March 2017 - Volume 205 - Issue 3

  • John A. Talbott, MD
  • 0022-3018
  • 1539-736X
  • 12 issues / year
  • 1.836


Bipolar Issue
Francois Petitjean, MD


Substance Use Among Homeless Individuals With Schizophrenia and Bipolar Disorder
Angelo G.I. Maremmani, MD, Silvia Bacciardi, MD, Nicole D. Gehring, BSc, Luca Cambioli, MD, Christian Schütz, MD, Kerry Jang, PhD, Michael Krausz, MD

We aimed to estimate the prevalence of stigmatizing trends and beliefs related to anorexia nervosa (AN) and bulimia nervosa (BN). A total of 2,109 participants completed an online survey, including questionnaires related to stigmatizing beliefs toward AN and BN. Undergraduates reported almost overlapping low levels of stigmatizing trends for AN and BN, apart from personal responsibility and social distance. Those aged 18 to 25 and living with family held higher stigmatizing attitudes. Stigma was lower in underweight participants and in those (12%) reporting a previous eating disorder (ED) diagnosis.

A Reexamination of Nonpsychiatric Medication Adherence in Individuals With Bipolar Disorder and Medical Comorbidities
Jennifer B. Levin, PhD, Anna Krivenko, BS, Ashley Bukach, MA, Curtis Tatsuoka, PhD, Kristin A. Cassidy, MA, Martha Sajatovic, MD

This analysis reexamined correlates of poor adherence to nonpsychiatric medication in 73 patients with bipolar disorder (BD) and medical comorbidities. The majority was female (74%) and African American (77%), with a mean age of 48.08 (SD, 8.04) years, mean BD duration of 28.67 (SD, 10.24) years, mean years of education of 12.01 (SD, 1.87), and mean proportion of days with missed doses in past week of 43.25 (SD, 31.14). More BD medications and more severe psychiatric symptoms correlated with worse adherence. Among poorly adherent patients with BD and medical comorbidities, the number of BD medications, tension/anxiety, and somatic symptoms of depression related to worse nonpsychiatric medication adherence.

Clinical Characteristics Associated With Treatment-Resistant Bipolar Disorder
Gordon B. Parker, MD, PhD, FRANZCP, and Rebecca K. Graham, BA (Psych Hons), PhD

This exploratory study was designed to identify factors contributing to treatment-resistant bipolar disorder (TRBD) in patients with a bipolar (I or II) disorder. Patients were categorized with "low," "medium," or "high" levels of treatment resistance based on a) the total number of psychiatric medications received and, for a second analysis, b) the number of mood stabilizer medications received. The study identified a number of factors associated with TRBD, such as being female and older, and having an older age at illness onset, a higher incidences of family depression, less likelihood of being in paid employment, a higher number of lifetime stressors, medical conditions and comorbid anxiety disorders, a different personality and temperament profile, and more regular use of benzodiazepines.

Do Sleep Disturbances Predict or Moderate the Response to Psychotherapy in Bipolar Disorder?
Louisa G. Sylvia, PhD, Stephanie Salcedo, MA, Amy T. Peters, MA, Pedro Vieira da Silva Magalhães, MD, MSc, Ellen Frank, PhD, David J. Miklowitz, PhD, Michael W. Otto, PhD, Michael Berk, PhD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD

This study examined whether sleep disturbance predicted or moderated responses to psychotherapy in participants who participated in STEP-BD, a national, multisite study that examined the effectiveness of different treatment combinations for bipolar disorder. Participants received either a brief psychosocial intervention called collaborative care (CC; n = 130) or intensive psychotherapy (IP; n = 163), with study-based pharmacotherapy.

Theory of Mind in Euthymic Bipolar Patients and First-Degree Relatives
Josep Manel Santos, PhD, Esther Pousa, PhD, Estel Soto, MD, Anna Comes, MSc, Pere Roura, MD, Francesc X. Arrufat, PhD, Jordi E. Obiols, PhD

The present study analyzed the capacity for mentalization of patients with bipolar disorder (BD) and their first-degree relatives (FDR) and examined the implications of clinical variables and cognitive deficits. The study recruited 31 patients with type I BD, 18 FDR, and 31 paired healthy controls. Their capacity for mentalization was explored by means of first- and second-order false-belief tasks, the hinting task, and the Movie for the Assessment of Social Cognition (MASC). Patients and FDR were found to have a theory of mind (ToM) deficit when they were evaluated with the MASC, which was also related to a worse neurocognitive performance and to being a patient or FDR. The evidence of ToM deficits in FDRs supports the hypothesis that these deficits could be an independent trait marker for cognitive deficit.

Systems Training for Emotional Predictability and Problem Solving Program and Emotion Dysregulation: A Pilot Study
Silvia Boccalon, PsyD, Roberta Alesiani, PsyD, Laura Giarolli, PsyD, Andrea Fossati, PhD

The aim of this study was to assess the observed changes on emotion dysregulation obtained through the Systems Training for Emotional Predictability and Problem Solving (STEPPS) program. The sample is composed of 24 subjects with a personality disorder with borderline features. All participants filled out the Difficulties in Emotion Regulation Scale (DERS). There was a significant decrease in the DERS total score at the end of the treatment and at 6-month follow-up. Friedman test showed a significant decrease in suicide attempts and hospitalizations over time. The analysis of the DERS subscales showed that "goals" and "impulse" were the two dimensions on which the treatment acted and the changes were stable over time. STEPPS is associated with an improvement in emotion regulation and a reduction in the number of hospitalizations and suicide attempts.

