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Thesis statement for virtual reality

dissertation bipolar

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14.08.2018

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  • Bipolar Disorder. ACADEMIC DISSERTATION. To be presented with the permission of the Faculty of Medicine, University of Helsinki, for public. This thesis is an exploration of some of the risks associated with Bipolar Disorder and the lived experiences of people with Bipolar Disorder. It begins with a. Persons diagnosed with bipolar disorder for at least 1 year. • Must be 18 years or Richard Freedberg, Student Investigator for dissertation. From: Amy Naugle.

    dissertation bipolar

    Hence, dedication and persistent work towards creative goals appears to be a prerequisite for accomplishment in most cases, and this dedication may derive largely from ambition and dedication.

    Although the above findings have focused largely on traits that operate across many different domains of creativity, other traits, such as Neuroticism N may be related to more specific forms of creativity. The personality correlates of BD are reasonably well understood. Some studies have found that elevated E separates BD from unipolar depression and the internalizing disorders Bagby et al.

    The positive relationship between E and BD may be strongest in the mania-proneness component of BD diathesis Murray et al. These traits, then, may help explain some of the overlap between BD and creativity.

    One well-replicated finding is the importance of high goal-setting among persons at risk for mania. In each study, mania appears related to extrinsically-oriented ambitions to achieve the recognition of others, through popular fame, financial success, and creative accomplishment. Those who are mania-prone do not seem to differ from others on their lifetime ambitions for connectedness or other intrinsic goals. This tendency towards ambitions for public recognition may help fuel the determination and persistence required of highly creative quests.

    A final disposition of note in BD is impulsivity. A growing body of research suggests that impulsivity tends to be elevated among persons with BD, even during well states Leibenluft et al. Impulsivity tends to become even more pronounced during manic periods Swann et al. As noted above creativity appears related to impulsivity, or the unconstrained expression of impulses and needs Feist, ; Schuldberg, It is possible that impulsivity may help promote expressiveness without constraint, fostering ability to produce more unique products.

    A substantial literature links different domains of creativity with personality traits, motivational styles and affective tendencies. Hence, one way to refine our understanding of creativity among people with BD is to consider personality and motivational qualities associated with BD.

    There is reason to think that the association between creativity and BD partly operates through dispositional traits that are important in both phenotypes. The modal personality profile in BD appears to be consistent with creativity generally high O and artistic pursuits high N. Literature is more mixed concerning whether BD is characterized by high E, but those persons who do experience high E may be particularly drawn towards performance arts.

    Beyond personality, the motivational traits of high goal-setting and impulsivity are strongly implicated in both BD and creative output.

    Research into the creative process has focused on the ability to generate unusual associations and to use visual imagery in support of problem-solving as facets of creativity.

    There is robust evidence that positive moods can enhance the ability to generate unusual associations. Intriguingly, each of these affective and cognitive processes has been documented in BD as well. Some people had extremely strong associations, but generated relatively few exemplars. Others tended to produce a broader range of exemplars, many of which were less typical associations. Similarly, Eysenck's associational hypothesis Eysenck, proposes that creativity is facilitated when mechanisms that limit the formation of associations are weak.

    A testable deduction from the associational theory is that creativity might involve the use of information previously coded as irrelevant: These researchers have shown that individual differences in the use of imagery are reliably related to increased emotional intensity, and distress disorder diagnoses. Mood is probably the least disputed predictor of creative behaviour.

    A large number of studies affirm that, compared with neutral mood, positive affect exemplified in happiness is associated with increased fluency and originality e. Rather it appears that positive moods particularly happiness are particularly important in promoting creativity.

    Experimental studies indicated a small positive causal association between positive moods and creativity. The primary link between positive affective states and creative performance was also affirmed in a second recent meta-analysis Davis, The effect of positive mood is more clearly observed when original thinking or creative ideation is measured, rather than general problem-solving.

    Numerous studies suggest that moderate positive affect supports, while low and intense levels of emotion impede creativity Davis, ; De Dreu et al.

