (INECO) & Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina
| | - Agustín M. Ibañez
- Institute of Cognitive Neurology (INECO) & Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Laboratory of Cognitive and Social Neuroscience, Universidad Diego Portales, Santiago, Chile
- * E-mail:
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Dialectical Behavior Therapy for Adolescents: Theory, Treatment Adaptations, and Empirical Outcomes. Clin Child Fam Psychol Rev 2012; 16:59-80. [DOI: 10.1007/s10567-012-0126-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Keenan-Miller D, Peris T, Axelson D, Kowatch RA, Miklowitz DJ. Family functioning, social impairment, and symptoms among adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 2012; 51:1085-94. [PMID: 23021483 PMCID: PMC3462361 DOI: 10.1016/j.jaac.2012.08.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 07/16/2012] [Accepted: 08/02/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Impaired social functioning is common among youth with bipolar disorder (BD), emerges in multiple settings, and persists over time. However, little is known about factors associated with poor peer and family functioning in the early-onset form of BD. Using a sample of adolescents with BD I or II, we examined which symptoms of BD, including nonspecific symptoms such as inattention, aggression, and anxiety/depression, were associated with family functioning (adaptability, cohesion, and conflict) and peer relationship quality. METHOD Adolescents (N = 115; 46% male) with BD I and II and their parents were evaluated before participation in a multi-site randomized controlled trial. Adolescents had experienced an episode of depression, mania, or hypomania within the previous 3 months and were not in full remission. Adolescents' problem behaviors were assessed using the parent-rated Child Behavior Checklist (CBCL). Family functioning was assessed via child- and parent-report questionnaires. RESULTS Depressive symptoms were associated with lower child-ratings of family functioning. Contrary to hypotheses, moderate mania was associated with better parent-reported family conflict, adaptability, and cohesion. Aggression was associated with poorer family functioning across reporters and measures, even when controlling for the effects of depression, mania, and inattention. None of these symptom clusters were associated with peer functioning. CONCLUSIONS Aggression was the strongest correlate of family functioning in pediatric BD in this cross-sectional study. Findings speak to the potential value of addressing aggression and family dysfunction in the treatment of youth with BD. Clinical trial registration information-Effectiveness of Family-Focused Treatment Plus Pharmacotherapy for Bipolar Disorder in Adolescents; http://clinicaltrials.gov/; NCT00332098.
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Affiliation(s)
| | - Tara Peris
- the University of California–Los Angeles Semel Institute for Neuroscience and Human Behavior
| | - David Axelson
- the Western Psychiatric Institute, University of Pittsburgh School of Medicine
| | - Robert A. Kowatch
- Ohio State University School of Medicine and Nationwide Children’s Hospital
| | - David J. Miklowitz
- the University of California–Los Angeles Semel Institute for Neuroscience and Human Behavior
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Beaujean AA, Freeman MJ, Youngstrom E, Carlson G. The structure of cognitive abilities in youths with manic symptoms: a factorial invariance study. Assessment 2011; 19:462-71. [PMID: 21343151 DOI: 10.1177/1073191111399037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study compared the structure of cognitive ability (specifically, verbal/crystallized [Gc] and visual-spatial ability [Gv]), as measured in the Wechsler Intelligence Scale for Children, in youth with manic symptoms with a nationally representative group of similarly aged youth. Multigroup confirmatory factor analysis found the majority of the estimated parameters were invariant between the groups, although there was a difference in the intercepts for the Similarities subtest and difference in unique variances for the Picture Completion, Comprehension, and Picture Arrangement subtests. Thus, although there are many neurological changes associated with manic symptoms, the structure of verbal/crystallized and visual-spatial abilities appear relatively robust and invariant. As Gc and Gv are the primary domains on all the Wechsler Intelligence Scales for Children, results also indicate that clinical interpretation of the Wechsler scales may be appropriate to measure cognitive performance in youths with manic symptoms.
