There is still a great deal that is unknown about various depressive conditions, though it is a very common affliction and cause of disability throughout the world. Not only do the underlying mechanisms of various types of depression remain uncertain, but the mystery of how different treatment options work and who will respond to them also persists. The aim of this study was to identify potential non-invasive biomarkers, to predict responsiveness to electroconvulsive therapy. Two hypotheses were investigated in this study. The first was that patient improvement from baseline on the neurocognitive, computer based pattern separation task prior to the third ECT treatment will correlate with a clinical antidepressant response. The second was that increased prefrontal slowing relative to baseline will correlate with a decrease in depressive symptoms. As a first step to validate this approach, a healthy control group performed both the pattern separation and EEG tasks once per week over the course of three weeks. Patient participants completed both tasks before their first ECT treatment, prior to their third treatment, and prior to their last treatment. A spectral analysis of EEG data was then conducted. Results indicated good test-retest reliability for the pattern separation task and EEG measurements across all three trials in the healthy control group. Results from patient data are inconclusive, but indicates that there is a change from baseline to subsequent trials for at least the EEG measurements. However, a larger sample size is needed to determine this. The limited results from this small patient sample suggest that these measurements may have clinical value in refining ECT treatment, and merit further study.

Cognitive impairment is a key characteristic of schizophrenia and is a clear predictor of functional outcome. This thesis explores the relationship between cognitive ability relating to social and non-social processing. Schizophrenia patients demonstrate an impaired ability to recognise, label and discriminate emotional expression within the face. The underlying mechanisms behind this social cognitive impairment are not yet fully understood. This thesis explores the notion that a basic perceptual impairment in processing facial information adversely impacts on the perception of more complex information derived from faces, such as emotional expression. Face perception relies on processing the featural characteristics of a face as well as the relationship between these features. Information pertaining to the spatial distances between features is referred to as configural information. / A group of schizophrenia patients and healthy control participants completed a battery of tasks that assessed basic neurocognition, facial emotion processing and configural face processing. A model of face processing was proposed and used to systematically pinpoint specific deficits that may contribute to impaired face processing in schizophrenia. The results indicated that schizophrenia patients show impairments on three broad constructs; basic neurocognition, facial emotion processing, and most pertinently, deficits in configural processing. It was revealed that although neurocognitive and face processing both explained a significant proportion of the variance in facial emotion processing, the effect of neurocognition was indirect and mediated by face processing. / To investigate the diagnostic specificity of these findings, a group of bipolar disorder patients was also tested on the task battery. The results indicated that bipolar disorder patients also show social and non-social cognitive impairments, however, not as severe as that demonstrated by the schizophrenia patients. Furthermore, the effect of neurocognitive performance on facial emotion processing appeared more direct for bipolar disorder patients compared to schizophrenia patients. Although deficits in face processing were observable in bipolar, they were not specific to configural processing. Thus, deficits in emotion processing were more associated to neurocognitive ability in bipolar disorder patients, and more associated to configural face processing in schizophrenia patients. The configural processing deficits in schizophrenia are discussed as a lower-order perception problem. In conclusion, the results of this thesis are discussed in terms of their implication for treatment.

No description available.

De psykiatriska diagnoserna har ökat i antal det senaste decenniet. Hur påverkas en individ av att få en psykiatrisk diagnos? Bipolär sjukdom tillhör gruppen psykiska sjukdomar och kännetecknas av växlingar mellan förhöjda stämningslägen såsom mani eller hypomani samt perioder av depressioner. Sjukdomen delas in i bipolär I och II, där bipolär I är den allvarligare varianten. Syftet med föreliggande studie är att undersöka vilken betydelse diagnosen haft för individer med bipolär sjukdom. Åtta personer, sex kvinnor och två män mellan 39-65 år (medelålder 51.6) diagnosticerade med bipolär sjukdom I eller II intervjuades. Svaren bearbetades med hjälp av induktiv tematisk analys. Resultatet visar att diagnosen haft en klart övervägande positiv betydelse. De huvudteman som framkom var förklaring, förståelse och acceptans, samt adekvat behandling. De samstämmiga uppfattningarna om att diagnosen haft en stor positiv betydelse förklaras bland annat av att majoriteten av deltagarna levt i många år utan rätt diagnos, vilket i sin tur inneburit många år inom den psykiatriska vården utan att få rätt hjälp. Rätt diagnos har inneburit rätt behandling, i synnerhet medicinskt, men även via psykoedukativa och psykoterapeutiska insatser. Rätt typ av behandling har därmed medfört en balans i livet, där funktionsförmågan förbättrats avsevärt, och livskvalitén ökat. Ett fåtal negativa konsekvenser av diagnosen framkom i två teman; initiala effekter av diagnosen samt diagnosens begränsande effekt.

