Emotion regulation and residual depression predict psychosocial functioning in bipolar disorder: Preliminary study

This study explores the predictive value of various clinical, neuropsychological, functional, and emotion regulation processes for recovery in Bipolar Disorder. Clinical and demographic information was collected for 27 euthymic or residually depressed BD participants. Seventy one percent of the sample reported some degree of impairment in psychosocial functioning. Both residual depression and problems with emotion regulation were identified as significant predictors of poor psychosocial functioning. In addition, to residual depression, the results of the current study introduce a variable of emotion dysregulation to account for poor psychosocial functioning among BD populations. Improving emotion regulation strategies, in particular, concentration and task accomplishment during negative emotional states could have important consequences for improving overall psychosocial functioning among this population, helping to reduce both the economic burden and high costs to personal wellbeing associated with B

Emotion regulation in bipolar disorder: Are emotion regulation abilities less compromised in euthymic bipolar disorder than unipolar depressive or anxiety disorders?

This study investigated the profile of emotion dysregulation in Bipolar Disorder (BD) and com- pared it to Unipolar Depression, Anxiety, and Heal- thy control groups. Methods: 148 euthymic patients diagnosed with BD (n = 48), Unipolar Depressive dis- order (n = 50), Anxiety disorder (n = 50), and a Healthy Control (HC) group (n = 48) were evaluated using the Difficulties in Emotion Regulation Scale (DERS). The DERS yields a total score in addition to scores on six subcomponents believed to encapsulate the emotion dysregulation construct. Results: Com- pared to the healthy control group, all clinical groups (BD, Unipolar Depression, and Anxiety) reported significantly greater overall difficulties in emotion re- gulation (Total DERS) and difficulties specific to the DERS subcomponent measures: Goals, Impulse, and Strategies. The profile of emotion dysregulation was virtually identical for the Unipolar Depression and Anxiety groups, with BD demonstrating emotion regulation difficulties intermediate between controls and the two clinical groups. Specifically, emotion re- gulation in the BD group was significantly less com-promised in the domains of acceptance of emotions, emotional awareness, and emotional clarity com- pared to the depression and anxiety groups. Conclu- sions: Emotion regulation abilities among people with euthymic BD were significantly less compromised than Unipolar Depression and Anxiety groups with regards to emotional awareness, acceptance of emo- tions, and understanding of emotions. However, emo- tion regulation abilities pertaining to engagement in goal directed behaviour, impulse control, and access to emotion regulation strategies were similarly com- promised across all three clinical groups. This profile might help enrich extant adjunct psychological in- terventions for BD by enlisting emotion regulation strategies with the aim of decreasing the relapse rate that characterises BD

Revising Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for the bipolar disorders: Phase I of the AREDOC project

Objective: To derive new criteria sets for defining manic and hypomanic episodes (and thus for defining the bipolar I and II disorders), an international Task Force was assembled and termed AREDOC reflecting its role of Assessment, Revision and Evaluation of DSM and other Operational Criteria. This paper reports on the first phase of its deliberations and interim criteria recommendations. Method: The first stage of the process consisted of reviewing Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and recent International Classification of Diseases criteria, identifying their limitations and generating modified criteria sets for further in-depth consideration. Task Force members responded to recommendations for modifying criteria and from these the most problematic issues were identified. Results: Principal issues focussed on by Task Force members were how best to differentiate mania and hypomania, how to judge ‘impairment’ (both in and of itself and allowing that functioning may sometimes improve during hypomanic episodes) and concern that rejecting some criteria (e.g. an imposed duration period) might risk false-positive diagnoses of the bipolar disorders. Conclusion: This first-stage report summarises the clinical opinions of international experts in the diagnosis and management of the bipolar disorders, allowing readers to contemplate diagnostic parameters that may influence their clinical decisions. The findings meaningfully inform subsequent Task Force stages (involving a further commentary stage followed by an empirical study) that are expected to generate improved symptom criteria for diagnosing the bipolar I and II disorders with greater precision and to clarify whether they differ dimensionally or categorically

Risk assessment and management in bipolar disorders

Bipolar affective disorders carry significant risks to the patient and sometimes others. The form of the illness relapse needs to be determined, and high-risk features such as psychosis and suicide considered. Gathering collateral information from others is invaluable. Mania brings particular risks of disinhibition, poor judgement, risk taking and sometimes aggression. Depression carries notable risks of suicidal behaviour, poor self-care and homicide. Both mania and depression bring risks of substance misuse and disrupted relationships. Management requires an optimal therapeutic alliance with good communication, appropriate treatment and sometimes compulsory care during crises. Preventive strategies are invaluable

