Internal State Scale Research Articles

Adaption and validation of the Perceived Control of Internal States Scale (PCOISS) in Chinese adults: a cross-sectional study

BackgroundPerceived control of internal states is important for disease prevention, stress buffering and life adaptability. However, there is no psychometric scale to measure control beliefs over internal states in China. This study aimed to adapt and validate the Perceived Control of Internal States Scale (PCOISS) in a large sample of Chinese adults.MethodsData was collected through a big project, in which a cross-sectional online survey was conducted nationwide in China using a powerful Chinese online survey platform named WenJuanXing (https://www.wjx.cn/). We translated the PCOISS into Chinese (C-PCOISS) with the forward–backward translation procedure. For the first time of the survey, a sample of 2709 participants (Sample 1) was valid for final analysis. Sample 1 was split into two datasets for principal component analysis (PCA) (nA = 1355) and confirmatory factor analyses (CFA) (nB = 1354) to determine potential factor structure. The scale’s validity (i.e., discriminant validity, convergent validity, criterion validity) and internal consistency reliability were evaluated. Among the 1354 respondents (nB), 761 (nC = 761) participated in the follow-up second wave of the survey to assess a cross-sectional test–retest reliability.ResultsThe C-PCOISS retained 14 items. PCA yielded a three-factor model which was supported with the best fit indices in CFA. The C-PCOISS had satisfactory internal consistency with Cronbach’s alpha coefficients of 0.86, 0.78 and 0.72 for three subscales, respectively. The scale also showed adequate test–retest reliability (Pearson correlations coefficient of 0.64, 0.62 and 0.54 with p < 0.001 for three subscales, respectively). Three factors of the C-PCOISS were positively associated with positive affect, and negatively associated with negative affect, depression, compulsion-anxiety and perceived stress.ConclusionsThe C-PCOISS is reliable and valid for measuring control beliefs over internal states in Chinese adults.

Clinical Predictors of Engagement in Teleintegrated Care and Telereferral Care for Complex Psychiatric Disorders in Primary Care: a Randomized Trial

BackgroundTelepsychiatry Collaborative Care (TCC) and Telepsychiatry/Telepsychology Enhanced Referral (TER) expand the reach of specialty mental health services to underserved populations.ObjectiveAssess clinical predictors of treatment engagement for complex psychiatric conditions in TCC—in which remote specialists consult with primary care teams via an onsite care manager who also provides brief psychotherapy—and TER, in which remote specialists provide direct telehealth treatment.DesignA randomized pragmatic trial from twenty-four primary care clinics without onsite psychiatrists or psychologists.ParticipantsA total of 1,004 adult patients screened positive for posttraumatic stress disorder (PTSD)and/or bipolar disorder were randomized to receive TCC or TER for 1 year.Main MeasuresPsychotherapy engagement was measured by the number of sessions completed, and pharmacotherapy engagement by the medication adherence item from the Schizophrenia Care and Assessment Program Health Questionnaire (SCAP-HQ).Key ResultsEngagement in TCC psychotherapy visits was greater compared to TER. There was no association between the PTSD symptom severity and treatment engagement. The internal state scale (ISS) activation subscale, an indicator of mania, was associated with reduced odds of initiating psychotherapy (odds ratio [OR] = 0.70; 95% CI, 0.59 to 0.84) but not the number of sessions attended once psychotherapy started. The Drug Abuse Screening Test-10(DAST-10) score was associated with receipt of fewer psychotherapy sessions (incidence ratio rate [IRR] = 0.88; 95% CI, 0.81 to 0.95). The number of physical health comorbidities was associated with greater engagement in psychotherapy (IRR = 1.11, 95% CI, 1.03 to 1.19) and pharmacotherapy (OR = 1.54; 95% CI, 1.27 to 1.87). None of the findings varied by intervention group.ConclusionsBoth teleintegrated and telereferral care offer an opportunity to treat patients with complex psychiatric conditions. While there was no difference in clinical characteristics predicting engagement, onsite care managers engaged patients in more psychotherapy sessions than remote therapists.Trial RegistrationClinicalTrials.gov Identifier: NCT02738944

Dysfunctional Cognition in Individuals With an Increased Risk for Mania.