The proposed study has one central purpose, to determine if the Comprehensive System (CS), an empirically valid system for scoring and interpreting the Rorschach Inkblot Test, can effectively discriminate between individuals diagnosed with borderline personality disorder (BPD) and those diagnosed with bipolar disorder. Previously conducted, peer-reviewed studies since 1985 have uncovered CS variables that were statistically significant in BPD and in bipolar groups when examined separately. However, there have been relatively few such investigations, making the body of research with CS variables small in this area. It would be valuable to know whether or not the CS is a useful tool in distinguishing between these two disorders. A second goal of the current study is to uncover variables that help diagnose both bipolar disorder and BPD as separate entities. Some CS variables have not been previously studied with regard bipolar disorder or BPD. Additional research with variables known to be useful in identifying these disorders will cross-validate findings that already exist. Moreover, if the Rorschach could help classify individuals with these disorders and uncover distinct differences between them in their test results, these data would also lend support for the idea that these are indeed two different disorders, a tertiary goal of the current study. / text

There has recently been an intense debate about the increased rate of bipolar disorders (BPD) in children and adolescents observed in clinical settings. Thus, there is great interest in child and adolescent symptoms of hypomania and whether these symptoms subsequently will develop into BPD. More knowledge about early signs could give insight into the development of the disorder. There are also concerns that hypomanic symptoms in adolescence indicate excess risk of other health conditions. It has been reported that patients with mood disorders have a high consumption of prescription drugs in different ATC classes. The primary objective of this thesis was to better understand the mental health outcome of adolescents with hypomania spectrum symptoms and to identify early risk factors for adult bipolar disorder among adolescents with mood disorders. In order to widen the scope and investigate health outcome of mood disorder in general psychopharmacological outcomes were included. A community sample of adolescents (N=2 300) in the town of Uppsala, Sweden, was screened for depressive symptoms. Both participants with positive screening and matched controls (in total 631) were diagnostically interviewed. Ninety participants reported hypomania spectrum episodes, while another 197 fulfilled the criteria for major depressive disorder (MDD) without a history of a hypomania spectrum episode. A follow-up after 15 years included a blinded diagnostic interview, a self-assessment of personality disorders, and national register data on prescription drugs and health services use. Adolescent mood symptoms, non-mood disorders, and family characteristics were assessed. Univariate and multivariate analyses were used. The results indicate that the phenomenology of the hypomania spectrum episodes during childhood and adolescence per se does not predict adult bipolar disorder. However, having both affective symptoms during adolescence and a family history of bipolar disorder increases the risk of developing bipolar disorders in adulthood. Disruptive disorder in childhood or adolescence as well as family histories of BPD emerged as significant risk factors that differentiated between the future development of BPD and MDD. Adolescents with hypomania spectrum episodes and adolescents with MDD do not differ substantially in health outcomes in adulthood. Both groups are at increased risk for subsequent mental health problems, high consumption of prescription drugs, and high health care use, compared with the control group. The high rates of prescription drugs in many ATC classes found among the former depressed females seem to indicate a series of co-morbid somatic illnesses. Thus, it is important to identify and treat children and adolescents with mood disorders, and carefully follow the continuing course. Characteristics such as disruptive disorders and family history warrant particular attention.

This dissertation examines how bipolar disorder, a common and disabling psychiatric condition, is made relevant as a participants’ concern in a site of massively consequential psychological business – the psychotherapy session. As its central thesis is the claim that the practices by which bipolar disorder gets done as bipolar disorder are invariably absent in most formal accounts of the disorder. In this regard, the dissertation provides an empirically grounded description of a range of discursive practices associated with the doing of bipolar disorder in psychotherapy. This is undertaken from a discursive psychological orientation that draws extensively from ethnomethodology, conversation analysis, and Wittgensteinian philosophy. Following a review of bipolar disorder as a diagnostic psychiatric category, consideration is given to alternate conceptualisations which suggest the category is constructed in-and-through complex socio-historical practices which are often occluded and considered irrelevant to the category’s situated deployment. This notion is used to provide a more sustained examination of how one might ‘get at’ such practices in situ by way of conducting ethnomethodological and conversation analytically informed investigations. In consideration of how one might approach psychological categorisation practices in talk-in-interaction, a discursive psychological orientation is developed which stresses the social, public nature of psychological categories in use. The empirical materials examined in the dissertation are drawn from a corpus of audio recordings of seven ‘naturally occurring’ psychotherapy sessions involving a clinical psychologist and five clients for whom the category ‘bipolar disorder’ has demonstrable relevance. Practices examined include those relating to the production and recognition of what might count as a bipolar disorder ‘symptom’, the manner in which ‘moods’ operate as account production devices, and the methods by which psychological terms (such as ‘thought’ and ‘feel’) operate in-and-as situated practices involved in psychotherapeutic business.