    It is tempting to suggest that this helps explain the diminished level of creative output among those with mania compared to hypomania see above. Neurobiologically, this may be due to cortical activation and arousal effects mediated by dopamine and noradrenaline , particularly of the prefrontal cortex and its working memory functions e. Three core features of the creative process — fluency of association, use of cognitive imagery and positive affect are commonly reported in BD.

    First, bipolar traits are associated with divergent thinking and episodes of mania are associated with the cognitive symptom of overinclusiveness see Section 3. Second, reliance on cognitive imagery has been proposed to be a clinically-significant feature of BD Holmes et al. Finally, people with BD Bagby et al. Positive affectivity, a core facet of extraversion, also specifically predicts more severe manic symptoms over time Akiskal et al.

    Furthermore, a range of studies indicate a causal relationship between mesolimbic dopaminergic dysregulation and BD Berk et al. The present review therefore suggests that abnormalities of dopamine function may be a neurobiological substrate shared between BD and creativity process, and that associated positive affective traits may be one component of BD that helps explain creative cognitive styles.

    It can be concluded that BD is related to a number of characteristics that might drive creative accomplishment. An emphasis on high goal setting, and particularly ambitions for public recognition and creative accomplishment, may provide the fuel for pursuing creative accomplishments.

    Positive affectivity might promote more divergent, creative thinking, and impulsivity may foster production of novel products without self-censorship. Finally, personality traits of N, E and O may promote success and comfort in performance-based creative arts, and particularly careers consistent with Romantic values. Contained in Fig. Schematic representation between the bipolar disorder phenotype and two core components of creativity.

    Shown in the embedded box are variables in the three areas of overlap, and the direction of their association. A number of features of Fig. First, the large number of variables that can be independently forwarded as mechanisms linking BD to creativity is consistent with the range of evidence Section 2 above that such an association exists.

    Second, Fig. Third, while most variables have a positive relationship, there is some domain specificity N and E and some relationships are ambiguous e. Fourth, the model does not capture possible dynamic relationships e. Finally, the associations represented in Fig.

    Within its limitations, Fig. In the final sections of this review, we use this framework to introduce a set of considerations for clinicians working with creative-BD populations.

    The issues presented below are a synthesis of our clinical experience and cognate research; it is hoped that this review will stimulate more specific studies in the area. We commence by considering the possibility that the environmental niche of performers, while engaging and supportive of self-expression, may challenge a BD diathesis.

    Some features of the creative professions, particularly artistic performance, may be counterproductive for people with BD. Although not universal components of these careers, five features warrant attention — reinforcement of emotionality, occupational stress, substance misuse, irregular sleep and activity schedules, and challenges to goal regulation see also Table 1.

    Common characteristics of the performance lifestyle and possible consequences for case formulation and treatment planning. Emotional sensitivity may promote creativity within the arts, and high levels of N index this trait in BD patients and creative people see Section 3. The artistic niche may amplify this disposition, through the reinforcing effects of external reward for expressed emotionality. As discussed by Sass b , artists are valued for their ability to capture, express and engender states of intense emotion.

    Regular experience and sharing of intense emotions may challenge a preexisting mood regulation vulnerability. Unemployment is endemic: Likewise, a career path of increasing stability and recognition over time is rare in the performing arts de Chumaceiro, , with negative consequences for occupational identity and potentially for psychosocial development Munley, ; Skorikov, Moreover, substantial research indicates that negative life events and chronic stressors can predict greater severity of depressive symptoms within BD Johnson et al.

    Alcohol and drug comorbidity may be particularly prevalent among highly creative bipolar populations. For example, in a sample of 40 bebop musicians, Not only does the artistic environment support substance use see Table 1 , but substances may, through mood effects, perform an important creativity-enhancing function. The creative lifestyle may challenge a core neurobiological diathesis in the circadian system. Creative occupations are characterized by abnormal 24 hour activity patterns: Working hours are typically at night, with rehearsals and other engagements scheduled during the day Belli, Physical activity, social engagement and emotional stimulation may swing through peaks and troughs related to project-based work, producing challenges for the medium-term moderation of arousal Murray, This high amplitude variation in environmental engagement is largely out of the individual's control because of their dependence on others for the generation of work Wills, Each of these factors may interfere with effectively maintaining daily rhythms and sleep schedules.

