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Correction of excessive goal attainment beliefs in patients with bipolar disorder who enjoy being in a state of “mild hypomania” could help prevent them from assenting to a manic episode, say researchers.
Some individuals with bipolar disorder value the characteristics associated with being in a state of mild hypomania ??” termed a high “sense of hyper-positive self”, D Lam and colleagues from King’s College, London, UK, explain.
These characteristics include being particularly creative, dynamic, entertaining, and outgoing, and make individuals more likely to engage in goal-driven behavior.
Bipolar patients who identify with early warning signs as desirable self-descriptive traits are less inclined to see them as warning signs of a manic relapse, and may therefore engage in activities that cause further stimulation and a greater risk for a manic state, say the researchers.
To investigate, the team asked 54 bipolar I disorder patients to complete a self-report questionnaire that assessed preferred mood state, coping with scenarios, dysfunctional attitudes, and SHPS.
They found that patients’ Sense of Hyper-positive Self Scale (SHPSS) score predicted their preferred internal state of mania, with higher “ideal” scores and lower “usual” scores significantly associated with a higher preferred mania mood.
Indeed, a unit increase in SHPSS-Ideal score produced an increase of 0.169 points on the modified version of the Altman Self-Rating Mania scale (M-ASRM), while a unit increase in SHPSS-Usual score produced a decrease of 0.202 points on the M-ASRM, the researchers report.
Multiple linear regression showed that patients with high scores on the Dysfunctional Attitude Scale (DAS) were more likely than those with low scores to have high SHPSS scores, and the higher the DAS score the greater the tendency for the patient to identify with self-descriptors linked to hypomania.
Moreover, the DAS total score and the DAS Goal-attainment score correlated significantly with mania-escalating activities in response to hypothetical scenarios described in the Scenarios Rating Task, with goal-attainment explaining a further 12.8% of the variance in activity ratings after accounting for mood measures.
“Goal-attainment attitudes, characterized by a desire to strive for success and be admired, were predictive of the extent to which individuals indicated that they would increase their activity, eg, work harder, make more contributions to a project, and be more sociable, in these specified vulnerable situations,” Lam et al report in the journal Psychological Medicine.
“However, clinical experience would suggest that an increase in these activities in the scenario would stimulate the patient further, possibly resulting in an assent to a manic episode.”
The researchers therefore conclude that “excessive goal-attainment beliefs should be tackled in therapy.”
They recommend: “Clinicians could implement cognitive techniques to modify these beliefs and find alternatives that are more consistent with relapsed prevention goals.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
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Training community mental health teams (CMHTs) to offer enhanced relapse prevention (ERP) for bipolar disorder (BD) increases the time to recurrence of an episode and improves occupational functioning, suggest UK study findings.
“This study extends the existing evidence that teaching service users to recognize and then initiate management for the early warning signs is a clinically useful intervention,” say Fiona Lobban (Lancaster University) and co-authors.
For the cluster randomized controlled trial, 23 CMHT workers were allocated to receive six weekly 2-hour sessions in ERP using guidelines recommended by the National Institute for Health and Clinical Excellence for BD or to continue giving treatment as usual (TAU).
In total, 40 BD patients were randomly assigned to TAU and 56 to ERP treatment from CMHTs for a period of 3 months.
The researchers found that time to recurrence of an episode of depression or mania/hypomania was significantly increased by an average of 8.5 weeks (42.0 vs 33.5 weeks) in BD patients receiving ERP compared with those receiving TAU over a 48-week follow-up period.
Furthermore, the likelihood of having an episode during the follow-up period was significantly lower for those receiving ERP compared with those allocated to TAU, at 21% versus 38%.
Further analysis revealed the number of previous episodes and level of education were associated with time to first bipolar episode, while only number of previous episodes was associated with time to first depressive episode.
Consistent with previous study findings, Lobban and team also report that social and occupational functioning increased over time in the ERP group compared with TAU.
Writing in the British Journal of Psychiatry, the authors conclude that their study “demonstrates that approaches using early warning signs can be employed by existing staff who are already regularly following up these people, and do not necessarily require extensive training in psychological therapies.”
They add that further large-scale cluster trials are needed.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010