Kristine Kahr Nilsson

Self-esteem in remitted bipolar disorder patients: a meta-analysis

OBJECTIVES Low self-esteem has been found to be a risk factor for depression in major depressive disorder (MDD). In contrast, the role of self-esteem in bipolar disorder (BD) is still uncertain. In order to examine the characteristics of self-esteem in BD, we synthesized studies comparing self-esteem in BD patients with self-esteem in MDD patients and in normal controls. METHODS Database searches and identification of studies were conducted by two of the authors independently. Remission of BD and MDD was a major selection criterion. The results were generated through meta-analyses. RESULTS Random-effects models of 19 between-group comparisons (N= 1,838) suggested that the self-esteem of remitted BD patients was significantly lower than that of normal controls (Cohens d= -0.83), while significantly higher than that of remitted MDD patients (Cohens d= 0.54). Fail-safe numbers and tests for funnel plot asymmetry indicated that the results were robust and unlikely to reflect publication biases. Additional studies indicated that self-esteem may take a fluctuating course during remission of BD. CONCLUSIONS By revealing that BD patients do experience low self-esteem, the findings implicate a need for further understanding the causes and therapeutic impact of such abnormality in BD.

Self-esteem in remitted bipolar disorder patients

OBJECTIVES Low self-esteem has been found to be a risk factor for depression in major depressive disorder (MDD). In contrast, the role of self-esteem in bipolar disorder (BD) is still uncertain. In order to examine the characteristics of self-esteem in BD, we synthesized studies comparing self-esteem in BD patients with self-esteem in MDD patients and in normal controls. METHODS Database searches and identification of studies were conducted by two of the authors independently. Remission of BD and MDD was a major selection criterion. The results were generated through meta-analyses. RESULTS Random-effects models of 19 between-group comparisons (N= 1,838) suggested that the self-esteem of remitted BD patients was significantly lower than that of normal controls (Cohens d= -0.83), while significantly higher than that of remitted MDD patients (Cohens d= 0.54). Fail-safe numbers and tests for funnel plot asymmetry indicated that the results were robust and unlikely to reflect publication biases. Additional studies indicated that self-esteem may take a fluctuating course during remission of BD. CONCLUSIONS By revealing that BD patients do experience low self-esteem, the findings implicate a need for further understanding the causes and therapeutic impact of such abnormality in BD.

Affective temperaments' relation to functional impairment and affective recurrences in bipolar disorder patients

BACKGROUND The prognostic significance of affective temperaments in bipolar disorder is not yet fully understood. This study therefore examined the relationship between affective temperaments and two major illness outcomes in bipolar disorder: functional impairment and affective recurrences. METHOD At baseline fifty-one remitted bipolar disorder patients were administered the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Auto-questionnaire (TEMPS-A), and the Work and Social Adjustment Scale (WSAS). The patients were followed for 24 months as part of their routine treatment. At follow-up, data on affective recurrences were obtained through medical records combined with a semi-structured interview that enquired into medication adherence. RESULTS Scores on the cyclothymic temperament correlated significantly with functional impairment overall and with scores in three function domains: home-management, private leisure activities and social leisure activities. High scores on the cyclothymic temperament also significantly predicted the presence of depressive recurrences even when controlling for medication non-adherence. The presence of hypomanic or manic recurrences was not predicted by scores on any of the affective temperaments. LIMITATION Since all of the bipolar patients were newly diagnosed and therefore relatively young, the representativeness of the results may have been reduced. The prospective part of the study used data from medical records that may not be as systematic as data gathered from structured clinical interviews. CONCLUSION By suggesting that the cyclothymic temperament is related to both functional impairment and depressive recurrences the findings highlight a vulnerability area in need of further exploration in terms of its prognostic significance.

Theory of Mind in Children with Specific Language Impairment: A Systematic Review and Meta-Analysis

The relation between language and theory of mind (ToM) has been debated for more than two decades. In a similar vein, ToM has been examined in children with specific language impairment (SLI), albeit with inconsistent results. This meta-analysis of 17 studies with 745 children between the ages of 4 and 12 found that children with SLI had substantially lower ToM performance compared to age-matched typically developing children (d = .98). This effect size was not moderated by age and gender. By revealing that children with SLI have ToM impairments, this finding emphasizes the need for further investigation into the developmental interface between language and ToM as well as the extended consequences of atypical language development.

Low self-compassion in patients with bipolar disorder

BACKGROUND Emerging research suggests that low self-compassion may be linked to psychopathology and in particular depressive symptoms. To further elucidate this topic, the present study investigated self-compassion in patients with Bipolar Disorder (BD). METHOD Thirty remitted BD patients were compared to thirty age- and sex matched controls on the Self-Compassion Scale (SCS). The BD patients also completed the Altman Self-Rating Mania Scale (ASRM), the Major Depression Inventory (MDI), the Work and Social Adjustment Scale (WSAS), the Satisfaction With Life Scale (SWLS) and the Internalized Stigma of Mental Illness Scale (ISMI-10) and further reported their illness history on a survey sheet. RESULTS The BD patients were found to have significantly lower self-compassion than controls. In addition, self-compassion correlated positively and significantly with life-satisfaction but no significant correlations with functional impairment, internalized stigma or frequency of past affective episodes were found. LIMITATIONS The small sample size entailed reduced statistical power. CONCLUSIONS By suggesting that self-compassion is reduced and possibly linked to life-satisfaction in BD, the findings highlight a potential vulnerability meriting further investigations.

