Is the 4-factor model of symptomology equivalent across bipolar disorder subtypes?

O’Rourke, Norm; Sixsmith, Andrew; Michael, Tal; Bachner, Yaacov G.

doi:10.1186/s40345-021-00229-1

Cited by 4 publications

(4 citation statements)

References 35 publications

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“…The two depression and two hypo/mania factors are correlated, and affrontive symptoms of hypo/mania (eg, furious, disgusted, argumentative) are positively correlated with both depression factors suggesting pathways for mixed symptom presentation [44]. The construct validity of this four-factor model of symptomology was demonstrated across BD subtypes [45] and relative to quality of life with BD [46] (Figure 1).…”

Section: Instrumentsmentioning

confidence: 88%

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Ecological Momentary Assessment of Bipolar Disorder Symptoms and Partner Affect: Longitudinal Pilot Study

Yerushalmi¹,

Sixsmith²,

Star³

et al. 2021

JMIR Form Res

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Background The World Health Organization ranks bipolar disorder (BD) as the 7th leading cause of disability. Although the effects on those with BD are well described, less is reported on the impact of BD on cohabiting partners or any interactions between the two; this requires in vivo data collection measured each day over several months. Objective We set out to demonstrate the utility of ecological momentary assessment with BD couples measured using yoked smartphone apps. When randomly prompted over time, we assumed distinct patterns of association would emerge between BD symptoms (both depression and hypo/mania) and partner mood (positive and negative affect). Methods For this pilot study, we recruited an international sample of young and older adults with BD and their cohabiting partners where available. Both participants and partners downloaded separate apps onto their respective smartphones. Within self-specified “windows of general availability,” participants with BD were randomly prompted to briefly report symptoms of depression and hypo/mania (ie, BDSx), positive and negative mood (ie, POMS-15; partners), and any important events of the day (both). The partner app was yoked to the participant app so that the former was prompted roughly 30 minutes after the participant with BD or the next morning if outside the partner’s specified availability. Results Four couples provided 312 matched BD symptom and partner mood responses over an average of 123 days (range 65-221 days). Both were GPS- and time-stamped (mean 3:11 hrs between questionnaires, SD 4:51 hrs). Total depression had a small but significant association with positive (r=–.14; P=.02) and negative partner affect (r=.15; P=.01]. Yet total hypo/mania appeared to have no association with positive partner affect (r=–.01; P=.87); instead, negative partner affect was significantly correlated with total hypo/mania (r=.26; P=.01). However, when we look specifically at BD factors, we see that negative partner affect is associated only with affrontive symptoms of hypo/mania (r=.38; P=.01); elation or loss of insight appears unrelated to either positive (r=.10; P=.09) or negative partner affect (r=.02; P=.71). Yet affrontive symptoms of hypo/mania were significantly correlated with negative affect, but only when couples were together (r=.41; P=.01), not when apart (r=.22; P=.12). That is, these angry interpersonal symptoms of hypo/mania appear to be experienced most negatively by spouses when couples are together. Conclusions These initial findings demonstrate the utility of in vivo ambulatory data collection in longitudinal mental health research. Preliminary analyses suggest different BD symptoms are associated with negative and positive partner mood. These negative effects appear greater for hypo/mania than depressive symptoms, but proximity to the person with BD is important.

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Section: Instrumentsmentioning

confidence: 88%

“…The BDS x was developed for ecological momentary sampling of BD symptoms via smartphone app [43,44] but has also been validated for use online [45,46] and as a printed-page screening measure with BD outpatients [47,48]. In this study, α=.88 for depressive symptoms and α=.71 for the hypo/mania subscale.…”

Section: Instrumentsmentioning

confidence: 93%

Ecological Momentary Assessment of Bipolar Disorder Symptoms and Partner Affect: Longitudinal Pilot Study

Yerushalmi¹,

Sixsmith²,

Star³

et al. 2021

JMIR Form Res

Self Cite

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“…The construct validity of BDS x factors is supported in relation to quality of life with BD (O’Rourke et al., 2021 ) across BD subtypes (O’Rourke et al., 2021 ) and by responses from cohabiting partners. For instance, affrontive symptoms of hypo/mania appear to have the greatest negative impact on partners, especially when couples are physically together (i.e., same GPS coordinates; Yerushalmi et al., 2021 ).…”

