Residual Anxiety in Patients with Bipolar Disorder in Full or Partial Remission: Metacognitive Beliefs and Neurocognitiv
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ORIGINAL ARTICLE
Residual Anxiety in Patients with Bipolar Disorder in Full or Partial Remission: Metacognitive Beliefs and Neurocognitive Function M. L. Reinholdt‑Dunne1 · I. Seeberg1,2 · A. Blicher1 · N. Normann1 · M. Vinberg2,3 · L. V. Kessing1 · K. W. Miskowiak1,2 Accepted: 1 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Maladaptive metacognitive beliefs are frequent during depressive states of bipolar disorder (BD). Still, it is unclear whether they persist in remitted phases and play a role in patients’ residual anxiety. The study aimed to investigate whether remitted patients with BD display maladaptive metacognitive beliefs, and whether these beliefs are associated with more residual anxiety and lower attention control. Methods Patients with BD in full remission (n = 28) and healthy control participants (HCs) (n = 31) were assessed with selfreported questionnaires measuring metacognitions, anxiety, attention, and a screening for cognitive impairment as well as two computerised attention tasks. Results Patients with BD exhibited higher levels of maladaptive metacognitive beliefs than HCs, also after adjustment for subsyndromal mood symptoms. Patients with BD also showed reduced attention control and cognitive impairments. Across the entire sample, more maladaptive metacognitive beliefs were associated with more anxiety symptoms, poorer cognition and lower attention control. Conclusions Maladaptive metacognitive beliefs are associated with residual anxiety in remitted patients with BD. Treatments that specifically target maladaptive metacognitive beliefs may have potential to reduce anxiety in remitted phases of BD and enhance patients’ functional recovery and quality of life. Keywords Bipolar disorder · Metacognition · Anxiety · Attention · Treatment · Remission
Introduction Anxiety symptoms are highly common in bipolar disorder (BD). The lifetime prevalence and current comorbidity of anxiety disorders in patients with BD are 41% and 38%, M. L. Reinholdt-Dunne and I. Seeberg have contributed equally to this work. * K. W. Miskowiak [email protected] 1
Department of Psychology, University of Copenhagen, Copenhagen, Denmark
2
Neurocognition and Emotion in Affective Disorder (NEAD) Group, Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Faculty of Health and Medical Sciences, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
3
Psychiatric Research Unit, Psychiatric Centre North Zealand, Faculty of Health and Medical Sciences, University of Copenhagen, Hillerød, Denmark
respectively (Eser et al. 2018). These disorders are among the leading contributors to the global burden of disease (Kessler et al. 2005; Konnopka and Konig 2020). Comorbid anxiety often persists in otherwise symptom-free phases of BD, with 35% of remitted patients meeting the diagnostic criteria for one or more anxiety disorders (Pavlova et al. 2017). Further, remitted patients with BD with no comorbid an
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