A total of 21 recovered bipolar patients on prophylactic treatment were prospectively followed up for a period of 1 year. Data for major recurrences were retrospectively collected for an additional 3-year period. During the entire 4-year period, over half of the patients (52%) had no major affective recurrences. Eight patients experienced a major depressive episode, while only two experienced a manic one. Psychosocial and clinical variables were assessed at entry to the study. The effect of these variables on the subsequent 4-year illness course was analysed using survivorship curves. The results show that the following psychosocial variables significantly predicted the occurrence of a major affective episode: low level of social support, maladjustment in social and leisure activities, and poor quality of relationships with extended family. In contrast, clinical variables which characterize illness history were not significantly associated with major recurrences.
"In addition to these cross-sectional findings, there is evidence that impaired family functioning predicts increased rates of depressive (Yan et al., 2004) and manic (Kim and Miklowitz, 2004) episode relapse over time, even up to 6 years after an index episode (Keitner et al., 1997). Notably, previous studies have often combined patient and family member reports to create a composite of family functioning (e.g., Friedmann et al., 1997; Miller et al., 1986), whereas others have focused exclusively on patient-reported (Stefos et al., 1996) or family-reported (Kim and Miklowitz, 2004; Yan et al., 2004) functioning and their associations with mood disorder outcomes. However, in the absence of existing data on the degree of concordance between patients and their family members on measures of family functioning, it is unclear whether reports from patients and their family members necessarily reflect the same overall level of family functioning or whether combined reports somehow obscure important differences in perceptions of family functioning , should they exist. "
[Show abstract][Hide abstract] ABSTRACT: Despite the extensive literature on family functioning and mood disorders, less is known about concordance between patient- and family-reported family functioning. To address this question, adults with bipolar I disorder (BD; n = 92) or major depressive disorder (MDD; n = 121) and their family members (n = 135 and 201, respectively) were recruited from hospital sources. All patients and their family members completed the Family Assessment Device (Epstein, Baldwin, Bishop. J Marital Fam Ther. 9:171-180, 1983). Intraclass correlation coefficients revealed that, in contrast to the moderate degree of concordance in the MDD sample, degree of concordance between patient- and family-reported family functioning was significantly weaker in BD. Subsequent analysis revealed that this discordance was driven by the reports of the child and young adolescent family members of the patients with BD. Results highlight the importance of collateral reports in the assessment of family functioning, especially among families of patients with BD, in research and treatment.
"Previous studies report that social support is a good prognosis variable (O'Connell et al., 1985; Johnson et al., 1999; Gutiérrez-Rojas et al., 2008). In this case, we were not able to confirm the association of low level of social support with relapses (Cohen et al., 2004) or number of episodes (Stefos et al., 1996). "
[Show abstract][Hide abstract] ABSTRACT: We analyzed the association of previous course-of-illness and other variables of clinical interest with a high frequency of both depressive or (hypo)manic episodes controlling for the effect of socio-demographic characteristics.
A total of 108 outpatients with a DSM-IV diagnosis of bipolar disorder (BD) were recruited. A retrospective and naturalistic study was conducted to examine the number of affective episodes and their relationship with socio-demographic, clinical and course-of-illness variables, including adherence to medication, type of medication used and the use of addictive substances. The episode frequency was estimated as the number of "major instances" of depression, hypomania and mania during the illness. To classify the patients into two groups (higher and lower-episode frequency), we used the statistical criterion of median split. Results were analyzed with logistic regression models to control for the effects of potential confounders.
A high episode frequency (nine or more episodes) was associated with age (36-55years), delay in diagnosis, poor adherence to medication and current use of antipsychotic medication. In addition, a high frequency of manic episodes (four or more) was associated with female sex, age (>36years) and a manic onset of the illness, whereas a high frequency of depressive episodes (five or more) was associated with delay in diagnosis and poor adherence to medication.
Cross-sectional study design.
Avoiding delay in diagnosis and enhancing treatment adherence might be important targets for reducing recurrences in BD.
"This finding fits well with other findings on the importance of social support in bipolar disorder. The availability of social support has been associated with better adherence and response to lithium therapy (Kulhara et al., 1999; O'Connell et al., 1985), more rapid recovery from bipolar mood episodes and lowered vulnerability to depression over time (Johnson et al., 1999), and lower risk of major affective reoccurrence (Johnson et al., 2003; Stefos et al., 1996). In addition, social support may be understood as an index of general psychosocial functioning including, as our results indicate, one's ability to align with a treatment provider. "
[Show abstract][Hide abstract] ABSTRACT: The strength of the treatment alliance between patients and their clinicians may play a unique role in the management of bipolar disorder. However, few empirical studies have examined the alliance in bipolar disorder or its effects on patient outcomes. This study investigates variables associated with a strong treatment alliance in bipolar disorder, and the prospective effects of treatment alliance on patients' mood symptoms and treatment attitudes. Participants were 58 longitudinally followed individuals with Bipolar I disorder. We found that alliance ratings covaried with depressive symptoms, such that alliance strength increased as depressive symptoms decreased, and stronger alliances were associated with more social support. Tests of temporal association indicated that stronger alliances predicted fewer manic symptoms 6 months later. Stronger alliances also predicted less negative attitudes about medication and less of a sense of stigma about bipolar disorder. Thus, a strong treatment alliance may help to reduce manic symptoms over time. It may be that a strong treatment alliance encourages patients' greater acceptance of bipolar disorder and psychopharmacological interventions, and thus contributes to improved medication adherence and clinical outcomes. Considered in sum, these findings suggest that the treatment alliance is an integral component of the long-term management of bipolar disorder.
Psychiatry Research 01/2007; 145(2-3):215-23. DOI:10.1016/j.psychres.2006.01.007 · 2.47 Impact Factor
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