Hallo,
ausnahmsweise mal in Englisch ein - wie ich finde - interessanter Auszug aus dem letzten Entwurf des National Institute for Health and Clinic Excellence NICE (UK) vom Februar 2006 für eine Behandlungs-Leitlinie zu bipolaren Störungen, der sich mit den psychosozialen Faktoren befasst:
3.3.4 Psychosocial influences
12 Although the current mainstream view is that biological factors are of primary
13 importance in bipolar disorder, a number of psychosocial influences have been
14 identified that may be relevant to understanding illness course or a particular
15 individual’s presentation. Antecedent factors, such as childhood maltreatment, may
16 act as predisposing factors for developing the disorder, whereas concurrent factors
17 such as social class, social support, and self-esteem may act as course modifiers or
18 precipitants for episodes.
19
20 A potential role for psychosocial stressors in both the aetiology and exacerbation of
21 acute episodes has been identified in bipolar disorder. Prolonged psychosocial
22 stressors during childhood, such as neglect or abuse, are associated with HPA axis
23 dysfunction in later life which may result in hypersensitivity to stress. In future years
24 such dysregulation may predispose an individual to affective disturbance, and those
25 who develop bipolar disorder may experience an earlier age at onset, increased rates
26 of self-harm and psychotic symptoms. Likewise acutely stressful life situations and
27 hostility or criticism in a family may trigger episodes in those with an established
28 illness. The degree of negative emotionality expressed by close family members
29 (termed expressed emotion, or EE) has been shown to predict future depressive
30 episodes in patients with bipolar disorder (Yan et al, 2004) and levels of depressive
31 and manic symptoms (Kim & Miklowitz, 2004; Miklowitz et al, 2005). The high
32 prevalence of bipolar disorder in ethnic minority groups, as demonstrated in recent
33 studies in the UK (Lloyd et al, 2005), may relate to the psychosocial stressors of social
34 isolation and lack of social support often experienced by these groups (Bentall, 2004;
35 Leff, 2001).
36
37 Traumatic experiences in childhood have been associated with the development of
38 comorbid post traumatic stress disorder (PTSD) in patients with bipolar disorder in
39 adult life (Goldberg & Garno, 2005). It is estimated that 16% of patients with bipolar
40 disorder also have PTSD, the development of which is associated with greater
41 exposure to trauma, higher levels of neuroticism, lower social support and lower
42 social class (Otto et al, 2004). A study of the impact of childhood abuse on the illness
43 course of adult male patients with bipolar disorder found that those who reported
44 both sexual and physical abuse had higher rates of current PTSD and lifetime alcohol
45 misuse disorders, a poorer level of social functioning, a greater number of lifetime
46 depressive episodes and an increased likelihood of at least one suicide attempt
47 (Brown et al, in press).
48
1 Theories of the psychology of bipolar disorder have identified factors such as self
esteem and explanatory style that may contribute to mood symptoms. The manic
3 defence hypothesis, explained the appearance of manic symptoms as a defence
4 against destroying thought patterns associated with depression and anxiety. The
5 ascent into feelings of omnipotence and triumph were thought to overcompensate
6 for feelings of worthlessness which were seen as the backdrop to the manic
7 syndrome. This formulation suggests there is a degree of fragility to the manic state
8 and evidence of negative self-concept or thinking styles should be evident in both
9 patients with mania and remitted patients. There is evidence that patients with
10 bipolar disorder have a negative self-concept, highly variable self-esteem and
11 increased drive even during the remitted state (Winters & Neale, 1985; Lyon et al,
12 1999; Bentall et al, in press). Studies using implicit or disguised measures of
13 explanatory style have found that remitted patients tend to attribute negative
14 outcomes to themselves, but positive outcomes to others – a thinking style typical of
15 patients with depression (Winters & Neale, 1985; Lyon et al, 1999). However, this
16 may be better understood as chronic low-grade depression due either to the
17 debilitating aspects of the illness or due to the physiological processes outlined above
18 rather than as the underlying fuel for mania. Nonetheless, psychological theories of
19 bipolar disorder may help observers understand some of the ideas and beliefs held
20 by those suffering from mania.
Link zur Website von NICE mit den vollständigen Guidelines: nice.org.uk/page.aspx?o=290222
Wer des Englischen halbwegs mächtig ist, dem sei ein Blick in diese Guidelines empfohlen - im Gegensatz zum inzwischen überalterten und ohnehin mediziner-dominierten Weißbuch der DGBS (2003) sind hier aktuelle Forschungsergebnisse genauso eingearbeitet worden wie sehr praxisnahe Empfehlungen für die medizinischen und psychologischen BehandlerInnen.
