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Impact of triggers on bipolar disorder less than expected

Stressful events and a lack of support from the environment are both consequences and causes of mood swings in people with a bipolar disorder. This is the finding of PhD research by Leiden clinical psychologist Manja Koenders. PhD defence 7 April.

The illness creates its own circumstances

People with a bipolar disorder (commonly known as manic depression) suffer alternately from depressive and manic moods. The patients can be sombre and inactive for a period of time, and then hyperactive, unnaturally happy and extremely energetic. Environmental factors were for a long time thought to contribute to these mood swings, and to be a predictor of the course of the illness.  Such factors could be a very stressful event or situation, or a feeling of having to cope alone.  The Leiden research shows that this is only half the story as the  opposite also appears to be true: because of their illness, patients are more sensitive to stress and find it harder to connect with other people. Or, as Manja Koenders puts it: 'The illness creates its own unfavourable circumstances, to an extent, which increases the risk of a relapse. It can have an enormously destructive impact on the life and the environment of the patient.' 

Different types of patients

The research also shows that there are differences in the types of people who suffer from a bipolar disorder. Koenders distinguishes three groups: a group where the illness is reasonably stable, that is, with no extreme dips and peaks; a group where depression has the upper hand, and a group where there is a cyclic pattern. These last patients have alternating periods of depression and mania. 

Manja Koenders

Patients monitored for two years 

Koenders' research is based on data collected in the long-term Bipolar Stress Study. This study included 173 bipolar patients, who were treated by Psyq (a treatment centre for mental health disorders) in The Hague. Psyq recorded their moods throughout the whole period. Every three months there was contact with the researchers to discuss such issues as life events and social support. 

Modifying the treatment

What is the significance of this research? Koenders: ‘It's difficult - not to mention unhelpful - to determine the cause and effect of mood swings in people with a bipolar disorder. At least, not if they have had the condition for a long time and the disorder and the psychosocial factors affect one another. The focus in the treatment should not lie on possible triggers for mood swings; it's also important to look at the influence of the disorder on the patient's environment. This approach could mean that family and friends will be involved in the treatment. We've also found that getting patients to record their mood and the environmental factors is a good way to make the interaction between the two factors very clear.’

A new long-term study is due to start shortly with a large group of people suffering from a bipolar disorder from the start of their diagnosis and treatment. The aim of the study is to map the biological and psychological predictors of the course of the illness, as well as the effect of the treatment. Manja Koenders will co-ordinate this new study. 

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