Psychological processes leading to manic and depressive episodes

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Abstract/Journal of Affective Disorders 122 (2010) S9–S31

United Kingdom. Theory and management of anxiety and substance use disorder in people with bipolar disorder. Symposium 9 S9.1

psychological predictors will be briefly reviewed, as rationale for providing psychological treatments as adjuncts to bipolar disorder. doi:10.1016/j.jad.2010.01.050

Efficacy, nature and role of psychological interventions in the overall management of bipolar disorder S9.3 R. Morriss, University of Nottingham, UK Aims: To understand 1. the different forms of psychological treatment for bipolar disorder that have been shown to be efficacious in research; 2. the evidence base for the efficacy and effectiveness of different forms of psychological treatment for bipolar disorder; 3. when different forms of psychological treatment are most likely to be effective and how it can be integrated in an overall management for bipolar disorder. Background: Over the past 10 years, over 20 randomised controlled trials of psychosocial interventions or services incorporating psychosocial interventions in bipolar disorder have been completed. Method: Systematic review of psychosocial interventions for bipolar disorder. Critical review of trials given heterogeneity in results and different forms of treatment. Results: Overall psychosocial interventions appear to be effective in terms of delaying episode recurrence, reducing symptoms and improving function in people with bipolar disorder in remission in both the short term and up to 5 years later. There is some evidence of their effectiveness in achieving remission and reducing symptoms in bipolar depression but no evidence for their efficacy in mania or hypomania. A pattern is emerging of the techniques which tend to be components of effective treatments. There appear to be differences in effectiveness between different types of psychosocial intervention on their effectiveness in preventing mania relative to depression, the characteristics of patients, when and how it should be delivered. These recommendations are preliminary and are not robust, particularly in terms of cost effectiveness. They are intended for use alongside pharmacotherapy and there is evidence that they enhance concordance with pharmacotherapy. Conclusions: These findings offer scope for further refinement of psychosocial interventions themselves and the tailoring of treatment to individual needs in an overall package of care. doi:10.1016/j.jad.2010.01.049

Theory and management of anxiety and substance use disorder in people with bipolar disorder S. Jones Lancaster University, UK Aims: To understand: 1. current developments in psychological interventions for anxiety in bipolar disorder; 2. current developments in psychological interventions for substance use in bipolar disorder; 3. the impact of both comorbid conditions on recovery. Background: Substance use and anxiety are both commonly experienced comorbid conditions in bipolar disorder. The experience of either or both of these problems is associated with worse clinical outcomes and more problems with functioning. Despite this there has been a lack of research investigating the development of tailored psychological interventions for substance use and anxiety problems in bipolar disorder. This talk will consider the current evidence base for treating these comorbid conditions before going on to report the results of recent qualitative and pilot intervention research relevant to the development of new integrated approaches. Method: Structured literature review, interpretative phenomenological analysis, case series data. Results: Anxiety and substance use are both potentially amenable to structured psychological interventions which are sensitive to experiences of this sort in the context of an ongoing bipolar disorder. Conclusions: Implications of current studies for future research will be discussed in particular in relation to treatment development work current ongoing by our research team. doi:10.1016/j.jad.2010.01.051

S9.2 Psychological processes leading to manic and depressive episodes S.L. Johnson UC Berkeley, USA Over the past 15 years, a number of psychological and social factors have been found to robustly predict the course of bipolar disorder. Longitudinal studies, though, suggest that mania and bipolar depression are not predicted by the same variables. Bipolar depression is predicted by many of the same factors that predict unipolar depression, such as negative life events, family conflict, negative cognitive styles, and low levels of social support. None of these variables predict the course of mania. Rather, manic symptoms appear to be triggered by variables such as reward sensitivity and sleep deprivation. The evidence for these

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Psychological processes leading to the development of bipolar disorder in people at high risk R. Bentall University of Bangor, UK Background: Bipolar disorder is highly heritable, and children with a parent who has been diagnosed with the disorder are at high risk of developing affective symptoms in general and bipolar disorder in particular. The early detection of psychological abnormalities in the children of affected parents would open the possibility of early, targeted intervention with the aim of preventing the onset of illness