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Symptom-specific self-referential cognitive processes in bipolar disorder: a longitudinal analysis

Published online by Cambridge University Press:  30 November 2012

H. Pavlickova ,
F. Varese ,
O. Turnbull ,
J. Scott ,
R. Morriss ,
P. Kinderman ,
E. Paykel  and
R. P. Bentall
H. Pavlickova
Affiliation:
School of Psychology, Bangor University, UK
F. Varese
Affiliation:
School of Psychological Sciences, Manchester University, UK
O. Turnbull
Affiliation:
School of Psychology, Bangor University, UK
J. Scott
Affiliation:
Institute of Neuroscience, Newcastle University, UK Université Paris-Est Créteil (UPEC), France
R. Morriss
Affiliation:
Division of Psychiatry, School of Community Health Sciences, University of Nottingham, UK
P. Kinderman
Affiliation:
Institute of Psychology, Health and Society, University of Liverpool, UK
E. Paykel
Affiliation:
Department of Psychiatry, University of Cambridge, UK
R. P. Bentall*
Affiliation:
Institute of Psychology, Health and Society, University of Liverpool, UK
*
*Address for correspondence: Professor R. P. Bentall, Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building Block B, Liverpool L69 3GL, UK. (Email: [email protected])
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Abstract

Background

Although depression and mania are often assumed to be polar opposites, studies have shown that, in patients with bipolar disorder, they are weakly positively correlated and vary somewhat independently over time. Thus, when investigating relationships between specific psychological processes and specific symptoms (mania and depression), co-morbidity between the symptoms and changes over time must be taken into account.

Method

A total of 253 bipolar disorder patients were assessed every 24 weeks for 18 months using the Hamilton Rating Scale for Depression (HAMD), the Bech–Rafaelsen Mania Assessment Scale (MAS), the Rosenberg Self-Esteem Questionnaire (RSEQ), the Dysfunctional Attitudes Scale (DAS), the Internal, Personal and Situational Attributions Questionnaire (IPSAQ) and the Personal Qualities Questionnaire (PQQ). We calculated multilevel models using the xtreg module of Stata 9.1, with psychological and clinical measures nested within each participant.

Results

Mania and depression were weakly, yet significantly, associated; each was related to distinct psychological processes. Cross-sectionally, self-esteem showed the most robust associations with depression and mania: depression was associated with low positive and high negative self-esteem, and mania with high positive self-esteem. Depression was significantly associated with most of the other self-referential measures, whereas mania was weakly associated only with the externalizing bias of the IPSAQ and the achievement scale of the DAS. Prospectively, low self-esteem predicted future depression.

Conclusions

The associations between different self-referential thinking processes and different phases of bipolar disorder, and the presence of the negative self-concept in both depression and mania, have implications for therapeutic management, and also for future directions of research.

Keywords

Bipolar disorderlongitudinal analysisself-esteemself-referential processessymptoms
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 9 , September 2013 , pp. 1895 - 1907
Copyright
Copyright © Cambridge University Press 2012 

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