Highs and lows of bipolar disorder: Modern treatments

This article provides a brief overview and treatment update on bipolar disorder for the General Paractitioner. We commence with an outline of the bipolar concept, review clinical features and diagnostic issues and address differential diagnosis and co-morbidities. We then turn to psychological and pharmacological aspects of treatment

The Manic Depressiveness Scale: A preliminary effort at replication and extension

Michael A. Thalbourne and Darryl L. Basset

Emotion regulation in bipolar disorder: Self-report profiles and effects of psychotropic medication

Objective: given the importance of emotion regulation (ER) in the aetiology and/or maintenance of psychopathology, we investigated subjective reports of ER in a group of bipolar individuals and compared the results to a group of depressed and healthy control participants. Additionally, we explored the impact of psychotropic medication on ER. Method: 24 participants diagnosed with bipolar disorder (BD), 38 participants diagnosed with major depression (mD), and 38 healthy controls (hc), were administered a multifaceted measure of ER. We also explored the impact antidepressants on ER and explored whether the amount of psychotropic medication had a differential effect on ER. Results: BD and MD participants scored significantly higher than the HC groups on the overall DERS, suggesting, predictably, that the diagnostic groups had more difficulties regulating their emotions. Additionally, comparing MD and HC groups, participants with depression showed difficulties with acceptance, engaging with goal-directed behaviour, impulsivity, and access to effective strategies. In contrast, BD participants showed selective difficulties with accessing emotion regulation strategies as compared to HC group. The exploratory part of the study failed to find a positive effect of antidepressants on ER or any impact of the amount of psychotropic medications on ER. Conclusions: Difficulties in regulating emotions differentiate between healthy controls and diagnostic groups. Furthermore, BD participants showed less difficulties regulating emotions than MD but still more difficulties than HC. Assessment of these differences appears possible if a multifaceted measure of ER is utilised. Additionally, our results showed that antidepressants did not improve ER and that the overall amount of medication was not associated with ER. Although robust conclusions regarding medications and ER are not possible in this exploratory part of our study, it appears that the precise effect of psychotropic, including antidepressants, is an area in need of further research

Emotion regulation and residual depression predict psychosocial functioning in bipolar disorder: Preliminary study

This study explores the predictive value of various clinical, neuropsychological, functional, and emotion regulation processes for recovery in Bipolar Disorder. Clinical and demographic information was collected for 27 euthymic or residually depressed BD participants. Seventy one percent of the sample reported some degree of impairment in psychosocial functioning. Both residual depression and problems with emotion regulation were identified as significant predictors of poor psychosocial functioning. In addition, to residual depression, the results of the current study introduce a variable of emotion dysregulation to account for poor psychosocial functioning among BD populations. Improving emotion regulation strategies, in particular, concentration and task accomplishment during negative emotional states could have important consequences for improving overall psychosocial functioning among this population, helping to reduce both the economic burden and high costs to personal wellbeing associated with BD

Emotion regulation in bipolar disorder: are emotion regulation abilities less compromised in euthymic bipolar disorder than unipolar depressive or anxiety disorders?

Objective: This study investigated the profile of emotion dysregulation in Bipolar Disorder (BD) and compared it to Unipolar Depression, Anxiety, and Healthy control groups. Methods: 148 euthymic patients diagnosed with BD (n = 48), Unipolar Depressive disorder (n = 50), Anxiety disorder (n = 50), and a Healthy Control (HC) group (n = 48) were evaluated using the Difficulties in Emotion Regulation Scale (DERS). The DERS yields a total score in addition to scores on six subcomponents believed to encapsulate the emotion dysregulation construct. Results: Compared to the healthy control group, all clinical groups (BD, Unipolar Depression, and Anxiety) reported significantly greater overall difficulties in emotion regulation (Total DERS) and difficulties specific to the DERS subcomponent measures: Goals, Impulse, and Strategies. The profile of emotion dysregulation was virtually identical for the Unipolar Depression and Anxiety groups, with BD demonstrating emotion regulation difficulties intermediate between controls and the two clinical groups. Specifically, emotion regulation in the BD group was significantly less compromised in the domains of acceptance of emotions, emotional awareness, and emotional clarity compared to the depression and anxiety groups. Conclusions: Emotion regulation abilities among people with euthymic BD were significantly less compromised than Unipolar Depression and Anxiety groups with regards to emotional awareness, acceptance of emotions, and understanding of emotions. However, emotion regulation abilities pertaining to engagement in goal directed behaviour, impulse control, and access to emotion regulation strategies were similarly compromised across all three clinical groups. This profile might help enrich extant adjunct psychological interventions for BD by enlisting emotion regulation strategies with the aim of decreasing the relapse rate that characterises BD