Is bipolar disorder more common in highly intelligent people?

by on February 23, 2013 at 3:18 am in Medicine, Science | Permalink

Here is a new piece by Gale CR, Batty GD, McIntosh AM, Porteous DJ, Deary IJ, and Rasmussen F.:

Abstract

Anecdotal and biographical reports have long suggested that bipolar disorder is more common in people with exceptional cognitive or creative ability. Epidemiological evidence for such a link is sparse. We investigated the relationship between intelligence and subsequent risk of hospitalisation for bipolar disorder in a prospective cohort study of 1 049 607 Swedish men. Intelligence was measured on conscription for military service at a mean age of 18.3 years and data on psychiatric hospital admissions over a mean follow-up period of 22.6 years was obtained from national records. Risk of hospitalisation with any form of bipolar disorder fell in a stepwise manner as intelligence increased (P for linear trend <0.0001). However, when we restricted analyses to men with no psychiatric comorbidity, there was a ‘reversed-J’ shaped association: men with the lowest intelligence had the greatest risk of being admitted with pure bipolar disorder, but risk was also elevated among men with the highest intelligence (P for quadratic trend=0.03), primarily in those with the highest verbal (P for quadratic trend=0.009) or technical ability (P for quadratic trend <0.0001). At least in men, high intelligence may indeed be a risk factor for bipolar disorder, but only in the minority of cases who have the disorder in a pure form with no psychiatric comorbidity.

prior_approval February 23, 2013 at 3:34 am

‘Is bipolar disorder more common in highly intelligent people?’

So, according to the study, the answer is yes and no?

Or the answer is it depends?

dearieme February 23, 2013 at 4:04 am

I wonder why they said “there was a ‘reversed-J’ shaped association” and then go on to describe a ‘J’ shaped association.

rjs February 23, 2013 at 4:56 am

yep. & doping them all up is why we have your great stagnation..

Blaise February 23, 2013 at 5:37 am

It’s too bad they only report the p-values and not the effect. Anyway with a sample of 1 million, any small effect is significant. Moreover they seem to interpret a smaller p-value as a stronger effect!

The quadratic term doesn’t mean that super smart people are as likely as the least intelligent people to have a mental disorder. It may only mean that they are slightly more likely than smart people to have it. Again, it’s hard to judge the relevance of the study without the effects.

Finally, I’m wondering if there could be some spurios correlation. High intelligence=> higher social and cultural status => better access to psychiatric care.

prior_approval February 23, 2013 at 6:06 am

Except that in Sweden, the most consistent group to be treated for bipolar disorder was those with the lowest intelligence.

‘Risk of hospitalisation with any form of bipolar disorder fell in a stepwise manner as intelligence increased (P for linear trend <0.0001). However, when we restricted analyses to men with no psychiatric comorbidity, there was a ‘reversed-J’ shaped association: men with the lowest intelligence had the greatest risk of being admitted with pure bipolar disorder'

Keep in mind that using American standards generally is only relevant in America – other societies do things differently. Incarceration rates and terms come to mind also – if the Swedish results show a relevant pattern, it may be that in the U.S., we have decided that handling bipolar disorder among those with the lowest intelligence is not a psychiatriac matter, but a penal one.

Claudia February 23, 2013 at 5:44 am

I suspect the relationship is even more complicated than this study suggests and it often doesn’t matter much.

Bipolar is a mood disorder (not a cognitive disorder), such that individuals with bipolar disorder experience outsized emotional responses to stimuli, particularly during manic or depressive episodes. I suspect that intelligent individuals have different tools to manage this disorder (up to a point) just like intelligent diabetics probably manage their condition differently.

