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Aberrant emotional biases have been reported in bipolar disorder (BD), but results are inconsistent. Despite the clinical relevance of chronic mood variability in BD, there is no previous research investigating how the extent of symptom fluctuations in bipolar disorder might relate to emotional biases. This exploratory study investigated, in a large cohort of bipolar patients, whether instability in weekly mood episode symptoms and other clinical and demographic factors were related to emotional bias as measured in a simple laboratory task.
Participants (N = 271, BDI = 206, BDII = 121) completed an ‘emotional categorization and memory’ task. Weekly self-reported symptoms of depression and mania were collected prospectively. In linear regression analyses, associations between cognitive bias and mood variability were explored together with the influence of demographic and clinical factors, including current medication.
Greater accuracy in the classification of negative words relative to positive words was associated with greater instability in depressive symptoms. Furthermore, greater negative bias in free recall was associated with higher instability in manic symptoms. Participants diagnosed with BDII, compared with BDI, showed overall better word recognition and recall. Current antipsychotic use was associated with reduced instability in manic symptoms but this did not impact on emotional processing performance.
Emotional processing biases in bipolar disorder are related to instability in mood. These findings prompt further investigation into the underpinnings as well as clinical significance of mood instability.
Mood instability is a common reason for psychiatric referral. Very little
is known about how patients with unstable mood experience assessment and
To investigate the experiences of assessment and diagnosis among patients
with mood instability and to suggest improvements to this process.
Qualitative study, gathering data through individual interviews with 28
people experiencing mood instability and receiving a psychiatric
assessment in secondary care.
Participants described the importance of receiving an explanation for
their symptoms; the value of a good interpersonal relationship with their
clinician(s); being listened to and acknowledged; and being involved in
and informed about clinical decisions. These needs were not, however,
consistently met. Receiving a psychiatric diagnosis, including a
diagnosis of bipolar disorder or borderline personality disorder, evoked
both positive and negative responses among participants, relating to
stigma, personal understanding and responsibility, prognosis and
Patients with mood instability seek explanation for their symptoms and
difficulties, empathetic care and consistent support as much as cure.
Clinicians may incorrectly assume what patients' attitudes towards
diagnosis are, a mismatch which may hamper the development of a strong
therapeutic relationship. Clear, patient-centred communication, which
acknowledges the patient's experience, may result in greater patient
engagement and satisfaction.
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