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Öksüz E, Mersin S, Uçgun T, Sarikoc G. Experiences of nurses providing care to hospitalized patients with acute mania in Türkiye: A phenomenological study. Arch Psychiatr Nurs 2024; 50:33-39. [PMID: 38789231 DOI: 10.1016/j.apnu.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 10/01/2023] [Accepted: 03/07/2024] [Indexed: 05/26/2024]
Abstract
The main purpose of this study was to determine the experiences of nurses who care for hospitalized patients experiencing an acute manic episode. This qualitative study was carried out with 15 nurses working in a psychiatric ward in Türkiye. Data were collected through semi-structured in-depth individual interviews and focus-group interviews in which the face-to-face interview technique was used. Two main themes emerged from the analysis of the qualitative data: (1) the difficulties experienced and (2) the most effective elements of care. Under the first main theme, the following sub-themes emerged: difficulties in setting boundaries, safety concerns, difficulties in managing the patient's demands, inability to choose the appropriate word(s), and the "emotional whirlwind" experienced. The second main theme, on the other hand, included the following sub-themes: meeting basic needs, ensuring treatment compliance, encouragement to engage in physical activity, and having a sufficient number of qualified personnel. The study revealed that the nurses had difficulties in caring for their manic patients. On the basis of these results, it is recommended that nurses be given counseling and training on setting boundaries, ensuring safety, managing the patient's demands, coping with their own emotions, and communicating better. In addition, the study identified the importance of nursing interventions to meet patients' basic needs, encourage them to engage in physical activity, and ensure treatment compliance, and the importance of there being an adequate number of qualified personnel. These results may help students and other nurses in terms of assessing and setting priorities in cases needing acute psychiatric care.
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Affiliation(s)
- Emine Öksüz
- University of Health Sciences Turkey, Gulhane Faculty of Nursing, Psychiatric and Mental Health Nursing Department, Ankara, Turkey.
| | - Sevinç Mersin
- Bilecik Şeyh Edebali University, Faculty of Health Sciences, Psychiatric and Mental Health Nursing Department, Bilecik, Turkey.
| | - Tuğçe Uçgun
- Başkent University, Faculty of Health Sciences, Department of Mental Health and Psychiatric Nursing, Ankara, Turkey.
| | - Gamze Sarikoc
- University of Health Sciences Turkey, Gulhane Faculty of Nursing, Psychiatric and Mental Health Nursing Department, Ankara, Turkey.
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Koning E, McDonald A, Bambokian A, Gomes FA, Vorstman J, Berk M, Fabe J, McIntyre RS, Milev R, Mansur RB, Brietzke E. The concept of "metabolic jet lag" in the pathophysiology of bipolar disorder: implications for research and clinical care. CNS Spectr 2023; 28:571-580. [PMID: 36503605 DOI: 10.1017/s1092852922001195] [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] [Indexed: 12/14/2022]
Abstract
Bipolar disorder (BD) is a potentially chronic mental disorder marked by recurrent depressive and manic episodes, circadian rhythm disruption, and changes in energetic metabolism. "Metabolic jet lag" refers to a state of shift in circadian patterns of energy homeostasis, affecting neuroendocrine, immune, and adipose tissue function, expressed through behavioral changes such as irregularities in sleep and appetite. Risk factors include genetic variation, mitochondrial dysfunction, lifestyle factors, poor gut microbiome health and abnormalities in hunger, satiety, and hedonistic function. Evidence suggests metabolic jet lag is a core component of BD pathophysiology, as individuals with BD frequently exhibit irregular eating rhythms and circadian desynchronization of their energetic metabolism, which is associated with unfavorable clinical outcomes. Although current diagnostic criteria lack any assessment of eating rhythms, technological advancements including mobile phone applications and ecological momentary assessment allow for the reliable tracking of biological rhythms. Overall, methodological refinement of metabolic jet lag assessment will increase knowledge in this field and stimulate the development of interventions targeting metabolic rhythms, such as time-restricted eating.