    Illicit drugs may be used to help maintain energy levels through this unusual schedule. From a chronobiological perspective, the creative lifestyle may have extremely negative consequences for regulation of circadian function.

    Abnormal regulation of goal pursuit is common in BD. People with BD Hayden et al. One way this appears to be expressed is an increased reactivity to how well the pursuit of goals is going in both interpersonal and achievement domains.

    Life events involving success have been found to trigger manic symptoms in BD Johnson et al. Sadly, creative pursuits often involve long periods of lack of recognition and frank unemployment, frustrations that the person with BD may feel more keenly than others. At other times heights of public recognition and excitement may be destabilizing towards mania.

    In sum, many creative occupations involve features that may increase risk of symptoms for those with BD, including increased rates of stress, alcohol and substance use, extremes of achievement and frustration, and chaotic schedules. Effective treatment planning requires assessment of whether or not these features are of concern at the time of intake, but also over the broader life course.

    Open discussion of these sensitive issues requires a strong therapeutic alliance, as considered next. Ambivalence towards treatment is common for people with BD Leahy, Those with less severe forms of the disorder may be more reticent to accept a diagnosis, as by definition, hypomanic periods do not interfere with functioning.

    Hence, those with milder symptoms may treasure some of the benefits of increased energy, sociability, and faster thinking. Given evidence that creativity is particularly heightened among those with less severe forms of disorder above , clinicians will likely need to carefully consider the pros and cons of diagnoses for their clients. It is worth noting that many clients believe that their creative accomplishments are fostered by high periods. Although the sheer volume of output does tend to be higher during manic periods than depressive periods, such work may be of poor quality Weisberg, , so such beliefs are worth carefully evaluating.

    As discussed above, creative achievement requires not just spontaneous generation of new concepts, but attention to detail and critical thinking that are impaired by definition during periods of mania and hypomania Schuldberg, It may be helpful to share with clients evidence that creativity is not specifically related to manic periods, that people with a history of hypomania are more likely to have creative accomplishments than those with mania, and that unaffected family members are more likely to have creative accomplishments than are those with hypomania.

    A medical-model assumption of treatment as progression to normality may not be motivating for some creative persons Rothenberg, Above, we noted that impulsive expression of emotions and needs can be related to creative accomplishments across science and art, and some clients may have strong views about not wanting to feel constrained.

    Therapists who emphasize quantifying and defining symptoms may also find these approaches conflict with a Romantic worldview elevating emotion over reason. Given wide variability in the level and types of motivation for treatments, it is recommended that clinicians openly discuss treatment goals as part of the intake process.

    For some clients, a critical analysis of which components of spontaneity they wish to sustain may be helpful. From the clinician's viewpoint, patient creativity provides challenges and opportunities. Creativity is highly valued in western culture, and the therapist must be careful not to idealize the client's achievements and capacities.

    The therapist must also avoid the lay assumption that psychopathology is somehow necessary for creativity. On the other hand, many of the correlates of creativity and BD can be considered strengths.

    Positive affectivity, a motivation to achieve success, openness to experience, and relatively high energy levels can all foster positive outcomes in the right context. Having considered the fundamental issue of therapeutic engagement, we next address the implications of creativity for existing evidence-based treatments for BD. To our knowledge, there is no published research into creativity as a potential moderator or mediator of treatment outcome in BD.

    As a strategy for developing hypotheses, it is useful to consider points of possible match and mismatch between existing treatments and the characteristics of creative-BD presentations see Fig. Medication remains the first line treatment for BD I, but there is growing support for augmenting pharmacotherapy with psychosocial treatments Goodwin, ; Yatham et al.

