Bipolar affective disorder and its impact on various aspects of marital relationship

Marital concerns of long-term hospitalised patients with diagnosed schizophrenia: A descriptive phenomenological study

Marital concerns can trigger emotional stress, especially among long-term hospitalised individuals diagnosed with schizophrenia, significantly affecting their treatment and recovery. Unfortunately, rehabilitation programs tend to overlook the marital needs of individuals with diagnosed schizophrenia. This research aimed to investigate the content related to marital concerns of Chinese individuals diagnosed with schizophrenia who were undergoing extended hospitalisation. Fifteen participants diagnosed with schizophrenia were recruited through purposive sampling for face-to-face semi-structured interviews. The gathered data were analysed using Colaizzi's method, revealing three themes: (1) manifestations of marriage-related concerns, (2) effects of marriage on disease progression, and (3) the need for support from family and the hospital. This study offers new insights into marital concerns among long-term schizophrenia inpatients and underscores the significance of screening and intervention for such concerns. Healthcare professionals and family members should extend support to patients to foster confidence within their marital relationships.

Unheard voices: The sexual challenges of families of patients with bipolar disorder: A qualitative content analysis

OBJECTIVES

The aim of this study was to explore the voices of the family members of Bipolar Disorder (BD) patients about the challenges ahead of them.

METHODS

In this qualitative study, 22 participants shared their experiences of sexual challenges of patients with BD through in-depth, face-to-face, semi-structured interviews. Qualitative content analysis was used for data analysis.

RESULTS

An overarching theme entitled "Unheard voices" reflected this experience. It comprised four main categories include sexual promiscuity, a change in sexual patterns, sexual support, and sexual indifference. The results revealed that the families of patients with BD have to deal with sexual promiscuity and change in sexual patterns in their family, and the family system attempts to respond to these changes by sexual support mechanisms and sexual indifference.

CONCLUSIONS

Given the significant impact of healthy sexual behaviors on the quality of life of both the individual and the family, therapists and family support systems are advised to strengthen and educate families to support their patients' sexual health and needs and protect their sexual existence; they should also address the sexual challenges faced by these families as a diagnostic and therapeutic priority, and early sexual health interventions should be provided to these families.

Marriage in persons with severe mental illness: A narrative review-based framework for a supported relationship

Background

Studies in the past have shown the effect of mental illness on marriage in persons with severe mental illnesses (SMIs). Primary care and family physicians have a major role in addressing marriage-associated dilemmas in their life.

Methods

The literature search was conducted from databases such as PubMed, ProQuest, EBSCO, Scopus, and Google Scholar for understanding the context and the problem in-depth for bringing out the narrative-review based framework for addressing the dilemmas.

Results

Marriage rates in persons with SMI are high in Eastern countries. Marriage in persons with SMI enhances social support and prevents the stigma of being unmarried. Disability, unemployment, stigma, and disclosure-related issues are barriers to getting desirable alliances. Evidence based interventions are available to reduce the associated distress to an extent.

Conclusion

Published peer-reviewed literature has pointed out that marriage plays a significant role in the life of persons with SMI and their families, especially in Asian countries where marriage is an important social institution. It can have a positive impact or can lead to relapse, marital conflicts, and divorce based on contextual and clinical factors. Hence, there is a need to come up with tailor-made interventions to address marriage-related expectations in persons with SMI.

Bipolar bozukluğu olan hastalarda çocukluk çağı travması, çift uyumu ve cinsel işlevler arasındaki ilişki

Purpose: This study aimed to investigate the dyadic adjustment and sexual functions in patients with bipolar disorder (BD) during the remission period, and examine the effect of a history of childhood trauma on these. Materials and Methods: This cross-sectional study is consisted of 80 (46 female, 34 male) patients with bipolar disorder-1 and 40 (25 female, 15 male) healthy controls. The Dyadic Adjustment Scale (DAS), Childhood Trauma Questionnaire (CTQ-28), Arizona Sexual Questionnaire (ASEX) were administered to the participants. Results: The patient group showed significantly higher trauma scores in all subscales and total scores of the CTQ-28, and lower scores in the subscales and total score of DAS compared to the control group. 82.5% of bipolar patients and 57.5% of healthy controls were found to have sexual dysfunction (SED). According to the results of linear regression and multiple regression analyses, age and DAS-total score predicted SED, and male gender, absence of SED and CTQ-total score predicted DAS score. Conclusion: Patients with BD have more dyadic problems, sexual dysfunction, and trauma history than healthy controls. Sexual function and dyadic adjustment affect each other in two ways and a history of childhood trauma has a negative effect on both sexual function and dyadic adjustment.

