Functional Impairment, Stress, and Psychosocial Intervention in Bipolar Disorder

Miklowitz, David J.

doi:10.1007/s11920-011-0227-x

Cited by 45 publications

(23 citation statements)

References 77 publications

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“…However, such conclusions cannot be defin itively made without further longitudinal research. Most plausibly, there is a reciprocal mutually influential association between fam ily factors and the emergence in psychopathology in all family members over time (Miklowitz, 2011).…”

Section: Discussionmentioning

confidence: 99%

Family functioning in the context of parental bipolar disorder: Associations with offspring age, sex, and psychopathology.

Freed¹,

Tompson²,

Wang

et al. 2015

Journal of Family Psychology

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Previous research has shown that families with a parent who has bipolar disorder (BD) may experience family functioning difficulties. However, the association between family functioning and psychopathology among offspring of parents with BD, and offspring characteristics that may moderate this association, remains poorly understood. This study examined the cross-sectional associations between family functioning (cohesion, expressiveness, and conflict) and psychopathology in 117 offspring (ages 5-18) of 75 parents with BD. We also examined whether age and sex differences moderated these associations. We measured offspring psychopathology by examining current dimensional symptoms and DSM-IV emotional and behavioral disorders. Correlational analyses indicated that higher family conflict and lower cohesion were associated with higher internalizing and externalizing symptoms in offspring. Lower family cohesion was also associated with current offspring mood disorders. Moderation analyses indicated, first, that the link between lower family cohesion and internalizing symptoms was stronger for younger offspring compared to older offspring. Second, higher family conflict and current mood disorder were associated in younger males but not in older males or in females. Results remained the same after controlling for parental anxiety or substance use disorder comorbidity. Our study highlights the importance of accounting for family functioning when working with offspring at risk for BD, while also recognizing that the connections between family functioning and offspring outcomes are complex and differ based on offspring sex and developmental stage.

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Section: Discussionmentioning

confidence: 99%

Family functioning in the context of parental bipolar disorder: Associations with offspring age, sex, and psychopathology.

Freed¹,

Tompson²,

Wang

et al. 2015

Journal of Family Psychology

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“…Stress can both facilitate the onset as well as exacerbate the symptoms of a variety of disorders, such as depression, anxiety, and post-traumatic stress disorder (PTSD) (1, 2). Yet, the majority of individuals exposed to stressful life events exhibit normal resilience and recover from the stressful events without developing a psychiatric disorder.…”

Section: Introductionmentioning

confidence: 99%

Hippocampal gene expression changes underlying stress sensitization and recovery

et al. 2013

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Chronic and acute stressors have been linked to changes in hippocampal function and anxiety-like behaviors. Both produce changes in gene expression, but the extent to which these changes endure beyond the end of stress remains poorly understood. As an essential first step to characterize abnormal patterns of gene expression after stress, this study demonstrates how chronic restraint stress (CRS) modulates gene expression in response to a novel stressor in the hippocampus of wild type mice and the extent to which these changes last beyond the end of CRS. Male C57/bl6 mice were subjected to 1) a forced swim test (FST), 2) Corticosterone (Cort) or vehicle injections, 3) CRS for 21 days and then a FST, or 4) allowed to recover 21 days after CRS and subjected to FST. Hippocampal mRNA was extracted and used to generate cDNA libraries for microarray hybridization. Naïve acute stressors (FST and vehicle injection) altered similar sets of genes, but Cort treatment produced a profile that was distinct from both FST and vehicle. Exposure to a novel stress after CRS activated substantially more and different genes than naïve exposure. Most genes increased by CRS were decreased after recovery, but many remained altered and did not return to baseline. Pathway analysis identified significant clusters of differentially expressed genes across conditions, most notably the NfKB pathway. Quantitative RT-PCR validated changes from the microarrays in known stress-induced genes and confirmed alterations in the NfKb pathway genes, Ikbα, RelA and Nfkb1. FST increased anxiety-like behavior in both the naïve and recovery from CRS conditions, but not in mice 24hrs subsequent to their CRS exposure. These findings suggest the effects of naïve stress are distinct from Cort elevation and that a history of stress exposure can permanently alter gene expression patterns in the hippocampus and the behavioral response to a novel stressor. These findings establish a baseline profile of normal recovery and adaptation to stress. Importantly, they will serve as a conceptual basis to facilitate the future study of the cellular and regional basis of gene expression changes as well as genetic risk factors and adverse early life experiences that lead to impaired recovery from stress such as occurs in mood and anxiety disorders.