There is still a lack of knowledge about attitudes and cognitions that are related to bipolar disorder. Theoretically, it was proposed that exaggerated beliefs about the self, relationships, the need for excitement, and goal-related activities might lead to mania in vulnerable individuals, however, the few studies that examined this hypothesis provided mixed results. One of the unresolved issues is if such a cognitive style is associated with current mood symptoms or with different stages of the illness, i.e. at-risk versus diagnosed bipolar disorder. Therefore, the present study aimed at evaluating depression and mania-related cognitive style in individuals at-risk for mania. In an online survey, we collected data of 255 students of the University of Klagenfurt, Austria. All participants completed the Hypomanic Personality Scale (HPS), the Cognition Checklist for Mania - Revised (CCL-M-R), the Dysfunctional Attitude Scale (DAS), the Beck Depression Inventory (BDI), and the Internal State Scale (ISS). In a hierarchical regression, HPS was positively related to scores of all subscales of the CCL-M-R. The HPS did not significantly predict scores of the DAS. Current manic and depressive symptoms significantly contributed to the models. The present results suggest that a trait-like risk for mania is associated with mania-related but not depression-related cognitions.

Hypomania, Depression, Euthymia: New Evidence in Parkinson's Disease.

The field related to mood disorders in Parkinson's disease (PD) is fragmented. The aim of this cohort observational study was to evaluate whether the episodes of mood alteration could appear in different disease stages and to verify how nonmotor symptoms were led off into different stages. We enrolled 93 PD outpatients (three groups: drug naive—DN; not exhibiting motor fluctuations—n-MF; and exhibiting motor fluctuations—MF) and 50 healthy controls. Mood state was assessed through the Internal State Scale (ISS) while depressive symptoms were evaluated through the Beck Depression Inventory-II (BDI-II), nonmotor symptoms by means of the Non-Motor Symptoms Scale (NMSS), and the presence of impulse control disorders (ICDs) with the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP). Clinical and pharmacological data have also been recorded. No significant differences in mood state distribution between groups were observed. Nevertheless, as regards the mood state distribution within groups, in n-MF (47.6%) and MF patients (50%), (hypo)mania presence was significantly higher than other symptoms. In DN patients, hypomania showed a prevalence of 38.1% although it was not significant. At least one ICD was reported in 29.3% of n-MF and 50% of MF patients. In the MF group, a moderate positive correlation between ISS ACTivation subscale scores and the presence of ICDs and compulsive medication use emerged. Finally, MF patients reported higher BDI-II total scores than DN. Our results show that mood alterations in PD, considering both depressive symptoms and mood elevation, are related to the advanced stages of the disease as well as the presence of ICDs, and dopaminergic therapy would not always be able to restore a normal mood condition.

Cognitive Behavioral Therapy for Three Patients with Bipolar II Disorder during Depressive Episodes

Bipolar II disorder is a recurrent mental health disorder characterized by alternating hypomanic and depressive episodes. Providing cognitive behavioral therapy (CBT) as an adjuvant to pharmacotherapy can reduce the recurrence rate of bipolar disorder. It has not been examined whether CBT can be started during a depressive episode in patients with bipolar II disorder; however, the use of CBT during the remission period has been demonstrated to reduce recurrence. The current study is a case report involving three Japanese patients with bipolar II disorder, who started CBT during the depressive phase after a hypomanic episode was stabilized by pharmacotherapy. All patients experienced excessively positive thinking one week apart and were able to choose behaviors that would stabilize bipolar mood by observing its precursors. After intervention, patients' bipolar mood according to the Internal State Scale (ISS) and the Beck Depression Inventory-II (BDI-II) was improved. Our findings suggested that providing CBT to patients with bipolar II disorder during depressive episodes as an adjunct to pharmacotherapy is feasible.

