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29-06-2011 | Article

Conflicting appraisals of mood states points to bipolar disorder


Free abstract

MedWire News: Bipolar disorder patients appraise internal states as simultaneously extremely positive and extremely negative, which may contribute to the mood swing symptoms seen in such patients, report UK researchers.

Recent research has indicated that positive and negative biases in cognition occur in bipolar disorder, with individuals appraising the same mood states in multiple positive and negative ways. This, it is suggested, may drive mood fluctuations and affect the ability to change responses to extremely activated states.

Rebecca Kelly, from the University of Manchester, and colleagues studied 171 patients with bipolar disorder, 42 unipolar disorder patients, and 64 healthy controls.

The participants completed the 50-item Hypomanic Attitudes and Positive Predictions Inventory, which assesses positive and negative beliefs about internal states, and the Structured Clinical Interview for the Diagnostic and Statistical Manual and Mini-International Neuropsychiatric Inventory confirmed their diagnosis.

Overall, age and high negative appraisals of internal states were significant positive predictors of bipolar disorder, the researchers report in the Journal of Affective Disorders.

In a hierarchical logistic regression model comparing bipolar disorder patients and controls, bipolar disorder was most likely in individuals who gave high positive and high negative appraisals of the same activated internal states. It was least likely in those who gave low negative and high positive appraisals.

Comparing bipolar disorder patients and those with unipolar depression, the team found that a similar pattern was observed on hierarchical logistic regression analysis, with high positive and high negative appraisals of the same states predicting bipolar disorder.

Kelly and co-authors write: "The results of this study are in line with the integrative-cognitive model of bipolar disorder. The model suggests that opposing extreme positive and negative beliefs about the same mood states might lead to conflict… Thus, they may feel conflicted about whether to avoid or suppress this state or to strive to attain it."

They add that "further research in this area, including establishing the utility of the therapeutic approach based on the model is warranted."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Liam Davenport