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- Hales, Susie A., et al.
(författare)
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Cognitions in bipolar affective disorder and unipolar depression : imagining suicide
- 2011
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Ingår i: Bipolar Disorders. - : WILEY-BLACKWELL. - 1398-5647 .- 1399-5618. ; 13:7-8, s. 651-661
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Bipolar disorder has the highest rate of suicide of all the psychiatric disorders. In unipolar depression, individuals report vivid, affect-laden images of suicide or the aftermath of death (flashforwards to suicide) during suicidal ideation but this phenomenon has not been explored in bipolar disorder. Therefore the authors investigated and compared imagery and verbal thoughts related to past suicidality in individuals with bipolar disorder (n = 20) and unipolar depression (n = 20). Methods: The study used a quasi-experimental comparative design. The Structured Clinical Interview for DSM-IV was used to confirm diagnoses. Quantitative and qualitative data were gathered through questionnaire measures (e. g., mood and trait imagery use). Individual interviews assessed suicidal cognitions in the form of (i) mental images and (ii) verbal thoughts. Results: All participants reported imagining flashforwards to suicide. Both groups reported greater preoccupation with these suicide-related images than with verbal thoughts about suicide. However, compared to the unipolar group, the bipolar group were significantly more preoccupied with flashforward imagery, rated this imagery as more compelling, and were more than twice as likely to report that the images made them want to take action to complete suicide. In addition, the bipolar group reported a greater trait propensity to use mental imagery in general. Conclusions: Suicidal ideation needs to be better characterized, and mental imagery of suicide has been a neglected but potentially critical feature of suicidal ideation, particularly in bipolar disorder. Our findings suggest that flashforward imagery warrants further investigation for formal universal clinical assessment procedures.
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| 2. |
- Miklowitz, David J., et al.
(författare)
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Facilitated Integrated Mood Management for adults with bipolar disorder
- 2012
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Ingår i: Bipolar Disorders. - : WILEY. - 1398-5647 .- 1399-5618. ; 14:2, s. 185-197
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Forskningsöversikt (refereegranskat)abstract
- Objectives: We describe the development of a five-session psychoeducational treatment, Facilitated Integrated Mood Management (FIMM), which contains many of the core elements of longer evidencebased psychosocial treatments for bipolar disorder. FIMM incorporated a novel mood monitoring program based on mobile phone technology. Methods: Adult patients with bipolar I and II disorders (N = 19) received six sessions (Pilot I: n = 14) or five sessions (Pilot II: n = 5) of FIMM with pharmacotherapy. Treatment facilitators were novice counselors who were trained in a three-day workshop and supervised for six months. FIMM sessions focused on identifying early signs of recurrence, maintaining regular daily and nightly routines, rehearsing mood management strategies, maintaining adherence to medications, and education about substance abuse. Patients sent daily text messages or e-mails containing ratings of their mood and sleep, and weekly messages containing self-ratings on the Quick Inventory of Depressive Symptomatology (QIDS) and the Altman Self Rating Mania Scale (ASRM). Patients also completed a weekly mood management strategies questionnaire. Results: Of the 19 patients, 17 (89.5%) completed FIMM in an average of 9.2 +/- 3.4 weeks (Pilot I) and 7.6 +/- 0.9 weeks (Pilot II). Patients reported stable moods on the QIDS and ASRM over a 120-day period, and on average responded to 81% of the daily message prompts and 88% of the weekly QIDS and ASRM prompts. Facilitators maintained high levels of fidelity to the FIMM manual. Patients +/- knowledge of mood management strategies increased significantly between the first and last weeks of treatment. Conclusions: Patients with bipolar disorder can be engaged in a short program of facilitated mood management. The effects of FIMM on the course of bipolar disorder await evaluation in randomized trials. The program may be a useful adjunct to pharmacotherapy in community centers that cannot routinely administer full courses of psychosocial treatment.
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| 4. |
- Di Simplicio, Martina, et al.