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Miklowitz DJ, Chang KD, Taylor DO, George EL, Singh MK, Schneck CD, Dickinson LM, Howe ME, Garber J. Early psychosocial intervention for youth at risk for bipolar I or II disorder: a one-year treatment development trial. Bipolar Disord 2011; 13:67-75. [PMID: 21320254 PMCID: PMC3077951 DOI: 10.1111/j.1399-5618.2011.00890.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Previous studies have identified behavioral phenotypes that predispose genetically vulnerable youth to a later onset of bipolar I or II disorder, but few studies have examined whether early psychosocial intervention can reduce risk of syndromal conversion. In a one-year open trial, we tested a version of family-focused treatment adapted for youth at high risk for bipolar disorder (FFT-HR). METHODS A referred sample of 13 children (mean 13.4±2.69 years; 4 boys, 9 girls) who had a parent with bipolar I or II disorder participated at one of two outpatient specialty clinics. Youth met DSM-IV criteria for major depressive disorder (n=8), cyclothymic disorder (n=1), or bipolar disorder not otherwise specified (n=4), with active mood symptoms in the past month. Participants were offered FFT-HR (12 sessions in four months) with their parents, plus psychotropic medications as needed. Independent evaluators assessed depressive symptoms, hypomanic symptoms, and global functioning at baseline and then every four months for one year, with retrospective severity and impairment ratings made for each week of the follow-up interval. RESULTS Families were mostly adherent to the treatment protocol (85% retention), and therapists administered the FFT-HR manual with high levels of fidelity. Youth showed significant improvements in depression, hypomania, and psychosocial functioning scores on the Adolescent Longitudinal Interval Follow-up Evaluation. They also showed significant improvements in Young Mania Rating Scale and Children's Depression Rating Scale scores. CONCLUSIONS FFT-HR is a promising intervention for youth at high risk for BD. Larger-scale randomized trials that follow youth into young adulthood will be necessary to determine whether early psychosocial intervention can reduce the probability of developing bipolar I or II disorder among genetically vulnerable youth.
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Affiliation(s)
- David J Miklowitz
- Division of Child and Adolescent Psychiatry, University of California Los Angeles School of Medicine, 760 Westwood Plaza, Los Angeles, CA 90024, USA.
| | - Kiki D Chang
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA
| | - Dawn O Taylor
- Department of Psychology, University of Colorado, Boulder, CO
| | | | - Manpreet K Singh
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA
| | - Christopher D Schneck
- Department of Psychiatry, University of Colorado Denver Health Sciences Center, Denver, CO
| | - L Miriam Dickinson
- Department of Psychiatry, University of Colorado Denver Health Sciences Center, Denver, CO
| | - Meghan E Howe
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA
| | - Judy Garber
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
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Matson JL, Neal D, Fodstad JC, Hess JA, Mahan S, Rivet TT. Reliability and validity of the Matson Evaluation of Social Skills with Youngsters. Behav Modif 2011; 34:539-58. [PMID: 20935234 DOI: 10.1177/0145445510384844] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Social skills are an important part of development, and deficits in this area have long-term impacts on a child. As a result, clinicians should include a measure of social skills as part of a comprehensive assessment. There are a few well-researched measures of social skills that are currently used, including the Matson Evaluation of Social Skills with Youngsters (MESSY). The MESSY has been translated and studied internationally in more than nine countries; however, updated norms for the United States have not been conducted since the inception of the measure. The purpose of this article is to examine the psychometric properties of the MESSY using an updated norm sample and age cohorts. Overall results indicated strong internal consistency and good to strong convergent and divergent validity. Psychometric properties for the older age cohorts were stronger and more consistent than those for the 2- to 5-year-olds. This reflects the variability of development and difficulty of assessing social skills at this young age.
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Affiliation(s)
- Johnny L Matson
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, USA.
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Depp CA, Mausbach BT, Harvey PD, Bowie CR, Wolyniec PS, Thornquist MH, Luke JR, McGrath JA, Pulver AE, Patterson TL. Social competence and observer-rated social functioning in bipolar disorder. Bipolar Disord 2010; 12:843-50. [PMID: 21176031 PMCID: PMC3639014 DOI: 10.1111/j.1399-5618.2010.00880.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Impairment in social functioning appears to be common in bipolar disorder, although estimates have been derived largely from self-report measures. We examined performance-based and observer-based ratings of social competence and functioning and assessed the contribution of symptoms and neurocognitive ability to social functioning in bipolar disorder. METHODS In this cross-sectional study, 164 subjects with bipolar disorder were administered the performance-based Social Skills Performance Assessment (SSPA), rated by an informant on the Specific Level of Functioning (SLOF)-Interpersonal subscale, received clinical ratings of depression and manic symptoms, and performed neurocognitive tests. We assessed the proportion of patients exhibiting social deficits and examined the associations between composite measures of neurocognitive ability, depression and manic symptoms, and SSPA scores with informant-rated, real-world social functioning. RESULTS Mean age of the sample was 47.6 years (SD = 14.1). Subjects were experiencing, on average, mild levels of depression and minimal manic symptoms. A total of 29% exhibited norm-referenced impairment on the SSPA, and 64% registered at least one impairment on SLOF items; unemployed subjects had lower SSPA and SLOF ratings. Neurocognitive performance correlated with both performance-based and observer-rated social functioning, whereas depressive and manic symptoms correlated only with observer-rated social impairments. In multivariate models, depression was the most potent association with social functioning, and impairment in social competence (i.e., capacity) increased the strength of the relationships between depression and neurocognitive impairment and social functioning (i.e., real-world functioning). CONCLUSIONS Our study confirmed the negative relationship of bipolar depression with social functioning. A subgroup of outpatients with bipolar disorder has impaired social competence, which, when present, worsened the impact of depression and cognitive impairment on social functioning.