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Affiliation(s)
- Elena Koning
- Centre for Neurosciences Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Alexandra McDonald
- Centre for Neurosciences Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Alexander Bambokian
- Centre for Neurosciences Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Fabiano A Gomes
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Jacob Vorstman
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Michael Berk
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Jennifer Fabe
- Department of Neurology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Roger S McIntyre
- Department of Psychiatry and Pharmacology, University of Toronto, The Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Roumen Milev
- Centre for Neurosciences Studies (CNS), Queen's University, Kingston, ON, Canada
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
- Department of Psychiatry, Providence Care Hospital, Kingston, ON, Canada
| | - Rodrigo B Mansur
- Department of Psychiatry and Pharmacology, University of Toronto, The Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Elisa Brietzke
- Centre for Neurosciences Studies (CNS), Queen's University, Kingston, ON, Canada
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
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Geerling B, Kelders SM, Stevens AWMM, Kupka RW, Bohlmeijer ET. Why patients diagnosed with bipolar disorder start, continue or discontinue health-related apps supporting their self-management. J Psychiatr Ment Health Nurs 2023; 30:537-546. [PMID: 36582041 DOI: 10.1111/jpm.12894] [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: 03/17/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: Self-management is essential in the treatment of those who have bipolar disorder. There are many apps to support self-management, but we know that these apps only sometimes cover the users' needs. WHAT IS ADDED TO EXISTING KNOWLEDGE?: In our research, we made an inventory of apps that people with bipolar disorder use to cover their needs in self-management. We also have searched for the reasons to start, continue, switch or quit the use of those apps. We found that 44% (n = 18) of our respondents use health-related apps for self-management purposes. Apps for physical activity, planning and structure and apps for relaxation were most used. In the use of apps, the "freedom of choice" and user-friendliness are the most important in continuing the use of apps, while malfunctioning and "not fitting in individual needs" the main reasons were for quitting the use of apps. IMPLICATIONS FOR PRACTICE Various apps can be used for self-management purposes as long as these apps meet the individual user's requirements. Clinicians and patients should have a broad view when looking for suitable apps and not limit the search to just professional apps. In developing new apps, patients, clinicians and developers should collaborate in the development process, requirements and design. ABSTRACT INTRODUCTION: Self-management is one of the cornerstones in the treatment of bipolar disorder (BD). Complementing interventions by apps are seen as a good opportunity to support self-management. However, there is insufficient knowledge about understanding the use of health-related applications by consumers with BD for self-management purposes. AIM The study aims to gain insight from patients diagnosed with BD about reasons to use, continue or discontinue health-related apps. METHOD This study employed a mixed-method design in which 41 participants diagnosed with BD participated in a quantitative survey, and 11 participants also participated in an in-depth interview. RESULTS The survey showed that 44% (n = 18) of the participants use health-related apps, and 26.8% (n = 11) use those apps consistently. Interviews revealed that adjustability, usability, trustworthiness and the guarantee of privacy were the main reasons determining whether participants used or terminated the use of a health-related app. IMPLICATIONS FOR PRACTICE Although we found that a substantial number of patients diagnosed with BD use one or more apps to support self-management, their use is often discontinued due to content that needs more robust to address their needs. Besides appropriate content, tailoring and persuasive technologies will likely promote the continued use of an app for self-management purposes. Cooperation between those diagnosed with bipolar disorder and health professionals (like mental health nurses) in developing and designing applications that are aimed to support self-management in BD is necessary for successful implementation and adaptation.
