Expressed emotion versus relationship quality variables in the prediction of recurrence in bipolar patients
ABSTRACT The expressed emotion (EE) construct has predicted clinical outcomes in schizophrenia and depression, but few studies have been conducted with bipolar patients. Moreover, there is a particular dearth of information regarding the prediction of depressive versus manic episodes in bipolar patients. Questions also remain about the utility of EE compared to other variables (perceived criticism, relationship negativity, and chronic strain in close relationships) that more directly evaluate interpersonal stress and about specific predictions of mania or depression.
Forty-seven outpatients with bipolar I disorder participated in a 1-year longitudinal study. A close collateral of the patient completed the Five Minute Speech Sample (FMSS) to assess EE, and participants completed perceived criticism and negativity ratings of collaterals. Clinical outcomes and chronic interpersonal stress were assessed by interview at 3-month intervals.
High EE predicted depressive, but not manic recurrence. Other variables of close interpersonal relationships were not significant predictors of recurrence.
Participants nominated collaterals, and those who did not have such a confidant were excluded.
The FMSS was sensitive to even mild negativity by the collateral that predicted later depressive episodes. This is the first study to demonstrate polarity-specific effects of EE on the prediction of recurrence in bipolar disorder.
- SourceAvailable from: Rebecca Owen
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- "A prospective follow-up study of participants with a diagnosis of bipolar disorder demonstrated that a critical and hostile family atmosphere, known as high expressed emotion, significantly predicted the rate of relapse into acute mood episodes (Miklowitz et al., 1988). The presence of these family attitudes has been associated with more frequent relapses and worse symptomatic outcomes in a number of studies (Honig et al., 1997; Kim and Miklowitz, 2004; Miklowitz et al., 2000; O'Connell et al. 1991; Yan et al., 2004). Moreover, psychosocial family interventions which focused upon educating family members about bipolar disorder, facilitating better communication, and optimising problem-solving have been associated with better global functioning (Clarkin et al., 1998) in addition to fewer relapses and greater improvements in depressive symptoms (Miklowitz et al., 2000). "
ABSTRACT: The prevalence rate of completed suicide in bipolar disorder is estimated to be as high as 19%. Social factors or influences, such as stigmatisation and family conflict, contribute to the development of suicidal ideation in clinical and non-clinical populations. Yet, there is a lack of studies examining suicidality from a psychosocial perspective in people who experience bipolar disorder. Semi-structured interviews were used to collect qualitative data from 20 participants with bipolar disorder. The interview focused on the effects of social factors upon participants׳ experiences of suicidality (suicidal thoughts, feelings or behaviours). A thematic analysis was used to understand the data. Social or interpersonal factors which participants identified as protective against suicidality included, 'the impact of suicide on others' and, 'reflecting on positive social experiences'. Social factors which triggered suicidal thoughts included, 'negative social experiences' and, 'not being understood or acknowledged'. Social factors which worsened suicidal thoughts or facilitated suicidal behaviour were, 'feeling burdensome,' and 'reinforcing negative self-appraisals'. Some participants had not experienced suicidal thoughts for many years and were recalling experiences which had taken place over ten years ago. The accuracy and reliability of these memories must therefore be taken into consideration when interpreting the results. The themes help to enhance current understanding of the ways in which social factors affect suicidality in people who experience bipolar disorder. These results highlight the importance of considering the social context in which suicidality is experienced and incorporating strategies to buffer against the effects of negative social experiences in psychological interventions which target suicide risk in bipolar disorder. Copyright © 2015. Published by Elsevier B.V.Journal of Affective Disorders 02/2015; 176:133-140. DOI:10.1016/j.jad.2015.02.002 · 3.38 Impact Factor
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- "In addition, researchers have found that low social support predicts increases in both bipolar and unipolar depression (Cohen et al. 2004; Johnson et al. 1999, 2008) as does family conflict (Butzlaff and Hooley 1998; Kim and Miklowitz 2004; Yan et al. 2004). Hence, it is noted that the risk factors that predict unipolar depressive episodes are likely to predict bipolar depression as well. "
ABSTRACT: Rejection sensitivity has been found to predict the course of unipolar depression as well as key outcomes, but has not yet been considered within bipolar disorder. The present study investigated the effects of rejection sensitivity on outcome in bipolar disorder. Fifty-three participants diagnosed with bipolar I disorder in remission using the Structured Clinical Interview for DSM-IV were compared to 44 controls with no history of mood disorder. A subset of 38 bipolar participants completed follow-up interviews using standard symptom severity measures at 6 months. People with bipolar I disorder reported higher rejection sensitivity scores than did controls. Within the bipolar sample, rejection sensitivity at baseline predicted increases in depression, but not mania, over the following 6 months; heightened rejection sensitivity was also correlated with poorer quality of life, social support, and psychological well-being. Findings highlight the importance of interpersonal-cognitive factors for treating depression and improving outcome within bipolar I disorder.Cognitive Therapy and Research 12/2013; 37(6). DOI:10.1007/s10608-013-9552-1 · 1.70 Impact Factor
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- "The largely Caucasian sample further limits the generalizability of study findings to those with more diverse racial and ethnic backgrounds. The generalizability of study results to other realms of family functioning that are not assessed by the FAD (e.g., expressed emotion; Kim and Miklowitz, 2004; Yan et al., 2004) also remains unclear. Given the dates of data collection, it is important to note that mood disorder diagnoses were based on DSM-III-R criteria. "
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.Journal of Nervous & Mental Disease 04/2013; 201(5). DOI:10.1097/NMD.0b013e31828e1041 · 1.69 Impact Factor