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Symptom-specific self-referential cognitive processes in bipolar disorder: a longitudinal analysis

Published online by Cambridge University Press:  30 November 2012

H. Pavlickova ,
F. Varese ,
O. Turnbull ,
J. Scott ,
R. Morriss ,
P. Kinderman ,
E. Paykel  and
R. P. Bentall
H. Pavlickova
Affiliation:
School of Psychology, Bangor University, UK
F. Varese
Affiliation:
School of Psychological Sciences, Manchester University, UK
O. Turnbull
Affiliation:
School of Psychology, Bangor University, UK
J. Scott
Affiliation:
Institute of Neuroscience, Newcastle University, UK Université Paris-Est Créteil (UPEC), France
R. Morriss
Affiliation:
Division of Psychiatry, School of Community Health Sciences, University of Nottingham, UK
P. Kinderman
Affiliation:
Institute of Psychology, Health and Society, University of Liverpool, UK
E. Paykel
Affiliation:
Department of Psychiatry, University of Cambridge, UK
R. P. Bentall*
Affiliation:
Institute of Psychology, Health and Society, University of Liverpool, UK
*
*Address for correspondence: Professor R. P. Bentall, Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building Block B, Liverpool L69 3GL, UK. (Email: richard.bentall@liverpool.ac.uk)
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Abstract

Background

Although depression and mania are often assumed to be polar opposites, studies have shown that, in patients with bipolar disorder, they are weakly positively correlated and vary somewhat independently over time. Thus, when investigating relationships between specific psychological processes and specific symptoms (mania and depression), co-morbidity between the symptoms and changes over time must be taken into account.

Method

A total of 253 bipolar disorder patients were assessed every 24 weeks for 18 months using the Hamilton Rating Scale for Depression (HAMD), the Bech–Rafaelsen Mania Assessment Scale (MAS), the Rosenberg Self-Esteem Questionnaire (RSEQ), the Dysfunctional Attitudes Scale (DAS), the Internal, Personal and Situational Attributions Questionnaire (IPSAQ) and the Personal Qualities Questionnaire (PQQ). We calculated multilevel models using the xtreg module of Stata 9.1, with psychological and clinical measures nested within each participant.

Results

Mania and depression were weakly, yet significantly, associated; each was related to distinct psychological processes. Cross-sectionally, self-esteem showed the most robust associations with depression and mania: depression was associated with low positive and high negative self-esteem, and mania with high positive self-esteem. Depression was significantly associated with most of the other self-referential measures, whereas mania was weakly associated only with the externalizing bias of the IPSAQ and the achievement scale of the DAS. Prospectively, low self-esteem predicted future depression.

Conclusions

The associations between different self-referential thinking processes and different phases of bipolar disorder, and the presence of the negative self-concept in both depression and mania, have implications for therapeutic management, and also for future directions of research.

Keywords

Bipolar disorderlongitudinal analysisself-esteemself-referential processessymptoms

Information

Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 9 , September 2013 , pp. 1895 - 1907
Copyright
Copyright © Cambridge University Press 2012 

