Journal article

Extreme attributions predict transition from depression to mania or hypomania in bipolar disorder

Jonathan P Stange, Louisa G Sylvia, Pedro Vieira da Silva Magalhaes, Ellen Frank, Michael W Otto, David J Miklowitz, Michael Berk, Andrew A Nierenberg, Thilo Deckersbach



BACKGROUND: Relatively little is known about psychological predictors of the onset of mania among individuals with bipolar disorder, particularly during episodes of depression. In the present study we investigated attributional style as a predictor of onset of hypomanic, manic or mixed episodes among bipolar adults receiving psychosocial treatment for depression. We hypothesized that "extreme" (i.e., excessively pessimistic or optimistic) attributions would predict a greater likelihood of developing an episode of mood elevation. METHOD: Outpatients with DSM-IV bipolar I or II disorder (N = 105) enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were rando..

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University of Melbourne Researchers


Awarded by National Institute of Mental Health

Awarded by National Research Service Award from NIMH

Awarded by K-23 NIMH Career Award


Funding Acknowledgements

STEP-BD was funded in part by contract N01MH80001 from the National Institute of Mental Health (Gary Sachs). Support for the development of the psychosocial treatments was provided by grants MH29618 (Ellen Frank), MH43931 (David Miklowitz), and MH55101 (David Miklowitz) from the National Institute of Mental Health and by the National Alliance for Research on Schizophrenia and Depression (David Miklowitz). Jonathan Stange was supported by National Research Service Award F31MH099761 from NIMH. Louisa Sylvia was employed by Massachusetts General Hospital, served as a Consultant for Bracket Global and Clintara, received research support from NIMH, is a former stockholder in Concordant Rater Systems, and has received support from New Harbinger Publishers. Pedro Vieira da Silva Magalhaes reports no relevant financial interests. Ellen Frank has served as a consultant for Servier International, and has received other financial or material support from Guilford Press and the American Psychological Association Press. Michael Otto has served as a consultant for Micro-Transponder, Inc. David Miklowitz has received research support or honoraria from NIMH, Brain and Behavior Research Foundation, Danny Alberts Foundation, and Attias Family Foundation; He has received other financial or material support from Guilford Press, and John Wiley and Sons. Michael Berk is an employee of Barwon Health, Deakin University; he has received research support from NIH; NHMRC, CRC, Rotary and the Simons Foundation; he has received honoraria from Lundbeck, Astrazeneca, Servier, Lilly, and ISBD Korea; he has served as a speaker or on the advisory board for Astrazeneca, Lundbeck, Lilly, and Janssen; and he has received financial or material support from Allen & Unwin and Cambridge University Press. Andrew Nierenberg has received honoraria or travel expenses from: American Society of Clinical Psychopharmacology, Australasian Society for Bipolar Disorder, Bayamon Region Psychiatric Society, San Juan, Puerto Rico, Belvoir Publishing, Boston Center for the Arts, Corcept, CRICO, Dartmouth, Dey Pharma, L.P./Mylan Inc., Israel Society for Biological Psychiatry, John Hopkins University, National Association of Continuing Education, PAL Pamlabs, Physicians Postgraduate Press, Ridge Diagnostics, Slack Publishing, Sunovion, Teva Pharmaceuticals, University of Florida, University of Michigan, University of New Mexico, University of Miami, University of Wisconsin, Wolters Klower Publishing. Potential consulting honoraria from Astra Zeneca, Bristol Myers Squibb, Forest, Pfizer, Ridge Diagnostics. Potential support of research at MGH through Biogen Idec, Dey Pharmaceuticals, Pamlabs, Shire, and Sunovian. He owns stock options in Appliance Computing, Inc. ( and BrainCells, Inc. Additional income is possible from depending on overall revenues of the company but no revenue has been received to date. Through MGH, Dr. Nierenberg is named for copyrights to: the Clinical Positive Affect Scale and the MGH Structured Clinical Interview for the Montgomery Asberg Depression Scale exclusively licensed to the MGH Clinical Trials Network and Institute (CTNI). Thilo Deckersbach was supported in part by a K-23 NIMH Career Award 1K23MH074895-01A2. His research has also been funded by NARSAD, TSA, OCF and Tufts University. He has received honoraria, consultation fees and/or royalties from the MGH Psychiatry Academy, Brain Cells Inc., Systems Research and Applications Corporation, Boston University, the Catalan Agency for Health Technology Assessment and Research, the National Association of Social Workers Massachusetts, the Massachusetts Medical Society, Tufts University, NIDA and Oxford University Press. He has also participated in research funded by NIH, NIA, AHRQ, Janssen Pharmaceuticals, The Forest Research Institute, Shire Development Inc., Medtronic, Cyberonics, and Northstar.