Dysfunctional attitudes in seasonal affective disorder

Research examining dysfunctional attitudes in Seasonal Affective Disorder (SAD) has produced contrasting results. The present study sought to resolve this contradiction by addressing some methodological problems of the previous studies. The study examined dysfunctional attitudes using the Dysfunctional Attitudes Scale (DAS) in individuals with SAD and never-depressed controls. The SAD group were tested both when depressed in the winter (Time 1) and during their remission period (Time 2). At Time 1 the SAD group displayed a relatively elevated DAS compared to controls and to their Time 2 scores. These data therefore provide potential support for a view that SAD is characterized by underlying dysfunctional attitudes.     

Diagnostic accuracy of the Millon test computer reports for bipolar affective disorder

The diagnostic accuracy of the Millon Clinical Multiaxial Inventory (MCMI) computer reports was assessed for the sample of 48 patients reliably identified as having bipolar affective disorder. Only 13 of the 48 reports were accurate in classifying the patients as having bipolar affective disorder, and this was significantly (p < .01) less than 50% of the cases. The diagnostic accuracy clearly left much to be desired. Additional research is needed to assess the validity of MCMI diagnostic suggestions for other patient groups.     

Studies of anticipation in bipolar affective disorder

Anticipation refers to the increase in disease severity or decrease in age of onset in successive generations. The concept evolved from the theories and dogma of degeneration that were pervasive in psychiatry and medicine in the late 19th century and into the early 20th century. The term was set aside with the criticism of geneticist Lionel Penrose, who argued that anticipation was the result of ascertainment biases. The renewed interest in anticipation followed the identification of its molecular genetic basis in the form of unstable trinucleotide repeats. Subsequently, several diseases have been studied clinically for the presence of anticipation. Although anticipation has been identified in many diseases, including bipolar disorder, only diseases showing a pattern of progressive neurodegeneration have been associated with unstable trinucleotide repeats. This review summarizes the research on anticipation in bipolar disorder and other secular trends in the patterns of the illness such as the cohort effect. The changing nature of bipolar disorder is likely to be a result of combined influences from several genes, some of which are likely to be in a state of flux, as well as environmental or cultural forces that converge to give the clinical picture of anticipation.     

Interactional patterns of bipolar patients and their spouses

This study examined the interactional patterns of eight bipolar patients (when manic and in remission) and their spouses by videotaping the couples' interactions and then quantifying those interactions using the Marital Interaction Coding system. These couples' interactions were compared to the interactions of eight happily and eight unhappily married nonbipolar psychiatric control patients and their spouses. The purposes were to determine (a) whether the interactional pattern between bipolar patients and their spouses changes or remains the same when the patient is in a manic vs. a nonmanic state and (b) how the interaction patterns of bipolar patients when manic and nonmanic compare to happily and unhappily married nonbipolar psychiatriccontrol patients. Significant differences in interactions were found between manic and nonmanic states, in addition to significant differences between these patients and the control groups. There were also expected differences between happily and unhappily married psychiatric control groups. Implications are discussed for marital therapy for manies that involves problemsolving and communication training.     

Validation of the Norwegian version of the Social Functioning Scale (SFS) for schizophrenia and bipolar disorder

Hellvin, T., Sundet, K.,Vaskinn, A., Simonsen, C.,Ueland, T., Andreassen, O.A. & Melle, I. (2010). Validation of the Norwegian version of the Social Functioning Scale (SFS) for schizophrenia and bipolar disorder. Scandinavian Journal of Psychology 51, 525–533. Studies of social functioning in severe mental disorders are disadvantaged by the multitude of different assessment instruments in use. The present study aims to establish reliability and validity of the Norwegian version of the Social Functioning Scale (SFS) and to examine social functioning in bipolar disorder (BD) compared to schizophrenia (SZ) and healthy controls (HC). SFS, a 76 item questionnaire divided into seven subscales measuring various aspects of daily life functioning, was administered to samples diagnosed with BD (n = 100) or SZ (n = 100) and to HC (n = 100), recruited from the ongoing Tematic Organized Psychosis (TOP) study. Reliability analyses prove adequate psychometric properties both for the composite full scale score (α: 0.81) as well as for the seven subscale scores (α: 0.60–0.88). Principal component analysis of the subscales confirms a one‐component structure, explaining 59% of the variance. Although significantly correlated with the Global Assessment of Functioning, our results indicate that the SFS measures different aspects of social functioning, is less influenced by demographic and clinical characteristics, but differentiates at the same time significantly BD from SZ. Thus, SFS adds valuable information as a supplement to standard clinician‐rated assessment tools of social functioning, suited both for research and clinical work.     