And why doesn’t it matter? Well in many professions, like economics, emotional reactions are considered the antithesis of intelligent arguments. I am pretty sure I have read such put downs here too. So if I am perceived as intelligent by my peers it is in spite, not because of my bipolar disorder. I do my best to keep my emotional reactions to myself…much easier now with medication, sleep, and therapy…but I am still often puzzled why the same data, the same events don’t upset more of those around me. And yet, I do appreciate how applied intelligence…as it’s expressed in combination with all our other traits…is amazingly diverse.

prior_approval February 23, 2013 at 6:23 am

‘Bipolar is a mood disorder (not a cognitive disorder)’

Well, that depends on how you phrase cognitive. Back in the dim days of the late 70s/early 80s, the relevant treatment for people with extreme delusional states, word salad, etc when first brought into an institutional setting was 2 weeks of lithium along with the then standard medications to keep the patient in a state which was manageable. If after two weeks when the standard medications were withdrawn, the symptoms were gone, the person was classified as manic-depressive. If no improvement, then schizophrenic. And this was a profound step forward in the entire realm of psychiatry – for the first time, there was an actual empirical measure to base a diagnosis, independent of an evaulation based on opinion.

What has happened, in my observation, is that the term bipolar disorder has become so broad as to be meaningless. Nonetheless, extreme manic episodes can be easily confused with schizophrenic ones. Here is a good overview –

‘Mania involves extreme behaviors such as irritability, excessive happiness, over-reaction, difficulty concentrating, rapid and non-stop speech, dangerous behavior, heightened interest in sex, impaired decision-making, spending large sums of money, and grandiose ideas. Incidents of mania are sometimes referred to as manic episodes or severe mood swings.

Mania can range from mild to disabling, and it may be part of a major mood disorder or organic mental disorder such as bipolar disorder. Onset of a manic episode may occur over time, and in some instances, mania may occur rapidly and without warning signs. During manic episodes, people are unable to control their behavior and may need medication to return to a normal state.’

http://learningdisabilities.about.com/od/mo/g/mania.htm

Claudia February 23, 2013 at 6:43 am

It is a mood disorder. See also: http://www.nimh.nih.gov/health/publications/bipolar-disorder/what-is-bipolar-disorder.shtml for more information.

Also many health conditions are a spectrum (true of autism as well). A wide range of impact does not render a diagnosis meaningless…knowledge of one’s limits can be helpful even if they are generally not severe.

prior_approval February 23, 2013 at 7:14 am

Well, I’m just going on my personal experiences of someone I knew back in the early 80s, the diagnostic criteria of the time, and various research from that period.

And that link tends to be an example of what I meant by much of what is now called bipolar disorder being unrecognizable to my previous experience.

Though the criteria for measuring both types of episodes include ‘Behavioral Changes’ – changes which, at least in the past, were considered fairly consistent, and obviously this is still considered valid, which is why they are listed.

Whether behavioral changes are mood or cognitive based would seem to be a matter of which way one looks at the situation. And by what action lithium plays in terms of treatment – to my knowledge, its mechanism is still not known (seemingly supported by this link – http://en.wikipedia.org/wiki/Lithium_(medication) – and much of the information concerning treatment and toxicity seems quite accurate, based on 3 decade old memories)

However, reading through the link, it seems as this is what I would have considered a reasonable definition of manic-depressive illness – ‘Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care.’ I would venture that the incidence of this variety of bipolar disorder has remained more or less the same over the last 3 decades.

prior_approval February 23, 2013 at 7:48 am

And to keep delving into the information at the link – ‘Lithium … was the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) in the 1970s for treatment of mania. It is often very effective in controlling symptoms of mania and preventing the recurrence of manic and depressive episodes.’

This may get to the nub – back in the very early 80s, manic-depression was not seen as a mood disorder. It was seen, more or less, as something like schizophrenia – which the manic episodes would often mimic (understandable in the sense that schizophrenics also can have phases, oscillating between different states). Things change over time, of course – as do medications.

Since the consensus is now ‘mood disorder,’ I’ll bow to consensus. Though pointing out that even this consensus incorporates all sorts of consistent patterns of behavior in acute manic episodes that include what were formerly considered psychotic episodes.

