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Adaptability and cultural competency are core qualities that concern the profession of social work. The primary goal for a social worker is to enhance human well-being and improve for all sorts of complex and basic needs. The aim of this study was to investigate social workers attitudes regarding humanistic creative art as an intervention tool for clients with bipolar disorder. The main focus was to investigate how these approaches could be applied internationally and if it could affect stigmatization.  The social workers had various experiences and came from Sweden, Finland/Australia and Nepal. The study was conducted through qualitative research with an inductive thematic analysis, data collection and semi structured interviews. Two theories were applied in order to interpret the results: Erving Goffman’s stigma theory and Carl Rogers’ person centered therapy theory, combined with Natalie Rogers’ person centered expressive arts. The results showed that humanistic art approaches aims for connectedness and could function as an intervention tool. The results also showed a fear of accidentally exacerbating mania and inexperience with bipolar disorder.

<p>Theory of mind (ToM) and empathic responding are thought to rely on the joint contribution of cognitive and affective processes, and the corresponding complex neural networks involved in these diverse cognitive and affective functions. Individuals with mood disorders demonstrate deficits in many of the same cognitive and affective processes thought to mediate ToM and empathy, and demonstrate structural and functional changes in the neural regions that subserve these social cognitive domains. We examined ToM and empathic responding in patients with major depressive disorder (MDD) and bipolar disorder (BD) using standardized measures of social cognitive responding. Patients with BD and MDD with sub-syndromal depressive symptoms showed deficits on a cognitively challenging task that required them to integrate two perspectives simultaneously (second-order ToM stimuli). Sub-syndromal patients with BD also showed a trend toward poor performance on a less demanding first-order ToM task; no such deficit was observed for sub-syndromal MDD patients. Patients with BD were also impaired at discriminating mental states from pictures of eyes and in making complex social judgments. Both patient groups reported reduced levels of cognitive empathy, but differed in response on affective empathy domains. Specifically, whereas the BD group reported higher levels of distress in response to others' negative experiences, the MDD group reported less feelings of care and concern in response to another’s emotional experience. Across the BD studies, impaired ToM and empathic responding were found to be associated with poor social functioning and increased depressive symptoms, but the influence of illness burden variables on performance was variable. Across the MDD studies, the associations between social cognitive performance, illness variables, and social functioning were inconsistent. Taken together, our findings indicate that patients with mood disorders demonstrate altered ToM and empathic responding that may contribute to the difficulties in social communication observed in these patient populations.</p> / Doctor of Philosophy (PhD)

<p>This thesis presents research examining the impact circadian rhythm disturbances experienced in bipolar disorder (BD) have at two levels of investigation. First, circadian rhythm disturbance is studied with regard to quality of life in individuals with BD. The results of an analysis investigating the impact of self-reported circadian rhythm disturbance on quality of life (QOL) show circadian rhythm is strongly associated with poor QOL in patients with BD, independent of severity of depressive symptoms, sleep disturbance and use of sleep medications. Next, the impact of circadian rhythm disturbance on oxidative stress was studied. Oxidative stress has previously been implicated in BD, yet no studies have investigated the relationship between these systems in the context of the disorder. We demonstrate that circadian rhythm disturbance is related to increased lipid peroxidation in BD patients, which is not seen in controls. This study provides a basis for further investigation of the links between oxidative stress and circadian rhythms in the pathophysiology of BD. Taken together, these results provide evidence that circadian rhythms have a widespread impact on two separate aspects of BD: personal sense of well being and a biological marker of oxidative stress. These novel findings contribute to the mounting evidence indicating circadian rhythm disturbance as one of the core features of BD, and an important target for treatment.</p> / Master of Science (MSc)