Improving Work Performance: Examining the Role of Mindfulness and Perceived Control of Internal States in Work Engagement

Abstract Introduction: Organizations are in constant endeavor to find ways to enhance their employees’ productivity and efficiency. In this context, the present study attempted to examine if mindfulness and perceived control of internal states along with major demographic variables act as indicators of work engagement in front-liner employees. Method: In this survey, 180 front-liners who were selected through purposive sampling from five private organizations participated. The Cognitive and Affective Mindfulness Scale-Revised, Perceived Control of Internal States Scale, and Utrecht Work Engagement Scale were administered. The obtained quantitative data were analyzed in terms of descriptive statistics, Pearson’s r, and multiple hierarchical regression analysis. Results: Findings revealed that out of the six predictors under study, five predictors—mindfulness, perceived control of internal states along with three demographic variables (age, marital status, and years of service)—were found to significantly correlate with employees work engagement. Conclusion: It was observed that mindfulness was a significant predictor when it was considered solely as an indicator of work engagement. Nevertheless when other predictors were considered, perceived control of internal states was found to be a dominant indicator of work engagement across the models. The shortcomings, future directions, and implications were also discussed.

Are existing self-ratings of acute manic symptoms in adults reliable and valid?-A systematic review.

Depression research historically uses both self- and clinician ratings of symptoms with significant and substantial correlations. It is often assumed that manic patients lack insight and cannot accurately report their symptoms. This delayed the development of self-rating scales for mania, but several scales now exist and are used in research. Our objective is to systematically review the literature to identify existing self-ratings of symptoms of (hypo)mania and to evaluate their psychometric properties. PubMed, Web of Knowledge, and Ovid were searched up until June 2018 using the keywords: "(hypo)mania," "self-report," and"mood disorder" to identify papers which included data on the validity and reliability of self-rating scales for (hypo)mania in samples including patients with bipolar disorder. We identified 55 papers reporting on 16 different self-rating scales claiming to assess (hypo)manic symptoms or states. This included single item scales, but also some with over 40 items. Three of the scales, the Internal State Scale (ISS), Altman Self-Rating Mania Scale (ASRM), and Self-Report Manic Inventory (SRMI), provided data about reliability and/or validity in more than three independent studies. Validity was mostly assessed by comparing group means from individuals in different mood states and sometimes by correlation to clinician ratings of mania. ASRM, ISS, and SRMI are promising self-rating tools for (hypo)mania to be used in clinical contexts. Future studies are, however, needed to further validate these measures; for example, their associations between each other and sensitivity to change, especially if they are meant to be outcome measures in studies.

Systematic Review of Symptom Assessment Measures for Use in Measurement-Based Care of Bipolar Disorders.

Utilization of measurement-based care (MBC) for bipolar disorders is limited, in part because of uncertainty regarding the utility of available measures. The aim of this study was to synthesize the literature on patient-reported and clinician-observed measures of symptoms of bipolar disorder and the potential use of these measures in MBC. A systematic review of multiple databases (PubMed, Embase, PsycINFO, Cochrane Library, and other gray literature) was conducted in June 2017 to identify validated measures. Data on the psychometric properties of each measure were extracted and used to assess the measure's clinical utility on the basis of established guidelines. Twenty-eight unique measures were identified in 39 studies, including four patient-reported and six clinician-observed measures assessing manic symptoms, three patient-reported and five clinician-observed measures of depressive symptoms, and six patient-reported and four clinician-observed measures of both symptom types. Patient-reported measures with the highest clinical utility included the Altman Self-Rating Mania Scale for assessment of manic symptoms, the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) (depressive symptoms), and the Internal State Scale (both types). Highly rated clinician (C)-observed scales were the Bech-Rafaelsen Mania Rating Scale (mania), the QIDS-C (depressive symptoms), and the Bipolar Inventory of Symptoms Scale (both types). Suitable choices are available for MBC of bipolar disorders. The choice of a measure could be informed by clinical utility score and may also depend on how clinicians or practices weigh each category of the clinical utility scale and on the clinical setting and presenting problem.

Rate of Corticosteroid-Induced Mood Changes in Patients with Inflammatory Bowel Disease: A Prospective Study.

