Cheryl A. Chessick

Suicide and suicide attempts in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

BACKGROUND The current report describes individuals with bipolar disorder who attempted or completed suicide while participating in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study. METHODS Baseline and course features of individuals with suicide events are described. RESULTS Among the 4360 people with bipolar disorder enrolled, 182 individuals made 270 prospectively observed suicidal acts, including 8 completed suicides. This represents a suicide rate of .014 per 100 person years in STEP-BD, which included frequent clinical visits, evidence based care, and standardized assessment at each patient contact. Approximately 1/3 of those who attempted suicide had more than one attempt during study participation. Those who completed suicide tended to do so early in study participation, and half of them did so on their first attempt. LIMITATIONS While this study is limited to description of individuals and precipitants of completed suicides and attempts in STEP-BD, further analyses are planned to explore risk factors and potential interventions for prevention of suicidal acts in persons with bipolar disorder. CONCLUSIONS Persons with bipolar disorder are at high risk for suicide. Overall rates of suicide events in STEP-BD were lower than expected, suggesting that the combination of frequent clinical visits (i.e., access to care), standardized assessment, and evidence-based treatment were helpful in this population.

Are exposure-based cognitive behavioral therapies safe during pregnancy?

Anxiety disorders during pregnancy are highly prevalent and associated with serious and enduring consequences for both mother and child. Exposure-based cognitive behavioral (CBT) and behavioral therapies (BT) represent the most empirically supported psychosocial treatments for anxiety disorders in general adult samples. Pregnant women, however, generally have been excluded from this body of research. Evidence that pregnant women inhabit a unique biological context combined with untested assumptions that exposure would unduly stress or harm the fetus have likely prohibited inquiry. This paper seeks to remedy this gap by integrating findings from obstetric, psychiatric, and psychological research to inform central questions regarding exposure-based treatment of anxiety disorders during pregnancy. Based on available evidence, we consider the potential risks and benefits of CBT/BT for anxiety disorders during pregnancy relative to other currently available treatment options. From a multidisciplinary research perspective, we argue that exposure-based therapies are likely to be safe during pregnancy, particularly relative to the alternatives. However, we also highlight critical questions for future research to directly test the biopsychological impact of exposure-based therapies among pregnant women.

Screening for bipolar disorder during pregnancy and the postpartum period.

Bipolar disorder is a significant mental health problem among perinatal women; however, little attention has been devoted to methods of screening for bipolar disorder during this phase of women’s life cycle. There is a need for reliable and valid screening instruments for perinatal women. This paper presents a review of 11 self-report measures used to screen bipolar disorder in the general population and discusses their applicability to screening among perinatal women. Published psychometric data, including reliability, sensitivity, specificity, and positive predictive value of each self-report instrument, is presented and critiqued. We make recommendations for screening in clinical practice and highlights priorities for future research. The need for more research in this area is emphasized.

DBT Graduate Group Pilot Study: A Model to Generalize Skills to Create a “Life Worth Living”

Dialectical Behavioral Therapy (DBT) is an evidence-based program aimed at decreasing impulsive and self-harming behaviors. One part of this treatment is a skills training group, in which participants learn specific techniques to manage behaviors, interact with others and learn how to tolerate painful emotions. During this part of treatment, the focus is primarily on skills acquisition, but may not necessarily provide the chance to strengthen the skills or generalize the skills into day-to-day problems. One possibility to address this issue is to implement a DBT graduate group, in which clients can continue to develop the skills they have learned. This article presents a pilot study for a DBT graduate group in which 11 clients created specific target goals and then used the skills to work toward these goals, overcome barriers and experience emotions related to life problems. Results from this study indicate an improvement in mood based on decreases in depression scores on the Patient Health Questionnaire (PHQ-9), reports of achievements of target goals and positive and successful transitions out of therapy. While more information is needed about DBT aftercare programs, this article suggests components of a possible graduate group curriculum to help clients continue with the positive momentum gained from the skills training groups.