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Affiliation(s)
- Bart Geerling
- Dimence Mental Health Institute, Centre for Bipolar Disorder, Deventer, The Netherlands
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research University of Twente, Enschede, The Netherlands
| | - Saskia M Kelders
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research University of Twente, Enschede, The Netherlands
- Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
| | - Anja W M M Stevens
- Dimence Mental Health Institute, Centre for Bipolar Disorder, Deventer, The Netherlands
| | - Ralph W Kupka
- Department Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ernst T Bohlmeijer
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research University of Twente, Enschede, The Netherlands
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Meng J, Xiao X, Wang W, Jiang Y, Jin Y, Wang H. Sleep quality, social rhythms, and depression among people living with HIV: a path analysis based on social zeitgeber theory. Front Psychiatry 2023; 14:1102946. [PMID: 37215662 PMCID: PMC10192574 DOI: 10.3389/fpsyt.2023.1102946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/14/2023] [Indexed: 05/24/2023] Open
Abstract
Background People living with HIV frequently report sleep disturbances. The social zeitgeber theory, which proposes that stressful life events can interfere with sleep and even depression by destabilizing daily routines, provides new insights into identifying predictors of sleep disturbances and improving sleep in people living with HIV. Objective To explain the pathways affecting sleep quality in people living with HIV based on social zeitgeber theory. Methods A cross-sectional study was conducted to assess sleep quality, social rhythms, depression, social support, and coping styles from December 2020 to February 2021. The hypothetical model was tested and respecified by performing path analysis and a bias-corrected bootstrapping method using IBM AMOS 24 software. The report of this study followed the STROBE checklist. Results A total of 737 people living with HIV participated in the study. The final model presented a good fit (goodness of fit = 0.999, adjusted goodness of fit index = 0.984, normed fit index = 0.996, comparative fit index = 0.998, Tucker-Lewis index = 0.988, root mean square error of approximation = 0.030, chi-squared/degree of freedom = 1.646), explaining 32.3% of the variance in sleep quality among people living with HIV. Lower social rhythm stability was directly associated with poorer sleep quality, and depression mediated the relationship between social rhythms and sleep quality. Social support and coping styles affected sleep quality through social rhythms and depression. Limitation The cross-sectional study design precludes making assumptions about causality among factors. Conclusion This study validates and extends the applicability of the social zeitgeber theory in the HIV context. Social rhythms have direct and indirect effects on sleep. Social rhythms, sleep, and depression is not simply linked in a cascading sequence but is theoretically linked in a complex way. More studies are needed to explore the predictors of social rhythms, and interventions for stabilizing social rhythms have the potential to alleviate sleep disturbances and depression in people living with HIV.
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Affiliation(s)
- Jingjing Meng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Xueling Xiao
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yanfei Jin
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Honghong Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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Kahawage P, Bullock B, Meyer D, Gottlieb J, Crowe M, Swartz HA, Yatham LN, Inder M, Porter RJ, Nierenberg AA, Meesters Y, Gordijn M, Haarman BCM, Murray G. Social Rhythm Disruption is Associated with Greater Depressive Symptoms in People with Mood Disorders: Findings from a Multinational Online Survey During COVID-19. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:831-840. [PMID: 35535550 PMCID: PMC9096005 DOI: 10.1177/07067437221097905] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Societal restrictions imposed to prevent transmission of COVID-19 may challenge circadian-driven lifestyle behaviours, particularly amongst those vulnerable to mood disorders. The overarching aim of the present study was to investigate the hypothesis that, in the routine-disrupted environment of the COVID-19, amongst a sample of people living with mood disorders, greater social rhythm disruption would be associated with more severe mood symptoms. METHODS We conducted a two-wave, multinational survey of 997 participants (MAge=39.75±13.39,Female=81.6%) who self-reported a mood disorder diagnosis (i.e., major depressive disorder or bipolar disorder). Respondents completed questionnaires assessing demographics, social rhythmicity (The Brief Social Rhythm Scale), depression symptoms (Patient Health Questionnaire-9), sleep quality and diurnal preference (The Sleep, Circadian Rhythms and Mood questionnaire) and stressful life events during the COVID-19 pandemic (The Social Readjustment Rating Scale). RESULTS The majority of participants indicated COVID-19-related social disruption had affected the regularity of their daily routines to at least some extent (n = 788, 79.1%). As hypothesised, lower social rhythmicity was associated with greater depressive symptoms when tested cross-sectionally (standardised β = -.25, t = -7.94, P = 0.000) and when tested using a 2-level hierarchical linear model across two time points (b = -0.14, t = -3.46, df = 264, P ≤ 0.001). CONCLUSIONS These results are consistent with the social zeitgeber hypothesis proposing that mood disorders are sensitive to life events that disrupt social rhythms.
