Residual symptoms and specific functional impairments in euthymic patients with bipolar disorder

Samalin, Ludovic; Chazeron, Ingrid de; Vieta, Eduard; Bellivier, Frank; Llorca, Pierre‐Michel

doi:10.1111/bdi.12376

Cited by 88 publications

(59 citation statements)

References 70 publications

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“…Bipolar disorder (BD) is a severe medical condition often associated with functional impairments even when affected individuals are euthymic [1]. Many studies report cognitive deficits in this population, most often in executive functions [2], attention [3], and verbal memory [4], which is coherent with recent meta-analyses on this topic [5, 6].…”

Section: Introductionmentioning

confidence: 71%

Cognitive-behavioral rehabilitation vs. treatment as usual for bipolar patients: study protocol for a randomized controlled trial

Gomes

Rocca

Belizário

et al. 2017

Trials

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BackgroundBipolar disorder (BD) is commonly associated with cognitive and functional impairments even during remission periods, and although a growing number of studies have demonstrated the benefits of psychotherapy as an add-on to pharmacological treatment, its effectiveness appears to be less compelling in severe presentations of the disorder. New interventions have attempted to improve cognitive functioning in BD patients, but results have been mixed.MethodsThe study consists of a clinical trial comparing a new structured group intervention, called “Cognitive-Behavioral Rehabilitation,” with treatment as usual (TAU) for bipolar patients. The new approach is a combination of cognitive behavioral strategies and cognitive remediation exercises, consisting of 12 weekly group sessions of 90 min each. To be included in the study, patients must be diagnosed with BD type I or II, aged 18–55 years, in full or partial remission, and have an IQ of at least 80. A comprehensive neuropsychological battery, followed by mood, social functioning, and quality of life assessments will occur in three moments: pre and post intervention and 12 months later. The primary outcome of the study is to compare the time, in weeks, that the first full mood episode appears in patients who participated in either group of the study. Secondary outcome will include improvement in cognitive functions.DiscussionThis is the first controlled trial assessing the validity and effectiveness of the new “Cognitive-Behavioral Rehabilitation” intervention in preventing new mood episodes and improving cognitive and functional impairments.Trial registrationClinicaltrial.gov, NCT02766361. Registered on 2 May 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1896-5) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 71%

Cognitive-behavioral rehabilitation vs. treatment as usual for bipolar patients: study protocol for a randomized controlled trial

Gomes

Rocca

Belizário

et al. 2017

Trials

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“…When compared to females, males with bipolar disorder tend to have more sexual partners and are more likely to have sexual intercourse with strangers 121 . Sexual dysfunction is a common residual symptom in euthymic patients with bipolar disorder, and has a significant negative impact on quality of life, similar to that of residual depressive symptoms and occupational stigma 122 . Moreover, impairment in desire, excitement and ability to achieve orgasm is significantly associated with suicide plans or a feeling that life is not worth living 123 .…”

Section: Bipolar Disorder and Sexual Dysfunctionmentioning

confidence: 99%

The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management

2018

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Sexual dysfunction often accompanies severe psychiatric illness and can be due to both the mental disorder itself and the use of psychotropic treatments. Many sexual symptoms resolve as the mental state improves, but treatment-related sexual adverse events tend to persist over time, and are unfortunately under-recognized by clinicians and scarcely investigated in clinical trials. Treatment-emergent sexual dysfunction adversely affects quality of life and may contribute to reduce treatment adherence. There are important differences between the various compounds in the incidence of adverse sexual effects, associated with differences in mechanisms of action. Antidepressants with a predominantly serotonergic activity, antipsychotics likely to induce hyperprolactinaemia, and mood stabilizers with hormonal effects are often linked to moderate or severe sexual dysfunction, including decreased libido, delayed orgasm, anorgasmia, and sexual arousal difficulties. Severe mental disorders can interfere with sexual function and satisfaction, while patients wish to preserve a previously satisfactory sexual activity. In many patients, a lack of intimate relationships and chronic deterioration in mental and physical health can be accompanied by either a poor sexual life or a more frequent risky sexual behaviour than in the general population. Here we describe the influence of psychosis and antipsychotic medications, of depression and antidepressant drugs, and of bipolar disorder and mood stabilizers on sexual health, and the optimal management of patients with severe psychiatric illness and sexual dysfunction.