    Four adjunctive psychological treatments for BD have been investigated in some depth: They are highly structured, based on an explicit stress-vulnerability model, provide a clear rationale for the intervention, and encourage patient self-efficacy through independent use of developed skills.

    Each of these treatments has been found to reduce hospitalizations, to increase time to relapse, and to specifically diminish depressive symptoms Frank et al. Psychoeducation has consistently been found to diminish risk of manic symptoms Colom et al. The relationship between creativity and pharmacotherapy for BD is under-researched and poorly understood Andreasen, There is some evidence that, on balance, creative output is improved over the long-term by pharmacotherapy. On the other hand, patients commonly assume that mood-stabilizing medication flattens expression, insight and alertness and that outside frank episodes of illness, prophylactic pharmacotherapy may on balance inhibit creative process Rothenberg, Many of the components of psychoeducation would seem applicable for this population.

    First, most psychoeducation programs provide information about medications, and may help clients make informed decisions about different treatments. Second, teaching patients to recognize symptoms of mania may be particularly applicable for this population, as travel schedules may preclude regular monitoring by a professional. Third, most psychoeducation programs include didactic training regarding triggers of symptoms, such as stress, substance abuse, and sleep disruption.

    Given the prevalence of such triggers in many creative occupations, as described above, such material may be particularly relevant. A key feature of psychoeducation is its ease of application, and a number of good quality sources of information are freely available on the web. Several self-help manuals have also been developed e.

    The core aims of this approach, viz. As part of psychoeducation about social rhythm management, we find it useful to draw an analogy between the endogenous circadian rhythm and the role of the drummer in a band.

    Just as coordinated self-expression by the band depends on the drummer's rhythm, staying well with BD depends on a stable 24 hour rhythm Murray, CBT for BD has received more research attention than any other adjunctive psychosocial treatment.

    Above, we described evidence that N is associated with artistic creativity, as well as being elevated in BD. Recent applied and basic research suggests some ways that CBT might be tailored for those who are inclined to high emotional intensity.

    Holmes and colleagues have postulated that BD may involve a reliance on mental imagery Holmes et al. Although this work has largely been with cognitive imagery in the visual domain, auditory imagery may be potent for musicians, dancers and other performance artists Holmes, personal communication, Sept If this hypothesis is supported, it has important implications for how cognitions are approached in CBT for creative-BD presentations.

    Ball and colleagues have shown that affect-inducing experiential techniques e. The broad aims of FFT are to improve family communication patterns and to minimize unproductive reactions to the diagnosis and symptoms of BD Miklowitz et al. Second, there is some evidence that insecure attachment is elevated in musicians Costello, , creating a challenge for family-based work. Finally, the career-development problems common to artistic pursuits Section 5 may be a barrier to financial independence and career momentum, potentially generating family tensions.

    In summary, existing research shows that psychosocial interventions hold promise as adjunctive treatments for BD. There is no reason to think that outcomes will be dramatically affected by creativity in the patient, but case formulation and treatment planning will benefit from considering the personality profile, values and environmental challenges that typify such presentations. Assessments should carefully integrate attention to features of the creative lifestyle that may portend increased risk of symptoms, including potential stressors, substance abuse, challenges to goal regulation, and schedule disruptions.

    Some features of treatment may need to be modified to enhance outcomes for highly creative people with BD. Among these, clinicians may need to consider barriers to treatment engagement, and to openly discuss individual goals towards treatment engagement. Specific concerns about the influence of medication on creativity must be evaluated, and this may include gathering data with a client on how mood swings influence creative output.

    Specific forms of adjunctive therapy may also need to be tailored. For example, psychoeducational programs could provide enhanced content to address the needs of highly creative persons with BD. Better attention could be provided to issues such as the following. Is it true that creativity and BD are linked, and if so does successful management of BD threaten creativity?

    Does medication for BD decrease creativity and emotionality? Is a career involving disturbed sleep feasible for someone with a bipolar diathesis? Is abstinence the best means of decreasing the detrimental impact of substances on BD?