Improving the Assessment Process of Family Functioning in Adult Bipolar Disorders: A PRISMA Systematic Review

In order to determine family functioning in the treatment of adults with bipolar disorders, guidelines are needed regarding the way family functioning may be assessed. The present systematic review aims to investigate how family functioning is assessed in this context. Following PRISMA guidelines, a total of 29 studies were reviewed. Results showed that although there was no consensual family functioning assessment across studies, 27 studies (93%) relied on self-report questionnaires, 12 studies (41%) relied on one family member as an informant (adult with bipolar disorder or other) and the adult considered was mostly a woman in the acute phase of bipolar I disorder. Significant heterogeneity was observed in the assessment of family functioning. Methodological considerations regarding the assessment of family functioning are discussed.

Frequency of psychiatric comorbid symptoms in bipolar disorder patients in remission

INTRODUCTION

Psychiatric comorbidity has been detected in one-third of bipolar patients. The illness itself may be a precipitating factor for developing substance use and anxiety disorders. Comorbid anxiety disorders with bipolar disorder (BD) are associated with decreased chances of recovery, poorer role functioning, and quality of life, and greater likelihood of suicide attempts. Hence, identifying comorbid symptoms in remitting patients has important preventive and therapeutic implications.

AIMS

The aim of the study was to estimate the frequency of psychiatric comorbid symptoms in patients of bipolar affective disorder in remission and to identify its relationship with sociodemographic variables.

METHODOLOGY

This is a cross-sectional study conducted in Father Muller Medical College and Hospital, Mangalore (April 2019-July 2019), which included 90 patients aged 18-50 years with BD, manic, or depressive episodes in remission for 8 weeks who were evaluated using mini international neuropsychiatric interview plus, Hamilton rating scale for depression, and young mania rating scale. Sociodemographic details were assessed by a semi-structured pro forma. The data were analyzed using frequency, Chi-square test, and t-test.

RESULTS

Most common psychiatry comorbid symptoms seen in BD were found to be drug dependence/abuse (n = 31), second most common being alcohol dependence/abuse (n = 21), followed by suicidality (n = 8), antisocial personality, social phobia, panic disorder, and agoraphobia. Significance was found for suicidality, agoraphobia, and social phobia if the last episode was depressive and for suicidality if index episode was depressive and if age of onset was >40 years.

CONCLUSION

Psychiatric comorbidities in BD may worsen the course and prognosis of the disorder and hence, clinicians must maintain a high index of suspicion for them. Furthermore, comorbidities may need to be identified and appropriate interventions employed to prevent iatrogenic complications.

The Impact of Bipolar Disorder on Couple Functioning: Implications for Care and Treatment. A Systematic Review

If there is an abundant literature on the impact of bipolar illness on the family and/or caregivers of patients, few studies have addressed its impact on marital relationship and couple functioning. Uncovering information relating specifically to this topic may be particularly relevant due to the unusually high divorce rate among individuals with bipolar disorder. We therefore conducted a systematic literature search to evaluate the existing data on bipolar disorder and marital issues, with a special focus on the help and support that can be provided by mental health professionals in this regard. We identified quantitative studies with pre-defined outcomes as well as qualitative investigations trying to understand the experiences of partners. A total of 27 articles were included in the review. The literature was found to capture the impact of bipolar disorder on partners as well as on the marital relationship itself or the children. Bipolar illness has a negative impact on the lives of partners including self-sacrifice, caregiver burden, emotional impact, and health problems. This negative impact can be aggravated by a lack of care and a lack of information from health personnel. The negative impact on the relationship includes volatility in the relationship, stigmatization, dissatisfaction with sexual life, and lower rates of childbearing. Negative impacts are likely to favor disease relapses for the patient. Children may also be negatively impacted. However, the illness may sometimes have positive impacts such as personal evolution, strengthening relationship, or new hope and perspectives. Based on these findings, the interventions of mental health professionals should be aimed at minimizing the negative impacts while favoring the positive ones.

Psychological predictors of bipolarity in panic disorder

BACKGROUND

Panic disorders frequently occur with affective disorders, particularly bipolar disorder. Patients with panic disorder and bipolar disorder are more likely to present with severe symptoms, such as high rates of suicidal behavior, poor symptomatic and functional recovery, and poor drug responses.

AIM

To investigate the psychological characteristics of panic disorder patients related to bipolarity.