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References

Abler, B, Greenhouse, I, Ongur, D, Walter, H, Heckers, S (2008). Abnormal reward system activation in mania. Neuropsychopharmacology 33, 2217–2227.CrossRefGoogle ScholarPubMed
Abraham, K (1911/1927). Notes on the psychoanalytic investigation and treatment of manic-depressive insanity and allied conditions. In Selected Papers of Karl Abraham (ed. Jones, E.), pp. 137–156. Hogarth: London.Google Scholar
Alloy, LB, Abramson, LY, Walshaw, PD, Gerstein, RK, Keyser, JD, Whitehouse, WG, Urosevic, S, Nusslock, R, Hogan, ME, Harmon-Jones, E (2009). Behavioral Approach System (BAS) – relevant cognitive styles and bipolar spectrum disorders: concurrent and prospective associations. Journal of Abnormal Psychology 118, 459–471.CrossRefGoogle ScholarPubMed
Alloy, LB, Abramson, LY, Walshaw, PD, Neeren, AM (2006). Cognitive vulnerability to unipolar and bipolar mood disorders. Journal of Social and Clinical Psychology 25, 729–754.CrossRefGoogle Scholar
APA (1994). Diagnostic and Statistical Manual for Mental Disorders, 4th edn.American Psychiatric Association Press: Washington, DC.Google Scholar
Bech, P, Bolwig, TG, Kramp, P, Rafaelsen, OJ (1979). The Bech-Rafaelsen Mania Scale and the Hamilton Depression Scale. Acta Psychiatrica Scandinavia 59, 420–430.CrossRefGoogle ScholarPubMed
Bentall, RP, Kinderman, P, Manson, K (2005). Self-discrepancies in bipolar disorder: comparison of manic, depressed, remitted and normal participants. British Journal of Clinical Psychology 44, 457–473.CrossRefGoogle ScholarPubMed
Corwyn, RF (2000). The factor structure of global self-esteem among adolescents and adults. Journal of Research on Personality 34, 357–379.CrossRefGoogle Scholar
Depue, RA, Iacono, WG (1989). Neurobehavioural aspects of affective disorders. Annual Review of Psychology 40, 457–459.CrossRefGoogle ScholarPubMed
Depue, RA, Krauss, SP, Spoont, MR (1987). A two-dimensional threshold model of seasonal bipolar affective disorder. In Psychopathology: An Interactional Perspective (ed. Magnusson, D. and Ohman, A.), pp. 44–68. Academic Press: New York.Google Scholar
Dilsaver, SC, Chen, YR, Shoaib, AM, Swann, AC (1999). Phenomenology of mania: evidence for distinct depressed, dysphoric, and euphoric presentations. American Journal of Psychiatry 156, 426–430.CrossRefGoogle ScholarPubMed
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Higgins, ET, Bond, R, Klein, R, Strauman, TJ (1986). Self-discrepancies and emotional vulnerability: how magnitude, accessibility and type of discrepancy influence affect. Journal of Personality and Social Psychology 41, 1–15.Google Scholar
Johnson, SL (2005). Mania and dysregulation in goal pursuit: a review. Clinical Psychology Review 25, 241–262.CrossRefGoogle ScholarPubMed
Johnson, SL, Meyer, B, Vinett, C, Small, J (2000 a). Social support and self-esteem predict changes in bipolar depression but not mania. Journal of Affective Disorders 58, 79–86.CrossRefGoogle Scholar
Johnson, SL, Morriss, R, Scott, J, Paykel, E, Kinderman, P, Kolamunnage-Dona, R, Bentall, RP (2011). Depressive and manic symptoms are not opposite poles in bipolar disorder. Acta Psychiatrica Scandinavica 123, 206–210.CrossRefGoogle Scholar
Johnson, SL, Sandow, D, Meyer, B, Winters, R, Miller, I, Solomon, D, Keitner, G (2000 b). Increases in manic symptoms after life events involving goal attainment. Journal of Abnormal Psychology 109, 721–727.CrossRefGoogle ScholarPubMed
Jones, B, Scott, J, Haque, S, Gordon-Smith, K, Heron, J, Caesar, S, Cooper, C, Forty, L, Hyde, S, Lyon, L, Greening, J, Sham, P, Farmer, A, McGuffin, P, Jones, I, Craddock, N (2005). Cognitive style in bipolar disorder. British Journal of Psychiatry 187, 431–437.CrossRefGoogle ScholarPubMed
Keller, M, Lavori, P, Friedman, B, Nielson, E, Endicott, J, McDonald-Scott, M, Andreassen, N (1987). The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry 44, 540–548.CrossRefGoogle ScholarPubMed
Kinderman, P, Bentall, RP (1995). A new measure of causal locus: the internal, personal and situational attributions questionnaire. Personality and Individual Differences 20, 261–264.CrossRefGoogle Scholar
Knowles, R, Tai, S, Jones, SH, Highfield, J, Morriss, R, Bentall, RP (2007). Stability of self-esteem in bipolar disorder: comparison among remitted bipolar patients, remitted unipolar patients and healthy controls. Bipolar Disorders 6, 490–495.CrossRefGoogle Scholar
Licht, RW, Jensen, J (1997). Validation of the Bech-Rafaelsen Mania Scale using latent structure analysis. Acta Psychiatrica Scandinavica 96, 367–372.CrossRefGoogle ScholarPubMed