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“…In largely separate literatures, both disorders have been associated with impaired occupational functioning (Ansell, Sanislow, McGlashan, & Grilo, 2007;Kessler et al, 2006;Morgan, Mitchell, & Jablensky, 2005;Skodol et al, 2002;Zanarini, Jacoby, Frankenburg, Reich, & Fitzmaurice, 2009;Zimmerman et al, 2010), impaired social functioning (Grant et al, 2008;Gunderson et al, 2011;Jeung & Herpertz, 2014;Jovev & Jackson, 2006;Judd et al, 2008;Lazarus, Cheavens, Festa, & Zachary Rosenthal, 2014;Miklowitz, 2011), substance use problems (Di Florio, Craddock, & van den Bree, 2014;Farren, Hill, & Weiss, 2012;Goldberg, 2001;Grant et al, 2008;Oquendo et al, 2010;Trull, Sher, Minks-Brown, Durbin, & Burr, 2000), high rates of suicide (F. Angst, Stassen, Clayton, & Angst, 2002;Baldessarini, Pompili, & Tondo, 2006;Isometsa, Henriksson, Aro, & Lonnqvist, 1994;McIntyre et al, 2008;Oquendo et al, 2010;Pompili, Girardi, Ruberto, & Tatarelli, 2005) and suicide attempts (Baldessarini et al, 2006;McIntyre et al, 2008;Oquendo et al, 2010;, and high health care utilization and costs (Bender et al, 2001;Dilsaver, 2011;Kessler et al, 2006;Kleine-Budde et al, 2014;Morgan et al, 2005;…”

Section: Mark Zimmerman MDmentioning

confidence: 99%

Improving the Recognition of Borderline Personality Disorder in a Bipolar World

Zimmerman

2016

Journal of Personality Disorders

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Both bipolar disorder and borderline personality disorder (BPD) are serious mental health disorders resulting in significant psychosocial morbidity, reduced health-related quality of life, and excess mortality. Yet research on BPD has received much less funding from the National Institute of Health (NIH) than has bipolar disorder during the past 25 years. Why hasn't the level of NIH research funding for BPD been commensurate with the level of psychosocial morbidity, mortality, and health expenditures associated with the disorder? In the present article, the author illustrates how the bipolar disorder research community has done a superior job of "marketing" their disorder. Studies of underdiagnosis, screening, diagnostic spectra, and economics are reviewed for both bipolar disorder and BPD. Researchers of bipolar disorder have conducted multiple studies highlighting the problem with underdiagnosis, developed and promoted several screening scales, published numerous studies of the operating characteristics of these screening measures, attempted to broaden the definition of bipolar disorder by advancing the concept of the bipolar spectrum, and repeatedly demonstrated the economic costs and public health significance of bipolar disorder. In contrast, researchers of BPD have almost completely ignored each of these four issues and research efforts. Although BPD is as frequent as (if not more frequent than) bipolar disorder, as impairing as (if not more impairing than) bipolar disorder, and as lethal as (if not more lethal than) bipolar disorder, it has received less than one-tenth the level of funding from the NIH and has been the focus of many fewer publications in the most prestigious psychiatric journals. The researchers of BPD should consider adopting the strategy taken by researchers of bipolar disorder before the diagnosis is eliminated in a future iteration of the DSM or the ICD.

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Functional Impairment, Stress, and Psychosocial Intervention in Bipolar Disorder

Cited by 45 publications

References 77 publications

Family functioning in the context of parental bipolar disorder: Associations with offspring age, sex, and psychopathology.

Family functioning in the context of parental bipolar disorder: Associations with offspring age, sex, and psychopathology.

Hippocampal gene expression changes underlying stress sensitization and recovery

Improving the Recognition of Borderline Personality Disorder in a Bipolar World

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