Introdução: Pacientes com Transtorno Bipolar (TB) e seus familiares apresentam níveis de estresse significativamente mais elevados que a população geral. Coping, utilizado para gerenciar situações estressantes, tem sido alvo de investigação e intervenções psicossociais em pacientes bipolares, auxiliando-os no manejo destes fatores e melhorando desfechos clínicos no tratamento. Objetivos: O presente estudo tem por objetivo primário comparar pacientes com TB, seus familiares de primeiro grau e um grupo de controles saudáveis quanto ao uso de estratégias de coping adaptativas e desadaptativas. Como objetivos secundários, serão feitas análises explorando diferenças de tipos específicos de coping utilizados pelos indivíduos dos diferentes grupos (pacientes, familiares e controles), através da escala Brief COPE. Outras correlações com variáveis clínicas serão exploradas, como fatores sociodemográficos e clínicos, buscando encontrar relações com as estratégias de coping na amostra de pacientes com TB. Método: Trata-se de um estudo transversal com amostragem por conveniência. O estudo incluiu 36 pacientes eutímicos com TB, 39 familiares de primeiro grau destes pacientes e 44 controles. As estratégias de coping foram avaliadas através da Escala Brief COPE. Resultados: Diferenças significativas foram encontradas quanto ao uso de estratégias adaptativas e desadaptativas entre pacientes, familiares e controles. Pacientes utilizam em menor grau estratégias adaptativas, quando comparados aos controles. Por outro lado, os familiares demonstram maior uso de estratégias desadaptativas, semelhante ao que é observado nos pacientes, diferindo do grupo controle. Limitações: O tamanho amostral é um importante limitador para as conclusões do estudo. Ainda, as conclusões foram baseadas em dados transversais. A utilização de avaliações psicológicas e clínicas em estudos longitudinais permitiriam um melhor mapeamento das mudanças ou manutenção nos padrões psicológicos dos participantes. Conclusões: O grupo de familiares encontra-se em um nível intermediário entre pacientes e controles, ou seja, familiares fazem uso de estratégias desadaptativas em níveis semelhantes ao grupo de pacientes, mas apresentam maior uso de estratégias adaptativas, assim como o grupo controle. Intervenções psicossociais com este grupo são justificadas, favorecendo o uso das estratégias adaptativas em detrimento das estratégias desadaptativas. / Background: Patients with Bipolar disorder (BD) and their relatives exhibit significantly higher stress levels than the general population. Coping strategies, used to manage stressful situations, have been the subject of research and have also been used in psychosocial interventions with bipolar patients in order to help them manage stress factors and improve the clinical outcome of treatment. Objectives: This study has the objective to compare BD patients, their first-degree relatives and a group of healthy controls on the use of adaptive strategies and maladaptive coping. The specific objectives, analyzes will be made by exploiting differences in specific types of coping used by individuals from different groups (patients, relatives and controls) through the Brief COPE scale. Other correlations with clinical variables will be explored, such as demographic and clinical factors, trying to find relations with coping strategies in the sample of patients with BD. Method: This was a cross-sectional study with sampling by convenience, enrolling 36 patients with BD, 39 of their first-degree relatives and 44 controls. Coping strategies were assessed using the Brief COPE scale. Results: Significant differences were detected between use of adaptive and maladaptive strategies by patients, patients' relatives and controls. Patients used adaptive strategies less often than the patients' relatives and controls. In contrast, the patients' relatives reported greater use of maladaptive strategies than the controls and were similar to the patients in this respect. Limitations: The sample size is an important factor limiting the conclusions that can be drawn from this study. Furthermore, these conclusions are based on cross-sectional data. Conclusions: The group of patients' relatives were at an intermediate level between the patients and the healthy controls, i.e. family make use of maladaptive strategies at similar levels to the group of patients, but greater use of adaptive strategies, as well as the control group. This group merits psychosocial interventions to encourage use of adaptive strategies rather than maladaptive strategies.

