• Melatonin response to bright light in recovered, drug-free, bipolar patients

      Perini, Tony (1991)
      Melatonin suppression by bright light was investigated in 15 drug-free euthymic bipolar patients and control subjects matched for age and sex with the patients. There were no differences between groups on the extent of melatonin suppression by 500 lux bright light administered between 0200h and 0400h. These results do not support the hypothesis that melatonin suppression by bright light is a reliable trait marker in recovered bipolar patients. © 1991.
    • The epidemiology of bipolar affective disorder; a review of the literature and introduction to work in progress

      Lloyd, Tuhina (2000)
      The past 20 years have seen much research into affective disorders, reflecting advances in both pharmacological and psychological treatments. However, there has been little basic epidemiological research into bipolar illness. This is particularly apparent regarding its basic occurrence and possible epigenetic causes. This presentation will attempt to bring together and integrate the available evidence regarding the basic epidemiology of bipolar disorder, define areas where further research is needed, and outline a large epidemiological study including bipolar affective disorder that has been supported by the Stanley Foundation.
    • Incidence of bipolar affective disorder in three UK cities: Results from the ÆSOP study

      Lloyd, Tuhina (2005)
      Background: There has been a relative dearth of epidemiological research into bipolar affective disorder. Furthermore, incidence studies of bipolar disorder have been predominantly retrospective and most only included hospital admission cases. Aims: To determine the incidence of operationally defined bipolar disorder in three areas of the UK and to investigate any differences in gender and ethnicity. Method: All patients who contacted mental health services with first-episode psychosis or non-psychotic mania between September 1997 and August 1999 were identified and diagnosed according to ICD-10 criteria. Incidence rates of bipolar affective disorder were standardised for age and stratified by gender and ethnic group across the three areas. Results: The incidence rate per 100 000 per year in south-east London was over twice that in Nottingham and Bristol. There was no significant difference in the rates of disorder in men and women. Incidence rates of bipolar disorder in the combined Black and minority ethnic groups in all three areas were significantly higher than those of the comparison White groups. Conclusions: The incidence of bipolar disorder was higher in south-east London than in the other two areas, and was higher among Black and minority ethnic groups than in the White population. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)
    • Psychological models of mood disorders

      Morriss, Richard K. (2006)
      A number of psychological models for depression and bipolar disorder have at least some empirical support, are in common use and spawned effective psychological treatments for mood disorder. The article will discuss cognitive behaviour therapy and life events and social support models for unipolar depressive episodes, and more briefly review psychodynamic and medication adherence models for depression, and the development of psychological models in bipolar disorder. These models fit well with the view of many patients that their mood disorder is at least in part psychologically and socially caused. They also promote active self-management of their condition rather than passive compliance with treatment. As a result, these psychological approaches tend to improve the outcomes from medication. Effective care plans can be based on a formulation of cases with mood disorders using these psychological models without employing a formal course of psychological treatment. However, people who do not improve with such a plan may require a formal course of psychological treatment based on these models from an experienced therapist. Since these models tend to utilize information from the past that often cannot be verified, they are open to reporting and recall bias. Also, severely ill or immature patients may not be able to utilize these techniques. However, in suitable patients the use of these psychological models in addition to optimal prescribing of medication and continuity of care probably represent the current gold standard of care for mood disorders. © 2006 Elsevier Ltd. All rights reserved.
    • Aggressive behaviour at first contact with services: Findings from the AESOP First Episode Psychosis Study

