bipolar disorder

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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]

Acknowledgement

Written by: Patrick Kennedy-Williams
Reviewed by:
Last updated: Sep 2015
Review due: Sep 2016

Our bipolar disorder Blogs

What do you want from your psychiatric medication?

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John Baker presents a systematic review of preferences for medication-associated outcomes in mental disorders, which concludes that we just don’t know what value mental health service users place on the different outcomes that come from taking psychiatric medication.

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Is it bipolar disorder or borderline personality disorder?

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Murtada Alsaif considers the challenges facing psychiatrists in diagnosing bipolar disorder or borderline personality disorder. He reports on a recent qualitative study that explores the practical experience of psychiatrists and nurses and concludes that clinical diagnostic practice cannot reliably distinguish the two conditions.

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Crisis intervention for severe mental illness: Cochrane call for more evidence

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John Baker is struck by the lack of evidence for crisis intervention for people with severe mental illness, highlighted by a recently updated Cochrane systematic review.

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Is the NICE guideline for bipolar disorder biased in favour of psychosocial interventions?

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Guy Goodwin reviews a new paper in the Lancet Psychiatry by Jauhar, McKenna and Laws, that calls into question the trustworthiness of the NICE bipolar disorder guidance.

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Lamotrigine, quetiapine and folic acid for bipolar depression: the CEQUEL trial

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Michael Ostacher considers the findings of the CEQUEL trial, which asks: Does lamotrigine treat bipolar depression when added to quetiapine, and does adding folic acid help any more?

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No sexual health history please, we’re British!

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Kirsten Lawson presents the results of a systematic review of observational cross-sectional studies, which looks at the worldwide prevalence of HIV, hepatitis B and hepatitis C in people with severe mental illness.

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Does QOF reduce hospitalisation for people with severe mental illness?

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Andres Fonseca appraises a regression analysis looking at the quality and outcomes framework (QOF) and the impact it has on psychiatric admissions in people with severe mental illness.

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Improving diagnosis of bipolar disorder: can blood-based diagnostic panels help?

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Can blood-based diagnostic panels help us reduce the misdiagnosis and inappropriate treatment often experienced by people with bipolar disorder? Murtada Alsaif reviews a recent retrospective study that has some encouraging findings for biologically identifying the disease.

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Employment opportunities for all? Social enterprises and mental health

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Martin Webber considers a Canadian study about social enterprises and employment opportunities for people with mental health problems such as psychosis.

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