Role of stressful life events and kindling in bipolar disorder: Converging evidence from a mania-predominant illness course

Subramanian, Karthick; Sarkar, Siddharth; Kattimani, Shivanand; Rajkumar, Ravi Philip; Penchilaiya, Venkatalakshmi

doi:10.1016/j.psychres.2017.08.073

Cited by 10 publications

(17 citation statements)

References 31 publications

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“…Results from included studies are summarized in Table 1. Eighteen studies (n = 1513) reported a significant association between stressful life events and subsequent relapse of psychosis (Aronson & Shukla, 1987;Birley & Brown, 1970;Castine et al, 1998;Chabungbam, Avasthi, & Sharan, 2007;Christensen et al, 2003;Das, Kulhara, & Verma, 1997;Ellicott, Hammen, Gitlin, Brown, & Jamison, 1990;Hirsch et al, 1996;Hui et al, 2016;Hultman, Wieselgren, & Öhman, 1997;Hunt, Bruce-Jones, & Silverstone, 1992;Leff, Kuipers, Berkowitz, Vaughn, & Sturgeon, 1983;Nuechterlein et al, 1992;Pallanti, Quercioli, & Pazzagli, 1997;Sam, Nisha, & Varghese, 2019;Simhandl, Radua, König, & Amann, 2015;Subramanian, Sarkar, Kattimani, Philip Rajkumar, & Penchilaiya, 2017;Ventura, Nuechterlein, Lukoff, & Hardesty, 1989), whereas five studies (n = 531) found a non-significant association between stressful life events and subsequent relapse of psychosis (Al Khani, Bebbington, Watson, & House, 1986; Dols Significantly more SLEs in 3 months prior to relapse in relapsed than non-relapsed (mean number of events = 0.85 v. 0.51), ( p < 0.001). The number of SLEs also significantly higher in 1 month prior to relapse in relapse group v. non-relapsed ( p = 0.02).…”

Section: Main Findingsmentioning

confidence: 99%

“…For example, the criteria relating to the life event 'bereavement' varied between studies. In some instances the category 'bereavement' included solely bereavement of a first-degree relative (Hunt et al, 1992) whereas in other instances the category 'bereavement' included the death of any close family member (Subramanian et al, 2017). The latter question is broader so perhaps more participants could identify.…”

Section: Measurement Of Life Eventsmentioning

confidence: 99%

“…Of the 19 studies defining relapse as a return of psychotic symptoms, 14 studies (74%) found a significant association between stressful life events and relapse (Aronson & Shukla, 1987;Castine et al, 1998;Chabungbam et al, 2007;Christensen et al, 2003;Das et al, 1997;Ellicott et al, 1990;Hirsch et al, 1996;Hui et al, 2016;Hunt et al, 1992;Leff et al, 1983;Nuechterlein et al, 1992;Pallanti et al, 1997;Subramanian et al, 2017;Ventura et al, 1989), whereas five studies did not find a signficant association (Al Khani, Bebbington, Watson, & House, 1986;Dols et al 2018;Draman at al., 2005;Malla, Cortese, Shaw, & Ginsberg, 1990;McPherson et al, 1993). The one study defining relapse as readmission or a return of symptoms found a positive association between stressful life events and relapse (Simhandl et al, 2015).…”

Section: Relapse and Psychosis Measurementsmentioning

confidence: 99%

“…Fourteen studies included participants with a diagnosis of schizophrenia, psychosis or schizoaffective psychosis, of these, 11 studies (79%) found a significant association between stressful life events and relapse (Birley & Brown, 1970;Castine et al, 1998;Chabungbam et al, 2007;Das et al, 1997;Dols et al, 2018;Hirsch et al, 1996;Hui et al, 2016;Hultman et al, 1997;Leff et al, 1983;Nuechterlein et al, 1992;Pallanti et al, 1997;Ventura et al, 1989). Eleven studies included participants with bipolar I or bipolar II disorder, of these, nine found a significant association between stressful life events and relapse (Aronson & Shukla, 1987;Christensen et al, 2003;Ellicott et al, 1990;Hunt et al, 1992;Sam et al, 2019;Simhandl et al, 2015;Subramanian et al, 2017). It does not therefore appear that diagnosis had any impact on whether the association between life events and relapse was significant.…”

Section: Diagnosismentioning

confidence: 99%

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Are adult stressful life events associated with psychotic relapse? A systematic review of 23 studies

Martland

Martland²,

Cullen³

et al. 2020

Psychol. Med.