Researcher February 26, 2013 at 5:37 pm

What Claudia writes is naive. Episodes wear you out and during an episode your cognitive abilities are certainly lower than normal, due to lack of sleep, lack of concentration, or lack of energy. If you add medication side effects on that, significant cognitive problems are inevitable.

I am a researcher and have the disorder. Doing research when even moderately “low” is virtually impossible. Doing research when hypomanic can be good, but mostly there is what I call “brain salad”. Too many ideas and no structure. Mania is even worse. If this is not considered a cognitive problem, then what is?

Eric Rasmusen February 23, 2013 at 8:05 am

A good definition of bipolar would perhaps be a condition which responds to lithium. Some conditions too, and some don’t, and as one commentor said, it’s useful to differentiate the two, especially since it isn’t severity of symptoms that prevents lithium from working.

The paper is disappointing. They have great data, and then don’t tell us enough about it to let us know what’s going on. They drop about 80,000 men with pre-military mental problems, compared to just a few thousand with bipolar later. They don’t tell us what the “comorbid” conditions are, or how any individual comorbid conditions relate. They don’t give us coefficients or estimate magnitudes of effects. And I fear that they follow the bad custom of medical researchers and won’t let anybody else use their data and get it right. But maybe I’m wrong on this last.

Garrett Sparks February 23, 2013 at 5:45 pm

“A good definition of bipolar would perhaps be a condition which responds to lithium.”

That is perhaps the worst definition of bipolar disorder I have every heard. Lithium has evidence in unipolar depression as well (old trials as monotherapy, and even recently as an adjunct in one arm of Star*D), and is a reasonable adjunctive treatment of schizophrenia or schizoaffective disorder along with an antipsychotic. Heck, there is evidence it reduces aggression and impulsivity in autism and conduct disorder, though the risks of treatment typically outweigh the benefit.

Besides catatonia, there is absolutely no disorder in psychiatry that should be diagnosed based on response to treatment.

That said, this paper is terrible. The idea that pure bipolar disorder without comorbidity is more common in a group is incredibly stupid. The right thing to say is that intelligence actually correlates with a lower risk of comorbidity in bipolar disorder. It’s the equivalent of saying “people with more strengths and resources tend to have better courses of psychiatric illness.” It doesn’t mean that intelligent people are more likely to have something just because when they have something it is less severe.

Ray Lopez February 23, 2013 at 8:51 am

Saw a chart once in Davies the historian’s book I think that linked mental illnesses (incl I would imagine bipolar, thoughts of suicide, etc), left handedness and homosexuality with high IQ and creativity–so this is another study confirming that. After all, think of all the intelligent, left handed gays in theatre and the arts, not to mention science–you could probably fill a large book.

David Bley February 23, 2013 at 10:12 am

The measurement of intelligence in an IQ test is a very small subset of a person’s abilities. I would suggest that a better measure would be a person’s ability to function in society by conforming to its mores and making a contribution. What is the dividing line between a different method of functioning and an outright disorder? I would like to suggest that our culture has zero tolerance for people that are different and expends much effort to make everyone function the same.

I would also like to suggest that people that demonstrate higher intelligence are more able to develop coping strategies and escape hospitalization.

Andrew February 23, 2013 at 11:12 am

Take these results with a grain of salt.

In the US, at least, two patients, one white and one black, with exact same presentations, will on average be diagnosed differently. The black patient will be diagnosed with schizophrenia, and the white patient will be diagnosed with bipolar disorder.

I would not be surprised if the correlation between intelligence and bipolar risk coincides with a lowered risk of schizophrenia. In other words, nicer name for the same problem.

Claudia February 23, 2013 at 11:37 am

“nicer name for the same problem” … personally I liked the label of ‘creative’ a lot more than ‘bipolar.’