BackgroundCorticosteroid is an effective therapeutic option for inflammatory bowel disease flares, but its adverse effects may compromise treatment adherence and reduce patients’ quality of life. There is lack of data on the incidence of corticosteroid-induced mood changes in this patient population, which may be underappreciated by healthcare providers in clinical practice and interfere with optimal care. This study aimed to determine the rate of mood changes in this patient population.MethodsIn this prospective observational study, adult outpatients treated with prednisone for inflammatory bowel disease flares were considered for inclusion. Participants completed validated questionnaires (Beck Depression Inventory-II and Activation Subscale of Internal State Scale version two) before starting prednisone, after two weeks of prednisone, and at the end of prednisone taper to assess for mood changes. Harvey-Bradshaw Index and Simple Clinical Colitis Activity Index were used to monitor clinical disease activity.ResultsFifty-three subjects were included in the analyses. The rate of mood change after two weeks of prednisone was 49.1%, primarily driven by increase in mood towards (hypo)mania. Younger age was an independent risk factor. Mood state returned to pretreatment level at the end of treatment. There was no correlation between clinical disease activity change and mood change.ConclusionsOral prednisone for inflammatory bowel disease flare is associated with high rate of mood change. As prednisone is a critical part of induction therapy, ways to minimize this adverse event must be studied. For now, healthcare providers should inform patients and monitor closely for this adverse event.

Relationship between wisdom, perceived control of internal states, perceived stress, social intelligence, information processing styles and life satisfaction among college students

This study aimed to investigate the relationship between wisdom, social intelligence, perceived control of internal states, perceived stress, information processing styles and life satisfaction among college students. Three hundred and nine students (270 female and 39 male students with a mean age of 27 years) were selected using random cluster sampling method. The Self-Assessed Wisdom Scale, Perceived Control of Internal States Scale, Perceived Stress Scale, Tromso Social Intelligence Scale, Rational-Experiential Inventory and Satisfaction with Life Scale were used for data collection. Results showed that there were significant correlation between emotion regulation, humor (subscales of wisdom), social awareness, social skills (subscales of social intelligence), perceived control of internal states, perceived stress and life satisfaction. The information processing styles had no statistically significant relationship with life satisfaction. Furthermore, the multiple regression analysis revealed that perceived stress, humor and social skills were strongest predictors of life satisfaction among college students. The roles of these variables in life satisfaction were discussed.

A prospective study of bipolar disorder vulnerability in relation to behavioural activation, behavioural inhibition and dysregulation of the Behavioural Activation System

BackgroundThe weak regulation, or “dysregulation”, of the Behavioural Activation System (BAS) is implicated in the development and recurrence of bipolar disorder. However, there has been a lack of prospective studies investigating the predictive role of BAS dysregulation in relation to bipolar-vulnerability. Furthermore, no studies have tested the prospective predictive utility of the DYS self-report measure of BAS dysregulation in an analogue sample. The goal of the current study was to redress this gap. MethodsParticipants (n=127) completed baseline self-report measures of mood symptoms (Internal States Scale [ISS]), the Hypomanic Personality Scale (HPS), behavioural activation, inhibition and dysregulation of BAS (BIS/BAS and DYS), and at six months, the Mood Disorders Questionnaire (MDQ). ResultsLinear regression analysis indicated a significant main effect of BAS Dysregulation, and a significant interaction between BIS and BAS Fun Seeking, on prospective MDQ scores whilst controlling for baseline mood symptoms and HPS scores. The interaction effect indicated that the relationship between high BAS Fun Seeking and follow-up MDQ scores was strongest when BIS scores were high, whilst the lowest MDQ scores were observed for a combination of low BAS Fun Seeking and high BIS. However, DYS scores were the stronger predictor of MDQ scores compared to the BAS Fun Seeking and BIS interaction. ConclusionsBipolar-vulnerability is prospectively associated with heightened BAS Dysregulation, as measured by the DYS subscale, similar to prior findings in clinical samples. Further research investigating the longer-term associations between BAS Dysregulation with the development of clinically significant bipolar mood symptoms is required.

The Turkish Adaptation, Validity, and Reliability of the Internal States Scale.

