Cognitive styles in individuals with bipolar disorders
Background. Published studies of emotional processing and cognitive style in bipolar disorders tend to have small sample sizes or use non-clinical samples. Larger clinically representative studies are needed.
Method. Self-esteem, dysfunctional attitudes and personality style were compared in unipolar (N=16) and bipolar disorder (N=77); and then investigated in the different phases of bipolar disorder (remitted=26; depressed=38; hypomanic=13). One-year outcome was assessed in 36 bipolar subjects.
Results. Unipolar subjects and bipolar subjects differed significantly in their mean levels of negative self-esteem (unipolar=15·5; bipolar=12·7; P<0·05). Bipolar subjects with hypomania reported mean levels of dysfunctional beliefs that were higher than individuals in remission but lower than depressed subjects (remitted=136·7; depressed=153·8; hypomanic=144·8; P<0·05). Hypomanic subjects recorded the highest levels of negative as well as positive self-esteem. In the exploratory analysis of outcome, negative self-esteem (Exp [B] 1·91; 95% CI 1·11 to 3·32; P<0·05) was the most robust predictor of relapse.
Conclusions. There are similarities in the cognitive style of individuals with unipolar as compared to bipolar disorders. Cognitive style in hypomania represents a phase between remission and depression rather than the polar opposite of depression. The implications of these findings are considered for psychological and neural network models.
c1 Professor Jan Scott, Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF.