bipolar disorder

8560840624_7452a42f5e_k

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

Can pharmacotherapy help smokers with severe mental disorders?

25470348902_cd8daa9fed_k

Andrew Jones reports on an ecological pragmatic clinical trial, which suggests that it is feasible to support smoking cessation in people with severe mental disorders such as bipolar disorder and schizophrenia.

[read the full story...]

Evidence-based guidelines for treating bipolar disorder

2704560472_63b23c8c4e_b

Joseph Hayes summarises the recent British Association for Psychopharmacology guidelines for the treatment of bipolar disorder, and compares their recommendations with those found in the NICE bipolar disorder guidance from 2014.

[read the full story...]

#PreventableHarm discussion 20/7/16: Can risk assessment in mental health be evidence-based?

PreventableHarm

Can risk assessment in mental health be evidence-based? Join us for the #PreventableHarm discussion in London on Wed 20th July 2016. This free open ‘question time’ style debate is being organised by the UCL Division of Psychiatry, The Lancet Psychiatry and the National Elf Service.

[read the full story...]

Psychiatric disorders: what’s the significance of non-random mating?

7960674098_2070f1fe64_b

Marcus Munafo considers the implications of a recent Swedish population study, which explores patterns of non-random mating within and across 11 major psychiatric disorders.

[read the full story...]

Cochrane find no evidence for as required PRN medication for mental health inpatients

4711660113_49676b8c32_b

John Baker summarises an updated Cochrane review on ‘as required’ PRN medication regimens for seriously mentally ill people in hospital, which finds no randomised controlled trials that support this widely used intervention.

[read the full story...]

Childhood maltreatment and bipolar disorder

7166752339_902ff47895_k

Emily Currell writes her debut Mental Elf blog about a recent Lancet Psychiatry systematic review, which reports that childhood maltreatment is associated with an unfavourable course of bipolar disorder in adult years.

[read the full story...]

Mental health crisis care: clinical and cost effectiveness of models of care

Punctuation marks made of puzzle pieces

Caroline Leah publishes her debut blog on crisis care for people with mental health issues, which concludes that better quality evidence is needed to support the overall effectiveness of crisis care interventions.

[read the full story...]

Psychotropic medication in pregnancy: new evidence may help achieve a safe balance

pregnant with ipad

Joanne Wallace considers a recent health technology assessment on the risks and benefits of psychotropic medication in pregnancy, which supports previous associations between valproate and adverse child outcomes.

[read the full story...]

Cannabis and mental illness: it’s complicated!

9682828741_fb4d35f165_k

Suzi Gage considers the findings of a big new US cohort study, which investigates the relationship between cannabis use and various substance use, mood and anxiety disorders.

The blog also features a podcast interview with Suzi Gage talking about this new study and her own work in this field, plus a short conversation with Ian Hamilton highlighting his forthcoming #CannabisMatters event.

[read the full story...]

What do you want from your psychiatric medication?

4741451457_6344b99835_b

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.

[read the full story...]