      Lloyd, Tuhina (2007)
      Background: Aggressive behaviour is increased among those with schizophrenia but less is known about those with affective psychoses. Similarly, little is known about aggressive behaviour occurring at the onset of illness. Method: The main reasons for presentation to services were examined among those recruited to a UK-based first episode psychosis study. The proportion of individuals presenting with aggressive behaviour was determined and these individuals were compared to those who were not aggressive on a range of variables including sociodemographic, clinical, criminal history, service contact, and symptom characteristics. Among the aggressive group, those who were physically violent were distinguished from those who were not violent but who were still perceived to present a risk of violence to others. Results: Almost 40% (n = 194) of the sample were aggressive at first contact with services; approximately half of these were physically violent (n = 103). Younger age, African-Caribbean ethnicity and a history of previous violent offending were independently associated with aggression. Aggressive behaviour was associated with a diagnosis of mania and individual manic symptoms were also associated with aggression both for the whole sample and for those with schizophrenia. Factors differentiating violent from non-violent aggressive patients included male gender, lower social class and past violent offending. Conclusions: Aggressive behaviour is not an uncommon feature in those presenting with first episode psychosis. Sociodemographic and past offending factors are associated with aggression and further differentiate those presenting with more serious violence. A diagnosis of mania and the presence of manic symptoms are associated with aggression. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)
    • Adult attachment in bipolar 1 disorder

      Morriss, Richard K. (2009)
      OBJECTIVES: To determine how security of adult attachment style is related to the mania, major depression and euthymic mood states in bipolar 1 (BP1) disorder.
    • Psychological management of mood disorders

      Morriss, Richard K. (2009)
      Evidence-based psychological treatments for adults with unipolar depressive disorder and bipolar disorder are reviewed. There is most empirical evidence for cognitive behavioural therapy (CBT), which is examined in terms of what it is and its evidence base in unipolar depression, including severe, chronic, and treatment-resistant cases. The evidence base for the combination of CBT plus antidepressant treatment, including where continuation CBT may be usefully employed, reveals greater effectiveness than antidepressant treatment with continuing clinical support or other forms of psychotherapy in patients with severe, chronic, and treatment-resistant depression or depression with co-morbid personality disorder. Briefer descriptions and evidence for the role of mindfulness-based cognitive therapy, behaviour therapy, problem-solving, interpersonal therapy, psychodynamic therapy and cognitive analytical therapy are reviewed. All of these have some evidence for effectiveness and the roles of some of these treatments are starting to become clearer. Simple psychological treatments for bipolar disorder, such as medication adherence and early warning symptoms interventions, can improve some types of clinical outcome, but longer psychological interventions delivered by highly skilled therapists such as CBT and group psycho-education may have more comprehensive evidence of effectiveness. There is some preliminary evidence for the effectiveness of some psychological treatments in bipolar depression. Overall, the effectiveness of psychological treatments for unipolar depressive disorder and bipolar disorder is now well established and an understanding is starting to be obtained as to when they may be employed most usefully. © 2009 Elsevier Ltd. All rights reserved.
    • Reasons for substance use in dual diagnosis bipolar disorder and substance use disorders: A qualitative study

      Morriss, Richard K. (2009)
      Background: Few systematic studies have examined the reasons why patients with bipolar disorder and substance use disorders misuse alcohol and drugs of abuse. Such reasons may depend heavily on context so qualitative research methods that made no prior theoretical assumptions were employed. We explored the reasons patients give for misusing drugs and alcohol and how these relate to their illness course. Method: Qualitative semi-structured interviews and thematic analysis with a purposive sample of 15 patients with bipolar disorder and a current or past history of drug or alcohol use disorders. Results: Patients based their patterns of and reasons for substance use on previous personal experiences rather than other sources of information. Reasons for substance use were idiosyncratic, and were both mood related and unrelated. Contextual factors such as mood, drug and social often modified the patient's personal experience of substance use. Five thematic categories emerged: experimenting in the early illness; living with serious mental illness; enjoying the effects of substances; feeling normal; and managing stress. Limitations: The prevalence of these underlying themes was not established and the results may not apply to populations with different cultural norms. Conclusions: Patterns of substance use and reasons for use are idiosyncratic to the individual and evolve through personal experience. Motivating the patient to change their substance use requires an understanding of their previous personal experience of substance use both in relation to the different phases of their bipolar disorder and their wider personal needs. © 2008 Elsevier B.V. All rights reserved.
    • Lithium plus valproate combination therapy versus monotherapy for relapse prevention in bipolar I disorder (BALANCE): A randomised open-label trial