This article suggests there are differences between the conditions, though they share some similar stigmas. Of course, I will grant you that the diagnosis and treatment of mental health conditions are subject to a lot of trial and error and I am skeptical of such studies too. http://psychcentral.com/lib/2006/the-differences-between-bipolar-disorder-schizophrenia-and-multiple-personality-disorder/all/1/

mike February 23, 2013 at 11:14 am

Well just using a simplified model, you definitely see lower rates of suicide in low-IQ countries (virtually none in Haiti, for example, despite the hellish conditions) and much higher rates in high-IQ countries (extremely high rates in Finland and Japan, despite extreme material comfort). Also I am not aware of any intentional suicidal tendencies whatsoever among our lowest-IQ brethren, non-human mammals.

tom February 24, 2013 at 1:29 pm

It’s not that the Bipolar Disorder is more common in intelligent folk it’s due to the Mania (Bipolar of course was more commonly described and dx’ed as Manic/Depressive).

The Mania is a beast all on it’s own and allows one with the disorder to “seem” or appear more intelligent for a number of reasons.
First, we do not see, while in a Manic state, failure as an option. During this stage there is no room for failure, nothing can go wrong,
we can go without sleep for days giving the appearance or acomplishment. Our mind works like no others, figuring out solutions and negating the consquences of defeat or failure.
Think of Winston Churchill for example. It’s pretty hard to explain but in brief summary the Manic state of Bipolar allows us to outhink the many.

I’ve gone from a High School (9th grade) dropout to teaching myself over the years telecommunication transmission equipment to becoming a multi-millionaire to bankruptcy.
I can confess that during the Manic stages, of which I had a great many and long eposides, I could take in, retain and execute upon a great deal of information and knowledge. I could
adapt to any enviroment, think of solutions where no one else could.

In closing, it’s not that the disorder strikes us more it’s the disorder itself that lifts us up to where it seems that we are more intelligent or it’s the disorder that allows our minds to
think differently and obtain some pretty amazing results that is, until the crash of depression. Here’s where we cannot figure out how to get out of bed.

anon February 24, 2013 at 7:47 pm

Maybe it seems that way to the person in the manic episode, likely not to those who know them well. Depression feels awful and different than mania. I tried to kill myself repeatedly when depressed, but when manic I destroyed cherished parts of my life. I am all for silver linings and forgiveness, but sickness is sickness, not intelligence. All that said, of course a healthy person with bipolar disorder can do amazing things.

Researcher February 26, 2013 at 5:45 pm

I agree with anon.

spohn February 25, 2013 at 4:46 pm

“Sickness is sickness, not intelligence.” “Bipolar is a mood disorder (not a cognitive disorder)…” These sorts of absolute statements are never going to best describe something far more complex and as stated,, fall far short of at least moving toward reasonable discussion on this topic. First, no need to separate mood and cognitive – and certainly no need to quote any government diagnostic tool as any sort of proof. Yes, BP is characterized by swings in mood over various periods, typically from high to low. But it also involves disturbances and distortions of thought, and to think it isn’t also a cognitive disorder is merely word-play. Swings in mood cross cross outside of some “normal” range can lead to separations of reality, grandiose thoughts, mental paralysis and all sorts of cognitive issues…. Ultimately this can be viewed as a chicken/egg question to some degree, a feedback loop that reinforces in both directions. But saying it is a mood disorder as if that somehow sums up the condition certainly falls far short of a more complete description that involves cognitive function and/or description. Stating that “sickness is sickness, not intelligence…” Yes, it is sickness but can be managed, much like a diabetic or any other number of conditions people live with these days. The question isn’t if BP is a sickness, but if those with BP have a greater probability of higher IQ. Not that it is really important to this question but I am a bit surprised at the statements made by a couple of people who likely have first-hand experience with BP. For silver linings and forgiveness, for understanding your problem(s) – perhaps the light is a little brighter and BP might be looked upon more favorably. Yes, higher intelligence or IQ is correlated with various forms of mental illness including BP. Not an absolute, but a higher likelihood.

http://en.wikipedia.org/wiki/List_of_people_with_bipolar_disorder

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