About the Project
Project description: Abstract: Bipolar disorder is a severe but complex condition, which may not be entirely separate from the other psychotic disorders such as schizophrenia (Tamminga et al., 2014). According to classical accounts, patients fluctuate between the three phases of euthymia (normal functioning), depression and mania (characterised by periods of intense excitement, irritability and sometimes psychosis (Cassidy, Forest, Murry, & Carroll, 1998); hence the term ‘bipolar disorder’. However, mania can co-occur with depression in a so-called ‘mixed episode’ (McElroy et al., 1992) and, longitudinally, the two types of mood symptoms fluctuate almost independently (Johnson et al., 2011). The manic state is probably the least understood psychopathological phenomenon, and existing psychological theories implicate dysfunctional strategies for avoiding depression and abnormal reward sensitivity (Mason, O’Sullivan, Montaldi, Bentall, & El-Deredy, 2014; van der Gucht, Morriss, Lancaster, Kinderman, & Bentall, 2009). Major progress in understanding bipolar disorder would be achieved by advancing our understanding of the manic state, and how it relates to the depressed state.
Network models provide a novel approach to understanding the structure of psychopathology and the underlying causal processes that lead to illness (Borsboom & Cramer, 2013). According to this approach, recognizable ‘syndromes’ (clusters of symptoms) occur, not because the symptoms have common underlying causes, but because symptoms are connected in a network of causal relationships so that triggering one symptom can lead to a cascade of others. Importantly, new statistical tools allows us to discover the potential underlying causal relationships. Mania is a network of symptoms, almost by definition, and yet this approach has never been applied to bipolar disorder.
This research will begin by using network analysis with two datasets: 255 well-characterized bipolar patients followed up at regular intervals over a two-year period; and a large population sample (N > 30,000) in which people were interviewed about mood symptoms. The aim will be to develop a network analysis of the relationship between depression and mania and, in the longitudinal datset, characterize how network structure is related to vulnerability to reoccurrence of symptoms (relapse). In later stages of the work, it may be possible to test hypotheses generated from the analyses in small-scale experimental studies with bipolar patients
Supervisor: Richard Bentall (second UoS supervisor to be negotiated). Prof Jamie Murphy at the University of Ulster will also play an important role in supervising this project.
References Borsboom, D., & Cramer, A. O. J. (2013). Network analysis: An integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology, 9, 91-121. Cassidy, F., Forest, K., Murry, M., & Carroll, B. J. (1998). A factor analysis of the signs and symptoms of mania. Archives of General Psychiatry, 55, 27-32. Johnson, S. L., Morriss, R., Scott, J., Paykel, E., Kinderman, P., Kolamunnage-Dona, R., & Bentall, R. P. (2011). Depressive and manic symptoms are not opposite poles in bipolar disorder. Acta Psychiatrica Scandinavica, 123, 206-210. Mason, L., O'Sullivan, N., Montaldi, D., Bentall, R. P., & El-Deredy, W. (2014). Decision-making and trait impulsivity in bipolar disorder are associated with reduced prefrontal regulation of striatal reward valuation. Brain, 137, 2346 - 2355. McElroy, S. L., Keck, P. E., Pope, H. G., Hudson, J. I., Faedda, G. L., & Swann, A. C. (1992). Clinical and research implications of the diagnosis of dysphoric or mixed mania or hypomania. American Journal of Psychiatry, 149, 1633-1644. Tamminga, C. A., Pearlson, G., Keshavan, M., Sweeney, J., Clementz, B., & Thaker, G. (2014). Bipolar and Schizophrenia Network for Intermediate Phenotypes: Outcomes across the psychosis continuum. Schizophrenia Bulletin, 40 suppl 2, S131-S137. doi:10.1093/schbul/sbt179 van der Gucht, E., Morriss, R., Lancaster, G., Kinderman, P., & Bentall, R. P. (2009). Psychological processes in bipolar affective disorder: Negative cognitive style and reward processing. British Journal of Psychiatry, 194, 146-151.