      Barrett, Sara; Lidder, Jasvinder S.; McCartney, Mark; Middleton, Hugh; Ononve, Frank; Solanki, Ramesh D. (2010)
      Background Lithium carbonate and valproate semisodium are both recommended as monotherapy for prevention of relapse in bipolar disorder, but are not individually fully effective in many patients. If combination therapy with both agents is better than monotherapy, many relapses and consequent disability could be avoided. We aimed to establish whether lithium plus valproate was better than monotherapy with either drug alone for relapse prevention in bipolar I disorder. Methods 330 patients aged 16 years and older with bipolar I disorder from 41 sites in the UK, France, USA, and Italy were randomly allocated to open-label lithium monotherapy (plasma concentration 0.4-1.0 mmol/L, n=110), valproate monotherapy (750-1250 mg, n=110), or both agents in combination (n=110), after an active run-in of 4-8 weeks on the combination. Randomisation was by computer program, and investigators and participants were informed of treatment allocation. All outcome events were considered by the trial management team, who were masked to treatment assignment. Participants were followed up for up to 24 months. The primary outcome was initiation of new intervention for an emergent mood episode, which was compared between groups by Cox regression. Analysis was by intention to treat. This study is registered, number ISRCTN 55261332. Findings 59 (54%) of 110 people in the combination therapy group, 65 (59%) of 110 in the lithium group, and 76 (69%) of 110 in the valproate group had a primary outcome event during follow-up. Hazard ratios for the primary outcome were 0.59 (95% CI 0.42-0.83, p=0.0023) for combination therapy versus valproate, 0.82 (0.58-1.17, p=0.27) for combination therapy versus lithium, and 0.71 (0.51-1.00, p=0.0472) for lithium versus valproate. 16 participants had serious adverse events after randomisation: seven receiving valproate monotherapy (three deaths); five lithium monotherapy (two deaths); and four combination therapy (one death). Interpretation For people with bipolar I disorder, for whom long-term therapy is clinically indicated, both combination therapy with lithium plus valproate and lithium monotherapy are more likely to prevent relapse than is valproate monotherapy. This benefit seems to be irrespective of baseline severity of illness and is maintained for up to 2 years. BALANCE could neither reliably confirm nor refute a benefit of combination therapy compared with lithium monotherapy.
    • Pragmatic randomised controlled trial of group psychoeducation versus group support in the maintenance of bipolar disorder

      Morriss, Richard K. (2011)
      Background: Non-didactically delivered curriculum based group psychoeducation has been shown to be more effective than both group support in a specialist mood disorder centre in Spain (with effects lasting up to five years), and treatment as usual in Australia. It is unclear whether the specific content and form of group psychoeducation is effective or the chance to meet and work collaboratively with other peers. The main objective of this trial is to determine whether curriculum based group psychoeducation is more clinically and cost effective than unstructured peer group support.; Methods/design: Single blind two centre cluster randomised controlled trial of 21 sessions group psychoeducation versus 21 sessions group peer support in adults with bipolar 1 or 2 disorder, not in current episode but relapsed in the previous two years. Individual randomisation is to either group at each site. The groups are carefully matched for the number and type of therapists, length and frequency of the interventions and overall aim of the groups but differ in content and style of delivery. The primary outcome is time to next bipolar episode with measures of the therapeutic process, barriers and drivers to the effective delivery of the interventions and economic analysis. Follow up is for 96 weeks after randomisation.; Discussion: The trial has features of both an efficacy and an effectiveness trial design. For generalisability in England it is set in routine public mental health practice with a high degree of expert patient involvement.;
    • Early warning signs checklists for relapse in bipolar depression and mania: Utility, reliability and validity