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Affiliation(s)
- Colin A Depp
- Stein Institute for Research on Aging, Department of Psychiatry, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0664, USA.
| | - Brent T Mausbach
- Department of Psychiatry, University of California at San Diego, San Diego, CA
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, USA
| | | | - Paula S Wolyniec
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary H Thornquist
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James R Luke
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John A McGrath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ann E Pulver
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas L Patterson
- Department of Psychiatry, University of California at San Diego, San Diego, CA
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Rodgers MJ, Zylstra RG, McKay JB, Solomon AL, Choby BA. Adolescent bipolar disorder: a clinical vignette. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2010; 12. [PMID: 21085549 DOI: 10.4088/pcc.09r00895ora] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 11/24/2009] [Indexed: 10/19/2022]
Abstract
Adolescence is a vulnerable developmental phase marked by physical, psychological, and social changes that rapidly expose young people to a wide range of new stressors. When differentiating between bipolar disorder and teenage "acting out," a careful history is important. Adolescent bipolar disorder is a psychiatric illness characterized by fluctuating episodes of mood elevation and depression that is frequently neither recognized nor formally diagnosed. Adolescents with bipolar disorder often manifest a more nonepisodic, chronic course with continuous rapid-cycling patterns than do adults. Pharmacologic treatment of adolescent bipolar disorder is difficult and often requires combination therapy to address comorbidities like attention-deficit/hyperactivity disorder and anxiety disorder. Adjuncts to pharmacologic treatment of bipolar disorder can be beneficial. Psychosocial treatments include family education, enhanced parenting techniques, stress management, and the development of effective coping strategies.
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Affiliation(s)
- Melissa J Rodgers
- Department of Family Medicine, College of Medicine, University of Tennessee-Chattanooga, Chattanooga, Tennessee, USA
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Miklowitz DJ, Johnson SL. Social and Familial Factors in the Course of Bipolar Disorder: Basic Processes and Relevant Interventions. ACTA ACUST UNITED AC 2009; 16:281-296. [PMID: 19684882 DOI: 10.1111/j.1468-2850.2009.01166.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This article reviews the role of social factors, notably life events and family relationships, in the course of bipolar illness in adults and youth. We also discuss psychological variables that help explain the vulnerability of bipolar patients to social environments, including personality factors (e.g., neuroticism), reward sensitivity, and difficulty with the accurate perception of facial emotions. Bipolar patients are highly sensitive to reward, and excessive goal pursuit after goal-attainment events may be one pathway to mania. Negative life events predict depressive symptoms, as do levels of familial expressed emotion. Psychosocial interventions can speed recoveries from episodes and delay recurrences over 1-2 year intervals. Future research should examine the nature of vulnerability/stress interactions at different phases of development, and the role of psychosocial interventions in altering these processes.
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Psychosocial functioning among bipolar youth. J Affect Disord 2009; 114:174-83. [PMID: 18715651 PMCID: PMC2709452 DOI: 10.1016/j.jad.2008.07.001] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 06/30/2008] [Accepted: 07/01/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evidence indicates that children and adolescents with bipolar disorder (BP) experience significant functional impairment. However, little is known about the association between psychosocial functioning and episodes of illness, demographic, and clinical variables in this population. METHODS Subjects included 446 patients aged 7 to 17 diagnosed with DSM-IV bipolar disorder via the K-SADS for the Course and Outcome of Bipolar Youth (COBY) study. The Psychosocial Functioning Schedule of the Adolescent Longitudinal Interval Follow-Up Assessment (A-LIFE) was administered at study intake. RESULTS Mild to moderate levels of psychosocial impairment were evident in work (includes academics), interpersonal, and overall domains of functioning among BP youth. Multivariate analyses indicated that the strongest predictors of psychosocial impairment were adolescence (regardless of age of onset), current mood episode, current affective symptom severity, current psychotic symptoms, and current comorbid conduct disorder. Bipolar youth in-episode were significantly more impaired than those in partial remission/recovery in every functional domain examined and were less satisfied with their functioning. Yet, BP youth in partial remission/recovery reported significant psychosocial impairment. LIMITATIONS Limitations include the reliance on patient and parent retrospective report of psychosocial functioning. Additionally, we did not account for the impact of psychosocial and pharmacological interventions on functioning. CONCLUSIONS Findings suggest pediatric BP is associated with significant impairment in psychosocial functioning during and between episodes, with greater impairment during mood episodes than during partial remission/recovery. Additionally, functional impairment in BP appears to increase during adolescence regardless of age of onset. Clinicians should carefully assess and address psychosocial impairment during and between mood episodes, with particular attention to the functioning of BP adolescents.