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Affiliation(s)
- Piyumi Kahawage
- Centre for Mental Health, 3783Swinburne University of Technology, Melbourne, Australia
| | - Ben Bullock
- Centre for Mental Health, 3783Swinburne University of Technology, Melbourne, Australia
| | - Denny Meyer
- Centre for Mental Health, 3783Swinburne University of Technology, Melbourne, Australia
| | - John Gottlieb
- Department of Psychiatry and Behavioural Sciences, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marie Crowe
- Department of Psychological Medicine, 2494University of Otago, Christchurch, New Zealand
| | - Holly A Swartz
- Department of Psychiatry, 6614University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lakshmi N Yatham
- Department of Psychiatry, 8166University of British Columbia, Vancouver, Canada
| | - Maree Inder
- Department of Psychological Medicine, 2494University of Otago, Christchurch, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, 2494University of Otago, Christchurch, New Zealand
| | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, 2348Massachusetts General Hospital, 1811Harvard Medical School, Boston, MA, USA
| | - Ybe Meesters
- Department of Psychiatry Groningen, 3647University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marijke Gordijn
- Chrono@Work & Chronobiology Unit, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, the Netherlands
| | - Bartholomeus C M Haarman
- Department of Psychiatry Groningen, 3647University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Greg Murray
- Centre for Mental Health, 3783Swinburne University of Technology, Melbourne, Australia
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Circadian depression: A mood disorder phenotype. Neurosci Biobehav Rev 2021; 126:79-101. [PMID: 33689801 DOI: 10.1016/j.neubiorev.2021.02.045] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 12/15/2022]
Abstract
Major mood syndromes are among the most common and disabling mental disorders. However, a lack of clear delineation of their underlying pathophysiological mechanisms is a major barrier to prevention and optimised treatments. Dysfunction of the 24-h circadian system is a candidate mechanism that has genetic, behavioural, and neurobiological links to mood syndromes. Here, we outline evidence for a new clinical phenotype, which we have called 'circadian depression'. We propose that key clinical characteristics of circadian depression include disrupted 24-h sleep-wake cycles, reduced motor activity, low subjective energy, and weight gain. The illness course includes early age-of-onset, phenomena suggestive of bipolarity (defined by bidirectional associations between objective motor and subjective energy/mood states), poor response to conventional antidepressant medications, and concurrent cardiometabolic and inflammatory disturbances. Identifying this phenotype could be clinically valuable, as circadian-targeted strategies show promise for reducing depressive symptoms and stabilising illness course. Further investigation of underlying circadian disturbances in mood syndromes is needed to evaluate the clinical utility of this phenotype and guide the optimal use of circadian-targeted interventions.
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Wynter E, Meade T, Perich T. Parental and partner role functioning and personal recovery in bipolar disorder. J Clin Psychol 2021; 77:1985-1996. [PMID: 33655558 DOI: 10.1002/jclp.23127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/23/2021] [Accepted: 02/11/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Bipolar disorder research has primarily focused on clinical outcomes but there is increasing understanding of the importance of personal recovery. This study aimed to explore the relationship between functioning in key social roles including parenting and intimate relationships with personal recovery. METHOD Participants with bipolar disorder (N = 393) were recruited to participate in an online survey. Participants provided clinical information and completed measures of personal recovery, parental and intimate relationship functioning. RESULTS Parental functioning and intimate relationship functioning were found to be significantly associated with recovery scores with higher scores being associated with greater recovery. Parental functioning was also found to have a predictive effect, with higher parental functioning predicting greater recovery scores. CONCLUSIONS This study suggests that greater parental functioning may have an important role in the experience of personal recovery for people living with bipolar disorder. Future studies should further assess how supporting parenting may contribute recovery outcomes.
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Affiliation(s)
- Edward Wynter
- Clinical and Health Psychology Research Initiative (CaHPRI), School of Psychology, Western Sydney University, Penrith, Australia
| | - Tanya Meade
- Clinical and Health Psychology Research Initiative (CaHPRI), School of Psychology, Western Sydney University, Penrith, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Tania Perich
- Clinical and Health Psychology Research Initiative (CaHPRI), School of Psychology, Western Sydney University, Penrith, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, Australia
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Murray G, Gottlieb J, Swartz HA. Maintaining Daily Routines to Stabilize Mood: Theory, Data, and Potential Intervention for Circadian Consequences of COVID-19. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:9-13. [PMID: 32909832 PMCID: PMC7890582 DOI: 10.1177/0706743720957825] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Greg Murray
- Centre for Mental Health, 3783Swinburne University of Technology, Melbourne, Victoria, Australia
| | - John Gottlieb
- Department of Psychiatry and Behavioral Sciences, 3270Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Holly A Swartz
- Department of Psychiatry, 6614University of Pittsburgh, Pittsburgh, PA, USA
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Crowe M, Inder M, Swartz HA, Murray G, Porter R. Social rhythm therapy-A potentially translatable psychosocial intervention for bipolar disorder. Bipolar Disord 2020; 22:121-127. [PMID: 31539451 DOI: 10.1111/bdi.12840] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The aim of this paper was to present Social Rhythm Therapy, which has been modified from Interpersonal and Social Rhythm Therapy, by drawing on implementation science to describe a process that for integrating this into routine clinical practice. METHOD On the basis of the principles of user-centred design, we aimed to modify an existing psychosocial therapy for bipolar disorder to make this readily translatable into a range of clinical practice models which could be further modified based on feedback from end users. RESULTS Social Rhythm Therapy has been adapted from Interpersonal and Social Rhythm Therapy which has demonstrated efficacy in research settings. The adaptation was developed in order to facilitate implementation of some of the key components in routine clinical practice. It is short, relatively simple, easily learned and intended to be flexible. CONCLUSIONS Social rhythm therapy for bipolar disorder has many characteristics which may make it translatable into clinical practice in different settings. There is a need for studies into the clinical effectiveness of this intervention that has been modified from an evidence-based intervention.
