Family functioning among adolescents with bipolar disorder.

This study examined the characteristics of families of adolescents with bipolar disorder during or shortly following a period of mood exacerbation, using measures of family conflict, cohesion, adaptability, and expressed emotion (EE). Demographic, diagnostic, and family functioning data were collected from 58 families (mean age = 14.48; 33 female, 25 male) before entering a randomized trial of family focused treatment. Compared to scale scores reported by healthy adolescents and their families, cohesion and adaptability were more impaired in families with an adolescent with bipolar disorder. Levels of conflict, while higher than normative scores reported by healthy families, were not significantly different from scores gathered from distressed, clinic-referred families. Parents rated high in EE reported less cohesion and adaptability, and more conflict, than parents rated low in EE. Parents expressing greater numbers of critical comments also reported more conflict than those who expressed fewer criticisms. These EE group differences were not accounted for by concurrent adolescent symptom levels. Family adaptability, cohesion, and conflict may be important targets for family treatments administered during the postepisode phases of early onset bipolar disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family functioning and mood disorders: A comparison between patients with major depressive disorder and bipolar I disorder.

Within a sample of patients with major depressive disorder (MDD; n = 121) and bipolar affective disorder (BPAD; n = 69), the authors examined (a) diagnostic differences in family functioning at acute episode, (b) diagnostic differences in family functioning at episode recovery, (c) within-group changes in family functioning from acute episode to recovery, and (d) whether within-group changes from acute episode to recovery varied by diagnosis. Using a multidimensional model, the authors evaluated interviewer, patient, and family ratings. Overall, patients with MDD and BPAD evidenced similar levels of family impairment at acute episode and recovery. Generally, patients in both groups experienced improvement in family functioning over time, yet mean scores at recovery continued to range from fair to poor. Although certain specific differences emerged, diagnostic groups appeared to be more similar than different in level and pattern of family functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dysregulation of the behavioral activation system in remitted bipolar I disorder.

The current study tests a prediction of the behavioral activation system (BAS) dysregulation theory of bipolar disorder, namely that following high levels of reward or frustration, individuals with bipolar disorder will take longer than will healthy controls to recover to baseline levels of BAS activity. Eighty individuals (40 with bipolar I disorder, currently euthymic; 40 with no history of affective disorder) completed a daily diary over a 28 day period. No differences were found between the 2 groups in terms of the relation among levels of reward or frustration experienced, magnitude of initial response, or time taken to recover. However, examination of the relation between number of previous episodes and time to recover revealed that history of mania was associated with prolonged activation following reward, whereas history of both mania and depression were associated with prolonged recovery following frustration. The findings do not support an association between lifetime diagnosis of bipolar disorder and slow recovery of BAS activity. Nevertheless, they offer tentative support for an association between number of previous episodes and slow recovery of BAS activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life events as predictors of mania and depression in bipolar I disorder.

[Correction Notice: An erratum for this article was reported in Vol 117(3) of Journal of Abnormal Psychology (see record 2008-11014-022). In the aforementioned article, Amy K. Cuellar's last name was misspelled. The corrected list of author names is: Sheri L. Johnson, Amy K. Cuellar, Camilo Ruggero, Carol Winett-Perlman, Paul Goodnick, Richard White, and Ivan Miller.] To date, few prospective studies of life events and bipolar disorder are available, and even fewer have separately examined the role of life events in depression and mania. The goal of this study was to prospectively examine the role of negative and goal-attainment life events as predictors of the course of bipolar disorder. One hundred twenty-five individuals with bipolar I disorder were interviewed monthly for an average of 27 months. Negative and goal-attainment life events were assessed with the Life Events and Difficulties Schedule. Changes in symptoms were evaluated using the Modified Hamilton Rating Scale for Depression and the Bech-Rafaelsen Mania Scale. The clearest results were obtained for goal-attainment life events, which predicted increases in manic symptoms over time. Negative life events predicted increases in depressive symptoms within regression models but were not predictive within multilevel modeling of changes in depressive symptoms. Given different patterns for goal attainment and negative life events, it appears important to consider specific forms of life events in models of bipolar disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological impairment among manic, depressed, and mixed-episode inpatients with bipolar disorder.

Previous research has demonstrated broad neurobehavioral abnormalities in bipolar affective disorder (cf. G. Cassens, L. Wolfe, & M. Zola, 1990). However, there have been no comparisons of neuropsychological function across patients with manic, depressed, or mixed subtypes. In the present study, 37 manic, 24 mixed-episode, and 25 depressed bipolar I inpatients and 34 control subjects were administered a brief battery of neuropsychological tests. The multivariate and univariate effects of participant group on the neuropsychological measures were uniformly significant (p     

PTSD treatment and 5-year remission among patients with substance use and posttraumatic stress disorders.