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West AE, Pavuluri MN. Psychosocial treatments for childhood and adolescent bipolar disorder. Child Adolesc Psychiatr Clin N Am 2009; 18:471-82, x-xi. [PMID: 19264274 DOI: 10.1016/j.chc.2008.11.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Adjunctive psychosocial interventions are increasingly recognized as an important aspect of comprehensive treatment for bipolar disorder (BPD) in childhood and adolescence. Research in this area is relatively new, but psychosocial interventions being developed and tested include: multi-family psychoeducation groups for school-aged children with either BPD or depressive disorders; family-focused treatment, dialectical behavior therapy, and interpersonal and social rhythm therapy for adolescents with BPD; and child and family-focused cognitive-behavioral therapy for school-aged children with BPD. Preliminary evidence, where available, indicates that these interventions are feasible, well-received by families, and associated with positive outcomes. The continued study of adjunctive psychosocial interventions will help identify critical treatment ingredients that target specific areas of functioning and enhance overall treatment effectiveness for children and adolescents with BPD and their families.
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Affiliation(s)
- Amy E West
- University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL 60608, USA.
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Matson JL, Wilkins J. Psychometric testing methods for children's social skills. RESEARCH IN DEVELOPMENTAL DISABILITIES 2009; 30:249-274. [PMID: 18486441 DOI: 10.1016/j.ridd.2008.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Social skill excesses and deficits have garnered considerable attention from researchers and clinicians over the last three decades. This trend is undoubtedly due to the central role these problems play in psychopathology and the general adjustment of children of all ages. Not surprisingly, these concerns and attention to such problems have also fostered a substantial literature on scaling methods specifically designed to help define and identify social skill deficits as well as track treatment progress. In this paper, for example, we identified 48 scales and related testing methods specifically designed for this purpose. Our goal here was to critically review the psychometric properties and patterns of research with existing social skill tests for children. Current strengths and weaknesses along with future directions for research are considered for this highly researched topic.
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Joseph MF, Frazier TW, Youngstrom EA, Soares JC. A quantitative and qualitative review of neurocognitive performance in pediatric bipolar disorder. J Child Adolesc Psychopharmacol 2008; 18:595-605. [PMID: 19108664 PMCID: PMC2768898 DOI: 10.1089/cap.2008.064] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Bipolar disorder (BD) is an increasingly prevalent diagnosis in youth. As a result, there has been a corresponding increase in interest about neuropsychological and cognitive profiles in children and adolescents diagnosed with BD. Meta-analysis of the existing literature comparing individuals with BD to healthy controls indicated that the largest differences are observed for measures of verbal memory (d = 0.77). Moderate differences were found in the areas of attention (d = 0.62), executive functioning (d = 0.62), working memory (d = 0.60), visual memory (d = 0.51), visual perceptual skills (d = 0.48), and verbal fluency (d = 0.45). Small differences were found for measures of reading (d = 0.40), motor speed (d = 0.33), and full-scale intelligence quotient (IQ) (d = 0.32). Often, few studies have provided relevant information for a particular neurocognitive domain. Despite this, several domains displayed heterogeneity of effect sizes across studies. Methodological factors explained the variance in effect sizes to different extents depending upon the cognitive domain. The changing influence of method artifacts is likely due to variable coverage of cognitive domains across studies and the use of different measures across studies. Findings are consistent with previous meta-analyses of the adult BD neurocognitive literature, suggesting that many of the deficits observed in adults are present earlier in the course of the illness. Study reporting guidelines are offered that may help clarify the impact of illness definitions, mood state, medication status, and other methodological variables on neurocognition in pediatric BD.