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Affiliation(s)
- Marie Crowe
- University of Otago, Christchurch, New Zealand
| | - Maree Inder
- University of Otago, Christchurch, New Zealand
| | | | - Greg Murray
- Swinburne University of Technology, Melbourne, Vic, Australia
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10
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Byrne JEM, Tremain H, Leitan ND, Keating C, Johnson SL, Murray G. Circadian modulation of human reward function: Is there an evidentiary signal in existing neuroimaging studies? Neurosci Biobehav Rev 2019; 99:251-274. [PMID: 30721729 DOI: 10.1016/j.neubiorev.2019.01.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 12/22/2022]
Abstract
Reward functioning in animals is modulated by the circadian system, but such effects are poorly understood in the human case. The aim of this study was to address this deficit via a systematic review of human fMRI studies measuring one or more proxies for circadian function and a neural reward outcome. A narrative synthesis of 15 studies meeting inclusion criteria identified 13 studies that show a circadian impact on the human reward system, with four types of proxy (circadian system biology, downstream circadian rhythms, circadian challenge, and time of day) associated with neural reward activation. Specific reward-related regions/networks subserving this effect included the medial prefrontal cortex, ventral striatum, putamen and default mode network. The circadian effect was observed in measures of both reward anticipation and reward receipt, with more consistent evidence for the latter. Findings are limited by marked heterogeneity across study designs. We encourage a systematic program of research investigating circadian-reward interactions as an adapted biobehavioural feature and as an aetiological mechanism in reward-related pathologies.
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Affiliation(s)
- Jamie E M Byrne
- Centre for Mental Health, Swinburne University of Technology, PO Box 312 John St Hawthorn, VIC, 3122, Australia
| | - Hailey Tremain
- Centre for Mental Health, Swinburne University of Technology, PO Box 312 John St Hawthorn, VIC, 3122, Australia
| | - Nuwan D Leitan
- Centre for Mental Health, Swinburne University of Technology, PO Box 312 John St Hawthorn, VIC, 3122, Australia
| | - Charlotte Keating
- Centre for Mental Health, Swinburne University of Technology, PO Box 312 John St Hawthorn, VIC, 3122, Australia
| | - Sheri L Johnson
- Department of Psychology, University of California, Berkeley, 3210, Tolman Hall, Berkeley, CA, 94720-1650, USA
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, PO Box 312 John St Hawthorn, VIC, 3122, Australia.
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Crowe M, Inder M. Staying well with bipolar disorder: A qualitative analysis of five-year follow-up interviews with young people. J Psychiatr Ment Health Nurs 2018; 25:236-244. [PMID: 29421858 DOI: 10.1111/jpm.12455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2018] [Indexed: 11/30/2022]
Abstract
UNLABELLED WHAT IS ALREADY KNOWN ABOUT THE TOPIC?: Bipolar disorder is a long-term condition which causes ongoing disruptions to the individual's life. Current evidence suggests that a combination of medication in combination with psychotherapy is more effective than medication alone. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: There are few published reports of the effects of interventions (pharmacological or psychotherapeutic) for treatment in bipolar disorder. While both psychotherapies provided a framework for understanding bipolar disorder each had specific strategies that participants identified as effective. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Because bipolar disorder is a long-term condition, its treatment needs to incorporate psychotherapeutic approaches that address the unique nature of its impact on each individual and provide individualized strategies for managing the disorder. Both Interpersonal and Social Rhythm Therapy and Specialist Supportive Care provide strategies that promote personal recovery. ABSTRACT Introduction The primary outcomes from this study of psychotherapy for young people with bipolar disorder identified that most participants had continued to remain well. Given that up to 80% of people relapse within 2 years, it was important to establish how these participants described the process of staying well. Aim To examine how participants in a psychotherapy for young people with bipolar disorder study at 5-year follow-up described their experiences of the intervention and its impact on living with the disorder. Methods This qualitative study was conducted 5 years after participants had completed a psychotherapy intervention in a randomized controlled trial for young people with bipolar disorder. Thirty people were recruited into this qualitative study and interviewed regarding their experiences. The data were analysed using an inductive thematic analysis. Findings Three themes were identified from the data: self-awareness in the context of bipolar disorder; understanding my bipolar disorder; and learning to stay well with bipolar disorder. Conclusions Mental health nurses can promote the factors that participants found helpful in learning to stay well self-awareness, understanding the unique characteristics of their disorder, learning to take care of the self and stabilization of social rhythms.