      Morriss, Richard K. (2011)
      Background: Recognising early warning signs (EWS) of mood changes is a key part of many effective interventions for people with Bipolar Disorder (BD). This study describes the development of valid and reliable checklists required to assess these signs of depression and mania. Methods: Checklists of EWS based on previous research and participant feedback were designed for depression and mania and compared with spontaneous reporting of EWS. Psychometric properties and utility were examined in 96 participants with BD. Results: The majority of participants did not spontaneously monitor EWS regularly prior to use of the checklists. The checklists identified most spontaneously generated EWS and led to a ten fold increase in the identification of EWS for depression and an eight fold increase for mania. The scales were generally reliable over time and responses were not associated with current mood. Frequency of monitoring for EWS correlated positively with social and occupational functioning for depression (beta = 3.80, p = 0.015) and mania (beta = 3.92, p = 0.008). Limitations: The study is limited by a small sample size and the fact that raters were not blind to measures of mood and function. Conclusions: EWS checklists are useful and reliable clinical and research tools helping to generate enough EWS for an effective EWS intervention. © 2011 Elsevier B.V. All rights reserved.
    • Varenicline induces manic relapse in bipolar disorder

      Tsoi, Daniel T. (2011)
      Varenicline (Chantix) is commonly used to assist individuals with smoking cessation. This medication is known to affect mood and behavior. We report a patient with bipolar disorder who developed manic relapse after starting treatment with varenicline for tobacco dependence. Further research is necessary to establish the safety of using varenicline in individuals who have significant mental illness and want to stop smoking.
    • Suicidality in bipolar affective disorder the nature of impulsivity and impulse control disorders - a cross sectional controlled study

      Thangavelu, Karthik; Morriss, Richard K.; Howard, Richard C. (2012)
      Patients with bipolar disorder have a higher risk of committing suicide(15-20%) Poor impulse control might be the mechanism by which suicidality may become manifest in bipolar disorder. Aims: To determine the nature of poor impulse control and suicidal behaviour. To understand the relationship between poor impulse control,co-morbid diagnosis and suicidal behaviour in patients with bipolar disorder. Method: A cross sectional study was carried out in 40 patients with bipolar disorder. Clinical parameters were established using semi-structured interview, co-morbid diagnosis and impulse control disorders using SCID. All completed impulsivity questionnaire (UPPS) and Suicidal behaviour questionnaire (SBQ). ANOVA and Pearsons correlation was performed. Results: There was high degree of co-morbidity (55 % anxiety, 30% substance use, 13% personality disorder and 47 % impulse control disorder). 45% did not have a past history of self harm, 40% had history of less severe self harm and 15%had near fatal self harm history.The sample mean showed significant difference compared to population mean ( P< 0.05) with marked difference noted for near fatal self harm group (P< 0.01) indicating that patients with bipolar disorder might have a high degree of trait impulsivity.The three items on impulsivity scale-lack of premeditation, urgency and lack of perseverance correlated significantly (P< 0.01) with the future likelihood of dying. Conclusion: This study supports the view that there is a high degree of suicidal behaviour in bipolar disorder.15% of the sample had past history of near-fatal self harm.High scores of trait impulsivity in sample are akin to scores for patients with borderline personality and addiction. There is a clear correlation between impulsivity scores and future risk of completed suicide.
    • Suicide in bipolar disorder in a national English sample, 1996–2009: Frequency, trends and characteristics

      Morriss, Richard K. (2013)
      BackgroundBipolar disorder (BD) has been reported to be associated with high risk of suicide. We aimed to investigate the frequency and characteristics of suicide in people with BD in a national sample.MethodSuicide in BD in England from 1996 to 2009 was explored using descriptive statistics on data collected by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI). Suicide cases with a primary diagnosis of BD were compared to suicide cases with any other primary diagnosis.ResultsDuring the study period 1489 individuals with BD died by suicide, an average of 116 cases/year. Compared to other primary diagnosis suicides, those with BD were more likely to be female, more than 5 years post-diagnosis, current/recent in-patients, to have more than five in-patient admissions, and to have depressive symptoms. In BD suicides the most common co-morbid diagnoses were personality disorder and alcohol dependence. Approximately 40% were not prescribed mood stabilizers at the time of death. More than 60% of BD suicides were in contact with services the week prior to suicide but were assessed as low risk.ConclusionsGiven the high rate of suicide in BD and the low estimates of risk, it is important that health professionals can accurately identify patients most likely to experience poor outcomes. Factors such as alcohol dependence/misuse, personality disorder, depressive illness and current/recent in-patient admission could characterize a high-risk group. Future studies need to operationalize clinically useful indicators of suicide risk in BD.
    • The role of beliefs about mood swings in determining outcome in bipolar disorder

