Thesis (Ph. D.)--University of Wisconsin--Madison, 1984. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 28-33).

No description available.

Background: Exercise is recommended as a non-pharmacological intervention for individuals with a bipolar disorder diagnosis (BDD). Although physical activity can be beneficial for reducing depressive symptoms, there is preliminary evidence that high-intensity exercise can exacerbate (hypo)mania-related symptoms. Risks associated with other forms of exercise remain unknown. Method: To investigate the potential risks and benefits of low-intensity exercise, non-clinical participants were asked to either copy repetitive movements (n = 20), copy variable movements (n = 20) or watch variable movements (n = 21), following approach motivation induction. Hypomania-like symptoms, positive affect and approach motivation were measured pre-, during and post-task. Trait behavioural activation system (BAS) sensitivity was measured as a moderating factor. Results: There were no group differences in symptom change over time. BAS sensitivity did not moderate this relationship. Limitations: A predominantly student population with low average trait BAS sensitivity was studied. The reliability and validity of the approach motivation induction, mania measure and physical activity task are uncertain. Conclusions: It is unclear whether different types of low-intensity exercise are of risk or benefit for individuals prone to (hypo)mania. This area requires further investigation.

This thesis examines potential associations between trait approach motivation and related measures, the everyday experience of affect and goal pursuit, and reward-related neural responses. The Behavioural Activation System (BAS) is a core motivational system, subserved by the neural reward circuitry, eliciting approach-type behaviour and positive emotion when activated by appetitive stimuli. Deficits in BAS sensitivity are thought to underlie the lack of motivation and positive affect (PA) that characterise anhedonia, whilst hyperactivation of the BAS has been linked to the increased goal-directed behaviour and positive affectivity associated with hypomania. In order to explore relationships between BAS sensitivity, goal pursuit, and reward processing, young participants, recruited from the student population (N = 65), and older participants, from the community (N = 63), underwent a 7-day period of experience sampling (ESM) to provide a naturalistic measure of momentary affect and goal-focused motivation. Functional Magnetic Resonance Imaging (fMRI; in a subset of n = 28 and n = 31 respectively) was then used to investigate individual differences in sensitivity of brain reward-related systems to various social and non-social rewards. Limited support was found for the relationship between BAS traits and the more motivational aspects of goal pursuit and reward processing, whilst anhedonia seemed to pertain more to reward consumption, with few links to everyday goal pursuit. This would indicate that anhedonia might not be as closely related to BAS sensitivity as was initially anticipated. Finally, in order to examine real-world correlates of neural activation, the data from the naturalistic measure were correlated with reward-related activation. Everyday PA correlated with striatal activation when viewing pleasant images, but no other associations emerged. This would suggest that the basic measures of brain function in relation to the particular reward-related stimuli used might be of limited relevance to everyday affective experience and goal pursuit.

No description available.

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

A literature search, supplemented by an expert survey and selected reanalyses of existing data from epidemiological studies was performed to determine the prevalence and associated burden of bipolar I and II disorder in EU countries. Only studies using established diagnostic instruments based on DSM-III-R or DSM-IV, or ICD-10 criteria were considered. Fourteen studies from a total of 10 countries were identified. The majority of studies reported 12-month estimates of approximately 1% (range 0.5–1.1%), with little evidence of a gender difference. The cumulative lifetime incidence (two prospective-longitudinal studies) is slightly higher (1.5–2%); and when the wider range of bipolar spectrum disorders is considered estimates increased to approximately 6%. Few studies have reported separate estimates for bipolar I and II disorders. Age of first onset of bipolar disorder is most frequently reported in late adolescence and early adulthood. A high degree of concurrent and sequential comorbidity with other mental disorders and physical illnesses is common. Most studies suggest equally high or even higher levels of impairments and disabilities of bipolar disorders as compared to major depression and schizophrenia. Few data are available on treatment and health care utilization.

We examined prospectively whether mania and hypomania are associated with an elevated risk for suicidality in a community sample of adolescents and young adults. Baseline and four-year follow-up data were used from the Early-Developmental- Stages-of-Psychopathology (EDSP) Study, a prospective longitudinal study of adolescents and young adults in Munich. Suicidal tendencies (ideation/attempts), mania, and hypomania were assessed using the standardized Munich-Composite-International- Diagnostic-Interview. At baseline, mania/hypomania was associated to a different degree with suicidality (Odds ratios [OR] range from 1.9 to 13.7). In the prospective analyses, the risk for subsequent incident suicidal ideation was increased in the presence of prior mania (38.0% vs. 14.1%; OR = 4:4; 95% CI = 1.4–13.5). No associations could be found between prior mania/hypo-mania and incident suicide attempts. The prospective analyses revealed a remarkable relationship between preexisting mania and increased risk for subsequent suicidal ideation.

A literature search, supplemented by an expert survey and selected reanalyses of existing data from epidemiological studies was performed to determine the prevalence and associated burden of bipolar I and II disorder in EU countries. Only studies using established diagnostic instruments based on DSM-III-R or DSM-IV, or ICD-10 criteria were considered. Fourteen studies from a total of 10 countries were identified. The majority of studies reported 12-month estimates of approximately 1% (range 0.5–1.1%), with little evidence of a gender difference. The cumulative lifetime incidence (two prospective-longitudinal studies) is slightly higher (1.5–2%); and when the wider range of bipolar spectrum disorders is considered estimates increased to approximately 6%. Few studies have reported separate estimates for bipolar I and II disorders. Age of first onset of bipolar disorder is most frequently reported in late adolescence and early adulthood. A high degree of concurrent and sequential comorbidity with other mental disorders and physical illnesses is common. Most studies suggest equally high or even higher levels of impairments and disabilities of bipolar disorders as compared to major depression and schizophrenia. Few data are available on treatment and health care utilization.

Maladie de l'homme mûr, le cancer de la prostate nécessite des traitements qui rendent le patient impuissant, parfois de manière irréversible. Cela fait écho psychiquement à l'appréhension d'une castration qui n'a pas attendu l'avènement de cette quasi-réalité pour s'avérer l'un des moteurs psychiques de l'angoisse des hommes et de leur dynamique identificatoire, narcissique et objectale. Le cancer de la prostate se révélant être tabou dans notre société, ces hommes sont sommés de souffrir en silence. À l'appui d'une double méthodologie composée d'entretiens et d'épreuves projectives auprès de 17 patients atteints d'un cancer de la prostate (et, dans une visée comparative, de 2 patients atteints d'un cancer du rein et de 2 patients venant pour un simple dépistage), nous nous sommes proposée de discerner comment cette détresse interdite pouvait expliquer en partie la mise en avant d'une position hyper phallique ("même pas peur, même pas triste, même pas mal"). Revendiquer de n'être ni touché ni ébranlé par ce qui arrive permettrait ainsi à ces hommes de pallier une décompensation dépressive, peut-être pire que tout pour eux, car "anti-virile", dans le sens où un homme n'est censé ni chuter, ni s'effondrer, ni se plaindre. C'est pourquoi, dans la filiation des travaux de C. Chabert et de F. Neau, nous avons proposé l'idée d'un "masculin hypomane" ; il serait une défense contre le mouvement mélancolique (à entendre comme traitement narcissique de la perte) insupportable et comme retournement de la passivité en activité contre l'être pénétré (par la maladie, les explorations médicales), l'être traversé (par l'angoisse, le temps qui passe) et l'être excité (par l'autre, son désir). Portée par un faux masculin abritant le genre neutre dans le latent et durcie par un hyperinvestissement narcissique, cette solution serait à la fois coûteuse et mortifère, mais aussi salvatrice et trophique pour le sujet, déplaçant alors les frontières entre normal et pathologique. En effet, elle protégerait le sujet contre les affres de l'effondrement dépressif dans le manifeste, soutiendrait son identité virile déjà bien malmenée. Elle lui permettrait de se défendre contre le mouvement mélancolique qui infiltre le latent et, enfin, elle contiendrait l'excitation désorganisatrice de la pulsion sexuelle derrière les remparts de la pulsion de mort dans sa valence anarchiste. La dimension performative de la virilité nous a ainsi permis d'envisager la clinique de la passation (mais également la relation clinique et les mouvements transférentiels pendant les entretiens) comme un espace potentiellement traumatique (car elle peut, certes, mettre en lumière et révéler une sensibilité à la castration à travers l'implicite de performance) mais aussi, comme un espace transitionnel et thérapeutique. Ce qui semble très important pour la construction future de projets thérapeutiques concernant ces patients. / A disease affecting older men, prostrate cancer requires treatment that renders patients impotent, sometimes permanently. Psychically speaking, this resonates with the fear of castration, which does not await the advent of this quasi-reality to emerge as one of the psychic driving forces of men's anxiety and of their identity-related, narcissistic and objectal dynamic. In today's society, prostrate cancer is a taboo subject; men suffering from the condition are thus forced to suffer in silence. We met 17 patients with prostate cancer and, in a comparative way, 2 patients with kidney cancer and 2 healthy patients. Using projective methods and semi-directive interviews, we attempted to discern how this forbidden distress could partly explain why patients chose to adopt a hyperphallic stance ("Ain't scared, ain't sad, doing just fine !"). Claiming to be neither affected nor shaken by unfolding events would allow these men to mitigate depressive decompensation, which might be the worst thing for them because it would be unmanly insofar as a man must never fall, collapse or complain. Drawing from the studies undertaken by C. Chabert and F. Neau, we thus put forward the notion of "masculine hypomania". This would not only be a defense against unbearable melancholia (construed as the narcissistic treatment of loss), but would also be the reversal of passivity into action against the penetrated being (by disease and medical explorations), the permeated being (by anxiety and the passing of time) and the excited being (by the other and his desire). Driven by narcissistic hyperinvestment, this solution would be costly and mortifying on the one hand, and life-saving and nourishing on the other, moving boards between normality and pathology. Indeed, it would enable patients to defend themselves against depressive decompensation, to support shaken male identity, to defend themselves against melancholic movement and, at last, to contain excitation of the sexual drive through the death instinct in its anarchist valency. The performative dimension of manhood allowed to consider the clinical perspective of test administration (but also clinical relationship and transference during interviews) as a potentially traumatic space (because it could reveal a sensitivity to castration behind the implicit of performance), but also as a transitional and therapeutic space, which seems very important for the construction of therapeutic projects for these patients in the future.