Given the high prevalence of comorbid substance use and posttraumatic stress disorders (SUD-PTSD), how to best treat these patients is a pressing concern for SUD providers. PTSD treatment may play an important role in patients' recovery. One hundred male SUD-PTSD patients who attended SUD treatment completed 1-, 2-, and 5-year follow-ups. Outpatient treatment information was gathered from Veterans Affairs databases. PTSD treatment and 12-Step group attendance in the 1st year predicted 5-year SUD remission. Patients who received PTSD treatment in the first 3 months following discharge and those who received treatment for a longer duration in Year 1 were more likely to be remitted in Year 5. The receipt of PTSD-focused treatment immediately after SUD treatment may enhance long-term remission. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Thought suppression in patients with bipolar disorder.

Suppression of negative thoughts has been observed under experimental conditions among patients with major depressive disorder (MDD) but has never been examined among patients with bipolar disorder (BD). Patients with BD (n = 36), patients with MDD (n = 20), and healthy controls (n = 20) completed a task that required unscrambling 6-word strings into 5-word sentences, leaving out 1 word. The extra word allowed the sentences to be completed in a negative, neutral, or “hyperpositive” (manic/goal-oriented) way. Participants completed the sentences under conditions of cognitive load (rehearsing a 6-digit number), reward (a bell tone), load and reward, or neither load nor reward. We hypothesized that patients with BD would engage in more active suppression of negative and hyperpositive thoughts than would controls, as revealed by their unscrambling more word strings into negative or hyperpositive sentences. Under conditions of load or reward and in the absence of either load or reward, patients with BD unscrambled more negative sentences than did controls. Under conditions of reward, patients with BD unscrambled more negative sentences than did patients with MDD. Patients with BD also reported more use of negative thought suppression than did controls. These group differences in negative biases were no longer significant when current mood states were controlled. Finally, the groups did not differ in the proportion of hyperpositive sentence completions in any condition. Thought suppression may provide a critical locus for psychological interventions in BD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temporal discounting of rewards in patients with bipolar disorder and schizophrenia.

Patients with bipolar disorder (BD) and schizophrenia (SZ) often show decision-making deficits in everyday circumstances. A failure to appropriately weigh immediate versus future consequences of choices may contribute to these deficits. We used the delay discounting task in individuals with BD or SZ to investigate their temporal decision making. Twenty-two individuals with BD, 21 individuals with SZ, and 30 healthy individuals completed the delay discounting task along with neuropsychological measures of working memory and cognitive function. Both BD and SZ groups discounted delayed rewards more steeply than did the healthy group even after controlling for current substance use, age, gender, and employment. Hierarchical multiple regression analyses showed that discounting rate was associated with both diagnostic group and working memory or intelligence scores. In each group, working memory or intelligence scores negatively correlated with discounting rate. The results suggest that (a) both BD and SZ groups value smaller, immediate rewards more than larger, delayed rewards compared with the healthy group and (b) working memory or intelligence is related to temporal decision making in individuals with BD or SZ as well as in healthy individuals. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Modal attention asymmetry in patients with schizophrenia and bipolar disorder.

This cross-sectional study examined modal attention asymmetries in patients with schizophrenia (n?=?47) and bipolar disorder (n?=?42), as contrasted to a matched-sample comparison group of normal participants (n?=?89). A test of continuous auditory and visual attention was the primary measure. The data were analyzed from 2 experimental conditions: simple modal responses (auditory and visual) and modal switching responses (ipsimodal and cross-modal switching). In the simple modal condition, patients with schizophrenia demonstrated a visual over auditory asymmetry; patients with bipolar disorder showed no differences. In modal switching conditions, however, patients with bipolar disorder displayed a significant auditory over visual asymmetry. No main effect was detected between medications and attention functioning. Results are discussed in light of differentiating these 2 populations on the basis of modal specificity of attention functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hooked on a feeling: Rumination about positive and negative emotion in inter-episode bipolar disorder.

Rumination has been consistently implicated in the onset and maintenance of depression. Less work has examined rumination in the context of bipolar disorder, especially rumination about positive emotion. The present study examined rumination about negative and positive emotion in interepisode bipolar disorder (BD; n = 39) and healthy controls (CTL; n = 34). Trait rumination about positive and negative emotion, as well as experiential and physiological responses to a rumination induction, was measured. Illness course was also assessed for the BD group. Results indicated that the BD group reported greater trait rumination about positive and negative emotion compared with the CTL group, though no group differences emerged during the rumination induction. For the BD group, trait rumination about positive and negative emotion, as well as increased cardiovascular arousal (i.e., heart rate), was associated with greater lifetime depression frequency; trait rumination about positive emotion was associated with greater lifetime mania frequency. These findings suggest that interepisode BD is associated with greater rumination about positive and negative emotion, which in turn is associated with illness course. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

"Life events as predictors of mania and depression in bipolar I disorder": Correction to Johnson et al. (2008).