Section: Methodsmentioning

confidence: 99%

Ecological momentary assessment of mood and movement with bipolar disorder over time: Participant recruitment and efficacy of study methods

O’Rourke

Sixsmith

2021

Int J Methods Psych Res

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Objectives: Mobile technology and ambulatory research tools enable the study of human experience in vivo, when and where it occurs. This includes cognitive processes that cannot be directly measured or observed (e.g., emotion) but can be reported in the moment when prompted.Methods: For the Bipolar Affective Disorder and older Adults (BADAS) Study, 50 participants were randomly prompted twice daily to complete brief smartphone questionnaires. This included the Bipolar Disorder Symptom Scale which was developed to briefly measure symptoms of both depression (cognitive and somatic) and hypo/mania (affrontive symptoms and elation/loss of insight). Participants could also submit voluntary or unsolicited app responses anytime; all were time-and GPSstamped. Herein, we describe BADAS study methods that enabled effective recruitment, adherence and retention. Results:We collected 9600 app responses over 2 year, for an average response rate of 1.4�/day. Over an average of 145 consecutive days (range 2-435 days), BADAS participants reported depression and hypo/mania symptom levels (a.m. and p.m.), sleep quality (a.m.), medication adherence (a.m.) and any significant events of the day (p.m.). They received $1/day for the first 90 days after submitting both a.m. and p.m. questionnaires. Conclusion:BADAS study methods demonstrates the utility of ecological momentary assessment in longitudinal psychiatric research.

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“…The construct validity of the BDS x is supported by quality of life with BD [ 20 ], across BD subtypes [ 32 ], and by responses from cohabiting partners [ 18 ]. For instance, affrontive symptoms of hypo/mania appear to have the greatest negative impact on partners, especially when couples are physically together (GPS coordinates) [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

Direct and Indirect Predictors of Medication Adherence With Bipolar Disorder: Path Analysis

Cohen¹,

Sixsmith²,

Star³

et al. 2023

JMIR Form Res

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Background Despite the efficacy of treatment and severity of symptoms, medication adherence by many with bipolar disorder (BD) is variable at best. This poses a significant challenge for BD care management. Objective For this study, we set out to identify psychosocial and psychiatric predictors of medication adherence with BD. Methods Using microtargeted social media advertising, we recruited an international sample of young and older adults with BD living in North America (Canada and the United States), Western Europe (eg, United Kingdom and Ireland), Australia and New Zealand (N=92). On average, participants were 55.35 (SD 9.65; range 22-73) years of age, had been diagnosed with BD 14.25 (SD 11.14; range 1-46) years ago, and were currently prescribed 2.40 (SD 1.28; range 0-6) psychotropic medications. Participants completed questionnaires online including the Morisky Medication Adherence Scale. Results Medication adherence did not significantly differ across BD subtypes, country of residence, or prescription of lithium versus other mood stabilizers (eg, anticonvulsants). Path analyses indicate that alcohol misuse and subjective or perceived cognitive failures are direct predictors of medication adherence. BD symptoms, psychological well-being, and the number of comorbid psychiatric conditions emerged as indirect predictors of medication adherence via perceived cognitive failures. Conclusions Alcohol misuse did not predict perceived cognitive failures. Nor did age predict medication adherence or cognitive failures. This is noteworthy given the 51-year age range of participants. That is, persons in their 20s with BD reported similar levels of medication adherence and perceived cognitive failures as those in their 60s. This suggests that perceived cognitive loss is a facet of adult life with BD, in contrast to the assumption that accelerated cognitive aging with BD begins in midlife.

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Is the 4-factor model of symptomology equivalent across bipolar disorder subtypes?

Cited by 4 publications

References 35 publications

Ecological Momentary Assessment of Bipolar Disorder Symptoms and Partner Affect: Longitudinal Pilot Study

Ecological Momentary Assessment of Bipolar Disorder Symptoms and Partner Affect: Longitudinal Pilot Study

Ecological momentary assessment of mood and movement with bipolar disorder over time: Participant recruitment and efficacy of study methods

Direct and Indirect Predictors of Medication Adherence With Bipolar Disorder: Path Analysis

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