Early Maladaptive Schemas: A Comparison Between Bipolar Disorder and Major Depressive Disorder

BACKGROUND It is still unclear how bipolar disorder (BD) differentiates from major depressive disorder (MDD) outside major mood episodes. To further elucidate this area, the present study compared the two mood disorders in terms of early maladaptive schemas (EMSs) during remission. METHOD The sample consisted of 49 participants with BD and 30 participants with MDD who were currently in remission. The participants completed the Young Schema Questionnaire. RESULTS The BD group scored significantly higher than the MDD group on seven EMSs: abandonment, failure to achieve, insufficient self-control, subjugation, unrelenting standards, enmeshment and entitlement. CONCLUSION By suggesting that EMSs are more severe in BD compared with MDD, the findings highlight potential vulnerabilities in BD, which merit further examination in terms of their underlying causes and potential treatment implications. KEY PRACTITIONER MESSAGE Early maladaptive schemas are relevant psychological dimensions to consider in remitted phases of major mood disorders. Findings from the current study suggest that early maladaptive schemas are more prevalent in adults with bipolar disorder compared to adults with major depressive disorder when measured during remission. Interventions targeting early maladaptive schemas may be valuable in treatment of bipolar disorder.

Characteristics, Correlates and Outcomes of Perceived Stigmatization in Bipolar Disorder Patients

BACKGROUND The aim of this study was to elucidate the characteristics, correlates and outcomes of perceived stigmatization in patients with Bipolar Disorder (BD). METHODS At baseline 50 remitted BD patients completed the Stigma Questionnaire (SQ), the Work and Social Adjustment Scale (WSAS), and the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Auto-Questionnaire - Short Version (TEMPS-A). The BD patients were followed for 24 months as part of their ongoing treatment. Information on illness course and treatments was obtained at baseline and at follow-up through medical records and interviews. RESULTS The prevalence of perceived stigmatization ranged from 37% to 57% across the areas measured by the SQ. The areas with most perceived stigmatization were work-ability and psychiatric hospitalization. Psychoeducation and affective temperaments emerged as significant independent predictors of perceived stigmatization. Perceived stigmatization was not related to affective recurrences. LIMITATIONS The follow-up period might have been too short to measure the long-term impact of perceived stigmatization. CONCLUSIONS The findings suggest that BD patients consider issues concerning work-ability and psychiatric hospitalizations to be particularly affected by stigmatization. Psychoeducation and affective temperaments were, furthermore, identified as factors implicated in perceived stigmatization in this population.

Early maladaptive schemas

BACKGROUND It is still unclear how bipolar disorder (BD) differentiates from major depressive disorder (MDD) outside major mood episodes. To further elucidate this area, the present study compared the two mood disorders in terms of early maladaptive schemas (EMSs) during remission. METHOD The sample consisted of 49 participants with BD and 30 participants with MDD who were currently in remission. The participants completed the Young Schema Questionnaire. RESULTS The BD group scored significantly higher than the MDD group on seven EMSs: abandonment, failure to achieve, insufficient self-control, subjugation, unrelenting standards, enmeshment and entitlement. CONCLUSION By suggesting that EMSs are more severe in BD compared with MDD, the findings highlight potential vulnerabilities in BD, which merit further examination in terms of their underlying causes and potential treatment implications. KEY PRACTITIONER MESSAGE Early maladaptive schemas are relevant psychological dimensions to consider in remitted phases of major mood disorders. Findings from the current study suggest that early maladaptive schemas are more prevalent in adults with bipolar disorder compared to adults with major depressive disorder when measured during remission. Interventions targeting early maladaptive schemas may be valuable in treatment of bipolar disorder.

Early Maladaptive Schemas: A Comparison Between Bipolar Disorder and Major Depressive Disorder: Early Maladaptive Schemas

BACKGROUND It is still unclear how bipolar disorder (BD) differentiates from major depressive disorder (MDD) outside major mood episodes. To further elucidate this area, the present study compared the two mood disorders in terms of early maladaptive schemas (EMSs) during remission. METHOD The sample consisted of 49 participants with BD and 30 participants with MDD who were currently in remission. The participants completed the Young Schema Questionnaire. RESULTS The BD group scored significantly higher than the MDD group on seven EMSs: abandonment, failure to achieve, insufficient self-control, subjugation, unrelenting standards, enmeshment and entitlement. CONCLUSION By suggesting that EMSs are more severe in BD compared with MDD, the findings highlight potential vulnerabilities in BD, which merit further examination in terms of their underlying causes and potential treatment implications. KEY PRACTITIONER MESSAGE Early maladaptive schemas are relevant psychological dimensions to consider in remitted phases of major mood disorders. Findings from the current study suggest that early maladaptive schemas are more prevalent in adults with bipolar disorder compared to adults with major depressive disorder when measured during remission. Interventions targeting early maladaptive schemas may be valuable in treatment of bipolar disorder.