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The long-term burden of symptoms is an important outcome in bipolar disorder (BD). A method which has minimal burden of assessment uses a retrospective interview, the Longitudinal Interval Follow-up Examination (LIFE), although this may be subject to problems with recall. This study examines the relationship between the retrospective LIFE scale and concurrently-rated mood rating scales in two clinical trials of 18 months of psychotherapy for patients with BD. The Montgomery-Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) were administered every eight to nine weeks and the LIFE was carried out every 6 months. Correlations between scores on mood rating scales and at equivalent times on the LIFE were examined, as well as of potential clinical moderators. There were significant correlations between LIFE depression ratings and concurrent MADRS score (r = 0.57) and between LIFE mania ratings and YMRS score (r = 0.40). In determining "mild depression" on the MADRS, a receiver operating characteristics (ROC) analysis showed an AUC of 0.78 for LIFE scores. Correlations, particularly for depression scores, were high even when the LIFE rating was several months before the interview, suggesting that the LIFE has validity in examining the burden of mood symptoms over time, with relatively little burden of assessment. Future research should examine the relationship between symptom burden and quality of life measured in this way. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Traditional mental health services are not meeting the needs of service users.Peer support is an alternative approach of providing support founded on relationship where there is respect and shared responsibility.Peer support relationships are mutual and reciprocal. What the paper adds to existing knowledge?: The experience of peer‐led care can be transformative.A key aspect is the validation and valuing of lived experience and being seen as a person not as an illness.The nature and quality of relationships is paramount and needs to be based on equity. What are the implications for mental health nursing?: Nurses have a key role to advocate and promote peer support services.Relationships need to be based on respect and "being alongside" service users in their recovery journey rather than trying to "fix the problem." Introduction: Peer‐led services provide an approach to support based on mutuality, respect and shared experience. Aim: To provide an understanding of my experiences of receiving help from a peer‐led service. Method: Journaling experiences captured in detail the reality of my experiences at the time and were used to inform this paper. Results: The Narrative describes entering a Peer‐Led Acute Alternative Service when I was amid a mental health crisis and feeling broken. Here, relationships were based on connecting with others who have experienced similar struggles, being seen as an individual rather than a patient, treated with dignity and respect, being heard, having my feelings acknowledged rather than medicated and feeling understood. This created a shift in me to a place of healing and finding meaning in my experiences of mental distress which led to me training in peer support. Discussion: Peer‐led services can be a transformative experience which redefines the relationship and shifts the person from being a passive recipient of help to an active participant in their recovery. Choice and increased options for peer services as an integral aspect of services available for individuals on their mental health journey is critical. [ABSTRACT FROM AUTHOR]

The majority of patients with bipolar disorder have onset prior to twenty years with early onset associated with increased impairment. Despite this, little attention has been given to the psychosocial developmental impact of this disorder. This qualitative study explored the impact of having bipolar disorder on the development of a sense of self and identity. Key findings from this qualitative study identified that for these participants, bipolar disorder had a significant impact in the area of self and identity development. Bipolar disorder created experiences of confusion, contradiction, and self doubt which made it difficult for these participants to establish continuity in their sense of self. Their lives were characterized by disruption and discontinuity and by external definitions of self based on their illness. Developing a more integrated self and identity was deemed possible through self-acceptance and incorporating different aspects of themselves. These findings would suggest that it is critical to view bipolar disorder within a psychosocial developmental framework and consider the impact on the development of self and identity. A focus on the specific areas of impact and targeting interventions that facilitate acceptance and integration thus promoting self and identity development would be recommended.

Objective: To examine the impact of a treatment package combining Interpersonal and Social Rhythm Therapy (IPSRT) and cognitive remediation (CR), vs IPSRT alone, on cognition, functioning, and mood disturbance outcomes in mood disorders. Methods: A pragmatic randomised controlled trial in adults with bipolar disorder (BD) or major depressive disorder (MDD), recently discharged from mental health services in Christchurch, New Zealand, with subjective cognitive difficulties. Individuals were randomised to a 12‐month course of IPSRT with CR (IPSRT‐CR), or without CR (IPSRT). In IPSRT‐CR, CR was incorporated into therapy sessions from approximately session 5 and continued for 12 sessions. The primary outcome was change in Global Cognition (baseline to 12 months). Results: Sixty‐eight individuals (BD n = 26, MDD n = 42; full/partial remission n = 39) were randomised to receive IPSRT‐CR or IPSRT (both n = 34). Across treatment arms, individuals received an average of 23 IPSRT sessions. Change in Global Cognition did not differ between arms from baseline to treatment‐end (12 months). Psychosocial functioning and longitudinal depression symptoms improved significantly more in the IPSRT compared with IPSRT‐CR arm over 12 months, and all measures of functioning and mood symptoms showed moderate effect size differences favouring IPSRT (0.41–0.60). At 18 months, small to moderate, non‐significant benefits (0.26–0.47) of IPSRT vs IPSRT‐CR were found on functioning and mood outcomes. Conclusions: Combining two psychological therapies to target symptomatic and cognitive/functional recovery may reduce the effect of IPSRT, which has implications for treatment planning in clinical practice and for CR trials in mood disorders. [ABSTRACT FROM AUTHOR]