Social support and the course of bipolar disorder

The current study prospectively examined the impact of social support on symptom severity and recovery from episodes in bipolar disorder, both as a direct influence and as a buffer of life events. Fifty-nine individuals with Bipolar I disorder were followed longitudinally with monthly symptom severity interviews. Social support was measured by the Interpersonal Support Evaluation List and the Interview Schedule for Social Interaction, and life events were assessed using the Life Events and Difficulties Schedule. Individuals with low social support took longer to recover from episodes and were more symptomatic across a 6-month follow-up. Results suggest a polarity-specific effect, in that social support influences depression but not mania. Discussion focuses on theoretical implications of a series of polarity-specific findings within the field.     

Social support,coping, and psychological adjustment among caregivers of head-injured patients

Abstract

The purpose of this study was to test a mediational model of risk and protective factors associated with the psychological adjustment of caregivers of head-injured patients. Forty-three caregivers of patients who had suffered a head injury participated in the study. Findings strongly supported hypotheses. Caregiver burden was associated with poorer psychological adjustment. Social support and a higher percentage of approach coping strategies relative to overall coping strategies were associated with better psychological adjustment. As predicted, caregiver burden showed a direct relationship to psychological adjustment, while social support showed an indirect relationship to adjustment mediated by percentage approach coping.     

Social cognition and the manic defense: attributions, selective attention, and self-schema in bipolar affective disorder.

Manic patients, depressed bipolar patients, and normal controls were compared on measures of social cognition. Manic patients showed a normal self-serving bias on the Attributional Style Questionnaire, but depressed patients attributed negative events more than positive events to self. On an implicit test of attributional style, both patient groups attributed negative events more than positive events to self. Both patient groups showed slowed color naming for depression-related but not euphoria-related words. Manic patients, like normal controls, endorsed mainly positive words as true of self but, like the depressed patients, recalled mainly negative words. Findings from the implicit tests indicate a common form of psychological organization in manic and depressed patients, whereas the contrasts between the scores on the implicit and explicit measures are consistent with the hypothesis of a manic defense.     

Social skills in women with Turner Syndrome

The aim of this study was to evaluate the performance of a group of women with Turner Syndrome (TS) in interpersonal situations where several social skills were required, and to compare the results with unaffected sisters. Fifty-two TS females aged 15-35 years and 33 sisters aged 16-43 were evaluated using Del-Prette Social Skills Inventory (SSI) and individual interviews. Thirty mothers to subjects and sisters answered questionnaires. It was found that TS girls' performance in SSI was as good as their sisters' and even better in meeting new people and facing unknown situations (p = 0.020). Older TS women scored better than younger ones, differently from their sisters. There were no significant correlations between total score of TS women and their age at diagnosis, time of follow-up and height z-score. Mothers reported having more problems with TS girls than with sisters. Although TS girls demonstrated having social difficulties, just a few of them spontaneously complained about interpersonal problems in the interview. Results suggest that social difficulties may not cause TS girls major problems nor make them unhappy with their social lives, and/or TS girls may not be able to perceive their own difficulties. Good performance in SSI also suggests that TS girls can identify adequate skills in presented situations and answer in a way to obtain good scores, but they may not necessarily use their skills due to other factors like anxiety and shyness. They may also have a tendency to answer SSI in a way they consider socially desirable, masking their real difficulties.     