(författare)
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An investigation of mental imagery in bipolar disorder : Exploring "the mind's eye"
- 2016
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Ingår i: Bipolar Disorders. - : WILEY-BLACKWELL. - 1398-5647 .- 1399-5618. ; 18:8, s. 669-683
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Mental imagery abnormalities occur across psychopathologies and are hypothesized to drive emotional difficulties in bipolar disorder (BD). A comprehensive assessment of mental imagery in BD is lacking. We aimed to test whether (i) mental imagery abnormalities (abnormalities in cognitive stages and subjective domains) occur in BD relative to non-clinical controls; and (ii) to determine the specificity of any abnormalities in BD relative to depression and anxiety disorders. Methods: Participants included 54 subjects in the BD group (depressed/euthymic; n=27 in each subgroup), subjects with unipolar depression (n=26), subjects with anxiety disorders (n=25), and non-clinical controls (n=27) matched for age, gender, ethnicity, education, and premorbid IQ. Experimental tasks assessed cognitive (non-emotional) measures of mental imagery (cognitive stages). Questionnaires, experimental tasks, and a phenomenological interview assessed subjective domains including spontaneous imagery use, interpretation bias, and emotional mental imagery. Results: (i) Compared to non-clinical controls, the BD combined group reported a greater impact of intrusive prospective imagery in daily life, more vivid and "real" negative images (prospective imagery task), and higher self-involvement (picture-word task). The BD combined group showed no clear abnormalities in cognitive stages of mental imagery. (ii) When depressed individuals with BD were compared to the depressed or anxious clinical control groups, no significant differences remained-across all groups, imagery differences were associated with affective lability and anxiety. Conclusions: Compared to non-clinical controls, BD is characterized by abnormalities in aspects of emotional mental imagery within the context of otherwise normal cognitive aspects. When matched for depression and anxiety, these abnormalities are not specific to BD-rather, imagery may reflect a transdiagnostic marker of emotional psychopathology.
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| 7. |
- Wingard, Louise, et al.
(författare)
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Initiation and long-term use of benzodiazepines and Z-drugs in bipolar disorder
- 2018
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Ingår i: Bipolar Disorders. - : Wiley. - 1398-5647 .- 1399-5618. ; 20:7, s. 634-646
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesIncreasing evidence points to the harmful effects of long‐term benzodiazepine treatment. Our objective was to study the incidence of, and predictors for, long‐term use of benzodiazepines and Z‐drugs in bipolar disorder.MethodsWe conducted a population‐based cohort study, using data from Swedish national registers. Swedish residents aged 18‐75 years with a recorded diagnosis of bipolar disorder or mania between July 2006 and December 2012, and no history of benzodiazepine/Z‐drug use in the past year, were included. Patients were followed for 1 year with regard to prescription fills of benzodiazepines/Z‐drugs. Initiators were followed for another year during which continuous use for >6 months was defined as “long‐term”. Patient and prescription characteristics were investigated as potential predictors for long‐term use in multivariate logistic regression models.ResultsOut of the 21 883 patients included, 29% started benzodiazepine/Z‐drug treatment, of whom one in five became long‐term users. Patients who were prescribed clonazepam or alprazolam had high odds for subsequent long‐term use (adjusted odds ratios [aORs] 3.78 [95% confidence interval (CI) 2.24‐6.38] and 2.03 [95% CI 1.30‐3.18], respectively), compared to those prescribed diazepam. Polytherapy with benzodiazepines/Z‐drugs also predicted long‐term use (aOR 2.46, 95% CI 1.79‐3.38), as did age ≥60 years (aOR 1.93, 95% CI 1.46‐2.53, compared to age <30 years), and concomitant treatment with psychostimulants (aOR 1.78, 95% CI 1.33‐2.39).ConclusionsThe incidence of subsequent long‐term use among bipolar benzodiazepine initiators is high. Patients on clonazepam, alprazolam or benzodiazepine/Z‐drug polytherapy have the highest risk of becoming long‐term users, suggesting that these treatments should be used restrictively.
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