Reports an error in "Life events as predictors of mania and depression in bipolar I disorder" by Sheri L. Johnson, Amy K. Cueller, Camilo Ruggero, Carol Winett-Perlman, Paul Goodnick, Richard White and Ivan Miller (Journal of Abnormal Psychology, 2008[May], Vol 117[2], 268-277). In the aforementioned article, Amy K. Cuellar's last name was misspelled. The corrected list of author names is: Sheri L. Johnson, Amy K. Cuellar, Camilo Ruggero, Carol Winett-Perlman, Paul Goodnick, Richard White, and Ivan Miller. (The following abstract of the original article appeared in record 2008-05639-002.) To date, few prospective studies of life events and bipolar disorder are available, and even fewer have separately examined the role of life events in depression and mania. The goal of this study was to prospectively examine the role of negative and goal-attainment life events as predictors of the course of bipolar disorder. One hundred twenty-five individuals with bipolar I disorder were interviewed monthly for an average of 27 months. Negative and goal-attainment life events were assessed with the Life Events and Difficulties Schedule. Changes in symptoms were evaluated using the Modified Hamilton Rating Scale for Depression and the Bech-Rafaelsen Mania Scale. The clearest results were obtained for goal-attainment life events, which predicted increases in manic symptoms over time. Negative life events predicted increases in depressive symptoms within regression models but were not predictive within multilevel modeling of changes in depressive symptoms. Given different patterns for goal attainment and negative life events, it appears important to consider specific forms of life events in models of bipolar disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The structure of personality disorders in individuals with posttraumatic stress disorder.

Research on the structure of personality disorders (PDs) has relied primarily on exploratory analyses to evaluate trait-based models of the factors underlying the covariation of these disorders. This study used confirmatory factor analysis to evaluate whether a model that included both PD traits and a general personality dysfunction factor would account for the comorbidity of the PDs better than a trait-only model. It also examined if the internalizing/externalizing model of psychopathology, developed previously through research on the structure of Axis I disorders, might similarly account for the covariation of the Axis II disorders in a sample of 245 veterans and nonveterans with posttraumatic stress disorder. Results indicated that the best fitting model was a modified bifactor structure composed of nine lower-order common factors. These factors indexed pathology ranging from aggression to dependency, with the correlations among them accounted for by higher-order Internalizing and Externalizing factors. Further, a general factor, reflecting a construct that we termed boundary disturbance, accounted for additional variance and covariance across nearly all the indicators. The Internalizing, Externalizing, and Boundary Disturbance factors evidenced differential associations with trauma-related covariates. These findings suggest continuity in the underlying structure of psychopathology across DSM–IV Axes I and II and provide empirical evidence of a pervasive, core disturbance in the boundary between self and other across the PDs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Observed emotional involvement and overinvolvement in families of patients with bipolar disorder.

Many studies have examined the construct validity of the criticism component of expressed emotion, but little work has been done on clarifying the emotional overinvolvement (EOI) construct. In a sample of 115 recently episodic patients with bipolar disorder, the authors of the present study examined the construct validity of an observational coding system for both appropriate and inappropriate emotional involvement that permitted separate ratings for relatives' intrusiveness, self-sacrificing behaviors, and distress related to the patient's well-being. Findings support the measure's reliability and convergent validity and are moderately supportive of the measure's discriminant validity. Results also suggest that Camberwell Family Interview (C. E. Vaughn & J. P. Leff, 1976) EOI ratings do not discriminate among the different dimensions of the emotional involvement construct (or their appropriateness or inappropriateness) as revealed in laboratory-based interactions. The findings suggest that clinicians working with such families might consider differentiating among the various ways in which family members are involved with the patient and helping them learn to judge under what circumstances such involvement is appropriate and inappropriate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Craving and physiological reactivity to trauma and alcohol cues in posttraumatic stress disorder and alcohol dependence.