Social anxiety in body dysmorphic disorder

Although clinical impressions suggest that patients with body dysmorphic disorder (BDD) experience distress in social situations, social anxiety in BDD has received little investigation. This study examined social anxiety in 81 patients with BDD and change in social anxiety with pharmacotherapy. Subjects completed the Social Avoidance and Distress Scale (SADS) and were assessed with measures of BDD symptomatology. Participants in a placebo-controlled fluoxetine trial completed measures at baseline and endpoint. The mean SADS score was 1.3 SD units higher than nonclinical sample means but consistent with other clinical sample means. Social anxiety was significantly correlated with BDD severity. Greater depressive symptoms as well as comorbid avoidant personality disorder, but not comorbid social phobia, were also associated with higher SADS scores. Social anxiety did not improve more with fluoxetine than placebo, yet it improved significantly more in fluoxetine responders than in nonresponders. Understanding social anxiety in BDD has implications for reducing rates of misdiagnosis and treatment dropout.     

Patients with bipolar disorder show a selective deficit in the episodic simulation of future events

A substantial body of evidence suggests that autobiographical recollection and simulation of future happenings activate a shared neural network. Many of the neural regions implicated in this network are affected in patients with bipolar disorder (BD), showing altered metabolic functioning and/or structural volume abnormalities. Studies of autobiographical recall in BD reveal overgeneralization, where autobiographical memory comprises primarily factual or repeated information as opposed to details specific in time and in place and definitive of re-experiencing. To date, no study has examined whether these deficits extend to future event simulation. We examined the ability of patients with BD and controls to imagine positive, negative and neutral future events using a modified version of the Autobiographical Interview (Levine, Svoboda, Hay, Winocur, & Moscovitch, 2002) that allowed for separation of episodic and non-episodic details. Patients were selectively impaired in imagining future positive, negative, and neutral episodic details; simulation of non-episodic details was equivalent across groups.     

Group therapy as an adjunct to medication in the management of bipolar affective disorder

This paper asserts that, contrary to the beliefs of many clinicians, patients with bipolar affective disorder often experience a deteriorating course characterized by pervasive social dysfunction. It reviews the literature, identifying a rationale for group psychotherapy as an adjunct to medication in the management of these chronic patients. It outlines a theoretical approach to bipolar group therapy, and presents a retrospective study comparing the course of 43 lithium-treated bipolar patients before and after entering bipolar groups. During the year in group therapy, bipolar patients displayed significant improvements in symptom relief as well as social functioning. It is proposed that group process enhances treatment with medication, providing benefits not evident with medication alone.     

Religion and spirituality in the context of bipolar disorder: a literature review

Religion and spirituality (R/S) may play an important role for individuals with bipolar disorder (BD) by providing a means of coping with, and an explanatory model for, their disorder. We conducted a systematic review of empirical studies that have explored R/S in individuals with BD or samples that explicitly delineate individuals with BD. Only six studies met our inclusion criteria. Findings from these studies suggest that R/S strategies may be important for some people in the management of BD. Religion and spirituality thus become relevant concerns for a therapeutic regime that seeks to develop wellness within a bio-psycho-social model. However, the limited body of research and methodological shortcomings of existing research make it difficult to draw relevant conclusions about how this might be accomplished. The authors propose a need for longitudinal, prospective, mixed methods research in order to inform evidence-based practice.     

Fragile self-esteem and affective instability in posttraumatic stress disorder

Temporal fluctuations in self-esteem and affect are prominent features of several clinical conditions (e.g., depression), but there is an absence of empirical work examining their role in posttraumatic stress disorder (PTSD). Individuals who experience large fluctuations in self-evaluations and affect are considered more vulnerable to psychopathology than individuals able to adequately modulate their self-image and emotional responses. We examined the relevance of self-esteem and affective instability to PTSD. Veterans with and without PTSD completed 14 daily ratings of self-esteem, positive affect, negative affect, and gratitude. Compared to veterans without PTSD, veterans with PTSD exhibited more temporal fluctuations in self-esteem, negative affect, and gratitude, with a smaller effect for positive affect. For all veterans, self-esteem and negative affective instability was associated with diminished well-being. Except for self-esteem instability, most findings were substantially reduced after accounting for variance attributable to PTSD diagnoses and mean intensity levels over the 14-day monitoring period. These data suggest self-esteem instability is important in understanding the lives of veterans with and without PTSD.     

