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Using a polygenic risk score method analogous to that of Power et al. Creative controls and unaffected relatives would presumably fall in the center of the curve with higher positive trait values conferred by mild-to-moderate risk for illness. The inclusion of twins discordant for bipolar disorder would be useful for disentangling genetic and environmental effects [ 80 ]. The use of a comprehensive, standardized battery would facilitate cross-study comparisons and allow for the sample sizes needed to resolve these issues.
Understanding the Spectrum of Bipolar Disorder | NAMI: National Alliance on Mental Illness
For inclusion in such a battery, a task should show evidence of reliability and stability; provide a range of phenotypic variation in both clinical and nonclinical samples; relate to the bipolar spectrum; and, most importantly, have the potential to function as a positive trait. Options for such a battery that meet many of these criteria are listed in online supplementary Table 1 www. For some traits, such as temperament and personality, we would expect relatively intermediate values to provide an advantage, whereas extreme values on either end would be expected to confer a disadvantage. Other traits, such as creativity or cognitive flexibility, would be expected to function more simply, with higher more extreme values conferring the advantage.
The administration of an array of creative tasks is also necessary to capture the range of creative ability and gain insight into the mechanism by which the various personality, cognitive, and affective traits associated with the bipolar spectrum impact creativity.
While creativity is generally conceptualized as a spontaneous process that may be difficult to fully capture within a laboratory setting, several standardized and validated measurements exist, including figure preference and divergent thinking tasks. Divergent thinking involves originality of thought, fluency of ideas, and creative problem solving ability and thus represents an advantageous trait that drives invention and achievement across many domains e. Divergent thinking tasks can be conceptualized as the opposite of fluid intelligence tasks, which measure logical reasoning, and high performance across both types of tasks would particularly promote success across a number of disciplines.
In addition to mood and personality, assessments of creativity should thus be combined with comprehensive cognitive assessments to allow for an evaluation of overall intelligence and the full range of individual capabilities.
Little is currently understood of the molecular mechanisms underlying bipolar disorder, and current treatments are far from maximally effective. Part of the value of research in this area is to better understand the genetic pathways contributing to risk. The low signal produced by genome-wide studies, with individual allelic effect sizes on the order of 0.
Through the assessment of positive traits, we broaden the concept of bipolar disorder into a fully dimensional spectrum and presumably capture specific portions of the variance, which will facilitate the detection of the underlying genes and pathways contributing to risk. Understanding the relationship between positive traits and bipolar disorder may thus provide insight into the mechanisms of illness, which may someday lead to novel therapeutic targets. Although this discussion has focused on positive traits, it is important to note that the patients themselves exist at the extreme and may be pushed beyond the limit of positive value, either at euthymia or in a state-dependent manner.
Behavioral traits conforming to a shared vulnerability model may provide excellent targets for evidence-based therapies. For example, individuals with bipolar disorder often exhibit poor judgment in terms of impulsivity or reward-based decision-making [ 34 , 35 , ]. Modulation of risk-reward valuation can easily be viewed according to this model, as a slight overvaluation of risk, in appropriate balance with reward valuation, can lead to great accomplishments, yet a large overvaluation of risk as compared with reward, which is correlated with mania, may have disastrous consequences [ , ].
Even individuals with subsyndromal hypomanic symptoms show a greater hedonic impact of reward and a preference for immediate over delayed, but superior, rewards [ , ].
There is thus likely a threshold along the bipolar spectrum at which a loss of inhibition and false positive error rates increase for tasks of impulsivity and risk-reward valuation, which would implicate a possible point of intervention and suggest a target for behavioral therapy to improve emotion-based decision-making or enhance self-control.
In general, treatments aimed at reducing subsyndromal symptoms and relapses may indirectly improve the cognitive deficits associated with the disorder.
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Adjunctive therapies that improve focus and concentration, such as yoga therapy, also hold promise for improving cognitive function across several domains in both bipolar disorder and schizophrenia [ ]. Additionally, cognitive behavioral therapy and self-monitoring techniques can be used to help patients modulate cognitive disorganization and perform better on executive function tasks [ ]. Finally, although controversial, there is evidence to suggest that cognitive training exercises can not only increase working memory but also improve fluid intelligence, which includes such abilities as pattern recognition, abstract reasoning, and problem-solving [ , ].
Although more research in this area is needed, this is potentially promising for bipolar patients with complex cognitive deficits, and all tasks improving cognitive functioning in bipolar disorder may ultimately improve performance in those with creative abilities [ 77 ]. Thus, the investigation of behavioral traits that follow this model may not only further our understanding of the underlying neural networks involved in bipolar disorder but also facilitate treatment.
It has long been conventional wisdom that positive traits or enhanced abilities occur in the unaffected relatives of individuals with bipolar disorder, as well as many patients themselves, a view supported by numerous studies. If it can be shown that bipolar disorder is merely an extension of normal population variation in beneficial traits, it may erase some of the stigma still associated with this severe mental illness.
Studies evaluating positive aspects and character strengths associated with bipolar disorder are aligned with the growing interest in research on the impact of positive psychological traits on health [ , ]. Positive psychological traits of spirituality, empathy, creativity, realism, and resilience are frequently observed in bipolar individuals [ ]. By gaining a better appreciation for the positive aspects of mental illness and exploring methods to enhance these traits, we may improve clinical outcomes [ ].
Current practice in psychiatry is geared more towards controlling the symptoms of bipolar disorder, rather than understanding a patient's true needs and potential capabilities. Creative expression is a source of well-being, and many of those struggling with bipolar disorder consider increased creativity a truly positive aspect of their illness [ , ].
In fact, bipolar patients often discontinue their medications due to subjective experiences of diminished creativity, among other unpleasant side effects [ , ].
Others find the hypomanic phase so enjoyable and so integral to their creative work that they prefer to go untreated rather than risk limiting or losing it [ ]. However, bipolar disorder usually worsens with time. While the side effects of medications may be unpleasant for some, the consequences of the disorder left untreated can be fatal, as evidenced by the ninefold increase in suicide rate and the countless artists and writers with bipolar disorder who have committed suicide [ 19 ]. Studying the link between creativity and bipolar disorder will thus promote a deeper understanding of patients' needs and experiences and facilitate better treatment, thereby enhancing patient compliance.
Still, reports across several disciplines now provide scientific evidence to bolster what was once a collection of anecdotal evidence and lend legitimacy to these claims. Future studies will need to evaluate potential positive traits in the appropriate samples to identify those that will be most useful for exploring the genetic architecture of the shared vulnerability and the evolutionary context of bipolar disorder.
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An understanding of the role of bipolar risk genes in the general population as they relate to positive traits may provide insight into the mechanism of illness and thus facilitate the development of novel therapeutic treatments. Additionally, while the mild to moderate expression of these positive traits may hold advantages, more extreme expressions likely contribute to the severe symptoms associated with illness.
Further research in this area would thus represent an important step toward advancing our understanding of bipolar disorder, from both etiological and population perspectives, and toward promoting better patient care.
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Mol Neuropsychiatry ; Go to Top Abstract. FullText PDF. Abstract Bipolar disorder is a severe, lifelong mood disorder for which little is currently understood of the genetic mechanisms underlying risk.