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

Alcohol and bipolar: how does heavy alcohol use predict the course of bipolar disorder?

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Danielle Windget and Sammy Eden review a recent study on the patterns and clinical correlates of lifetime alcohol consumption in women and men with bipolar disorder.

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Hospital presentations for self-harm: a window of opportunity to prevent or treat psychosis and bipolar disorder

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Alison Clarke and Jo Robinson review a Finnish cohort study which suggests that hospital presentations for self-harm represent a clear opportunity for the identification and subsequent treatment of psychosis and bipolar disorder.

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Ending self-stigma: not at all straightforward

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Dave Steele summarises a recent randomised controlled trial, which suggests that there may be benefit in self-stigma programmes for those with severe mental illness, but more work is needed.

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Group physical activity for people with severe mental illness: from inactivity to engagement

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A group of MSc Clinical Mental Health Sciences students at UCL Psychiatry summarise a systematic review on the experience of initiating community-based group physical activity by people with serious mental illness.

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Transcranial direct current stimulation (tDCS) for unipolar and bipolar depression

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Delia Ciobotaru reviews a recent randomised controlled trial on the neurocognitive effects of transcranial direct current stimulation in depression.

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Charlotte Walker reviews a recent qualitative study on monitoring mood in bipolar disorder, which suggests that people with lived experience should customise monitoring questions to create a more responsive, personalised approach.

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In his debut blog, Andrew Steptoe summarises two recent papers using electronic health record datasets, which suggest that having a psychiatric diagnosis may put people at risk of COVID-19 infection.

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RESPECT! Find out what it means to me(ntal health services)

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Beccy White explores the recently published RESPECT trial – a feasibility RCT which finds that a sexual health promotion intervention was safe and acceptable for people with severe mental illness.

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Reducing cardiovascular risk in people with severe mental illness

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Masuma Mishu from the Closing the Gap Network reviews a recent US trial of a comprehensive cardiovascular risk reduction intervention in people with severe mental illness, which shows promising results.

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PACT advance decision-making template: is another form really the answer?

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Peter Bartlett considers the usefulness of the new PACT advance-decision making template, which is a fillable template for advance decision making in fluctuating mental health conditions – PACT (Preferences and Advance decisions for Crisis and Treatment).

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