The Internal State Scale (ISS) was developed to simultaneously assess manic and depressive symptoms in bipolar disorder. In the present study, the validity and reliability of the Turkish version of ISS (ISS-TR) were examined. The present study aimed to present the psychometric properties of this scale. The sample consisted of 200 outpatients with bipolar disorder and 49 healthy controls. Participants completed the Turkish Internal State Scale (ISS-TR), the Brief Psychiatric Rating Scale (BPRS), the Hamilton Depression Rating Scale (HDRS), and the Young Mania Rating Scale (YMRS). Reliability analyses revealed that the Cronbach alfa coefficient of ISS was 0.88 for the whole sample. Item-total correlations ranged from 0.15 to 0.78. Two factors emerged as a result of factor analysis: "mania" and "depression-well-being." Test-retest correlations were determined for the mania subscale as r=0.654, p<0.01 and for the depression-well-being subscale as r=0.356, p<0.01. The correlations between BPRS and both subscales were quite high. The correlation between HDRS and the depression-well-being subscale was higher (r=0.475) than that between HDRS and the mania subscale, whereas the correlation between YMRS and the mania subscale was higher (r=0.818) than that between YMRS and the depression-well-being subscale. It was seen that ISS could discriminate between the clinical and healthy control samples. In addition, it was observed that the mania subscale predicted a manic period more strongly, while the depression-well-being subscale predicted a depressive period better. ISS is a valid and reliable scale that can be used to simultaneously assess manic and depressive symptoms. It is thought that ISS will be useful in the recognition of prodromal symptoms and in the process of maintenance treatment.

Psychological factors mediate key symptoms of fibromyalgia through their influence on stress.

The clinical features of fibromyalgia are associated with various psychological factors, including stress. We examined the hypothesis that the path that psychological factors follow in influencing fibromyalgia symptoms is through their direct effect on stress. Ninety-eight females with ACR 1990 classified fibromyalgia completed the following questionnaires: The Big 5 Personality Inventory, Fibromyalgia Impact Questionnaire, Perceived Stress Scale, Profile of Mood States, Mastery Scale, and Perceived Control of Internal States Scale. SPSS (PASW version 22) was used to perform basic t tests, means, and standard deviations to show difference between symptom characteristics. Pathway analysis using structural equation modelling (Laavan) examined the effect of stress on the relationships between psychological factors and the elements that define the fibromyalgia phenotype. The preferred model showed that the identified path clearly linked the psychological variables of anxiety, neuroticism and mastery, but not internal control, to the three key elements of fibromyalgia, namely pain, fatigue and sleep (p < 0.001), via the person's perceived stress. Confusion, however, did not fit the preferred model. This study confirms that stress is a necessary link in the pathway between certain identified, established and significant psychological factors and key fibromyalgia symptoms. This has implications for the understanding of contributing mechanisms and the clinical care of patients with fibromyalgia.

A technology-enabled adherence enhancement system for people with bipolar disorder: results from a feasibility and patient acceptance analysis.

ObjectiveAs poor medication adherence is common in bipolar disorder (BD), technology-assisted approaches may help to monitor and enhance adherence. This study evaluated preliminary feasibility, patient satisfaction and effects on adherence, BD knowledge, and BD symptoms associated with the use of a multicomponent technology-assisted adherence enhancement system.MethodsThis prospective study tested the system in five BD patients over a 15-day period. System components included: 1) an automated pill cap with remote monitoring sensor; 2) a multimedia adherence enhancement program; and 3) a treatment incentive program. This study evaluated system usability, patient satisfaction and effects on adherence (Morisky scale), knowledge (treatment knowledge test [TKT]), and symptoms (internal state scale [ISS]).ResultsMean age of the sample was 62 years, 4/5 (80%) Caucasian, and 4/5 (80%) single/divorced or widowed. Most participants (4/5, 80%) were on a single BD medication. Participants had BD for an average of 21 years. Challenges included attaching the pill sensor to standard pharmacy bottles for individuals using very large pill containers or those with multiday pill boxes. Three of five (60%) individuals completed the full 15-day period. Usability scores were high overall. Mean Morisky scores improved. Means on all four subscales of the ISS were all in the direction of improvement. On the TKT, there was a 40% increase in mean scores.ConclusionA multicomponent technology-assisted BD adherence enhancement system is feasible. Challenges include accommodating multiple types of pill containers and monitoring multiple drugs simultaneously. The system can also generate adherence information that is potentially useful for treatment planning.