METHODS

A total of 254 patients (136 men and 118 women, mean age = 33.48 ± 3.2 years) who were diagnosed with panic disorder were included in the study. Panic disorder with bipolarity (BP+) was defined as a score of ≥ 7 on the Korean version of the Mood Disorder Questionnaire (K-MDQ), and a score lower than 7 was considered as a panic disorder without bipolarity (BP-). Self-report questionnaires were analyzed to examine their association with bipolarity. Psychological tests used in the study were the Mood Disorder Questionnaire (MDQ), Panic Disorder Severity Scale, Beck Depression Inventory, State-Trait Anxiety Inventory (STAI), Temperament and Character Inventory (TCI), and Minnesota Multiphasic Personality Inventory (MMPI). Statistical analyses were performed to evaluate the correlation between bipolarity of panic disorder patients and various psychological test results indicative of psychological characteristics.

RESULTS

Patients with a K-MDQ score of 7 or more were considered to have a history of manic or hypomanic episodes (BP+ group, n = 128), while patients with K-MDQ scores below 7 were defined as those without bipolarity (BP- group, n = 126). The BP+ group were more likely to be unmarried (single 56.2% vs 44.4%, P = 0.008) and younger (30.78 ± 0.59 vs 37.11 ± 3.21, P < 0.001). Additionally, the BP+ group had significantly higher scores on psychological assessment scales, such as the hypochondriasis, psychopathic deviate, masculinity-femininity, psychasthenia, schizophrenia, and hypomania (Ma) in MMPI, and novelty seeking, harm avoidance and self-transcendence in TCI, and STAI (state and trait) compared to the BP- group. In logistic regression analysis, depression in MMPI, self-directedness in TCI, and age were negatively associated with MDQ score, meanwhile, Ma in MMPI and STAI (trait) were positively associated with MDQ score.

CONCLUSION

The result of this study suggests that almost 50% of patients with panic disorder are likely to have hypomanic or manic symptoms, and certain psychological factors are associated bipolarity in panic disorder.

Social support in patients with bipolar disorder and differing ages at onset

OBJECTIVE

The main purpose of this study was to evaluate the association between age at onset and social support in outpatients with bipolar disorder who were in the recovery phase. We also investigated the association between age at onset and disability.

METHODS

A total of 180 bipolar disorder I outpatients, of whom 50 had early onset with age at onset ≤18 years old, 108 had middle onset with age at onset between 19 and 39 years old, and 22 had late onset with age at onset ≥40 years old, were assessed with the Medical Outcomes Study Social Support Scale and Sheehan Disability Scale.

RESULTS

The early onset group had lower tangible social support, longer length of illness, more childless participants, lower income and more suicide attempters than the late onset group.

CONCLUSIONS

Early onset seems to have inferior outcomes in tangible social support than late onset, but this trend should be considered as a starting point for future studies.

Perceived stress, marital satisfaction, and sexual satisfaction in spouses of males having bipolar disorder with and without alcohol use disorder: A cross-sectional study

BACKGROUND

Bipolar affective disorder (BPAD) and alcohol use disorder (AUD) are frequently comorbid and affect the social, occupational, and personal domains of patients and their spouses.

AIM

This cross-sectional study was conducted to assess and compare the levels of stress, marital satisfaction, and sexual satisfaction between the spouses of males with BPAD + AUD and of those without AUD.

MATERIALS AND METHODS

Spouses of 100 males with diagnosed BPAD, currently in remission, including fifty patients having comorbid AUD, were recruited as participants. Participants were assessed with Perceived Stress Scale-10, Dyadic Adjustment Scale, and Sexuality Scale.

STATISTICAL ANALYSIS

Descriptive statistics, Chi-square, t-test, analysis of variance, and correlation on SPSS were used for statistical analysis.

RESULTS

More stress (59%), poorer marital (53%) and sexual satisfaction (89%) were found in the majority participants, with significantly higher stress in the group with husbands having both BPAD + AUD (P < 0.01). Duration of cohabitation had a direct, and education and family income had inverse relations with stress.

CONCLUSIONS

BPAD worsens stress, marital satisfaction, and sexual satisfaction in the study participants, the stress increasing further with comorbid AUD. Education, family income, and duration of cohabitation have a significant bearing on stress.

