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The Role of Beliefs About Mood Swings in Determining Outcome in Bipolar Disorder

Abstract

This study explored the impact of beliefs about mood swings on symptomatic outcome in bipolar disorder (BD). Ninety-one people with BD completed a Brief Illness Perception Questionnaire at baseline. Outcome was measured using weekly measures of mood and time to relapse over the following 24 weeks. Beliefs about the consequences of mood swings [Hazard ratio (HR) = 1.38, 95 % CI = (1.07,1.77)], perceived symptoms associated with mood swings [HR = 0.75, 95 % CI = (0.59,0.95)], and emotional concern about mood swings [HR = 1.30, 95 % CI = (1.04,1.61)] had statistically significant effects on hazard of relapse, while beliefs about the consequences of mood swings [Odds ratio (OR) = 1.24, 95 % CI = (1.01,1.52)] and the amount of personal effort individuals believed they were making to get well [OR = 0.82, 95 % CI = (0.67,1.02)] had important effects on weekly LIFE scores of depressive symptoms controlling for baseline depression, mood stabilizer medication and number of previous bipolar episodes. In conclusion, beliefs about mood swings had important effects on weekly fluctuations in depression severity and time to relapse.

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References

  • Addington, J. (2003). An integrated treatment approach to substance use in an early psychosis programme. In H. Graham, A. Copello, M. Birchwood, & K. T. Mueser (Eds.), Substance misuse in psychosis: Approaches to treatment and service delivery. Chichester: Wiley.

    Google Scholar 

  • Alatiq, Y., Crane, C., Williams, J. M. G., & Goodwin, G. M. (2010). Dysfunctional beliefs in bipolar disorder: Hypomanic vs. depressive attitudes. Journal of Affective Disorders, 122(3), 294–300.

    PubMed  Article  CAS  Google Scholar 

  • Bech, P., Rafaelsen, O. J., Kramp, P., & Bolwig, T. G. (1978). The mania rating scale: Scale construction and inter-observer agreement. Neuropharmacology, 17(6), 430–431.

    PubMed  Article  CAS  Google Scholar 

  • Broadbent, E., Ellis, C. J., Thomas, J., Gamble, G., & Petrie, K. J. (2009). Further development of an illness perception intervention for myocardial infarction patients: A randomized controlled trial. Journal of Psychosomatic Research, 67, 17–23.

    PubMed  Article  Google Scholar 

  • Broadbent, E., Petrie, K. J., Main, J., & Weinman, J. (2006). The brief illness perception questionnaire. Journal of Psychosomatic Research, 60(6), 631–637.

    PubMed  Article  Google Scholar 

  • Colom, F., Vieta, E., Martinez-Aran, A., Reinares, M., Goikolea, J. M., Benabarre, A., et al. (2003). A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Archives of General Psychiatry, 60(4), 402–407.

    PubMed  Article  Google Scholar 

  • Cook, R. J., & Farewell, V. T. (1996). Multiplicity considerations in the design and analysis of clinical trials. Journal of the Royal Statistical Society, 159, 93–110.

    Article  Google Scholar 

  • Cox, D. R. (1965). A remark on multiple comparison methods. Technometrics, 7, 223–224.

    Article  Google Scholar 

  • First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997). Structured clinical interview for DSM-IV axis I disorders, research version, patient edition. Washington, DC: American Psychiatric Press, Inc.

    Google Scholar 

  • Goldman, H. H., Skodol, A. E., & Lave, T. R. (1992). Revising axis V for DSM-IV: A review of measures of social functioning. American Journal of Psychiatry, 149(9), 1148–1156.

    PubMed  CAS  Google Scholar 

  • Hamilton, M. (1960). A rating scale for depression. Journal of Neurology and Psychiatry, 23, 59–62.

    Google Scholar 

  • Hollyman, J. A., Freeling, P., Paykel, E. S., Bhat, A., & Sedgewick, P. (1988). Double-blind placebo-controlled trial of amitriptyline among depressed patients in general practice. Journal of Royal College of General Practice, 38, 393–397.

    CAS  Google Scholar 

  • Jones, S., Mansell, W., & Waller, L. (2006). Appraisal of hypomania-relevant experiences: Development of a questionnaire to assess positive self-dispositional appraisals in bipolar and behavioural high risk samples. Journal of Affective Disorders, 93(1–3), 19–28.

    PubMed  Article  Google Scholar 

  • Khazaal, Y., Richard, C., Matthieu-Darekar, S., Quement, B., Kramer, U., & Preisig, M. (2008). Advance directives in bipolar disorder, a cognitive behavioural conceptualization. International Journal of Law and Psychiatry, 31(1), 1–8.

    PubMed  Article  Google Scholar 

  • Lam, D., Watkins, E. R., Hayward, P., Bright, J., Wright, K., Kerr, N., et al. (2003). A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: Outcome of the first year. Archives of General Psychiatry, 60(2), 145–152.

    PubMed  Article  Google Scholar 

  • Lam, D., Wright, K., & Smith, N. (2004). Dysfunctional assumptions in bipolar disorder. Journal of Affective Disorders, 79(1–3), 193–199.

    PubMed  Article  Google Scholar 

  • Leventhal, H., Nerenz, D. R., & Steele, D. F. (1984). Illness representations and coping with health threats. In A. Baum & J. Singer (Eds.), A handbook of psychology and health (pp. 219–252). Hillsdale, New Jersey: Erlbaum.

    Google Scholar 

  • Lobban, F., Barrowclough, C., & Jones, S. (2003). A review of the role of illness models in severe mental illness. Clinical Psychology Review, 23(2), 171–196.