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“…BD are disorders particularly characterized by both emotion lability and the inability to adaptively manage or regulate emotional experiences, which are further intensified by anxiety symptoms (Heissler, Kanske, Schonfelder, & Wessa, 2014). Chronic emotion dysregulation can permeate every domain of functioning for individuals struggling with BD, and is linked to impulsive, risky or self-destructive behaviors, interpersonal problems, disruptions in work productivity, and even suicidality (Kessler et al, 2006; Muhtadie, Johnson, Carver, Gotlib, & Ketter, 2014; Samalin, de Chazeron, Vieta, Bellivier, & Llorca, 2016; Swann, Lijffijt, Lane, Steinberg, & Moeller, 2009; Van Rheenen, Murray, & Rossell, 2015). BD patients report investing more time and effort in trying to regulate their emotions than healthy controls, and engage maladaptive emotion regulation strategies such as rumination and suppression more frequently (Gruber, Harvey, & Gross, 2012; Thomas, Knowles, Tai, & Bentall, 2007; Van der Gucht, Morriss, Lancaster, Kinderman, & Bentall, 2009; Van Rheenen et al, 2015; Wolkenstein, Zwick, Hautzinger, & Joormann, 2014).…”

Section: Introductionmentioning

confidence: 99%

Transdiagnostic treatment of bipolar disorder and comorbid anxiety using the Unified Protocol for Emotional Disorders: A pilot feasibility and acceptability trial

Ellard

Bernstein

Hearing

et al. 2017

Journal of Affective Disorders

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Background Comorbid anxiety in bipolar disorder (BD) is associated with greater illness severity, reduced treatment response, and greater impairment. Treating anxiety in the context of BD is crucial for improving illness course and outcomes. The current study examined the feasibility, acceptability and preliminary efficacy of the Unified Protocol (UP), a transdiagnostic cognitive behavioral therapy, as an adjunctive treatment to pharmacotherapy for BD and comorbid anxiety disorders. Methods Twenty-nine patients with BD and at least one comorbid anxiety disorder were randomized to pharmacotherapy treatment-as-usual (TAU) or TAU with 18 sessions of the UP (UP+TAU). All patients completed assessments every four weeks to track symptoms, functioning, emotion regulation and temperament. Linear mixed-model regressions were conducted to track symptom changes over time and to examine the relationship between emotion-related variables and treatment response. Results Satisfaction ratings were equivalent for both treatment groups. Patients in the UP+TAU group evidenced significantly greater reductions over time in anxiety and depression symptoms (Cohen’s d’s >.80). Baseline levels of neuroticism, perceived affective control, and emotion regulation ability predicted magnitude of symptom change for the UP+TAU group only. Greater change in perceived control of emotions and emotion regulation skills predicted greater change in anxiety related symptoms. Limitations This was a pilot feasibility and acceptability trial; results should be interpreted with caution. Conclusions Treatment with the UP+TAU was rated high in patient satisfaction, and resulted in significantly greater improvement on indices of anxiety and depression relative to TAU. This suggests that the UP may be a feasible treatment approach for BD with comorbid anxiety.

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Residual symptoms and specific functional impairments in euthymic patients with bipolar disorder

Cited by 88 publications

References 70 publications

Cognitive-behavioral rehabilitation vs. treatment as usual for bipolar patients: study protocol for a randomized controlled trial

Cognitive-behavioral rehabilitation vs. treatment as usual for bipolar patients: study protocol for a randomized controlled trial

The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management

Transdiagnostic treatment of bipolar disorder and comorbid anxiety using the Unified Protocol for Emotional Disorders: A pilot feasibility and acceptability trial

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