Objectives: (1) To examine the differences between interpersonal and social rhythm therapy (IPSRT) and specialist supportive care (SSC) in the longer term impacts of IPSRT and SSC on cumulative depression and mania symptoms over a further 78‐week follow‐up period post treatment. (2) To calculate the survival time before recurrence of a new mood episode over the 3‐year period. Methods: One hundred young people with bipolar disorder aged between 15 and 36 years who had been randomized to treatment with either IPSRT or SSC for 78 weeks were followed up for a subsequent 78 weeks. The Longitudinal Interval Follow‐up Evaluation was completed at 26‐week intervals. A Mann‐Whitney U test was used to determine if there were significant differences between therapy types and a Kaplan‐Meier survival analysis was used to determine time to recurrence. Cox regression was used to assess the association between time to relapse and therapy type. Results: There were no significant differences between therapies at each of the data points for either depression or mania scores. The mean change in depression and mania in both groups was significantly different for all three follow‐up data points. The actuarial cumulative recurrence rates were 53% for IPSRT and 49% for SSC. There was no significant difference between the groups in time to recurrence. Conclusions: While there were no significant differences between the two therapies, there was an overall reduction in symptoms in both therapies. There may be sustained benefits in providing intensive psychotherapies in conjunction with pharmacotherapy for young people with bipolar disorder. [ABSTRACT FROM AUTHOR]

Objectives: Given the sensitivity of individuals with mood disorders to circadian disruption, transmeridian travel would likely be a high-risk endeavour leading to onset or relapses in mood. A systematic review was undertaken to identify the evidence of the impact of transmeridian travel on people with mood disorders. Methods: Databases search included the following: CINAHL, MEDLINE, PsycINFO and manual searching using the keywords jetlag, transmeridian travel, circadian rhythm disruption, mood disorder, bipolar, major depression, seasonal affective disorder, depression, mania and hypomania. Results: Only three studies were identified that related to transmeridian travel and jetlag in people with mood disorders. There is some suggestion that transmeridian travel does appear to precipitate mood episodes with an increased rate of episodes of depression with westward compared with an increased rate of manic/hypomanic episodes with eastward travel. Individuals with a previous history of mood disorder appear to be more vulnerable if adherence to medication is compromised. Conclusion: Given the limited evidence that transmeridian travel precipitates mood episodes, this poses difficulties in identifying suitable ways to mitigate the effects of transmeridian travel in mood disorders. However, in the absence of mood-specific guidelines, some guidance can be given based on our current understanding of the relevance of circadian disruption to both jetlag and mood disorders. Further research is required to identify more focused strategies to mitigate the impact of transmeridian travel for individuals with mood disorders. [ABSTRACT FROM AUTHOR]

Objective: Bipolar disorder is a chronic relapsing disorder associated with high rates of suicide, suicide attempts and nonsuicidal self-injury. The study aimed to prospectively identify the rates of suicide attempts and nonsuicidal self-injury in young people participating in an adjunctive randomised controlled psychotherapy for bipolar disorder and to identify differences in individuals who engaged in nonsuicidal self-injury, made suicide attempts or did both. Method: In all, 100 participants aged 15–36 years with bipolar disorder received 78 weeks of psychotherapy and were followed up for a further 78 weeks. Data were collected using the Longitudinal Interval Follow-up Evaluation. Results: Suicide attempts reduced from 11% at baseline to 1% at the end of follow-up (week 156). Similarly, self-harm reduced from 15% at baseline to 7% at the end of follow-up. Individuals who engaged in both nonsuicidal self-injury and made suicide attempts differed from those with who only made suicide attempts, engaged in nonsuicidal self-injury or did neither. They were characterised by a younger age of illness onset and higher comorbidity. Conclusion: Adjunctive intensive psychotherapy may be effective in reducing suicide attempts and nonsuicidal self-injury and warrants further attention. Particular attention needs to be paid to individuals with early age of onset of bipolar disorder. [ABSTRACT FROM AUTHOR]

The article discusses a study that examines whether bipolar disorder patients have slower alternation rates, examined the influence of depression and explored the role of clinical variables and cognitive functions on alternation rate. A slow and a normal alternation group were created by median split and used different computerized functional tests. A slowing in alternation rate in some bipolar disorder participants was replicated.