Objectives. – Clinical heterogeneity during euthymic states is a crucial issue in bipolar disorders. Indeed,
actual data are not sufficient to understand why some patients are unharmed by subthreshold symptoms
and have ...
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Objectives. – Clinical heterogeneity during euthymic states is a crucial issue in bipolar disorders. Indeed,
actual data are not sufficient to understand why some patients are unharmed by subthreshold symptoms
and have functional impairments whereas others have a functional remission but have subthreshold
symptoms. Based on the Ball model, cognitive and schematic vulnerability interact with genetic vul nerability and trigger affective symptoms with the intervention of s according to this model, adjustment and adaptation to illness assessed by functional outcome and illiness experience are associated with this cognitive and schematic vulnerability. So, theoretical arguments
support that childhood adversity and temperamental deregulation characterize patients with bipolar
disorders. Thus, the aim of this study is to systematically review studies of Early Maladaptive Schemas in
bipolar disorder, to determine whether Early Maladaptive Schemas have specificity in bipolar disorder in
comparison with other populations, and to identify which Early Maladaptive Schemas could be activated.
The challenge of this review is to identify if the taking of early maladaptive schemas into account could
allow us to better identify, understand and manage bipolar disorders.
Methods. – This systematic review was led according to the Preferred Reporting Items for Systematic
review and Meta-Analysis statement on the electronic databases Cochrane, PsycArticles, Psychology and
Behavioral Sciences Collection, PsycInfo, PubMed, ScienceDirect and Scopus with « early maladaptive
schemas » AND « bipolar disorder » as keywords. Only studies meeting eligibility criteria concerning
publication status, language, population and outcomes were included after several screenings on basis
of title, abstract and full-text. Then, we carried out data extraction in accordance with criteria defined
in principle (about characteristics of participants, objectives, materiel and methods, principle results and
bias).
Results. – Among 39 records identified, a total of 10 studies met eligibility criteria for inclusion in this
review. Synthesizing findings across the studies revealed three important topics. First, early maladaptive
schemas appear as potential cognitive characteristics that clinicians have to investigate in clinical practice.
Indeed, patients with bipolar disorders present greater activation of the early maladaptive schemas in
comparison with people who have no disorder. This point supports the first part of Ball’s theoretical model
that considers schemas as a vulnerability to bipolarity. Secondly, early maladaptive schemas are relevant
to distinguish bipolar disorders from unipolar depression and borderline personality disorder. A greater
and a lower activation are respectively identified among bipolar disorders. Thirdly, supporting the second
part of Ball’s model, early maladaptive schemas play a key role in recovery regarding their impact on the
course of bipolarity, in particular on suicidality and functional impairment. Finally, these dysfunctional
schemas allow us to understand the clinical heterogeneity of bipolar disorder, and among others, about
the type of bipolarity. These results have several implications, but there are some limits in this systematic
review. First, no French study has been done. Then, reduced sample sizes in these studies increased the
risk to conclude wrongly to an activation difference between groups. Furthermore, probably due to the
variety of methods and populations, we could not identify an homogeneous pattern of early activated
maladaptive schemas. Overall, scientific approaches used in these studies are based on statistical models
using mean and standard deviation. These types of statistical analyses are the main limit because they
cannot represent the heterogeneity of early maladaptive schemas profiles.
Conclusions. – Schema theory proves to be a relevant approach in bipolar disorders, and early maladaptive
schemas appear to be important to take into account in clinical practice. Nevertheless, in order to propose
schemas therapy appropriately, it is necessary to specify if early maladaptive schemas are activated and
to specify therapeutic indications because of clinical heterogeneity. Moreover, data do not yet allow us to
understand the disparity of profiles during the inter-episode period. Indeed, a French research perspective
is being considered that will prefer a person-oriented approach.
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