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Affiliation(s)
- M Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - M Inder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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12
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Crowe M. Evaluating the effectiveness of mental health nursing interventions. J Psychiatr Ment Health Nurs 2018; 25:67-68. [PMID: 29154483 DOI: 10.1111/jpm.12443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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13
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Byrne JEM, Bullock B, Murray G. Development of a Measure of Sleep, Circadian Rhythms, and Mood: The SCRAM Questionnaire. Front Psychol 2017; 8:2105. [PMID: 29250023 PMCID: PMC5717824 DOI: 10.3389/fpsyg.2017.02105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/17/2017] [Indexed: 12/13/2022] Open
Abstract
Sleep quality, circadian phase, and mood are highly interdependent processes. Remarkably, there is currently no self-report questionnaire that measures all three of these clinically significant functions: The aim of this project was to address this deficit. In Study 1, 720 participants completed a set of potential items was generated from existing questionnaires in each of the three domains and refined to follow a single presentation format. Study 2 used an independent sample (N = 498) to interrogate the latent structure. Exploratory factor analysis was used to identify a parsimonious, three-factor latent structure. Following item reduction, the optimal representation of sleep quality, circadian phase, and mood was captured by a questionnaire with three 5-item scales: Depressed Mood, Morningness, and Good Sleep. Confirmatory factor analysis found the three-scale structure provided adequate fit. In both samples, Morningness and Good Sleep were positively associated, and each was negatively associated with the Depressed Mood scale. Further research is now required to quantify the convergent and discriminant validity of its three face-valid and structurally replicated scales. The new sleep, circadian rhythms, and mood (SCRAM) questionnaire is the first instrument to conjointly measure sleep quality, circadian phase, and mood processes, and has significant potential as a clinical tool.
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Affiliation(s)
- Jamie E M Byrne
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Ben Bullock
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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Nestsiarovich A, Hurwitz NG, Nelson SJ, Crisanti AS, Kerner B, Kuntz MJ, Smith AN, Volesky E, Schroeter QL, DeShaw JL, Young SS, Obenchain RL, Krall RL, Jordan K, Fawcett J, Tohen M, Perkins DJ, Lambert CG. Systemic challenges in bipolar disorder management: A patient-centered approach. Bipolar Disord 2017; 19:676-688. [PMID: 28901625 PMCID: PMC5763323 DOI: 10.1111/bdi.12547] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/08/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES As part of a series of Patient-Centered Outcomes Research Institute-funded large-scale retrospective observational studies on bipolar disorder (BD) treatments and outcomes, we sought the input of patients with BD and their family members to develop research questions. We aimed to identify systemic root causes of patient-reported challenges with BD management in order to guide subsequent studies and initiatives. METHODS Three focus groups were conducted where patients and their family members (total n = 34) formulated questions around the central theme, "What do you wish you had known in advance or over the course of treatment for BD?" In an affinity mapping exercise, participants clustered their questions and ranked the resulting categories by importance. The research team and members of our patient partner advisory council further rated the questions by expected impact on patients. Using a Theory of Constraints systems thinking approach, several causal models of BD management challenges and their potential solution were developed with patients using the focus group data. RESULTS A total of 369 research questions were mapped to 33 categories revealing 10 broad themes. The top priorities for patient stakeholders involved pharmacotherapy and treatment alternatives. Analysis of causal relationships underlying 47 patient concerns revealed two core conflicts: for patients, whether or not to take pharmacotherapy, and for mental health services, the dilemma of care quality vs quantity. CONCLUSIONS To alleviate the core conflicts identified, BD management requires a coordinated multidisciplinary approach including: improved access to mental health services, objective diagnostics, sufficient provider visit time, evidence-based individualized treatment, and psychosocial support.