Gruß an alle
Peter[Blockierte Grafik: http://www.xrtheme.com/content/emoticons/Kids/02.gif]
aka Pierrot le Fou(che)
aka Pedro el Loco
aka Peter the Maniac
ausnahmsweise mal in Englisch ein - wie ich finde - interessanter Auszug aus dem letzten Entwurf des National Institute for Health and Clinic Excellence NICE (UK) vom Februar 2006 für eine Behandlungs-Leitlinie zu bipolaren Störungen, der sich mit den psychosozialen Faktoren befasst:
3.3.4 Psychosocial influences
12 Although the current mainstream view is that biological factors are of primary
13 importance in bipolar disorder, a number of psychosocial influences have been
14 identified that may be relevant to understanding illness course or a particular
15 individual’s presentation. Antecedent factors, such as childhood maltreatment, may
16 act as predisposing factors for developing the disorder, whereas concurrent factors
17 such as social class, social support, and self-esteem may act as course modifiers or
18 precipitants for episodes.
19
20 A potential role for psychosocial stressors in both the aetiology and exacerbation of
21 acute episodes has been identified in bipolar disorder. Prolonged psychosocial
22 stressors during childhood, such as neglect or abuse, are associated with HPA axis
23 dysfunction in later life which may result in hypersensitivity to stress. In future years
24 such dysregulation may predispose an individual to affective disturbance, and those
25 who develop bipolar disorder may experience an earlier age at onset, increased rates
26 of self-harm and psychotic symptoms. Likewise acutely stressful life situations and
27 hostility or criticism in a family may trigger episodes in those with an established
28 illness. The degree of negative emotionality expressed by close family members
29 (termed expressed emotion, or EE) has been shown to predict future depressive
30 episodes in patients with bipolar disorder (Yan et al, 2004) and levels of depressive
31 and manic symptoms (Kim & Miklowitz, 2004; Miklowitz et al, 2005). The high
32 prevalence of bipolar disorder in ethnic minority groups, as demonstrated in recent
33 studies in the UK (Lloyd et al, 2005), may relate to the psychosocial stressors of social
34 isolation and lack of social support often experienced by these groups (Bentall, 2004;
35 Leff, 2001).
36
37 Traumatic experiences in childhood have been associated with the development of
38 comorbid post traumatic stress disorder (PTSD) in patients with bipolar disorder in
39 adult life (Goldberg & Garno, 2005). It is estimated that 16% of patients with bipolar
40 disorder also have PTSD, the development of which is associated with greater
41 exposure to trauma, higher levels of neuroticism, lower social support and lower
42 social class (Otto et al, 2004). A study of the impact of childhood abuse on the illness
43 course of adult male patients with bipolar disorder found that those who reported
44 both sexual and physical abuse had higher rates of current PTSD and lifetime alcohol
45 misuse disorders, a poorer level of social functioning, a greater number of lifetime
46 depressive episodes and an increased likelihood of at least one suicide attempt
47 (Brown et al, in press).
48
1 Theories of the psychology of bipolar disorder have identified factors such as self
esteem and explanatory style that may contribute to mood symptoms. The manic
3 defence hypothesis, explained the appearance of manic symptoms as a defence
4 against destroying thought patterns associated with depression and anxiety. The
5 ascent into feelings of omnipotence and triumph were thought to overcompensate
6 for feelings of worthlessness which were seen as the backdrop to the manic
7 syndrome. This formulation suggests there is a degree of fragility to the manic state
8 and evidence of negative self-concept or thinking styles should be evident in both
9 patients with mania and remitted patients. There is evidence that patients with
10 bipolar disorder have a negative self-concept, highly variable self-esteem and
11 increased drive even during the remitted state (Winters & Neale, 1985; Lyon et al,
12 1999; Bentall et al, in press). Studies using implicit or disguised measures of
13 explanatory style have found that remitted patients tend to attribute negative
14 outcomes to themselves, but positive outcomes to others – a thinking style typical of
15 patients with depression (Winters & Neale, 1985; Lyon et al, 1999). However, this
16 may be better understood as chronic low-grade depression due either to the
17 debilitating aspects of the illness or due to the physiological processes outlined above
18 rather than as the underlying fuel for mania. Nonetheless, psychological theories of
19 bipolar disorder may help observers understand some of the ideas and beliefs held
20 by those suffering from mania.
Link zur Website von NICE mit den vollständigen Guidelines: nice.org.uk/page.aspx?o=290222
Wer des Englischen halbwegs mächtig ist, dem sei ein Blick in diese Guidelines empfohlen - im Gegensatz zum inzwischen überalterten und ohnehin mediziner-dominierten Weißbuch der DGBS (2003) sind hier aktuelle Forschungsergebnisse genauso eingearbeitet worden wie sehr praxisnahe Empfehlungen für die medizinischen und psychologischen BehandlerInnen.
Gruß an alle
Peter[Blockierte Grafik: http://www.xrtheme.com/content/emoticons/Kids/02.gif]
aka Pierrot le Fou(che)
aka Pedro el Loco
aka Peter the Maniac
You'll never gonna change anything!
(John Rambo in Rambo IV)
(John Rambo in Rambo IV)
![:]](http://www.bipolar.at/wbbdrei/wcf/images/smilies/pleased.gif)