    Similarly, the values and sociocultural context of the creative BD individual should determine the style of presentation of information and the strategies suggested. For some, it may be important to consider how beliefs in the value of intense emotion, personality traits of N and O, and cognitive styles emphasizing imagery will shape the best choice of specific interventions.

    For some, traits of E may lead to greater comfort with group interventions Miller, Some patients may benefit from structured career counselling e. We have recently shown that occupational therapy is a useful component of an effective treatment for chronic depression, presumably because it targets this vulnerability Murray et al.

    Ideal interventions would also be tailored to the peripatetic, shift-work lifestyle common in creative pursuits. BD is a chronic disorder and a chronic disease self-management model may be most appropriate Miklowitz, ; Suto et al. This model may play to the strengths of the creative person with BD, because chronic disease self-management assumes the capacity to proactively invent solutions to life challenges. Indeed, BD patients who are creative may be uniquely placed to generate novel self-management solutions that can be disseminated to the broader BD population.

    If creativity is a major part of a patient's self-concept, then therapy may be best viewed as a developmental endeavor, in which self creation and identity consolidation interact to moderate the course of BD Rothenberg, Treatment outcomes in bipolar disorder remain unsatisfactory Nierenberg, Although adjunctive psychosocial approaches have proven broadly effective in randomized controlled trials, refinement of these interventions is urgently required Miklowitz, Here, we outline basic and clinical implications of the link between creativity and BD, and demonstrate how creativity may both moderate and mediate treatment outcomes.

    For clinical research, the primary outputs of this review are testable hypotheses about creativity as a contextual variable in the targeting of psychosocial interventions. For the clinician, the review offers an account of creativity as one example of the patient characteristics, values and context that must be considered in evidence-based treatment of BD. The authors thank the Sean Costello Foundation for their encouragement to pursue this work. National Center for Biotechnology Information , U.

    Clin Psychol Rev. Author manuscript; available in PMC Aug 1. Johnson b. Sheri L. Author information Copyright and License information Disclaimer. Copyright notice. The publisher's final edited version of this article is available at Clin Psychol Rev. See other articles in PMC that cite the published article. Abstract Clinical implications of the high rates of creativity within bipolar disorder BD have not been explored. Bipolar disorder, Creativity, Personality, Positive affect, Psychosocial treatments.

    Introduction and overview American Psychological Association guidelines assert that best research evidence is only one driver of evidence-based practice American Psychological Association, Definitions Bipolar disorder is defined on the basis of manic symptoms of varying severity. Elevated rates of creativity within bipolar disorder Reviews of biographical material have suggested that BD is significantly over-represented among samples of authors Andreasen, ; Ludwig, , poets Jamison, , and visual artists Jamison, Personality and creativity Research has identified personality correlates of creativity that operate across domains of creativity, as well as some that are more related to specific domains.

    Personality traits and bipolar disorder The personality correlates of BD are reasonably well understood. Conclusion A substantial literature links different domains of creativity with personality traits, motivational styles and affective tendencies.

    Bipolar disorder and the process of creativity Research into the creative process has focused on the ability to generate unusual associations and to use visual imagery in support of problem-solving as facets of creativity. Bipolar disorder and the mechanisms of creativity process Three core features of the creative process — fluency of association, use of cognitive imagery and positive affect are commonly reported in BD.

    An organizing scheme It can be concluded that BD is related to a number of characteristics that might drive creative accomplishment. Open in a separate window. Performance lifestyle as a precipitating or perpetuating factor for mood dysregulation Some features of the creative professions, particularly artistic performance, may be counterproductive for people with BD. Table 1 Common characteristics of the performance lifestyle and possible consequences for case formulation and treatment planning.

    Reinforcement of emotionality Emotional sensitivity may promote creativity within the arts, and high levels of N index this trait in BD patients and creative people see Section 3. Irregular sleep and activity schedules The creative lifestyle may challenge a core neurobiological diathesis in the circadian system. Goal regulation challenges Abnormal regulation of goal pursuit is common in BD.