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Affiliation(s)
- Megan F. Joseph
- Department of Psychology, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina
| | - Thomas W. Frazier
- Pediatric Behavioral Medicine, The Cleveland Clinic
- Department of Psychology, University of North Carolina–Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Eric A. Youngstrom
- Department of Psychology, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina
| | - Jair C. Soares
- Department of Psychology, University of North Carolina–Chapel Hill School of Medicine, Chapel Hill, North Carolina
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Risk for bipolar disorder is associated with face-processing deficits across emotions. J Am Acad Child Adolesc Psychiatry 2008; 47:1455-61. [PMID: 19034190 PMCID: PMC2693273 DOI: 10.1097/chi.0b013e318188832e] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Youths with euthymic bipolar disorder (BD) have a deficit in face-emotion labeling that is present across multiple emotions. Recent research indicates that youths at familial risk for BD, but without a history of mood disorder, also have a deficit in face-emotion labeling, suggesting that such impairments may be an endophenotype for BD. It is unclear whether this deficit in at-risk youths is present across all emotions or if the impairment presents initially as an emotion-specific dysfunction that then generalizes to other emotions as the symptoms of BD become manifest. METHOD Thirty-seven patients with pediatric BD, 25 unaffected children with a first-degree relative with BD, and 36 typically developing youths were administered the Emotional Expression Multimorph Task, a computerized behavioral task, which presents gradations of facial emotions from 100% neutrality to 100% emotional expression (happiness, surprise, fear, sadness, anger, and disgust). RESULTS Repeated-measures analysis of covariance revealed that, compared with the control youths, the patients and the at-risk youths required significantly more intense emotional information to identify and correctly label face emotions. The patients with BD and the at-risk youths did not differ from each other. Group-by-emotion interactions were not significant, indicating that the group effects did not differ based on the facial emotion. CONCLUSIONS The youths at risk for BD demonstrate nonspecific deficits in face-emotion recognition, similar to patients with the illness. Further research is needed to determine whether such deficits meet all the criteria for an endophenotype.
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Face emotion labeling deficits in children with bipolar disorder and severe mood dysregulation. Dev Psychopathol 2008; 20:529-46. [PMID: 18423093 DOI: 10.1017/s0954579408000266] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Children with narrow phenotype bipolar disorder (NP-BD; i.e., history of at least one hypomanic or manic episode with euphoric mood) are deficient when labeling face emotions. It is unknown if this deficit is specific to particular emotions, or if it extends to children with severe mood dysregulation (SMD; i.e., chronic irritability and hyperarousal without episodes of mania). Thirty-nine NP-BD, 31 SMD, and 36 control subjects completed the emotional expression multimorph task, which presents gradations of facial emotions from 100% neutrality to 100% emotional expression (happiness, surprise, fear, sadness, anger, and disgust). Groups were compared in terms of intensity of emotion required before identification occurred and accuracy. Both NP-BD and SMD youth required significantly more morphs than controls to label correctly disgusted, surprised, fearful, and happy faces. Impaired face labeling correlated with deficient social reciprocity skills in NP-BD youth and dysfunctional family relationships in SMD youth. Compared to controls, patients with NP-BD or SMD require significantly more intense facial emotion before they are able to label the emotion correctly. These deficits are associated with psychosocial impairments. Understanding the neural circuitry associated with face-labeling deficits has the potential to clarify the pathophysiology of these disorders.
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de Almeida Rocca CC, de Macedo-Soares MB, Gorenstein C, Tamada RS, Issler CK, Dias RS, Schwartzmann AM, Lafer B. Social dysfunction in bipolar disorder: pilot study. Aust N Z J Psychiatry 2008; 42:686-92. [PMID: 18622776 DOI: 10.1080/00048670802203426] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of the present study was to assess the social skills of euthymic patients with bipolar disorder. METHODS A group of 25 outpatients with bipolar disorder type I were evaluated in comparison with a group of 31 healthy volunteers who were matched in terms of level of education, age, sex and intelligence. Both groups were assessed using a self-report questionnaire, the Brazilian Inventario de Habilidades Sociais (IHS, Social Skills Inventory). Two Wechsler Adult Intelligence Scale subtests (Picture Arrangement and Comprehension) were also used in order to assess subject ability to analyse social situations and to make judgements, respectively. RESULTS Patients with bipolar disorder had lower IHS scores for the domains that assessed conversational skills/social self-confidence and social openness to new people/situations. Patients with anxiety disorders had high scores for the domain that assessed self-confidence in the expression of positive emotions. No differences were found between patients and controls in performance on the Wechsler Adult Intelligence Scale Picture Arrangement and Comprehension subtests. CONCLUSIONS Euthymic patients with bipolar disorder present inhibited and overattentive behaviour in relation to other people and their environment. This behaviour might have a negative impact on their level of social functioning and quality of life.
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Affiliation(s)
- Cristiana Castanho de Almeida Rocca
- Psychology and Neuropsychology Units, and Bipolar Research Program, Department and Institute of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil.
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