    PubMed  Article  Google Scholar 

  • Lobban, F., Barrowclough, C., & Jones, S. (2005). Assessing cognitive representations of mental health problems. I. The illness perception questionnaire for schizophrenia. British Journal of Clinical Psychology, 44, 147–162.

    PubMed  Article  Google Scholar 

  • Lobban, F., Gamble, C., Kinderman, P., Taylor, L., Chandler, C., Tyler, E., et al. (2007). Enhanced relapse prevention for bipolar disorder–ERP trial. A cluster randomised controlled trial to assess the feasibility of training care coordinators to offer enhanced relapse prevention for bipolar disorder. BMC Psychiatry, 7, 6.

    PubMed  Article  Google Scholar 

  • Lobban, F., Solis-Trapala, I., Symes, W., Morriss, R., & Univ, L. (2011). Early warning signs checklists for relapse in bipolar depression and mania: Utility, reliability and validity. Journal of Affective Disorders, 133(3), 413–422.

    PubMed  Article  Google Scholar 

  • Lobban, F., Taylor, L., Chandler, C., Sellwood, W., Gamble, C., Tyler, E., et al. (2009). Training staff in enhanced relapse prevention for bipolar disorder: Uptake, skill and confidence. Psychiatric Services, 60, 702–706.

    PubMed  Article  Google Scholar 

  • Lobban, F., Taylor, L., Chandler, C., Tyler, E., Kinderman, P., Kolamunnage-Dona, R., et al. (2010). Enhanced relapse prevention for bipolar disorder by community mental health teams: Cluster feasibility randomised trial. British Journal of Psychiatry, 196, 59–63.

    PubMed  Article  CAS  Google Scholar 

  • Mansell, W., & Jones, S. H. (2006). The Brief-HAPPI: A questionnaire to assess cognitions that distinguish between individuals with a diagnosis of bipolar disorder and non-clinical controls. Journal of Affective Disorders, 93(1–3), 29–34.

    PubMed  Article  Google Scholar 

  • McCabe, R., & Priebe, S. (2004). Explanatory models of illness in schizophrenia: Comparison of four ethnic groups. British Journal of Psychiatry, 185, 25–30.

    PubMed  Article  Google Scholar 

  • McIntyre, R., Kennedy, S., Bagby, M., & Bakish, D. (2002). Assessing full remision. Journal of Psychiatry and Neuroscience, 27(4), 235–239.

    PubMed  Google Scholar 

  • Munoz, S. R., & Bangdiwala, S. I. (1997). Interpretation of Kappa and B statistics measures of agreement. Journal of Applied Statistics, 24, 105–111.

    Article  Google Scholar 

  • Paykel, E., Abbott, R., Morriss, R., Hayhurst, H., & Scott, J. (2006a). Sub-syndromal and syndromal symptoms in the longitudinal course of bipolar disorder. British Journal of Psychiatry, 189(2), 118–123. Royal College of Psychiatrists.

    PubMed  Article  Google Scholar 

  • Paykel, E., Scott, J., Morriss, R. M., Hayhurst, H., & Abbott, R. (2006b). Subsyndromal and syndromal symptoms in the longitudinal course of bipolar disorder. British Journal of Psychiatry, 189, 118–123.

    PubMed  Article  Google Scholar 

  • Presson, P. K., & Benassi, V. A. (1996). Locus of control orientation and depressive symptomatology: A meta-analysis. Journal of Social Behavior & Personality, 11(1), 201–212.

    Google Scholar 

  • R Development Core Team. (2009). A language and environment for statistical computing. R Foundation for Statistical Computing, from http://www.R-project.org.

  • Scott, J. (2002). Using health belief models to understand the efficacy-effectiveness gap for mood stabilizer treatments. Neuropsychobiology, 46(Suppl. 1), 13–15.

    PubMed  Article  Google Scholar 

  • Scott, J., Paykel, E., Morriss, R., Bentall, R., Kinderman, P., Johnson, T., et al. (2006). Cognitive-behavioural therapy for severe and recurrent bipolar disorders: Randomised controlled trial. British Journal of Psychiatry, 188, 313–320.

    PubMed  Article  Google Scholar 

  • Scott, J., & Pope, M. (2003). Cognitive styles in individuals with bipolar disorders. Psychological Medicine, 33(6), 1081–1088.

    PubMed  Article  Google Scholar 

  • Simon, G., & Rutter, C. (2008). Accuracy of recall for mania symptoms using a three month timeline follow-back interview. Journal of Affective Disorders, 107, 271–274.

    PubMed  Article  Google Scholar 

  • Terry Therneau and original R port by Thomas Lumley. (2009). Survival analysis, including penalised likelihood. R package version 2.35-4, from http://CRAN.R-project.org/package=survival.

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Acknowledgments

This work was funded by the Medical Research Council and Mersey Care NHS Trust, UK. The findings do not necessarily represent the views of the funders. Ivonne Solis-Trapala acknowledges additional support from the Medical Research Council [grant number G0701642].

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Correspondence to Fiona Lobban.

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The ERP group comprises: Claire Chandler, Carrol Gamble, Peter Kinderman, Fiona Lobban, Richard Morriss, Sarah Peters, Ellie Pontin, Anne Rogers, Bill Sellwood, Lee Taylor, Elizabeth Tyler, Caroline Williams.

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Lobban, F., Solis-Trapala, I., Tyler, E. et al. The Role of Beliefs About Mood Swings in Determining Outcome in Bipolar Disorder. Cogn Ther Res 37, 51–60 (2013). https://doi.org/10.1007/s10608-012-9452-9

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  • DOI: https://doi.org/10.1007/s10608-012-9452-9

Keywords

  • Beliefs
  • Outcome
  • Bipolar
  • Mood swings