A web-based preventive intervention program for bipolar disorder: Outcome of a 12-months randomized controlled trial

BackgroundThe Internet is used to deliver information on many psychiatric disorders such as bipolar disorder. This paper reports on the results of a 12-months randomised controlled trial, which examined the efficacy of an Internet-based preventive program for bipolar disorder, adjunctive to usual pharmacological management. MethodsParticipants were recruited by completing an online screening questionnaire accessed through the Black Dog Institute and Sentiens websites based in Australia. The treatment was predominantly psycho-educational with cognitive behavioral therapy optional elements. The attention control treatment comprised directing subjects to a variety of websites focused on ‘healthy living’. Time to recurrence was determined using Kaplan–Meier survival analysis. The main outcome measures were recurrence as defined by: (i) depressive and/or hypomanic symptomatology and functional capacity (using Beck Depression Inventory, Internal State Scale and Sheehan Disability Scale) and (ii) hospitalization. ResultsTwo-hundred-and-thirty-three subjects were randomized to the active or control treatment groups. There were no significant differences between the active and control treatment groups on any of the definitions of recurrence. LimitationsReliance on an online self-report tool to confirm diagnosis and hospitalization rates may have potentially allowed for inclusion of individuals with other diagnoses such as borderline personality disorder. The ‘attention control’ treatment may have included more ‘active’ components than intended. ConclusionsThis is the first report examining the efficacy of a randomized controlled web-based psychological intervention in a large sample of subjects with bipolar disorder. The potential reasons for failing to demonstrate a significant difference compared to the active control are discussed.

Interrelations of stress, optimism and control in older people's psychological adjustment

To investigate the influence of perceived stress, optimism and perceived control of internal states on the psychological adjustment of older adults. The sample consisted of 212 older adults, aged between 58 and 103 (M = 80.42 years, SD = 7.31 years), living primarily in retirement villages in Melbourne, Victoria. Participants completed the Perceived Stress Scale, Life Orientation Test-Revised, Perceived Control of Internal States Scale and the World Health Organisation Quality of Life-Bref. Optimism significantly mediated the relationship between older people's perceived stress and psychological health, and perceived control of internal states mediated the relationships among stress, optimism and psychological health. The variables explained 49% of the variance in older people's psychological adjustment. It is suggested that strategies to improve optimism and perceived control may improve the psychological adjustment of older people struggling to adapt to life's stressors.

Mediating Effects of Perceived Control in the Relationship Between Optimism and Adjustment in Parents of Children with Disabilities

Parents of children with disabilities are at increased risk of psychosocial maladjustment yet many parents adapt well. This study aimed to investigate the potential mediating effects of perceived control of internal states in the optimism-adjustment relationship in a sample of parents of children with disabilities. Eighty-three parents with children enrolled in various early intervention centres and special development schools in Victoria, Australia, completed the Life Orientation Test-Revised, the Perceived Control of Internal States scale, and the World Health Organization Quality of Life Bref scale. Perceived control was found to partially mediate the optimism-adjustment relationship. Interventions incorporating practical methods of increasing optimism and perceived control of internal states may enhance the adjustment of parents of children with disabilities.

Subjective Experience of Thought Overactivation in Mood Disorders: Beyond Racing and Crowded Thoughts

Background: Racing thoughts, crowded thoughts and flight of ideas are frequent symptoms in mood disorders, but the underlying subjective experience of overactivation of thought processes remains poorly documented. Methods: Qualitative analysis of audiotaped interviews explored subjective experience of thought overactivation in patients with mood disorders (sample 1, n = 45). Quantitative analysis considered the properties of a newly developed rating scale in sample 1, in an additional sample of patients with mood disorders (sample 2, n = 37) and in healthy subjects (sample 3, n = 38). Results: Qualitative analysis of individual interviews revealed that 5 conceptual categories characterized thought overactivation: sequential thought flow, overstimulation, competition for resource allocation, unexpected/unexplained onset, and association with mood and emotions. A principal component analysis of the initial 16-item rating scale indicated that a single component explained 55.9% of the variance, with major and exclusive contributions from 9 items, which were retained in the final 9-item Subjective Thought Overactivation Questionnaire (STOQ; Cronbach's α = 0.95). Total score correlated significantly with activation, depression and perceived conflict subscales of the Internal State Scale (ISS; r_s = 0.57-0.66, p < 0.001). It was associated with decreased well-being (ISS; r_s = -0.48, p = 0.001) and increased state anxiety (State-Trait Anxiety Inventory; r_s = 0.60, p < 0.001). The STOQ score was significantly higher in patients than in healthy subjects. It allowed distinguishing between ISS mood states, with the highest median score in mixed states. Limitations: Sample size, representativeness, possible bias in qualitative analysis, and quality of expert consensus. Conclusions: Qualitative analysis of clinical interviews, together with a new short rating scale, contributed to a documentation of subjective thought overactivation, an important but often undetected feature in mood disorders.