You Won't Get Me: Therapist Responses to Patients' Impression Management Tactics
Sarah Frühauf, PhD, Patrick Figlioli, MSc, Franz Caspar, PhD

We aimed to investigate how therapists respond to patient impression management and influence tactics. For 60 videotaped intake interviews, judges rated therapist responses to patient tactics as neutral, desired, or undesired from the patient perspective. Judges rated the therapist responses in 57% as neutral, in 40% as desired, and in 2% as undesired by the patients. The proportions of response outcomes varied across tactics. Overall, some patient tactics seem to be more challenging for therapists than others. Awareness of such response tendencies can help therapists prepare their reactions to certain patient impression management and influence tactics.

Hypochondriasis Differs From Panic Disorder and Social Phobia: Specific Processes Identified Within Patient Groups
Volkmar Höfling, PhD, and Florian Weck, PhD

In this study, the contrast among hypochondriasis, panic disorder, and social phobia was investigated using specific processes drawing on cognitive-perceptual models of hypochondriasis. Affective, behavioral, cognitive, and perceptual processes specific to hypochondriasis were assessed with 130 diagnosed participants based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria (66 with hypochondriasis, 32 with panic disorder, and 32 with social phobia). All processes specific to hypochondriasis were more intense for patients with hypochondriasis in contrast to those with panic disorder or social phobia (0.61 < d < 2.67). No differences were found between those with hypochondriasis with comorbid disorders and those without comorbid disorders.

Existential Well-Being: Spirituality or Well-Being?
Anja Visser, PhD, Bert Garssen, PhD, Ad J.J.M. Vingerhoets, PhD

Measures of spirituality often contain the dimension existential well-being (EWB). However, EWB has been found to overlap with emotional and psychological well-being. Using the Spiritual Attitude and Involvement List (SAIL), we have further investigated the overlap between aspects of spirituality and of well-being among patients with cancer, by determining a) the divergent validity of the subscales of the SAIL compared with a well-being questionnaire and b) the differences in their associations to changes in pain and fatigue, and the occurrence of negative life events. Our findings suggest that a sense of trust that one is able to cope with difficulties of life belongs to the realm of well-being, instead of spirituality. Other aspects, such as a sense of meaning in life, seem more similar to spirituality than to well-being. These results can bring researchers a step further toward constructing "pure" spirituality and well-being measures, which will allow them to investigate the (causal) relationship between these constructs.


Valued Living and Its Relationship to Medication Adherence in Patients with Bipolar and Comorbid Substance Use Disorders
Brandon A. Gaudiano, PhD, Susan J. Wenze, PhD, Lauren M. Weinstock, PhD, Katherine M. Tezanos, BA, Ivan W. Miller, PhD

We investigated the relationship between valued living, medication adherence, symptoms, and functioning in a sample of 39 patients diagnosed with bipolar disorder and a comorbid substance use disorder. Results showed that greater values-action consistency explained a unique amount of variance in medication adherence, even after controlling for symptom severity, functional impairment, and other reported reasons for nonadherence. Drug use and treatment beliefs also predicted nonadherence. Findings suggest that valued living should be investigated further as a potentially malleable treatment target in future adherence intervention research.

Bipolar Disorder With Psychotic Features and Ocular Toxoplasmosis: A Possible Pathogenetic Role of the Parasite?
Claudia Del Grande, MD, Carlo Contini, MD, Elisa Schiavi, MD, Grazia Rutigliano, MD, Martina Maritati, MD, Silva Seraceni, PhD, Barbara Pinto, Dr, Sci, Liliana Dell'Osso, MD, PhD, Fabrizio Bruschi, MD

In this report, we describe the case of a young Brazilian woman affected by recurrent ocular toxoplasmosis, and presenting with a manic episode with psychotic features in the context of a diagnosis of Bipolar Disorder (BD), type I. We observed a relationship between ocular manifestations and the clinical course of bipolar illness, confirmed by molecular analyses (Nested-PCR), as well as by the high level of T. gondii specific IgG. This case report is the first showing the presence of circulating parasite DNA at the time of occurrence of psychiatric symptoms, thus providing further support for a possible role of the parasite in the pathogenesis of some cases of BD.

Functional Outcome in the Middle Course of Bipolar Disorder: A Longitudinal Study
Diego J. Martino, MD, MSc, PhD, Ana Igoa, MD, María Scápola, PsyD, Eliana Marengo, MD, Cecilia Samamé, PsyD, Sergio A. Strejilevich, MD

The aim of this study was to assess the long-term functional outcome of patients with bipolar disorder (BD). At baseline and after a follow-up period of at least 48 months, three measures of functioning were administered: psychosocial functioning (GAF), employment status, and a self-reported measure of functional recovery. At baseline, patients with more than five previous affective episodes exhibited poorer outcomes on all measures of functioning than patients with less than five previous episodes. However, along a mean follow-up period of 77 months, measures of functioning tended to remain stable or improved slightly. These results highlight the limitation of studies comparing measures of functioning between patients with many and few episodes to evaluate functional outcome.


Commentary on "Existential Well-Being: Spirituality or Well-Being?"
Douglas A. MacDonald, PhD


Response to "Commentary on 'Existential Well-Being: Spirituality or Well-Being?'"​
Anja Visser, PhD, Bert Garssen, PhD, Ad J.J.M. Vingerhoets, PhD

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