Effect of Psychoeducation Group Training Based on Problem-Solving Skills for Women Experiencing Bipolar Spouse Abuse

Aim: Wives of patients with bipolar disorder as informal caregivers are at high risk for spouse abuse and need to learn coping strategies such as problem-solving skills to manage problematic situations. The purpose of this study was to assess the effectiveness of the psychoeducation group training based on problem-solving skills for women experiencing bipolar spouse abuse. Methods: A randomized clinical trial design was used for this study. In intervention group, women experiencing bipolar spouse abuse participated in four problem-solving skills training sessions and women in two groups (intervention = 30 and control = 30) completed the Index of Spouse Abuse at baseline and after 2 months. Results: The results indicated that changes in abuse scores (physical, non-physical and total of Index of Spouse Abuse) after the intervention were significantly different among the two groups (p < 0.0001). Although abuse scores decreased in both the intervention and the control groups, but lower abuse scores in the intervention than control group were statistically significant. Conclusion: Our findings support that the problem-solving skills training intervention can help to decrease the women experience of bipolar spouse abuse.

Symptom Profile and Clinical Course of Inpatients with Unipolar versus Bipolar Depression

BACKGROUND

Although differences in symptom profiles and outcome between depressive patients with an underlying major depressive disorder (MDD) and bipolar depression (BD) have been reported, studies with sequential short-interval assessments in a real-life inpatient setting are scarce.

OBJECTIVES

To examine potential differences in symptom profile and course of depressive symptomatology in depressive inpatients with underlying MDD and BD.

METHODS

A cohort of 276 consecutive inpatients with MDD (n = 224) or BD (n = 52) was followed during their hospitalization using routine outcome monitoring (ROM), which included a structured diagnostic interview at baseline (Mini-International Neuropsychiatric Interview Plus [MINI-Plus]) and repeated 17-item Hamilton Depression Rating Scale every 2 weeks. MDD and BD were compared regarding their symptom profiles and time to response and remission. Furthermore, the concordance between the MINI-Plus and clinical diagnosis was analyzed.

RESULTS

Patients were on average 52 and 47 years old in the MDD and BD group, respectively, and 66 versus 64% were female. Compared to patients with BD, patients with MDD scored higher on weight loss (p = 0.02), whereas the BD group showed a higher long-term likelihood of response (hazard ratio = 1.93, 95% confidence interval 1.16-3.20, p for interaction with time = 0.04). Although the same association was seen for remission, the interaction with time was not significant (p = 0.48). Efficiency between the MINI-Plus and clinical diagnosis of BD was high (0.90), suggesting that the MINI-Plus is an adequate ROM diagnostic tool.

CONCLUSIONS

In routine clinical inpatient care, minor differences in the symptom profile and the course of depressive symptomatology may be helpful in distinguishing MDD and BD, particularly when using sequential ROM assessments.

Bipolar Disorder Course and Outcome Study from India (BiD-CoIN study): Sample Description & Methods

OBJECTIVES

This multicentric study from India aimed to evaluate the long term course and outcome of bipolar disorder (BD).

METHOD

Seven hundred and seventy-three participants diagnosed with BD, attending 14 outpatient clinic centers across the country, were evaluated using the National Institute of Mental Health- Retrospective Life Charts to assess the long term course of BD.

RESULTS

The mean age of onset of the first episode of illness of the study sample was 26.3 (8.54) years, and mean duration of illness at the time of assessment was 233.05 (94.55) months. In terms of the total number of lifetime episodes, the mean number of manic episodes (mean: 3.68; SD: 4.75) exceeded the mean number of depressive episodes (mean: 3.36; SD: 5.51). The mean numbers of total lifetime episodes were 8.58 (10.6%). When the number of episodes per year was computed, the mean number of manic episodes per year exceeded that of the mean number of depressive episodes. Compared to females, a higher proportion of males had a history of comorbid substance dependence.

LIMITATIONS

The course was assessed retrospectively and the study was limited to participants attending the outpatient clinics.

CONCLUSIONS

The course of BD in India differs from that described from developed countries in the form of a number of manic episodes exceeding the depressive episodes.

Altered neural responses to social fairness in bipolar disorder

•

Bipolar disorder is characterized by impaired processing of social fairness.

•

BD patients exhibit increased rejection of moderate unfairness in Ultimatum Game.

•

BD patients display decreased response to moderate unfairness in anterior insula.

•

BD patients deactivate posterior and middle insula in response to unfairness.

•

Trait impulsivity positively correlated with deactivations in posterior insula.

