Bipolar Biobank Helps Identify At-Risk Patients For Early Intervention — Mayo Clinic
How to Recognize the Symptoms of Bipolar Disorder
BIPOLAR DISORDER CLEVELAND CLINIC
Risk/Prevention/Epidemiology
What are the risk factors for development of bipolar disorder?
The concept of risk is a modern one. The word risk derives from the Italian riscare, meaning “to dare.” Before such a concept was developed, the future could be predicted only by consulting the gods, prophets, or astrologers, and when bad things happened, they were attributed to fate.
The concept of risk is therefore revolutionary, because it has allowed for forecasting in a large number of fields, including economics, finance, medicine, meteorology, and other natural and social science fields. Yet the concept grew not out of a need to answer important life or death questions but out of a desire to win at games of chance when money was at stake. Given certain known events that just occurred in the game, what are the odds for winning the game?
From there, everything about predicting the future grew, and forecasting with degrees of certainty for future events of all kinds developed. Knowledge of risk gives one some power over future events so as to make the odds more favorable to one’s goals. A very simple yet practical example is that while wearing seat belts does not change the odds of getting into an accident, it does change the odds of surviving one. In medicine, the knowledge of risk factors helps one to understand the odds of developing certain diseases.
Remember, however, that odds, no matter how favorable or unfavorable, are still just odds with the outcome for any particular event still unknown. Just because your odds of developing lung cancer are greater if you smoke a pack of cigarettes a day does not mean that you will develop lung cancer and a nonsmoker will not. Neither Dana Reeve nor Andy Kaufman smoked and both succumbed to lung cancer. There are risk factors that you can change and risk factors that you cannot.
You cannot change the genes you inherit from your parents, but you can use the knowledge of your family history to help make choices in life to reduce other risk factors contributing to the probability of developing a particular disease. Thus, recommendations for various diagnostic tests for breast cancer, colon cancer, and heart disease vary depending on whether someone has a family history for a particular condition. With all of this in mind, the risk factors for bipolar disorder are as follows:
Gender: Bipolar I occur equally in both sexes; rapid-cycling bipolar disorder (four or more episodes a year) and bipolar II are more common in women than in men.
Age: The age of onset of bipolar disorder varies. The age range for both bipolar I and II disorders is from childhood to 50 years, with a mean age of approximately 21 years. Most cases first present between the ages of 15 and 24. Some patients diagnosed with recurrent major depression may indeed have bipolar disorder but do not develop their first manic episode until after 50 years of age. They may have a family history of bipolar disorder. Most patients who experience their first manic episode after the age of 50 should have a full medical or neurological workup.
Family history: First-degree relatives of people with bipolar I are approximately seven times more likely to develop the illness than people in the general population. Additionally, having a parent with bipolar disorder increases the odds of having another major psychiatric disorder by 50%. Twin studies demonstrate a concordance of 33–90% for bipolar I in identical twins. Adoption studies prove that children whose biologic parents have either bipolar I or a major depressive disorder remain at increased risk of developing a mood disorder whether or not their adoptive parents suffer from a mood disorder as well.
Postpartum: As many as half of women with bipolar spectrum illness experience an episode of depression, mania, or mixed state in the postpartum period. Bipolar disorder may have its first onset in the postpartum period as well.
Stressful life events: A manic cycle is often either directly or indirectly linked to external stressors. Often the first sign of trouble is loss of sleep due to the increased stress leading to increased worry. The stress need not be negative. An upcoming wedding, the birth of a child, a job promotion, or other celebratory event can also lead to mania or depression.
Premorbid personality factors: A possible association exists, particularly in patients who are cyclothymic.
Substance abuse or alcoholism history: An association exists.
Socioeconomic status: A possible association exists. In bipolar disorder, the risk factors that one has control over are very limited when compared with a disease like heart disease, which has opportunities for lowering cholesterol, blood pressure, and weight through various options, including diet, exercise, smoking cessation, and prescription medications. It is often difficult, if not impossible, to change exposure to any of the risk factors for bipolar disorder mentioned here, except for substance abuse and alcoholism, and yet the perceived level of control over developing bipolar disorder is much greater than for other diseases, another paradox of mental illness! Regarding the risk of recurrence, some control over risk factors can be taken by ensuring aggressive treatment with a competent clinician or team of clinicians and sticking to the treatment plan, with frequent follow-up visits to ensure that the symptoms are controlled effectively with all available therapies.
Aside from staying on medication, ensuring a regular and healthy sleep pattern will go far toward maintaining a stable mood.
Terms:
First-degree – relative immediate biologically related family member, such as biological parents or full siblings.
Concordance – in genetics, similarity in a twin pair with respect to presence or absence of illness.
Adoption study – a scientific study designed to control for genetic relatedness and environmental influences by comparing siblings adopted apart.
Postpartum – referring to events occurring within a specified time after giving birth. Usually within the first four weeks.