      Morriss, Richard K. (2013)
      This study explored the impact of beliefs about mood swings on symptomatic outcome in bipolar disorder (BD). Ninety-one people with BD completed a Brief Illness Perception Questionnaire at baseline. Outcome was measured using weekly measures of mood and time to relapse over the following 24 weeks. Beliefs about the consequences of mood swings [Hazard ratio (HR) = 1.38, 95 % CI = (1.07,1.77)], perceived symptoms associated with mood swings [HR = 0.75, 95 % CI = (0.59,0.95)], and emotional concern about mood swings [HR = 1.30, 95 % CI = (1.04,1.61)] had statistically significant effects on hazard of relapse, while beliefs about the consequences of mood swings [Odds ratio (OR) = 1.24, 95 % CI = (1.01,1.52)] and the amount of personal effort individuals believed they were making to get well [OR = 0.82, 95 % CI = (0.67,1.02)] had important effects on weekly LIFE scores of depressive symptoms controlling for baseline depression, mood stabilizer medication and number of previous bipolar episodes. In conclusion, beliefs about mood swings had important effects on weekly fluctuations in depression severity and time to relapse. © 2012 Springer Science+Business Media, LLC.
    • A feasibility study of expert patient and community mental health team led bipolar psychoeducation groups: Implementing an evidence based practice

      Morriss, Richard K. (2013)
      Background: Group psychoeducation is a cost effective intervention which reduces relapse and improves functioning in bipolar disorder but is rarely implemented. The aim of this study was to identify the acceptability and feasibility of a group psychoeducation programme delivered by community mental health teams (CMHTs) and peer specialist (PS) facilitators. Organisational learning was used to identify and address systematically barriers and enablers, at organisational, health professional and patient levels, to its implementation into a routine service.Methods: A systematic examination of barriers and enablers to a three day training process informed the delivery of a first treatment group and a similar process informed the delivery of the second treatment group. Triangulation of research methods improved its internal validity: direct observation of training, self-rated surveys of participant experiences, group discussion, and thematically analysed individual participant and facilitator interviews were employed.Results: Barriers and enablers were identified at organisational, educational, treatment content, facilitator and patient levels. All barriers under the control of the research team were addressed with subsequent improvements in patient knowledge about the condition and about local service. In addition, self-management, agency and altruism were enhanced. Barriers that could not be addressed required senior clinical and education leadership outside the research team's control. PS and professional facilitators were successfully trained and worked together to deliver groups which were generally reported as being beneficial.Conclusion: Psychoeducation groups involving CMHT and PS facilitators is acceptable and feasible but their sustainment requires senior leadership within and outside the organisation that control finance and education services. © 2013 Coulthard et al.; licensee BioMed Central Ltd.
    • Differential effects of depression and mania symptoms on social adjustment: Prospective study in bipolar disorder

      Morriss, Richard K.; Chopra, Arun (2013)
      OBJECTIVES: Previous studies of social adjustment in bipolar disorder have been cross-sectional and small in sample size, have examined a limited number of roles, or were not controlled for baseline mood and other clinical, social, or treatment confounders. We aimed to prospectively explore the strength and stability of correlations between depression and mania-type symptoms and impairment in a broad range of social adjustment roles and domains.
    • A novel cognitive behaviour therapy for bipolar disorders (Think Effectively About Mood Swings or TEAMS): Study protocol for a randomized controlled trial

