Stress, social rhythms, and behavioral activation: psychosocial factors and the bipolar illness course.

Current, more sophisticated models of bipolar disorder emphasize the interaction of psychosocial factors with biology as determinants of the long-term illness course. Recent research has documented the effects of psychosocial stress on the onset of new episodes, exacerbation of symptoms, and response to pharmacologic treatment in bipolar individuals. In this article, relevant theories and empiric findings regarding these relationships will be reviewed. In particular, two specific pathways relating psychosocial stressors to the onset of mania (eg, social rhythm disruption and behavioral activation) will be explicated.