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Extreme attributions predict transition from depression to mania or hypomania in bipolar disorder

Version 2 2024-05-30, 15:41
Version 1 2014-11-04, 11:53
journal contribution
posted on 2024-05-30, 15:41 authored by JP Stange, LG Sylvia, PVDS Magalhães, E Frank, MW Otto, DJ Miklowitz, Michael BerkMichael Berk, AA Nierenberg, T Deckersbach
BACKGROUND: Relatively little is known about psychological predictors of the onset of mania among individuals with bipolar disorder, particularly during episodes of depression. In the present study we investigated attributional style as a predictor of onset of hypomanic, manic or mixed episodes among bipolar adults receiving psychosocial treatment for depression. We hypothesized that "extreme" (i.e., excessively pessimistic or optimistic) attributions would predict a greater likelihood of developing an episode of mood elevation. METHOD: Outpatients with DSM-IV bipolar I or II disorder (N = 105) enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were randomly allocated to one of three types of intensive psychotherapy for depression or a brief psychoeducational intervention. Patients completed a measure of attributional style at baseline and were followed prospectively for up to one year. All analyses were by intent to treat. RESULTS: Logistic regressions and Cox proportional hazards models indicated that extreme (both positively- and negatively-valenced) attributions predicted a higher likelihood of (and shorter time until) transition from depression to a (hypo)manic or mixed episode (ps < .04), independent of the effects of manic or depressive symptom severity at baseline. Extreme attributions were also retrospectively associated with more lifetime episodes of (hypo)mania and depression (ps < .05). CONCLUSIONS: Evaluating extreme attributions may help clinicians to identify patients who are at risk for experiencing a more severe course of bipolar illness, and who may benefit from treatments that introduce greater cognitive flexibility.

History

Journal

Journal of psychiatric research

Volume

47

Pagination

1329-1336

Location

Amsterdam, The Netherlands

ISSN

0022-3956

eISSN

1879-1379

Language

eng

Publication classification

C Journal article, C1.1 Refereed article in a scholarly journal

Copyright notice

2013, Elsevier Ltd.

Issue

10

Publisher

Elsevier