      Tinning, Neil (2014)
      Background: Existing psychological therapies for bipolar disorders have been found to have mixed results, with a consensus that they provide a significant, but modest, effect on clinical outcomes. Typically, these approaches have focused on promoting strategies to prevent future relapse. An alternative treatment approach, termed 'Think Effectively About Mood Swings' (TEAMS) addresses current symptoms, including subclinical hypomania, depression and anxiety, and promotes long-term recovery. Following the publication of a theoretical model, a range of research studies testing the model and a case series have demonstrated positive results. The current study reports the protocol of a feasibility randomized controlled trial to inform a future multi-centre trial. Methods/Design: A target number of 84 patients with a diagnosis of bipolar I or II disorder, or bipolar disorder not-otherwise-specified are screened, allocated to a baseline assessment and randomized to either 16 sessions of TEAMS therapy plus treatment-as-usual (TAU) or TAU. Patients complete self-report inventories of depression, anxiety, recovery status and bipolar cognitions targeted by TEAMS. Assessments of diagnosis, bipolar symptoms, medication, access to services and quality of life are conducted by assessors blind to treatment condition at 3, 6, 12 and 18months post-randomization. The main aim is to evaluate recruitment and retention of participants into both arms of the study, as well as adherence to therapy, to determine feasibility and acceptability. It is predicted that TEAMS plus TAU will reduce self-reported depression in comparison to TAU alone at six months post-randomization. The secondary hypotheses are that TEAMS will reduce the severity of hypomanic symptoms and anxiety, reduce bipolar cognitions, improve social functioning and promote recovery compared to TAU alone at post-treatment and follow-up. The study also incorporates semi-structured interviews about the experiences of previous treatment and the experience of TEAMS therapy that will be subject to qualitative analyses to inform future developments of the approach. Discussion: The design will provide preliminary evidence of efficacy, feasibility, acceptability, uptake, attrition and barriers to treatment to design a definitive trial of this novel intervention compared to treatment as usual. Trial registration: This trial was registered with Current Controlled Trials (ISRCTN83928726) on registered 25 July 2014. Copyright © 2014 Mansell et al.; licensee BioMed Central Ltd.
    • Shared white-matter dysconnectivity in schizophrenia and bipolar disorder with psychosis

      Kumar, Jyothika; Iwabuchi, Sarina J.; Balain, Vijender; Palaniyappan, Lena; Liddle, Peter F. (2015)
      Background: There is an appreciable overlap in the clinical presentation, epidemiology and treatment response of the two major psychotic disorders - schizophrenia and bipolar disorder. Nevertheless, the shared neurobiological correlates of these two disorders are still elusive. Using diffusion tensor imaging (DTI), we sought to identify brain regions which share altered white-matter connectivity across a clinical spectrum of psychotic disorders.; Method: A sample of 41 healthy controls, 62 patients in a clinically stable state of an established psychotic disorder (40 with schizophrenia, 22 with bipolar disorder) were studied using DTI. Tract-based spatial statistics (TBSS) was used in order to study group differences between patients with psychosis and healthy controls using fractional anisotropy (FA). Probabilistic tractography was used in order to visualize the clusters that showed significant differences between these two groups.; Results: The TBSS analysis revealed five clusters (callosal, posterior thalamic/optic, paralimbic, fronto-occipital) with reduced FA in psychosis. This reduction in FA was associated with an increase in radial diffusivity and a decrease in mode of anisotropy. Factor analysis revealed a single white-matter integrity factor that predicted social and occupational functioning scores in patients irrespective of the diagnostic categorization.; Conclusions: Our results show that a shared white-matter dysconnectivity links the two major psychotic disorders. These microstructural abnormalities predict functional outcome better than symptom-based diagnostic boundaries during a clinically stable phase of illness, highlighting the importance of seeking shared neurobiological factors that underlie the clinical spectrum of psychosis.;