Lyon, H, Startup, M, Bentall, RP (1999). Social cognition and the manic defense. Journal of Abnormal Psychology 108, 273–282.CrossRefGoogle ScholarPubMed
Mansell, W, Morrison, AP (2007). The interpretation of, and responses to, changes in internal states: an integrative cognitive model of mood swings and bipolar disorders. Behavioural and Cognitive Psychotherapy 35, 515–539.Google Scholar
Mansell, W, Pedley, R (2008). The ascent into mania: a review of psychological processes associated with the development of manic symptoms. Clinical Psychology Review 28, 494–520.CrossRefGoogle Scholar
Nilsson, KK, Jorgensen, CR, Craig, TKJ, Straarup, KN, Licht, RW (2010). Self-esteem in remitted bipolar disorder patients: a meta-analysis. Bipolar Disorders 12, 585–592.CrossRefGoogle ScholarPubMed
Pardoen, D, Bauwens, F, Tracy, A, Martin, F, Mendlewicz, J (1993). Self-esteem in recovered bipolar and unipolar outpatients. British Journal of Psychiatry 163, 755–762.CrossRefGoogle Scholar
Peterson, C, Semmel, A, von Baeyer, C, Abramson, L, Metalsky, GI, Seligman, MEP (1982). The Attributional Style Questionnaire. Cognitive Therapy and Research 3, 287–300.CrossRefGoogle Scholar
Power, MJ, Duggan, CF, Lee, AS, Murray, RM (1995). Dysfunctional attitudes in depressed and recovered depressed patients and their first-degree relatives. Psychological Medicine 25, 87–93.CrossRefGoogle ScholarPubMed
Power, MJ, Katz, , McGuffin, P, Duggan, CF, Lam, D, Beck, AT (1994). The Dysfunctional Attitudes Scale (DAS): a comparison of forms A and B and proposal for a new sub-scaled version. Journal of Research in Personality 28, 263–276.CrossRefGoogle Scholar
Rabe-Hesketh, S, Skrondal, A (2005). Multilevel and Longitudinal Modeling Using Stata. Stata Press: College Station, TX.Google Scholar
Rehm, LP (1988). Assessment of depression. In Behavioral Assessment: A Practical Handbook (ed. Bellack, A. S. and Hersen, M.), pp. 313–364. Pergamon Press: Oxford.Google Scholar
Rosenberg, M (1965). Society and the Adolescent Self-Image. Princeton University Press: Princeton, NJ.CrossRefGoogle Scholar
Sato, T, Bottlender, R, Klenidienst, N, Moller, HJ (2005). Irritable psychomotor elation in depressed inpatients: a factor validation of mixed depression. Journal of Affective Disorders 84, 187–196.CrossRefGoogle ScholarPubMed
Scott, J, Paykel, E, Morriss, R, Bentall, R, Kinderman, P, Johnson, T, Abbott, M, Hayhurst, H (2006). Cognitive-behavioural therapy for severe and recurrent bipolar disorders. British Journal of Psychiatry 188, 313–320.CrossRefGoogle ScholarPubMed
Scott, J, Pope, M (2003). Cognitive styles in individuals with bipolar disorders. Psychological Medicine 33, 1081–1088.CrossRefGoogle ScholarPubMed
Scott, J, Stanton, B, Garland, A, Ferrier, IN (2000). Cognitive vulnerability in patients with bipolar disorder. Psychological Medicine 30, 467–472.CrossRefGoogle ScholarPubMed
Scott, L, O'Hara, MW (1993). Self-discrepancies in clinically anxious and depressed university students. Journal of Abnormal Psychology 102, 282–287.CrossRefGoogle ScholarPubMed
Staner, L, Tracy, A, Dramaix, M, Genevrois, C (1997). Clinical and psychosocial predictors of recurrence in recovered bipolar and unipolar depressives: a one-year controlled prospective study. Psychiatry Research 69, 39–51.CrossRefGoogle ScholarPubMed
Strauman, TJ (1989). Self-discrepancies in clinical depression and social phobia: cognitive structures that underlie emotional disorders? Journal of Abnormal Psychology 98, 14–22.CrossRefGoogle ScholarPubMed
Strauman, TJ, Higgins, ET (1988). Self-discrepancies as predictors of vulnerability to distinct syndromes of chronic emotional distress. Journal of Personality 56, 685–707.CrossRefGoogle ScholarPubMed
Sweeney, PD, Anderson, K, Bailey, S (1986). Attributional style in depression: a meta-analytic review. Journal of Personality Processes and Individual Differences 50, 974–991.Google ScholarPubMed
Taylor, P, Mansell, S (2008). ‘I get so energetic and dominating!’ A study of hypomanic personality and conflicting self-perception during activated states in a co-operative task. Personality and Individual Differences 45, 483–487.CrossRefGoogle Scholar
Thomas, J, Knowles, R, Tai, S, Bentall, RP (2007). Response styles in bipolar disorder. Journal of Affective Disorders 100, 249–252.CrossRefGoogle Scholar
Twisk, JWR (2006). Applied Multilevel Analysis. Cambridge University Press: New York.CrossRefGoogle Scholar
Van der Gucht, E, Morriss, R, Lancaster, G, Kinderman, P, Bentall, RP (2009). Psychological processes in bipolar affective disorder: negative cognitive style and reward processing. British Journal of Psychiatry 194, 146–151.CrossRefGoogle ScholarPubMed