Systematic review Background: Bipolar disorder is associated with a higher rate of physical health problems and lower levels of physical activity than other clinical and general populations. Despite the potential benefits of physical activity to people with bipolar disorder, little research has been published around this and no recent review of this topic is available. Due to the clinical utility of summarising the available research evidence on this topic, this review aimed to answer the question “Is physical activity associated with manic and depressive symptoms in people with bipolar disorder?”. Methods: Seven electronic databases were searched using a range of search terms to reflect physical activity and bipolar disorder variables. Results: Ten studies were identified that reported associations between physical activity and mood symptoms of bipolar disorder. There were inconsistent findings on the relationship between physical activity and mood, in particular with relation to manic symptoms, with reports of physical activity being both helpful and harmful to manic symptoms. Findings were more consistent with regards to the association between physical activity and depressive symptoms, with most showing that higher levels of physical activity are associated with lower depressive symptoms. Limitations: Many studies had small sample sizes and very few manipulated physical activity and included a control group. Measures and diagnosis method were heterogeneous. Four studies lacked a direct measure of manic symptoms. Conclusions: Results showed inconsistent findings with regards to the relationship between physical activity and mood symptoms and further research is needed to inform any guidelines developed for this client group. Empirical paper: Background: Despite the published evidence for the benefits of physical activity on mood in the general population and in people with mental illness, there is a lack of research into the associations between physical activity and mood in people with bipolar disorder. The current study therefore aimed to investigate the relationship between symptoms of mania and depression and different intensities, regularity, and total duration of physical activity per day and across the week. Methods: People with a diagnosis of bipolar disorder (N = 29) completed daily diaries on physical activity and manic and depressive symptoms over 14 days. Analysis included multilevel modelling, t-tests and correlation analysis. Results: No association was found between manic symptoms and physical activity, either at the within- or the between-person level. An association was found at the within-person level between higher duration of physical activity and lower depression symptoms, however no association was found at the between-person level. Limitations: The small sample size was adequate only to detect large-sized effects for between-person hypotheses. Participants were highly active and may not be representative of the wider BD population. Physical activity levels were assessed via self-report. Conclusions: The relationship between physical activity and manic symptoms in BD remains inconclusive, but a significant within-person association indicates that physical activity may reduce depressive symptoms in the short term. Given previous research on physical activity and manic symptoms, people with BD and professionals working with them may need to remain cautious, modifying any PA engagement depending on mood state.

OBJECTIVES. It has been illustrated in numerous studies that children with Bipolar Disorder (BD) consistently show deficits in declarative memory. There are a number of regions within the brain that have been inferred to correspond to these deficits. Currently, there are a limited number of studies that have analyzed the direct relationship between neuropsychological tests and anatomical brain regions. The purpose of this study was to establish a relationship between structural neuroanatomical measurements and cognitive tasks measurements in Pediatric Bipolar Patients. METHODS. We administered the California Verbal Learning Test-II (CVLT-II) to 46 children and adolescents with BD and compared their scores 35 age-matched healthy controls. A MANCOVA between PBD and Healthy was performed and Long-Delay Free Recall (LDFR) and Long-Delay Cued Recall (LDQR) were significantly different. A multiple linear regression between LDFR and LDQC cognitive variables and anatomical volume and cortical thickness was performed in SPM and FreeSurfer libraries. RESULTS. There was overall significance in CVLT-II Trial 1 (p=0.042), Long Delay Free Recall (LDFR) (p=0.047), and Long Delay Cued Recall (LDQC) scores (0.038), amongst the diagnostic groups (BD-I, BD-II, BD-NOS, Other, Healthy). Within Bipolar subjects, LDFR scores were positive correlated to the gray matter volume of the cingulate gyrus, Brodmann's area 6, parrahippocampal gyrus and the thickness of the lateralorbitofrontal region. LDQC scores were positive correlated to the gray matter volume of the cingulate gyrus, Brodmann's area 7 and middle temporal gyrus. LDQC was also correlated to the volume of the superior frontal, pars triangularis, insula and the thickness of the rostral middle frontal region. CONCLUSION. These results reaffirm previous reports of the cognitive deficits present in children with bipolar disorder. This study also revealed a positive correlation between gray matter density of structures within the limbic system and performance on cognitive variables of the California Verbal Learning Test-II Children's version.