Gender differences in health-related quality of life in patients with bipolar disorder

Health-related quality of life (HRQOL) is a widely accepted measure of illness state that is related to morbidity and mortality. Findings from various populations show that women report lower HRQOL than men. We analyzed baseline HRQOL data for gender differences from a multisite, randomized controlled study for adults with bipolar disorder. HRQOL was assessed using the 12-item Short Form (SF-12) physical component summary (PCS) and mental component summary (MCS) health scales. Multivariate linear and bivariate regression models examined differences in self-reported data on demographics, depressive symptoms (nine-item Patient Health Questionnaire), bipolar disorder symptoms (Internal State Scale), and medical comorbidities. Out of 384 enrolled (mean age = 42 years), 256 were women (66.7 %). After controlling for sociodemographic characteristics and clinical factors, women had lower SF-12 PCS scores than men [β = -1.78, standard error (SE) = 0.87, p < 0.05], indicating worse physical health, but there were no gender differences in MCS scores. After controlling for patient factors including medical and behavioral comorbidities, the association between gender and PCS score was no longer significant. Of the medical comorbidities, pain was associated with lower PCS scores (β = -4.90, SE = 0.86, p < 0.0001). Worse physical HRQOL experienced by women with bipolar disorder may be explained by medical comorbidity, particularly pain, suggesting the importance of gender-tailored interventions addressing physical health conditions.

Predictors of Psychopathological Outcome During Peg-Interferon and Ribavirin Therapy in Patients with Chronic HCV-Correlated Hepatitis

Peg-interferon (Peg-IFN) and ribavirin (RBV) therapy is reported to induce psychiatric symptoms and syndromes in 20% of patients treated for Hepatitis C Virus (HCV) infection. Present study was aimed to quantify the phenomenon and assess the influence of psychiatric counseling over antiviral completion rate and the use of psychometric tools, in terms of prediction of psychopathological outcome. Ninety-six HCV patients were assessed, before antiviral treatment, by means of the Sheehan Disability Scale (SDS), Mood Disorder Questionnaire (MDQ), Symptom Checklist-90, and Internal State Scale (ISS). Sociodemographic and clinical variables and completion rate were collected. Binary logistic regression was performed to evaluate whether scores were predictive of psychiatric visit, development of psychiatric disorders, and need for treatment. Ninety-five patients (99%) completed antiviral treatment; 27 subjects (29%) needed psychiatric visit: among them, mood disorder was diagnosed in 15 (16%) and were pharmacologically treated. Baseline SDS and MDQ higher scores were found to be predictive of psychiatric visit [odds ratio (OR)=1.258, P<0.001 and OR=1.425, P=0.05, respectively]. Furthermore, higher MDQ score (P=0.017) and ISS hostility scores (OR=1.048, P=0.014) at baseline predicted the subsequent development of mood episodes, while ISS activation correlated negatively (OR=0.948, P=0.009). Finally, the need for treatment was predicted by higher scores at the MDQ and ISS activation items (OR=2.467, P=0.030; OR=0.970, P=0.038). Present findings suggest that psychiatric counseling may be needed in almost 30% of HCV patients on antiviral treatment, with positive influence over the completion rate. Baseline higher scores at psychometric questionnaires-MDQ-in particular, predictors of psychopathological outcome during Peg-IFN and RBV therapy in patients with chronic HCV-correlated hepatitis reflecting individual functioning before starting antiviral therapy and positive history for mood disorders, seem to predict psychiatric visit, onset of mood episodes, and need for psychopharmacological treatment. Further investigation is warranted to confirm results.