Denial or blame coping strategies common in prodromal BD patients with psychosis
MedWire News: Results from a Korean study show that bipolar disorder (BD) patients with psychosis tend to use denial or blame coping strategies and experience attenuated psychotic symptoms more often during the prodromal period than their counterparts without psychosis.
Writing in the journal Comprehensive Psychiatry, Hyun-Sang Cho (Yonsei University, Seoul) and team explain: "Despite the clinical significance of the psychotic features of bipolar disorder, little attention has been paid to the prodromes in manic patients with psychotic features."
The researchers therefore compared prodromal symptoms and coping styles among 42 BD patients with and 41 BD patients without psychosis. There were no significant differences between the groups regarding age, gender, educational background, or number of mood episodes.
All of the participants were interviewed and completed a 40-item checklist for prodromal symptoms, which consists of 15 manic symptoms, 15 depressive symptoms, and 10 mixed episode symptoms. They also completed the Coping Inventory for Prodromes of Mania (CIPM) - a 23-item scale designed to assess four types of coping responses to manic prodromes, including stimulation reduction, problem-directed coping, seeking professional help, and denial or blame.
The researchers found that the duration of the prodromal period was significantly longer in the psychotic than nonpsychotic patients, at 6.98 weeks (range, 1-26 weeks) versus 4.56 weeks (range, 1-16 weeks).
The prodromal symptom of "energetic-very active" was significantly more common in the nonpsychotic than psychotic group (80.5% vs 52.4%), while "afraid of going crazy" and "hearing hallucination" symptoms were more common in the psychotic than nonpsychotic group (31.0% vs 9.8%, and 45.2% vs 19.5%, respectively).
Furthermore, psychotic patients had higher CIPM scores for denial or blame than the nonpsychotic patients, at 2.32 versus 1.92.
Logistic regression analysis revealed that duration of the prodrome period and hearing hallucinations were significantly associated with the presence of psychosis.
Cho and team conclude: "Psychotic [BD] patients have more psychotic prodromes, problematic coping strategies, and longer prodromal duration."
They add: "These characteristics may affect the outcomes in psychotic BD patients. Therefore, psychosocial approaches, especially an early detection of prodromal symptoms and improving coping strategies, will be needed for better outcomes in psychotic BD patients."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Mark Cowen