    Conclusion In sum, many creative occupations involve features that may increase risk of symptoms for those with BD, including increased rates of stress, alcohol and substance use, extremes of achievement and frustration, and chaotic schedules.

    Creativity and engagement with treatment Ambivalence towards treatment is common for people with BD Leahy, Creativity and evidence-based treatments Medication remains the first line treatment for BD I, but there is growing support for augmenting pharmacotherapy with psychosocial treatments Goodwin, ; Yatham et al.

    Medication The relationship between creativity and pharmacotherapy for BD is under-researched and poorly understood Andreasen, Psychoeducation Many of the components of psychoeducation would seem applicable for this population.

    Cognitive behavioral treatment CBT for BD has received more research attention than any other adjunctive psychosocial treatment.

    Optimizing psychosocial treatments In summary, existing research shows that psychosocial interventions hold promise as adjunctive treatments for BD. Conclusions Treatment outcomes in bipolar disorder remain unsatisfactory Nierenberg, Acknowledgement The authors thank the Sean Costello Foundation for their encouragement to pursue this work. The dark side of creativity: Biological vulnerability and negative emotions lead to greater artistic creativity.

    Personality and Social Psychology Bulletin. Reassessing the prevalence of bipolar disorders: Clinical significance and artistic creativity. Psychiatrie et Psychobiologie. The theoretical underpinnings of affective temperaments: Implications for evolutionary foundations of bipolar disorder and human nature.

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    The bipolar patient with comorbid substance use disorder: Recognition and management. CNS Drugs. Behavioral approach system BAS sensitivity and bipolar spectrum disorders: A retrospective and concurrent behavioral high-risk design. Motivation and Emotion. Motivation and creativity: Journal of Personality and Social Psychology.

    Andreasen CN. Creativity and mental illness: Prevalence rates in writers and their first-degree relative. The American Journal of Psychiatry. The relationship between creativity and mood disorders. Dialogues in Clinical Neuroscience. The creative writer: Psychiatric symptoms and family history. Comprehensive Psychiatry. Overinclusive thinking in mania and schizophrenia. British Journal of Psychiatry.

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    Bipolar disorder, unipolar depression and the five-factor model of personality. A randomized controlled trial of cognitive therapy for bipolar disorder: Focus on long-term change. The Journal of Clinical Psychiatry. Schema-focused cognitive therapy for bipolar disorder: Reducing vulnerability to relapse through attitudinal change.

    Palo Alto, CA: Consulting Psychologists Press; The bipolar workbook: Tools for controlling your mood swings. Guilford; Creativity, intelligence, and personality: A critical review of the scattered literature. A psychobiographical analysis of Brian Douglas Wilson: Creativity, drugs, and models of schizophrenic and affective disorders.

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    European Journal of Personality. Decreased latent inhibition is associated with increased creative achievement in high-functioning individuals.

    Tendencies toward mania and tendencies toward depression have distinct motivational, affective, and cognitive correlates. Cognitive Therapy and Research. A randomised controlled trial of a comprehensive group-based psychosocial intervention for bipolar disorder: In press. The relationship of impulsivity to response inhibition and decision-making in remitted patients with bipolar disorder. European Psychiatry. Psychoeducation efficacy in bipolar disorders: Journal of Clinical Psychiatry.

    Group psychoeducation for stabilised bipolar disorders: Br J Psychiatry. Mood disorders and symbolic function: An investigation of object relations and ego development in classical musicians. Dissertation Abstracts International: Section B: The Sciences and Engineering. A critical look at dual-focused cognitive-behavioral treatments for comorbid substance use and psychiatric disorders: Strengths, limitations, and future directions.

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    Prodromal symptoms before onset of manic-depressive disorder suggested by first hospital admission histories.

    Creativity and personality: Suggestions for a theory. Psychological Inquiry. Music Therapy Today. Performance anxiety in gifted adolescent musicians. Journal of Anxiety Disorders.

