- 作者：Jonathan P. Stange ; Louisa G. Sylvia ; Pedro Vieira da Silva Magalh?es ; Ellen Frank ; Michael W. Otto ; David J. Miklowitz ; Michael Berk ; Andrew A. Nierenberg ; Thilo Deckersbach
- 关键词：Attributional style ; Cognitive style ; Cognitive vulnerability ; Mania ; Hypomania ; Manic switch
- 刊名：Journal of Psychiatric Research
- 出版年：2013
- 出版时间：October, 2013
- 年：2013
- 卷：47
- 期：10
- 页码：1329-1336
- 全文大小：389 K
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.