Bipolar disorder (BD) and unipolar depression (UD) are two severe mood disorders, with BD often misdiagnosed as UD. Given their severity and high rates of misdiagnosis, it is of paramount importance to understand the psychological and neurobiological mechanisms underlying these disorders to enhance our ability to diagnose, treat, and prevent them effectively. Many neuroimaging studies have shown that mood disorders are associated with abnormal reward-related responses, particularly in the ventral striatum (VS). Yet, the link between mood disorders and reward-related responses in other regions remains inconclusive, thus limiting our understanding of the pathophysiology of mood disorders. To provide insights into the neurobiological underpinnings of reward processing dysfunction in mood disorders, two studies were conducted. Study 1 (Chapter 2) is a coordinate-based meta-analysis of 41 whole-brain neuroimaging studies encompassing reward-related responses from a total of 794 patients with major depressive disorder (MDD), and 803 healthy controls (HC). It aims to address inconsistencies in the literature by synthesizing the literature quantitatively. The findings of Study 1 indicate that MDD is associated with opposing abnormalities in the reward circuit: hypo-responses in the VS and hyper-responses in the orbitofrontal cortex (OFC). These findings provide a foundation for Study 2 (Chapter 3) and help to reconceptualize our understanding of reward processing abnormalities in UD by suggesting a role for dysregulated corticostriatal connectivity. Study 2 is the first fMRI study to employ region-of-interest (VS and OFC), whole-brain, activation, connectivity, and network analyses to examine the similarities and differences in reward-related brain activation patterns between 46 children with remitted bipolar I disorder, 48 children with remitted MDD, and 46 HC. The results of Study 2 revealed differential connectivity in corticostriatal circuitry during reward processing among BD, UD, and HC in pre-adolescence. Specifically, BD exhibited increases in OFC-VS connectivity during anticipation of larger reward, whereas UD and HC showed no changes in OFC-VS connectivity across anticipation conditions ranging from large loss to large reward. Furthermore, BD and UD generally showed more abnormal whole-brain responses to reward anticipation in accordance with the valence of the stimuli than HC. These findings suggest that pre-adolescents with BD and UD exhibit reward processing dysfunction during reward anticipation relative to HC even outside of acute periods of illness. Taken together, the dissertation provides novel insight into the nature of reward processing abnormalities in mood disorders in pre-adolescence. As early onset BD or UD often is associated with long treatment delays and a persistently pernicious illness course, this dissertation may aid efforts to ensure early accurate diagnosis, which may improve our ability to intervene with appropriate treatments and result in a more benign prognosis and course of illness over the lifespan. / Psychology

Impulsivity and sleep and circadian rhythm disturbance are two core features of bipolar disorder that are elevated antecedents to bipolar disorder onset and persist even between mood episodes; their pervasive presence in bipolar disorder suggests that they may be particularly relevant to better understanding bipolar disorder etiology, onset, and course. Given considerable research demonstrating bidirectional associations between sleep and circadian rhythm disturbance and impulsivity in healthy individuals, it is surprising that little research has examined how these core features interact to impact bipolar disorder symptomatology, onset, and course. In a sample of late adolescents and young adults (N = 150) at low or high risk for developing bipolar disorder, we employed a naturalistic experiment in the context of an ecological momentary assessment (EMA) design to examine relationships between impulsivity, sleep and circadian rhythm alterations, and mood symptoms in everyday life. Furthermore, we sought to understand how the relationships between sleep and circadian rhythm alterations and mood fluctuation, collected during the EMA study, prospectively predicted mood symptom severity and mood episode onset at a 6-month follow-up. Linear regression, logistic regression, and multi-level modeling (MLM) revealed that higher impulsivity predicted increased mood symptoms during the EMA study, and less total sleep time (measured by actigraphy) predicted increased next-day EMA-assessed mood symptoms. Interaction analyses suggested that dim light melatonin onset time, total sleep time, and sleep onset latency moderated the relationship between impulsivity and mood symptoms (both next-day and at 6-month follow-up). Results are discussed in terms of their contribution to the existing literature. Findings highlight the necessity of multi-method, nuanced examination of the dynamic relationships between impulsivity and sleep and circadian disturbance within bipolar disorder. / Psychology

Neurobiological theories of bipolar spectrum disorder (BSD) propose that the emotional dysregulation characteristic of BSD stems from disrupted prefrontal control over subcortical limbic structures (Strakowski et al., 2012; Depue & Iacono, 1989). However, existing neuroimaging research on functional connectivity between frontal and limbic brain regions remains inconclusive, and is unable to adequately characterize global functional network dynamics. Graph theoretical analysis provides a framework for understanding the local and global connections of the brain and comparing these connections between groups (Sporns et al., 2004). The purpose of this study was to investigate resting state functional connectivity in individuals at low and high risk for BSD based on moderate versus high reward sensitivity, both with and without a BSD diagnosis, using graph theoretical network analysis. Results demonstrated decreased connectivity in a cognitive control region (dorsolateral prefrontal cortex), but increased connectivity of a brain region involved in the detection and processing of reward (bilateral orbitofrontal cortex), among participants at high risk for BSD. Participants with BSD showed increased inter-module connectivity of the dorsal anterior cingulate cortex (ACC). Reward sensitivity was associated with decreased global and local efficiency, and interacted with BSD risk group status to predict inter-module connectivity. Findings are discussed in relation to neurobiological theories of BSD. / Psychology