bipolar disorder

bipolar

Introduction

Bipolar, otherwise known as manic depression, now exists largely within common consciousness and understanding, thanks to high profile stigma-busting publicity.

Characterised by episodic shifts in a person’s mood (between manic and depressed states), as well as their energy and activity levels, which can significantly impact their daily functioning, bipolar is estimated to affect 1% of the population across the lifetime. However, this figure rises to over 4% if you include those who experience more than one episode of sub-threshold manic (or ‘hypomanic’) symptoms.

What we know already

Anxiety is unsurprisingly common in people living with bipolar. Similarly, substance abuse is frequently reported.

Whilst there is no cure, there are several well-established treatment options. Bipolar is usually treated using mood-stabiliser, atypical anti-psychotic and/or antidepressant medications, alongside psychological, and diet and lifestyle interventions. We know, for example, that bipolar can be well managed using regular monitoring of mood, keeping stress levels to a minimum, and ensuring good sleep.

Areas of uncertainty 

Like many mental health difficulties, the precise causes of bipolar are unknown, though they are likely multi-faceted. Research shows that you are more likely to develop bipolar if it exists in your family. Although most children with such circumstances will not go on to develop bipolar, there appears to be a strong genetic component. Environmental factors such as stressful life events are also thought to play an important role.

Recent research suggests that, whilst it appears beneficial to treat bipolar with psychological interventions, the heterogeneity of the evidence makes it difficult to decide which treatments (such as CBT, Mindfulness etc) work best.

What’s in the pipeline?

Large-scale studies, such as the U.S-based Bipolar Disorder Phenome Database, are seeking to better understand the complex genetic picture.

Advances in brain imaging will no doubt provide rich information regarding the neurochemical and neurostructural profile of bipolar. Similarly, technological advances are enabling more sophisticated ways of promoting self-management in conditions such as bipolar.

References

Merikangas, K.R., Akiskal, H.S., Angst, J., et al. (2007) Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Archives of General Psychiatry, 64, 543-552. [Abstract]

Stratford, H.J., Cooper, M.J., Di Simplicio, M., Blackwell, S.E. and Holmes, E.A. (2015) Psychological therapy for anxiety in bipolar spectrum disorders: a systematic review. Clinical Psychology Review, 35, 19-34. [Abstract]

Our bipolar disorder Blogs

Mood Matters: mood instability is common and associated with poor outcomes

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Farhana Mann summarises an observational study of mood instability in people with mental illness, which explores its relationship with days spent in hospital, frequency of admissions, the likelihood of being sectioned and the chance of being prescribed antipsychotics and mood stabilisers.

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Joining the dots: mental and physical health

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Lia Ali and colleagues from the IMPARTS project present the findings of their group discussions about a recent review of mortality in mental disorders. Along the way she discusses the staff training they carried out and the tweet chat they ran to consider the implications of this research, both to individuals and on the global burden of disease.

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Smoking cessation for people with severe mental illness

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Sally Adams appraises and summarises the SCIMITAR pilot RCT, which investigates smoking cessation for people with severe mental ill health. The paper presents a highly promising bespoke intervention for smokers with bipolar disorder, psychosis or schizophrenia.

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Premature mortality in bipolar disorder

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Elena Marcus appraises a recent systematic review and meta-analysis of premature mortality in bipolar affective disorder, which finds that people with bipolar disorder have increased mortality rates compared with the general population.

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Peer-led self-management for mental health: impressive programme, not so sure about the research

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Lucy Simons and Chris Sampson appraise a recent evaluation of peer-led self-management training for people with severe mental illness.

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Screening for bipolar spectrum disorders (MDQ, BSDS and HCL-32)

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Elena Marcus appraises a recent meta-analysis of screening for bipolar spectrum disorders, which concludes that the MDQ and HCL-32 tools are supported by more evidence than the BSDS tool.

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The antidepressant effects of ketamine are confirmed by a new systematic review and meta-analysis

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Helge Hasselmann summarises a new systematic review and meta-analysis, which confirms the antidepressant effects of ketamine.

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Poor oral health and severe mental illness: what are the links?

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Helge Hasselmann summarises a recent systematic review of poor oral health and severe mental illness (SMI), which found that people with SMI were 2.8 times more likely to have lost all their teeth, and had more missing, decayed or filled teeth.

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People with severe mental illness are more likely to be victims of violent and non-violent crime

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Vishal Bhavsar summarises a recent cross-sectional study of violent and non-violent crime against adults with severe mental illness, which finds that service users were five times more likely to be victims of assault, and three times more likely to be victims of household acquisitive crime.

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Searching for the cost of bipolar disorder

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Bipolar disorder is associated with high economic costs…or is it? Chris Sampson reports on a new systematic review, which highlights limitations in our understanding.

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