Bipolar Disorder (BD) has a debilitating impact on psychosocial functioning and social decision-making. Recent evidence using the Ultimatum Game (UG) has shown increased rejection of moderately unfair offers in BD, suggesting impaired processing of ambiguous social information related to fairness. The present study builds upon this finding to investigate the neural substrates of fairness processing in BD. During functional magnetic resonance imaging scanning, euthymic BD patients (n = 41) and matched healthy controls (HC; n = 41) accepted or rejected very unfair, moderately unfair, or fair offers in the UG. Acceptance rates of moderately unfair offers were significantly lower in BD patients. This aberrant behavior co-occurred with abnormal brain responses to moderately unfair offers. Compared to HC, BD patients exhibited hypoactivation of right anterior insula in response to moderately unfair offers suggesting impaired integration of affective and contextual information. BD patients also displayed stronger deactivation of posterior and middle insula in response to moderately unfair offers reflecting impaired processing of the contextual aspects of fairness. The level of impulsivity of BD patients positively correlated with the abnormal deactivation of posterior and middle insula. A separate analysis revealed increased activation of dorsal ACC and left ventrolateral PFC in response to rejected compared to accepted offers in BD patients. Taken together, our findings suggest impaired processing of ambiguous social information in euthymic BD patients which is associated with increased rejection of moderately unfair offers. This impairment may reflect a failure to integrate contextual information and may be related to increased trait impulsivity.

Bipolar disorder among married women in Bangladesh: Survey in Rajshahi city

BACKGROUND

Bipolar disorder (BPD) is a major mental disorder which not only affects the personal and social functioning of an individual, but also inflicts a huge economic burden on the family. Yet, the study of BPD in Bangladesh is rare and poorly documented. Responding to the dire need, we conducted a new study to determine the prevalence of, and detect the associated factors of, BPD among married women in Rajshahi City, Bangladesh.

METHODS

We conducted a cross-sectional study, selecting households in Rajshahi City using a multi-stage random sampling design. The data consisted of 279 married women, who were screened for BPD using the bipolar spectrum diagnostic scale (BSDS). Frequency distribution, chi-square test and binary logistic regression model were used respectively to determine the prevalence, identify the associated factors and quantify their effects on BPD.

RESULTS

The prevalence of BPD among married women in Rajshahi City was 2.5%, with an additional 7.2% classified as probable BPD. A binary logistic regression analysis established the following six main factors of BPD: (1) comorbid mental disorder [AOR = 8.232, 95% CI = (1.397, 50.000), p<0.05]; (2) poor relationship with husband [AOR = 11.775, 95% CI = (2.070, 66.667), p<0.01]; (3) poverty [AOR = 1.600, 95% CI = (2.086, 122.709), p<0.01]; (4) high educational level [AOR = 0.177, 95% CI = (0.037, 0.843), p<0.05]; (5) lack of immediate treatment if sick [AOR = 2.941, 95% CI = (1.259, 6.871), p<0.05]; and (6) death of beloved one/s [AOR = 2.768, 95% CI = (1.130, 6.777), p<0.05].

LIMITATIONS

Our survey involved self-reporting, which is typically affected by differing levels of understanding and bias. Also, a cross-sectional, observational study cannot establish an actual cause-and-effect relationship. Some other potentially important factors such as environment, lifestyle, familial customs, effects of drugs, treatment options and outcomes, etc. were not studied. Also, save mental disorder, all other comorbidities remained undocumented.

CONCLUSION

This study laid down the foundation for conducting further research on identifying different factors affecting BPD, and for studying other issues related to BPD among married women in Bangladesh. Among such factors are familial environment and culture, comorbidities, treatment options, treatment outcomes, biochemical feature, environmental factors, etc. This study also recommends that, while treating BPD patients, health professionals should focus on comorbidities and family matters.

Marital Problems among Partners of Patients with Bipolar Affective Disorder

BACKGROUND

Partners of patients with bipolar affective disorder (BPAD) have problems with their marital life. Identification of these problems is important to develop strategies to solve them for improving quality of life.

AIMS

To identify marital distress and problem areas in their marital life among the partners of patients with BPAD.

MATERIALS AND METHODS

A cross-sectional descriptive design was used to collect data from 125 participants, 59 males and 66 females, who were partners of patients with BPAD. The study was done in outpatient clinics of Community Mental Health Clinics of District Mental Health Program. Tools used for data collection included a semi-structured interview schedule to collect socio-personal data of partners of patients with BPAD and clinical data of the patient, Couple Satisfaction Index (CSI), and Problem Areas Questionnaire (PAQ). Purposive sampling technique was used.

RESULTS

Majority of the participants (male - 55.9%, female -54.5%) expressed marital distress on CSI. Handling family finances and career/job decisions were the most problematic areas for male participants, whereas household tasks, handling finances, and career/job decisions were the most problematic areas for female participants.

CONCLUSION

A significant proportion of spouses of BPAD patients have marital distress in important areas of life, with a potential for long-term consequences in their lives.