    A meta-analysis of personality in scientific and artistic creativity. Personality and Social Psychology Review. Frontotemporal and dopaminergic control of idea generation and creative drive. The Journal of Comparative Neurology. Interpersonal and social rhythm therapy: A means of improving depression and preventing relapse in bipolar disorder.

    Journal of Clinical Psychology: In Session. Interpersonal and social rhythm therapy for bipolar disorder: Integrating interpersonal and behavioural approaches. Behavior Therapist. The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. The American Psychologist. Positive emotions broaden the scope of attention and thought-action repertoires. Cognition and Emotion. In addition, in terms of comorbidity and course, early-onset cases are often highly comorbid with internalizing and externalizing symptomatology anxiety, disruptive behavior, neuropsychiatrie, cognitive, and developmental symptoms.

    No data have yet identified ADHD as a significant antecedent of bipolar disorder in high-risk children: The results are contradictory: Another area of ongoing debate is whether a specific subtype of conduct, disorder can be linked with BPD, as suggested by several studies. An important field of investigation is the early manifestation of SUDs in subjects who simultaneously or subsequently develop bipolar disorders.

    There is ample research on the association of BP-I with SUDs, 88 especially in women, as summarized recently by Lavander et al, 89 but little investigation of its association with the bipolar spectrum. There is evidence from the Zurich Study that, the traditional association between major depression and SLID may be misleading and based on an underdiagnosis of bipolarity, because a widening of the definition shifted the comorbidity to BP-II, and the association with MDD dwindled to insignificance.

    This finding is in sharp contrast, with the extensive literature reporting the association of MDD with alcohol use disorder AUD on the basis of conventional DSM diagnoses. Symptoms of anxiety are elements of the depressive syndrome and integrated into depression rating scales.

    Intuitively, one would therefore expect, generalized anxiety disorders GAD and repeated panic attacks to be more strongly associated with major depression than with BPD.

    However, the opposite would appear to be true. This new, unpublished finding is a consequence of the broadened definition of bipolarity; as in the case of comorbidity with alcohol use disorders mentioned above, a. Studies of comorbidity can be a fruitful method of checking the consequences of changing diagnostic criteria. The relationship between suicidal ideation, suicide attempts, and suicides is not.

    Suicide attempts occur most, frequently among adolescents and young adults, whereas suicide rates rise sharply with age. In addition, in most cultures women make more suicide attempts than men, but.

    Suicide attempts appear to be weak predictors of suicide. In our lifelong prospective study in hospitalized bipolar patients 92 only 3 of the 57 patients who had attempted suicide committed suicide later; overall, only 3 of 17 patients who committed suicide had previously made a suicide attempt. Prospective treatment research in this field is sparse, although suicide prevention by long-term medication is effective. As demonstrated by a lifelong follow-up study of patients with major mood disorders, 92 it, would appear that drugs which have antiaggressive effects, such as lithium and clozapine, could be especially promising for suicide prevention in bipolar subjects.

    The hypothesis of a long-term antisuicidal effect, of modern atypical neuroleptics - about which there is so far no data - should therefore be carefully studied.

    The association of BPD with dementia has been little investigated. A large Danish study found a correlation between dementia and the number of hospitalizations in bipolar patients, 93 whereas we found no comparable relationship in a. These findings are compatible with research on the neurotrophic and neuroprotective properties of some drugs, and will hopefully stimulate research into the long-term effects of atypical neuroleptics prescribed in large amounts today. The negative findings of the general practice study by Dunn et al, 97 who even found a correlation between numbers of prescriptions of lithium and dementia, may be explained by the severity of the disorders and a lack of an adequate untreated group of bipolar patients; comparisons using the general population as controls are not.

    Hauser et al recently summarized the present, difficulties in recognizing bipolarity. Another was derived from a symptom checklist, of 20 hypomanic symptoms, used since in the interviews of the Zurich Study, and applied successfully by Hantouche as the self-assessment hypomania checklist HCL in several large French studies.

