This thesis sought to investigate the relationships between treatment delays in bipolar disorder (BD) and cognitive impairments which characterize the disorder, measured both objectively and...Show moreThis thesis sought to investigate the relationships between treatment delays in bipolar disorder (BD) and cognitive impairments which characterize the disorder, measured both objectively and subjectively. Previous studies have established that a long delay occurs between the onset of mood symptoms in BD and the first form of treatment received, estimates ranging between 6 and 11 years. Cognitive impairments in the domains of executive functions, processing speed and memory were found to persist in BD patients even during euthymia. Such cognitive impairments burden BD patients, prevent them from regaining an appropriate level of general functioning and diminish their quality of life. Thus, in order to determine whether treatment delay impacts the cognitive impairments present in BD, 69 participants were followed over the course of one year, at three different time points. The participants took part in clinical interviews, and then were asked to complete multiple measures, such as the YMRS, the QIDS, four WAIS subscales (Block Design, Arithmetic, Information and Digit symbol), and the Cognition subscale of the WHODAS. The average treatment delay found in the current sample was 14.53 years. The results of the current study suggest that longer treatment delays did not significantly predict worse cognitive functioning in BD patients, either when measured subjectively, or when measured objectively.Show less
Background. Bipolar disorder is an affective disorder that can cause (temporary) disturbances in mood. It has been theorized and investigated how these episodes effect personality and whether or...Show moreBackground. Bipolar disorder is an affective disorder that can cause (temporary) disturbances in mood. It has been theorized and investigated how these episodes effect personality and whether or not cause (sustained) impairments. Personality is stated to be a lifelong stable factor and the current study aimed to research if this applies to patients with bipolar disorder. Method. This study has a within subject design and is a sub-project of the larger longitudinal naturalistic BINCO-study. A total of N = 36 participants completed the NEO-FFI, QIDS and YMRS on both baseline and one-year follow-up measurements. Results. Participants reported no significant changes in personality over time on any of the traits; Neuroticism, Extraversion, Openness, Agreeableness and Conscientiousness. Limitations. Results should be carefully interpreted since the research group was small, personality change was investigated over the course of only one year and there were no control groups included. Conclusions. There were found no statistically significant differences in personality for people with bipolar disorder over the course of one year. This is in line with the theory that personality is stable over time and indicates that people with bipolar disorder are no exception. In future research it would be meaningful to integrate a control group and baseline measurements prior to diagnosis and/or start of treatment.Show less
Introduction: Vulnerable groups, such as people with a psychiatric disorder appear to be more severely affected by the imposed COVID-19 restricted measures compared to healthy controls. Stressful...Show moreIntroduction: Vulnerable groups, such as people with a psychiatric disorder appear to be more severely affected by the imposed COVID-19 restricted measures compared to healthy controls. Stressful life events can induce the occurrence of depressive or (hypo)manic episodes in people with bipolar disorder. The objective of the current study is to compare the COVID-19 related concerns in terms of: perceived mental health impact, fear for COVID, positive coping, loneliness and symptom severity in younger adults with bipolar disorder (YABD) and older adults with bipolar disorder (OABD). It is hypothesized that YABD are more vulnerable to the effects of stressful life events, such as COVID-19 pandemic due to less life experience. Methods: The current study is an add-on study to two pre-existing cohort studies; in YABD and OABD. At three time points online self-fill in questionnaires in the first half a year of the COVID-19 pandemic in the Netherlands. Results: Results show no significant differences in the perceived mental health impact and positive coping between YABD and OABD. YABD experienced less fear for COVID-19 over time while for OABD the level of fear remained the same. Prominently, YABD experienced significantly more overall, emotional and social loneliness compared to OABD. The (re)occurrence of (hypo)mania increased significantly during COVID in both groups. Key conclusions: This study confirms that people with a severe mental health problem are more vulnerable for stressful life-events in this case COVID-19. Over time both OABD and YABD are negatively impacted by COVID-19 resulting in worse mania symptom severity, loneliness and less positive coping. YABD experiences more loneliness compared to OABD during COVID-19Show less
Bipolar disorder is a complex and severe mental disorder. Despite evidence-based pharmacological and psychosocial interventions, complete stability is only reached by a small proportion of people...Show moreBipolar disorder is a complex and severe mental disorder. Despite evidence-based pharmacological and psychosocial interventions, complete stability is only reached by a small proportion of people who have BD, with over 90% of BD patients relapsing into new mood episodes during their lifetime. However, tools to differentiate patients who benefit sufficiently from standardized guideline treatment from patients who need more intensive or highly specialized treatment are lacking. The aim of the current study is to develop a decision tool for bipolar disorder that aids clinicians in early identification of a complex disease course in patients with bipolar disorder that are in need of highly specialized tertiary treatment. An earlier literature review led to the identification of 37 factors associated with a more unfavorable and complex disease course. Based on two expert rounds, using the Delphi method seven items were selected for the final tool: insufficient symptomatic recovery, comorbid personality problems, rapid cycling pattern, trauma, somatic comorbidity, psychiatric comorbidity, (the wish to become) pregnant. The pilot validation study indicated that the tool demonstrated good validity to identify patients for highly specialized tertiary care. A total score of ≥3 was found to represent an optimal cut-off point for identifying bipolar patients in need of highly specialized care. The currently developed decision tool could aid clinicians in identifying complex and severe pathology in bipolar disorder in early stages of diagnoses and treatment and subsequently allocating patients to highly specialized treatment. Validation in larger samples sizes is needed to make this tool generalizable to healthcare systems where early identification of severe cases is needed, across and beyond the Netherlands.Show less
