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

Prescribing lithium for bipolar disorder: are we too scared?

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Deenan Edward and Suhana Ahmed summarise a Scottish study of prescribing for bipolar disorder between 2009-2016, which identified a clear trend towards decreasing lithium use.

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Bipolar disorder and distress: systematic review of first-person accounts

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A group of UCL Mental Health Masters Students summarise a meta-synthesis of qualitative research, which looks at what people diagnosed with bipolar disorder experience as distressing.

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How can digital technology help close the mortality gap for people with severe mental illness?

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Lina Gega from the Closing the Gap Network explores a recent review of digital technology for health promotion, which looks at opportunities to address excess mortality in people living with severe mental illness.

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Risk factors for suicide in people with bipolar disorder

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Dafni Katsampa explores a recent prospective cohort study of risk factors for suicide in bipolar disorder, which finds significant variation in risk factors in men and women.

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Mindfulness-based cognitive therapy for bipolar disorder

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Peter McMurray writes his debut elf blog on a systematic review of mindfulness-based cognitive therapy for bipolar disorder, which finds a lack of high quality research to support its use in clinical practice.

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Racial disparities in bipolar disorder diagnosis and treatment: time to talk about racism

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Syeda Akther writes her debut elf blog on a recent review looking at racial disparities in bipolar disorder treatment and research. She argues that we need to start having serious conversations about racism that go beyond unconscious bias.

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Improving care for people with bipolar disorder: meeting unmet needs

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Leela Sathyaputri and Jess Fiedorowicz write their debut elf blog on a narrative review of the recent bipolar disorder literature entitled: “Areas of uncertainties and unmet needs in bipolar disorders: clinical and research perspectives”.

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Smoking cessation for people with severe mental illness? “Oh yes they can!” SCIMITAR+

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David Shiers and Peter Byrne summarise the new SCIMITAR+ trial out today in The Lancet Psychiatry, which evaluates a bespoke smoking cessation intervention for people with severe mental illness.

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Pregnancy and bipolar disorder: international prescribing consensus?

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Dean Connolly looks at an international study which asks: Is there consensus across evidence-based guidelines for the psychotropic drug management of bipolar disorder during the perinatal period?

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Is self-management ready for the mental health mainstream?

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Josefien Breedvelt and Peter Coventry explore a new systematic review and meta-analysis of self-management interventions for people with severe mental illness.

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