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Affiliation(s)
- Anastasiya Nestsiarovich
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Stuart J Nelson
- University of New Mexico Health Sciences Library and Informatics Center, Albuquerque, NM, USA.,Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Annette S Crisanti
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Berit Kerner
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Matt J Kuntz
- National Alliance on Mental Illness Montana, Helena, MN, USA
| | - Alicia N Smith
- National Alliance on Mental Illness Montana, Helena, MN, USA
| | - Emma Volesky
- National Alliance on Mental Illness Montana, Helena, MN, USA
| | | | - Jason L DeShaw
- National Alliance on Mental Illness Montana, Helena, MN, USA
| | | | | | - Ronald L Krall
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kimmie Jordan
- National Alliance on Mental Illness New Mexico, Albuquerque, NM, USA
| | - Jan Fawcett
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Mauricio Tohen
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Douglas J Perkins
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Christophe G Lambert
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.,Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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15
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Melo MC, Abreu RL, Linhares Neto VB, de Bruin PF, de Bruin VM. Chronotype and circadian rhythm in bipolar disorder: A systematic review. Sleep Med Rev 2017; 34:46-58. [DOI: 10.1016/j.smrv.2016.06.007] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 12/01/2022]
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Abstract
PURPOSE OF REVIEW We review recent evidence for circadian rhythm dysregulation in bipolar spectrum disorders (BSDs). We examine evidence for endogenous abnormalities in the biological clock and disruptions in the external entrainment of circadian rhythms in BSDs. We also address whether circadian dysregulation provides vulnerability to onset of BSD and evidence for a new integration of reward and circadian dysregulation in BSD. RECENT FINDINGS Relative circadian phase delay (e.g., later melatonin peak, evening chronotype) is associated with BSD, particularly in the depressive phase. More consistent evidence supports irregularity of social rhythms, sleep/wake and activity patterns, and disruptions of social rhythms by life events, as stable trait markers of BSD and potential vulnerabilities for BSD onset. Growing research supports an integrative reward/circadian model. Both endogenous abnormalities in the biological clock pacemaking function and disruptions in the external entrainment of circadian rhythms by physical and social cues are involved in BSDs. Circadian dysregulation may provide vulnerability to BSD onset.
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Affiliation(s)
- Lauren B Alloy
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA.
| | - Tommy H Ng
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Madison K Titone
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Elaine M Boland
- Corporal Michael J. Crescenz Veterans Affairs Medical Center and University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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17
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Kragh M, Møller DN, Wihlborg CS, Martiny K, Larsen ER, Videbech P, Lindhardt T. Experiences of wake and light therapy in patients with depression: A qualitative study. Int J Ment Health Nurs 2017; 26:170-180. [PMID: 27804203 DOI: 10.1111/inm.12264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2016] [Indexed: 12/28/2022]
Abstract
Wake therapy can reduce depressive symptoms within days, and response rates are high. To sustain the effect, it is often combined with light therapy. Few studies have focussed on factors related to patients' adherence to the regime, and none has used qualitative methods to examine their experience of these combined interventions. Therefore, the aim of the present study was to illuminate patients' experiences with wake and light therapy and factors related to adherence. Thirteen inpatients with depression were included. They participated in an intervention consisting of three wake therapies during the first week, 30 min of daily light treatment for the entire 9 weeks, and ongoing psychoeducation regarding good sleep hygiene. Patients kept a diary, and individual semistructured interviews were conducted. Data were analysed using qualitative content analysis. The participants' overall experience with the treatment was positive. Some experienced a remarkable and rapid antidepressant effect, whereas others described more long-term benefits (e.g. improved sleep and diurnal rhythm). Yet recovery was fragile, and patients were only cautiously optimistic. Social support was important for maintaining the motivation to stay awake and receive daily light therapy. Overall, participants found the treatment worthwhile and would recommend it to others with depression. The study revealed a lack of knowledge among participants about the connection between regular sleep patterns and depression. In conclusion, this study provides insight into patients' experiences, and knowledge that can contribute to guidelines for future adherence-promoting organization of wake and light therapy.
