Article

Life stress and the course of early-onset bipolar disorder

University of Colorado, Boulder, CO, USA.
Journal of Affective Disorders (Impact Factor: 3.71). 05/2007; 99(1-3):37-44. DOI: 10.1016/j.jad.2006.08.022
Source: PubMed

ABSTRACT Studies of adult bipolar patients and adolescents with major depression indicate that life stress and mood symptoms are temporally and causally related to one another. This study examined whether levels of life stress predict levels of mood symptoms among bipolar adolescents participating in a treatment development study of family-focused psychoeducation and pharmacotherapy.
Bipolar adolescents (n=38) who reported a period of acute mood symptoms within the prior 3 months were recruited for a 1-year study of life stress. Clinician-administered evaluations were completed with adolescents and parents at 3-month intervals for up to 12 months, using the UCLA Life Stress Interview and the K-SADS Mania and Depression Rating Scales.
Chronic stress in family, romantic and peer relationships was associated with less improvement in mood symptoms over the study year. The frequency of severe, independent life events also predicted less improvement in mood symptoms. Higher levels of chronic stress in family and romantic relationships, and higher severity of independent events, were more strongly associated with mood symptoms among older adolescents. Results were independent of adolescents' psychosocial treatment regimens.
The majority of adolescents received family-focused psychoeducational treatment and all were being treated with psychotropic medication. The influence of life stress on mood symptoms may have been attenuated by intensive intervention.
Stress is linked to changes in mood symptoms among bipolar adolescents, although correlations between life events and symptoms vary with age. Chronic stress in family, romantic, and peer relationships are important targets for psychosocial intervention.

0 Followers
 · 
108 Views
 · 
0 Downloads
  • Source
    • "The reverse association, that mood predicts psychosocial outcomes, has also been found (Goldberg and Harrow, 2005). In BP youth, low maternal warmth and stress in family and romantic relationships are associated with faster relapse and longer time to symptom improvement (Geller et al., 2002, Geller et al., 2004, Kim et al., 2007). In BP adolescents, changes in family conflict and cohesion predict changes in mood symptoms over time (Sullivan et al., 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study examined the longitudinal association between mood episode severity and relationships in youth with bipolar (BP) disorder. Participants were 413 Course and Outcome of Bipolar Youth study youth, aged 12.6 ± 3.3 years. Monthly ratings of relationships (parents, siblings, and friends) and mood episode severity were assessed by the Adolescent Longitudinal Interval Follow-up Evaluation Psychosocial Functioning Schedule and Psychiatric Rating Scales, on average, every 8.2 months over 5.1 years. Correlations examined whether participants with increased episode severity also reported poorer relationships and whether fluctuations in episode severity predicted fluctuations in relationships, and vice versa. Results indicated that participants with greater mood episode severity also had worse relationships. Longitudinally, participants had largely stable relationships. To the extent that there were associations, changes in parental relationships may precede changes in episode severity, although the magnitude of this finding was small. Findings have implications for relationship interventions in BP youth.
    Journal of Nervous & Mental Disease 02/2015; 203(3). DOI:10.1097/NMD.0000000000000261 · 1.81 Impact Factor
  • Source
    • "Towards that end, family functioning is a particularly salient domain to examine in children and adolescents with psychopathology , particularly those with BD and ADHD. Studies have shown that children with BD have impairments in several familyrelated dimensions, including general family functioning, maternal warmth, expressed emotion, conflict, and family stress (Algorta et al., 2011; Belardinelli et al., 2008; Esposito-Smythers et al., 2006; Keenan et al., 2011; Kim et al., 2007; Miklowitz and Johnson, 2009; Sullivan and Miklowitz, 2010; Townsend et al., 2007). However, it is difficult to determine if family dysfunction is a trait characteristic of pediatric BD, or if it is state-dependent, corresponding to mood status (e.g., mania, depression, or euthymia) or Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jad "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Rates of diagnosis and treatment for bipolar disorder (BD) in youth continue torise. Researchers and clinicians experience difficulty differentiating between BD in youth andother conditions that are commonly comorbid or share similar clinical features with BD,especially attention-deficit/hyperactivity disorder (ADHD). Comparative studies of thephenomenology and psychosocial correlates of these conditions help to address this. Familyfunctioning is an important topic for both BD and ADHD since both are associated withnumerous family-related deficits. One previous study suggested that manic/hypomanic youths'family functioning differed from ADHD and typically developing control (TDC) groups.However, many family functioning studies with BD and ADHD youth have methodologicallimitations or fail to use comprehensive, validated measures. Methods: This investigation usedadolescent report on the Family Assessment Device (FAD), based on the McMaster Model offamily functioning. Youth were recruited in BD (n=30), ADHD (n=36), and TDC (n=41)groups. Results: Groups were similar on most demographic variables, but The TDC groupscored somewhat higher than the others on IQ and socioeconomic status. FAD results indicatedthat BD and ADHD groups scored worse than TDC on the General Functioning and Roles scalesof the FAD. In addition, the BD group showed impairment on the Problem Solving scale relativeto TDC. Limitations: sample size, lack of parent report, ADHD comorbidity in BD group.Conclusions: Family functioning deficits distinguish both clinical groups from TDC, andproblem-solving dysfunction may be specific to BD. These findings may apply to treatmentmodels for both conditions.
    Journal of Affective Disorders 05/2013; 150(3). DOI:10.1016/j.jad.2013.04.027 · 3.71 Impact Factor
  • Source
    • "There is evidence in unipolar depression that stressors predict both poorer clinical outcomes as well as greater social dysfunction over time (e.g., Cronkite et al., 1998). In the bipolar literature, several studies have examined the role of stressful life events and circumstances in bipolar episode recurrence (e.g., Cohen et al., 2004; Kim et al., 2007; Hammen and Gitlin, 1997; Swendsen et al., 1995; see Johnson and Roberts, 1995, for a review). Further, Johnson and Miller (1997) found that bipolar patients who experienced a recent major life event took more than 3 times longer to recover clinically from an episode than those who did not experience major events. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Identifying predictors of functional recovery in bipolar disorder is critical to treatment efforts to help patients re-establish premorbid levels of role adjustment following an acute manic episode. The current study examined the role of stressful life events as potential obstacles to recovery of functioning in various roles. 65 patients with bipolar I disorder participated in a longitudinal study of functional recovery following clinical recovery from a manic episode. Stressful life events were assessed as predictors of concurrent vs. delayed recovery of role functioning in 4 domains (friends, family, home duties, work/school). Despite clinical recovery, a subset of patients experienced delayed functional recovery in various role domains. Moreover, delayed functional recovery was significantly associated with presence of one or more stressors in the prior 3 months, even after controlling for mood symptoms. Presence of a stressor predicted longer time to functional recovery in life domains, up to 112 days in work/school. Interventions that provide monitoring, support, and problem-solving may be needed to help prevent or mitigate the effects of stress on functional recovery.
    Psychiatry Research 09/2010; 186(2-3):267-71. DOI:10.1016/j.psychres.2010.08.028 · 2.68 Impact Factor
Show more

Preview

Download
0 Downloads
Available from