Life stress and the course of early-onset bipolar disorder

University of Colorado, Boulder, CO, USA.
Journal of Affective Disorders (Impact Factor: 3.38). 05/2007; 99(1-3):37-44. DOI: 10.1016/j.jad.2006.08.022
Source: PubMed


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.

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    • "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). "
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    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 · 1.69 Impact Factor
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    • "positive versus negative life events, dependent versus independent life events) was also based on a priori categorization by the researchers (i.e. Christensen et al., 2003; Johnson et al., 2008b; Kim et al., 2007). For additional analyses of the effects of specific types of life events, life events were categorized into the above mentioned 10 life event categories. "
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    ABSTRACT: Background Life events are assumed to be triggers for new mood episodes in bipolar disorder (BD). However whether life events may also be a result of previous mood episodes is rather unclear. Method 173 bipolar outpatients (BD I and II) were assessed every three months for two years. Life events were assessed by Paykel׳s self-report questionnaire. Both monthly functional impairment due to manic or depressive symptomatology and mood symptoms were assessed. Results Negative life events were significantly associated with both subsequent severity of mania and depressive symptoms and functional impairment, whereas positive life events only preceded functional impairment due to manic symptoms and mania severity. These associations were significantly stronger in BD I patients compared to BD II patients. For the opposite temporal direction (life events as a result of mood/functional impairment), we found that mania symptoms preceded the occurrence of positive life events and depressive symptoms preceded negative life events. Limitations The use of a self-report questionnaire for the assessment of life events makes it difficult to determine whether life events are cause or consequence of mood symptoms. Second, the results can only be generalized to relatively stable bipolar outpatients, as the number of severely depressed as well as severely manic patients was low. Conclusions Life events appear to precede the occurrence of mood symptoms and functional impairment, and this association is stronger in BD I patients. Mood symptoms also precede the occurrence of life event, but no differences were found between BD I and II patients.
    Journal of Affective Disorders 06/2014; 161:55–64. DOI:10.1016/j.jad.2014.02.036 · 3.38 Impact Factor
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    • "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: "
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    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 · 3.38 Impact Factor
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