Goalattainment autonomy and the development of mania

Two previous studies have suggested a link between goal achievement and the development of mania: Lozano and Johnson (2001) found achievement-striving scores predictive of increases in manic symptoms, while an earlier study found goal-attainment life events to be predictive of increases in manic symptoms, whereas more general positive life events were not (Johnson et al., 1999).

The extremely high goal-attainment beliefs described above may lead to working excessively long hours, and seeking activities that may lead to positive mood but are impulsive and may have long-term undesirable consequences. Furthermore, as a way of coping with frequent relapses and hospitalisation, patients with these high goal-attainment goals may engage in extreme and driven behaviour, such as overworking to "make up for lost time", due to their illness episodes. This behaviour may disrupt the individual's important social routines, such as regular meal times and regular exercise. Disruption of routine and sleep can lead to a bipolar episode: empirically, there is evidence that life events, which disrupt sleep-wake routines, play an important role prior to the onset of a bipolar episode. In the 8 weeks prior to manic episodes, a significantly greater proportion of patients had social rhythm disruption events in the 8-week episode-free control period (Malkoff-Schwartz et al., 1998). Bipolar patients are also known to relapse after long-distance travel or jet lag (American Psychiatric Association, 1994; Healy & Williams, 1989). Clinically, it has been observed that chaos can lead to more episodes; hence, having a regular routine seems very important for bipolar patients. Therefore, extreme attitudes may—through effects upon behaviour—interact with biological vulnerability to precipitate a manic episode.

Extreme beliefs of an autonomous nature may exacerbate the onset of hypomania by motivating the bipolar individual to disregard negative social feedback. As social feedback can aid in identifying the prodromal symptoms of hypomania, this may precipitate increases in hypomanic symptoms.

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