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Relapse rates among individuals with psychotic disorders are high. In addition to the financial burden placed on clinical services, relapse is associated with worse long-term prognosis and poorer quality of life. Robust evidence indicates that stressful life events commonly precede the onset of the first psychotic episode; however, the extent to which they are associated with relapse remains unclear. The aim of this systematic review is to summarize available research investigating the association between recent stressful life events and psychotic relapse or relapse of bipolar disorder if the diagnosis included psychotic symptoms. PsycINFO, Medline and EMBASE were searched for cross-sectional, retrospective and prospective studies published between 01/01/1970 and 08/01/2020 that investigated the association between adult stressful life events and relapse of psychosis. Study quality was assessed using the Effective Public Health Practice Project guidelines. Twenty-three studies met eligibility criteria (prospective studies: 14; retrospective studies: 6; cross-sectional: 3) providing data on 2046 participants in total (sample size range: 14–240 participants). Relapse was defined as a return of psychotic symptoms (n = 20), a return of symptoms requiring hospitalization (n = 2) and a return of symptoms or hospitalization (n = 1). Adult stressful life events were defined as life events occurring after the onset of psychosis. Stressful life events included but were not limited to adult trauma, bereavement, financial problems and conflict. Eighteen studies found a significant positive association between adult stressful life events and psychotic relapse and five studies found a non-significant association. We conclude that adult stressful life events, occurring after psychosis onset, appear to be associated with psychotic relapse.

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Section: Main Findingsmentioning

confidence: 99%

Section: Measurement Of Life Eventsmentioning

confidence: 99%

Section: Relapse and Psychosis Measurementsmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

See 2 more Smart Citations

Are adult stressful life events associated with psychotic relapse? A systematic review of 23 studies

Martland

Martland²,

Cullen³

et al. 2020

Psychol. Med.

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“…There are only limited studies from India regarding the role of SLEs in bipolar disorder. [315222324]…”

Section: Introductionmentioning

confidence: 99%

Stressful Life Events and Relapse in Bipolar Affective Disorder: A Cross-Sectional Study from a Tertiary Care Center of Southern India

Sam¹,

Nisha²,

Varghese³

2019

Indian Journal of Psychological Medicine

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Background:Bipolar affective disorder (BAD) is a severe mental illness which results in serious lifelong struggles and challenges. The full impact of stressful life events (SLEs) on the course of BAD is poorly understood.Materials and Methods:A cross-sectional study was conducted on 128 consecutive patients with BAD currently admitted with a relapse. Our objectives were (1) to estimate the proportion, type, and timing of preonset SLEs in relapsed BAD patients and (2) to study the association between SLEs and selected clinical variables in this group. Semi-structured proforma, Young Mania Rating Scale, Hamilton Rating Scale for Depression, Presumptive Stressful Life Events Scale, and Brief Psychiatric Rating Scale were used. Statistical analysis was done using R software for Windows.Results:About 69.5% (89/128) of patients reported preonset SLEs – among which 50 (56.2%) had mania and 39 (43.8%) had depression. Conflict with in-laws and financial problems were the commonly reported SLEs. The mean duration between SLEs and the relapse was 19.73 ± 4.8 days. BPRS score was significantly high in subjects with preonset SLEs (P = 0.022). No significant association was detected between SLEs and the type of episode during relapse (P = 0.402).Conclusion:This study emphasizes the significance of SLEs in the relapse and longitudinal course of BAD. Understanding the association of SLEs and relapse in BAD will help in predicting further relapses and developing newer pharmacological and nonpharmacological measures targeting this aspect, thereby maximizing both symptom reduction and quality of life in patients with BAD.

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18.1 Higher Socioeconomic Status and Less Parental Psychopathology Improve the Prognosis in Youths With Bipolar Disorder

Diler

2022

Journal of the American Academy of Child & Adolescent Psych

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Role of stressful life events and kindling in bipolar disorder: Converging evidence from a mania-predominant illness course

Cited by 10 publications

References 31 publications

Are adult stressful life events associated with psychotic relapse? A systematic review of 23 studies

Are adult stressful life events associated with psychotic relapse? A systematic review of 23 studies

Stressful Life Events and Relapse in Bipolar Affective Disorder: A Cross-Sectional Study from a Tertiary Care Center of Southern India

18.1 Higher Socioeconomic Status and Less Parental Psychopathology Improve the Prognosis in Youths With Bipolar Disorder

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