Pharmacotherapy of schizophrenia and affective disorders: Behavioral assessment of psychiatric medications

Objectively defined, publicly observable ward behaviors (body activity, extremity activity, scanning, social interaction, proximity, participation, laughing/smiling, and idiosyncratic behavior) emitted by psychiatric inpatients with either schizophrenic or affective disorders were time sampled both before and during the administration of psychiatric medications (neuroleptics, tricyclics, and lithium). The data indicate that the primary effects of the pharmacological interventions are confined to activity measures and symptoms rather than social behaviors. The implications of these results for treatment protocols are discussed in terms of interactions between pharmacological and psychosocial interventions. In addition, rates of behavior during treatment were related to baseline rates via a log-log function of negative slope, a result that is consistent with data derived from the infrahuman laboratories. Taken together the results provide support for attempts to relate preclinical and clinical psychopharmacology and suggest that behavioral assessment can be applied profitably to drug effects in clinical situations.These investigations were supported in part by State of Illinois Department of Mental Health and Developmental Disabilities Grants RD836-13 and RD622-02 to the first author. The cooperation of the Illinois State Psychiatric Institute staff is gratefully acknowledged. Assistance in data collection was provided by S. Sussman and K. Mueser.     

Effects of social networks on cross-cultural adjustment

A total of 221 responses were obtained from a survey of international students in Japan, regarding the facilitative effects of social network formation on their adjustment. Regression analyses were conducted to explore the relationships among four types of adjustment revealed in a preceding study (“general adjustment,”“self-control,”“affiliative” and “dependent”), network size, demographic variables, expected social support, etc. For each adjustment type, predictive variables were identified. Two of the variables that showed network effects on adjustment were Japanese language proficiency and race (Asians vs. Westerners). From these results, it would appear that social network formation does facilitate adjustment, and insight into the effect of adjustment type and demographic variables on network functions was obtained. Furthermore, the actual conditions regarding network formation of international students in Japan were revealed.     

Drinking motives in alcohol use disorder patients with and without social anxiety disorder

The high comorbidity of alcohol use disorders (AUD) and social anxiety disorder (SAD) is often explained by excessive drinking in social situations to self-medicate social anxiety. Indeed, the motive to drink alcohol to lower social fears was found to be elevated in socially anxious persons. However, this social anxiety specific motive has not been directly investigated in primarily alcohol dependent individuals. We explored social anxiety, the motivation to drink alcohol in order to cope with social fears, and social anxiety as a consequence of drinking in AUD with and without comorbid SAD. Male AUD inpatients with (AUD+SAD group, N=23) and without comorbid SAD (N=37) completed a clinical interview and a questionnaire assessment. AUD+SAD patients reported higher levels of depression and an elevated motive to drink due to social anxiety but did not experience more social fears as a consequence of drinking. Previous results concerning alcohol drinking motives in order to relieve social fears could be replicated in a clinical AUD sample. Additionally, our findings suggest comorbid AUD+SAD patients to be more burdened regarding broader psychopathological symptoms. Thus, accessibility to SAD-specific screening and treatment procedures may be beneficial for primary AUD patients.     

The affective experience of the analyst in the extra-analytic moment

This exploration of the extra-analytic moment focuses on the analyst’s affective experience of encountering her patient outside the boundaries of the consulting room. Two complex interactions are presented in which the analyst is challenged to confront known and unknown aspects of herself and negotiate her next move. The authors discuss the value of examining oneself beyond the traditional boundaries, and highlight the potential for personal and professional growth in moments when the analyst’s fallibility and humanity are unwittingly revealed. In allowing the unpredictable to become less of an unwanted event and more of an opportunity to express that which makes us human, our analytic work is enriched.Janet Rivkin Zuckerman, Ph.D., is Visiting Instructor at the Westchester Center for the Study of Psychoanalysis and Psychotherapy, Adjunct Clinical Supervisor at the Derner Institute, Adelphi University, and Ferkauf Graduate School, Yeshiva University, and Faculty Member and Supervisor at The Center for Preventive Psychiatry, White Plains, New York.Lisa Horelick, Psy.D., is Faculty Member and Supervisor at the Suffolk Institute for Psychotherapy and Psychoanalysis, Adjunct Clinical Supervisor at the Ferkauf Graduate School, Yeshiva University, and Supervisor at the Postdoctoral Program in Psychoanalysis and Psychotherapy, Derner Institute, Adelphi University, New York.