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Affiliation(s)
- Mette Kragh
- Department of Affective Disorders, Aarhus University Hospital, Risskov, Denmark
| | | | | | - Klaus Martiny
- Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Erik Roj Larsen
- Department of Affective Disorders, Aarhus University Hospital, Risskov, Denmark
| | - Poul Videbech
- Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Denmark
| | - Tove Lindhardt
- Department of Internal Medicine, Copenhagen University Hospital, Herlev, Denmark
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18
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Melo MCA, Garcia RF, Linhares Neto VB, Sá MB, de Mesquita LMF, de Araújo CFC, de Bruin VMS. Sleep and circadian alterations in people at risk for bipolar disorder: A systematic review. J Psychiatr Res 2016; 83:211-219. [PMID: 27661417 DOI: 10.1016/j.jpsychires.2016.09.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sleep and circadian abnormalities have been mostly demonstrated in bipolar patients. However, it is not clear whether these alterations are present in population at high risk for bipolar disorder (BD), indicating a possible risk factor for this condition. OBJECTIVE This systematic review aims to define current evidence about sleep and rhythm alterations in people at risk for BD and to evaluate sleep and circadian disorders as risk factor for BD. METHODS The systematic review included all articles about the topic until February 2016. Two researchers performed an electronic search of PubMed and Cochrane Library. Keywords used were 'sleep' or 'rhythm' or 'circadian' AND 'bipolar disorder' or 'mania' or 'bipolar depression' AND 'high-risk' or 'risk'. RESULTS Thirty articles were analyzed (7451 participants at risk for BD). Sleep disturbances are frequent in studies using both subjective measures and actigraphy. High-risk individuals reported irregularity of sleep/wake times, poor sleep and circadian rhythm disruption. Poor sleep quality, nighttime awakenings, and inadequate sleep are possible predictive factors for BD. A unique study suggested that irregular rhythms increase risk of conversion. People at risk for BD showed high cortisol levels in different times of day. Studies about anatomopathology, melatonin levels, inflammatory cytokines and oxidative stress were not identified. The most important limitations were differences in sleep and rhythm measures, heterogeneity of study designs, and lack of consistency in the definition of population at risk. CONCLUSION Sleep and circadian disturbances are common in people at risk for BD. However, the pathophysiology of these alterations and the impact on BD onset are still unclear.
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Davies N, Crowe M, Whitehead L. Establishing routines to cope with the loneliness associated with widowhood: a narrative analysis. J Psychiatr Ment Health Nurs 2016; 23:532-539. [PMID: 27624679 DOI: 10.1111/jpm.12339] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Loneliness in older adults has been identified as an important public health issue in many countries. Widowhood is a time when many older people experience loneliness. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Little is known about strategies that are effective in mitigating experiences of loneliness and this paper explores this with older people who have been through the process. The narratives of the older people in this study described a trajectory in which loneliness was experienced as both a loss of spouse and a loss of routines that enabled them to maintain connections with others. This trajectory moved onto the establishment of new routines that enabled connections to be developed. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Loneliness is strongly associated with depression and anxiety in the elderly and mental health nurses should be encouraged to screen for loneliness when undertaking assessments. Interventions that facilitate the development of meaningful routines could be integrated into mental health nursing care of older people. ABSTRACT Background Loneliness in older people is a public health concern in many Western countries. While not necessarily a symptom of mental disorder, it is often associated with depression and anxiety. Widowhood is a transition period during which many older people experience acute loneliness but over time develops strategies to manage it. Little is known about effective strategies that older people have used to manage the experience. The strategies older people used to manage this was the focus of this paper. Aim The aim was to examine older widows' experiences of loneliness. Design The design of this study was a qualitative narrative analysis with thematic analysis and the participants were 40 older widow/widowers aged between 70 and 97 years. Findings The study found that the participants negotiated the experience of loneliness following widowhood from an acute phase of experiencing an absence and the associated loss of routine connection to the establishment of new routines that provided new connections and a new sense of identity as an individual rather than a couple. Conclusions It is important for mental health nurses to screen for loneliness and be able to facilitate interventions that may alleviate the experience of loneliness.
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Affiliation(s)
- N Davies
- Ara Institute of Canterbury and Adjunct Fellow, University of Canterbury, Christchurch, New Zealand
| | - M Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
| | - L Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia
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