Adverse or therapeutic? A mixed-methods study investigating adverse effects of Mindfulness-Based Cognitive Therapy in bipolar disorder.

BACKGROUND: Mindfulness-Based Interventions (MBIs) are widely used in clinical and non-clinical populations, but little attention has been given to potential adverse effects (AEs). AIMS: This study aimed to gain insight in the prevalence and course of AEs during Mindfulness-Based Cognitive Therapy (MBCT) for patients with bipolar disorder (BD). METHOD: The current mixed-methods study was conducted as part of a RCT on (cost-) effectiveness of MBCT in 144 patients with BD (Trial registered on 25th of April 2018, ClinicalTrials.gov, NCT03507647). During MBCT, occurrence of AEs was monitored prospectively, systematically, and actively (n = 72). Patients who reported AEs were invited for semi-structured interviews after completing MBCT (n = 29). Interviews were analysed with directed content analysis, using an existing framework by Lindahl et al. RESULTS: AEs were reported by 29 patients, in seven of whom the experiences could not be attributed to MBCT during the interview. AEs were reported most frequently up to week 3 and declined afterwards. Baseline anxiety appeared to be a risk factor for developing AEs. Seven existing domains of AEs were observed: cognitive, perceptual, affective, somatic, conative, sense of self, and social. Influencing factors were subdivided into predisposing, precipitating, perpetuating, and mitigating factors. With hindsight, more than half of patients considered the reported AEs as therapeutic rather than harmful. CONCLUSIONS: Although the occurrence of AEs in MBCT for patients with BD is not rare, even in this population with severe mental illness they were not serious or had lasting bad effects. In fact, most of them were seen by the patients as being part of a therapeutic process, although some patients only experienced AEs as negative.

First-onset psychosis occurring in the postpartum period: a prospective cohort study.

OBJECTIVE: To prospectively characterize a cohort of patients for whom first lifetime episode of psychosis occurs in the postpartum period. METHOD: Included in the study were 51 women admitted to an inpatient facility for postpartum psychosis and a population-based control group (n = 6,969). All patients received naturalistic treatment using the sequential addition of benzodiazepines, antipsychotics, and lithium. A clinician-administered questionnaire and parallel history provided information about obstetric history, pregnancy, delivery, breastfeeding, neonatal outcomes, and onset of the disease. Clinical remission was defined as the absence of psychotic, manic, and depressive symptoms for at least 1 week. The primary outcome measure was the Clinical Global Impressions-Severity scale. The study was conducted from 2005 to 2009. RESULTS: Compared to the general population sample, women with postpartum psychosis had a significantly higher incidence of primiparity (OR = 2.90; 95% CI, 1.49-5.67) but had no significant differences in delivery-related, lactational, or neonatal-related risk factors. The median onset of psychiatric symptoms occurred at 8 days' postpartum (interquartile range [IQR], 5-14), and median duration of episode was 40 days (IQR, 23-69). Patients with prominent depressive symptoms had a significantly later onset (P = .01) of psychosis and a longer duration of episode (P < .01) than patients without depressive symptoms. Psychotic symptoms were mood-incongruent in 64.7% of patients. CONCLUSIONS: In contrast to other findings related to postpartum psychosis in bipolar patients, no delivery-related, neonatal-related, or lactational risk factors could be identified. Further, our findings of a delayed onset and mood incongruence of postpartum psychotic symptoms markedly contrasts with that of patients with a previous history of bipolar disorder. These results suggest that women with psychosis limited to the postpartum period might have a distinct risk profile and phenomenology.

An overview of recent findings of the Stanley Foundation Bipolar Network (Part I).

AIM AND METHODS: Selected recent findings of the Stanley Foundation Bipolar Network are briefly reviewed and their clinical implications discussed. RESULTS: Daily prospective ratings on the NIMH-LCM indicate a high degree of residual depressive morbidity (three times that of hypomania or mania) despite active psychopharmacological treatment with a variety of modalities including mood stabilizers, antidepressants, and benzodiazepines, as well as antipsychotics as necessary. The rates of switching into brief to full hypomania or mania during the use of antidepressants is described, and new data suggesting the potential utility of continuing antidepressants in the small group of patients showing an initial acute and persistent response is noted. Bipolar patients with a history of major environmental adversities in childhood have a more severe course of illness and an increased incidence of suicide attempts compared with those without. Preliminary open data suggest useful antidepressant effects of the atypical antipsychotic quetiapine, while a double-blind randomized controlled study failed to show efficacy of omega-3 fatty acids (6 g of eicosapentaenoic acid compared with placebo for 4 months) in the treatment of either acute depression or rapid cycling. The high prevalence of overweight and increased incidence of antithyroid antibodies in patients with bipolar illness is highlighted. CONCLUSIONS: Together, these findings suggest a very high degree of comorbidity and treatment resistance in outpatients with bipolar illness treated in academic settings and the need to develop not only new treatment approaches, but also much earlier illness recognition, diagnosis, and intervention in an attempt to reverse or prevent this illness burden.