The high comorbidity of posttraumatic stress disorder (PTSD) and alcohol dependence (AD) has been firmly established. Although laboratory studies have examined self-reported craving in response to trauma and alcohol cues, no studies have reported on alcohol-related physiological responding in response to trauma cues in PTSD-AD individuals. Using a cue reactivity paradigm, this study examined the impact of personalized trauma-image cues and in vivo alcohol cues on alcohol-related responding (e.g., salivation, craving) in individuals with PTSD and AD (n = 40). Participants displayed reactivity to both trauma and alcohol cues when compared to neutral cues, including increased self-reported craving and distress, as well as greater salivation. These findings suggest that through repeated pairings of trauma memories and alcohol consumption, salivation may become classically conditioned to trauma cues. Moreover, the fact that the trauma-alcohol cue combination elicited greater alcohol craving, salivary responding, distress, and arousal than either the trauma-neutral or neutral-alcohol cue combinations suggests that effects of the trauma and alcohol cues were additive in nature. Evidence that AD individuals with PTSD report increased alcohol craving and display greater salivation in response to trauma memories, supplements prior research indicating that PTSD-related negative emotion and trauma-related alcohol craving may play an important role in the maintenance of AD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increased rates of events that activate or deactivate the behavioral approach system, but not events related to goal attainment, in bipolar spectrum disorders.

Research indicates that life events involving goal attainment and goal striving trigger hypomania/mania and that negative life events trigger bipolar depression. These findings are consistent with the behavioral approach system (BAS) dysregulation model of bipolar disorders, which suggests that individuals with bipolar disorders are hypersensitive to cues signaling opportunity for reward and cues signaling failure and loss of rewards. However, no studies to date have investigated whether individuals with bipolar spectrum disorders experience increased rates of these BAS-relevant life events, which would place them at double risk for developing bipolar episodes. The present study found that individuals with bipolar II disorder and cyclothymia experience increased rates of BAS-activating and BAS-deactivating, but not goal-attainment, life events. Finally, for bipolar spectrum individuals only, BAS-activating events predicted BAS-deactivating events' rates. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived barriers to care among veterans health administration patients with posttraumatic stress disorder.

Despite the availability of specialty posttraumatic stress disorder (PTSD) care within Department of Veterans Affairs (VA) facilities, many VA patients with PTSD do not seek needed PTSD treatment. This study examined institutional and stigma-related barriers to care among a large diverse group of Vietnam and Iraq/Afghanistan veterans who had been diagnosed with PTSD by a VA provider. A total of 490 patients who had not received VA treatment for PTSD in the previous 2 years (31% response rate) were asked about psychological symptoms and reasons for not using care. Stigma related barriers (concerns about social consequences and discomfort with help-seeking) were rated as more salient (rated in the “slightly” to “moderately” problematic range) than institutional factors (not “fitting into” VA care, staff skill and sensitivity, and logistic barriers; rated in the “not at all” to “slightly” problematic range). Regression analyses revealed that younger age and White females were associated with higher ratings on not fitting into VA health care, whereas non-White males were associated with higher ratings on logistic barriers. PTSD symptoms were positively associated with perceived barriers to care, with the most consistent results observed for PTSD avoidance symptoms. Magnitude of effects was generally small, suggesting the possibility that other factors not assessed in this study may also contribute to perceptions of barriers to care. Future research should attend to the effects of stigma, as well as institutional barriers to care, on VA mental health treatment seeking. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Trauma-focused imaginal exposure for individuals with comorbid posttraumatic stress disorder and alcohol dependence: Revealing mechanisms of alcohol craving in a cue reactivity paradigm.

With a sample (N = 43) of participants meeting current diagnostic criteria for both alcohol dependence and posttraumatic stress disorder (PTSD), the authors tested the hypothesis that alcohol craving elicited by a trauma cue might be attenuated if trauma-elicited negative emotion were reduced following trauma-focused imaginal exposure. In a laboratory-based experiment, participants were randomly assigned to either trauma-focused imaginal exposure or imagery-based relaxation. A cue reactivity paradigm was used to assess alcohol craving prior to, and after completion of, the 6 clinical sessions. Attrition was high but did not differ between experimental conditions. For study completers, PTSD symptoms decreased in the exposure condition but not in the relaxation condition. Alcohol craving and distress elicited by trauma images decreased in the exposure condition but did not change in the relaxation condition. Results support the hypothesis that negative emotion is a mechanism of alcohol craving. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment in individuals with social anxiety disorder: The relationship among adult attachment styles, social anxiety, and depression.

Despite their apparent implications for social functioning, adult attachment styles have never been specifically explored among persons with social anxiety disorder. In the current study, a cluster analysis of the Revised Adult Attachment Scale (N. L. Collins, 1996) revealed that 118 patients with social anxiety (58.6% males and 41.4% females, mean age 32.43 yrs) were best represented by anxious and secure attachment style clusters. Members of the anxious attachment cluster exhibited more severe social anxiety and avoidance, greater depression, greater impairment, and lower life satisfaction than members of the secure attachment cluster. This pattern was replicated in a separate sample of 56 patients and compared with the pattern found in 36 control participants. Social anxiety mediated the association between attachment insecurity and depression. Findings are discussed in the context of their relevance to the etiology, maintenance, and cognitive-behavioral treatment of social anxiety disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)