    CL month later. The Hypomania Checklist is. It is currently being validated in different, cultures, in order to ascertain whether there are universal core symptoms. A recent Taiwanese study identified the same two-factor structure of hypomania as found in earlier studies carried out, in Italy and Sweden and Spain. A cutoff of 10 on the H. CL and of 14 on the HCL seems to identify a. This article illustrates that conclusive clinical research into bipolar disorder still has a. We need more and longer representative prospective studies in children, adolescents, and adults.

    Major depressive disorder is still heavily overdiagnosed; it. We will have to revise and broaden the definition of bipolar disorder; this will have a great impact on rates of prevalence and comorbidity and on treatment. Estimates of the burden and costs of the disorder will have to be corrected upwards. This process could take at least, another 10 years. The forthcoming DSM-V and ICD may not, yet, be in a position to solve the serious diagnostic problem, because the data for the necessary revision are sparse.

    No definitive answer to this question has yet. However, this is nothing to be ashamed of: A clear cutoff is probably always to a certain extent, questionable, neglecting the normal interindividual variation of the population.

    It is conceptually important, to add dimensional measures for depression, hypomania, and anxiety to the categorical approach in classifying mood disorders and not, base expensive biological and clinical research exclusively on diagnostic categories whose definitions have a short, halflife.

    Finally, we need long-term treatment studies focusing on the potential effects of mood stabilizers and atypical neuroleptics against dementia, suicide, and vascular mortality. National Center for Biotechnology Information , U. Journal List Dialogues Clin Neurosci v.

    Dialogues Clin Neurosci. Author information Copyright and License information Disclaimer. This is an open-access article distributed under the terms of the Creative Commons Attribution License http: This article has been cited by other articles in PMC.

    Scale and source of the diagnostic problem The basis for any discussion of bipolar disorder BPD is the diagnosis. Open in a separate window. Figure 1. Bipolar II disorder as a percentage of major depressive episodes. Table I. Mood disorders: The bind of structured interviews All the most, frequently-used structured interviews: Subdiagnostic hypomania as a relatively strict concept for bipolarity For research purposes, the main question is whether bipolarity has to be defined by the presence of a clinically significant and relevant hypomanic episode.

    Bipolar specifier for depression In epidemiological studies, unlike patient studies, it. Minor bipolar disorders MinBPD Our diagnostic specifier for bipolar depression reclassified about half of subjects with dysthymia and many with recurrent, brief depression RBD and minor depression MinD as having minor bipolar disorders, including cyclothymic disorders; the cumulative incidence rate was 9. Pure subthreshold hypomania ie, without depression Pure subdiagnostic hypomanic subjects should not be considered as patients, but, rather as characterized by a mix of hypomania's favorable and unfavorable consequences, as shown recently by Gamma et al unpublished data.

    Normal subjects with hypomanic symptoms Hypomanic symptoms arc elements of normal mood swings. Stigma Stigmatization focuses on defined minorities; the best. The onset of bipolar disorder We know regrettably little about the onset of bipolar disorder, which in one third of adult cases is retrospectively dated before the age BPD and anxiety disorders Symptoms of anxiety are elements of the depressive syndrome and integrated into depression rating scales.

    Suicidal thoughts, suicide attempts, and completed suicides The relationship between suicidal ideation, suicide attempts, and suicides is not. Early recognition of bipolarity The early recognition and treatment of bipolarity is essential for preventing the serious social consequences, rapid cycling, chronicity, and suicidally associated with it, as well as for reducing the economic costs, as shown by McCombs et al.

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    BIPOLAR DISORDER TO STAY WELL. DISSERTATION. Presented to the Graduate Council of. Texas State University-San Marcos in Partial Fulfillment. Bipolar disorder is defined on the basis of manic symptoms of varying Dissertation Abstracts International: Section B: The Sciences and. Since its “rebirth” in , bipolar disorder (BPD) has rapidly come to occupy a .. Fallen [Medical Thesis] Zurich: University of Zurich; [Google Scholar].

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    BIPOLAR DISORDER TO STAY WELL. DISSERTATION. Presented to the Graduate Council of. Texas State University-San Marcos in Partial Fulfillment.

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