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Environmental causes of bipolar


Environmental factors, life events, and trauma in the course of bipolar disorder

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Environmental Risk Factors for Bipolar Disorders and High-Risk States in Adolescence: A Systematic Review

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Mental disorders linked to air pollution

Scientists revealed a correlation between the development mental disorders, such as bipolar disorder and major depressive disorder, and air pollution says in PLoS Biology . They are conducted research on large samples of 151 million US residents and 1.44 million people in Denmark.

By According to WHO, polluted air is cause of death of seven million people in year. According to a study published last year, it shortens life on average Russians for about nine months. Harmful substances in the atmosphere affect and on people's mental health. The researchers found that children with mental retarded and suffering from adolescence with psychosis are more likely to live in areas with polluted air. As shown metastudy of 14 million couples twins, at risk bipolar disorder, major depressive disorder and schizophrenia not only genetic factors but also the conditions surrounding the person, in including bad environment. However scientists started in detail explore the relationship between the occurrence mental and neurological diseases and environmental pollution only recently. nine0005

American and Danish doctors led by Andrey Rzhetsky (Andrey Rzhetsky) from the University of Chicago decided to study the relationship between the occurrence of mental and neurological disorders and environmental pollution. Study they conducted on two large samples. The first sample was based on the IBM database MarketScan, it included 151 million US residents under 65 years of age, who in 2003-2013 turned to doctors of any profile on medical insurance. because of large sample size study carried out at the district level. These are territorial units, smaller than larger than a state, but larger than a city. The researchers compared the quality air, water, land and security level in houses (passing nearby streets and highways, pedestrian safety) in each county with a level of one of six diseases - big depressive disorder, bipolar disorders, schizophrenia, disorders personality, Parkinson's disease and epilepsy. Same the authors took into account the socio-demographic characteristics such as median county income, population density and number of cities. Pollution Data provided by the Protection Agency US environment. In particular, for air, 87 potential pollutants, for water - 80, for land — 26.

Other the sample consisted of 1.44 million inhabitants of Denmark, born in 1979-2002 and lived for the first 10 years in the country. The authors analyzed dependence of the development of four mental illnesses (major depressive disorder, bipolar disorders, schizophrenia, disorders personality) depending on from air pollution. Its quality was calculated according to 14 indicators. In this case, the authors examined the health status of individuals, and not regions of the country.

The scientists analyzed the results using the distribution Poisson which allows us to estimate the probability occurrence of events for specific time, and Cox's regression, which makes it possible to predict the risk occurrence of any event. nine0005

It turned out that in the United States a high correlation was observed between the occurrence of two mental disorders and air pollution. Residents in the most polluted counties are at risk of bipolar disorder was at 27 percent ( p < 10 -4 ) higher, and the risk of a large depressive disorder six percent higher ( p = 0.05), than in areas with clean air. Risk of Personality Disorder correlated with soil pollution: in the dirtiest counties compared to the more prosperous, it was 19percent higher ( p < 10 -4 ). The links between the development of mental disorders and water pollution or safety level in the houses, the authors did not reveal. Same scientists have not found a link between pollution environment and the development of neurological diseases.

B Denmark correlation between pollution air and the emergence of mental disorders was even higher than in USA. Areas with the dirtiest air risk of major depression disorder was 50 percent higher schizophrenia by 148 percent, and disorders personality - 162 percent higher in compared to environmentally friendly regions of the country (everywhere p < 2×10 − 16 ). The risks of bipolar disorders in Denmark and the United States were are comparable: in areas of Denmark with strongly polluted air it was 29 percent higher ( p < 3×10 − 3 ).

Authors conclude that further research mental disorders should be addressed attention to the ecology in the area where the participants of the experiments live, and not only for genetic factors. Revealed correlation does not mean that air pollution and mental diseases have a causal connection. To reveal it, additional research. nine0005

How show other scientific works, each the sixth death on the planet is associated with environmental pollution. More often All these are non-communicable diseases, such as heart attacks, lung cancer, strokes, that occur as a result of pollution air. How calculated scientists, in 2015 in Russia due to poor ecology, 170 thousand people died.

Ekaterina Rusakova

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Bipolar disorder0001

General summary

Bipolar disorder, also known as bipolar affective disorder (BAD) and formerly known as manic-depressive psychosis (PMD). It is a set of mood disorders characterized by marked fluctuations in mood, thinking, behaviour, energy and ability to perform daily activities.

A person suffering from this disorder alternates his state of mind between mania or hypomania - a phase of joy, exaltation, euphoria and grandiosity and depression, with sadness, inhibition and ideas of death. nine0005

Four types of bipolar disorder were defined by severity and alternation of moods over time:

  • Bipolar I disorder
  • Bipolar disorder type II
  • Cyclothymia
  • Non-specific bipolar disorder

Because bipolar disorder occurs in young people, it has a high social cost. It is the second leading cause of disability worldwide. In addition, those who suffer from it pose a higher risk than the general population of deaths from suicide, homicide, accidents, and natural causes such as cardiovascular disease. nine0005

In type 1, the person alternates between depressive episodes with full manic episodes, and in type 2, he alternates between depressive episodes and hypomanic (less severe) episodes.

The symptoms of this disorder are severe, different from the normal highs and lows of mood. These symptoms can lead to relationship problems, work, school, or even suicide.

During the depression phase a person may experience:

  • Negative perception of life. nine0072
  • Inability to feel the pleasure of life.
  • No energy
  • Self-criticism.
  • In extreme cases, suicide.

During a manic phase a person may experience:

  • Denial that there is a problem.
  • Sudden change of mood.
  • Irrational financial decisions.
  • Feeling of great enthusiasm
  • Don't think about the consequences of your actions.
  • Lack of sleep
    • nine0079

    Although childhood onset occurs, the normal age of onset for type 1 is 18 years and for type 2 is 22 years.

    About 10% of bipolar 2 cases develop into type 1.

    Although the causes are unclear, genetic and environmental factors (stress, childhood abuse) play a role.

    Treatment usually includes psychotherapy, medication, sometimes electroconvulsive therapy may be helpful.

    Symptoms

    Signs and symptoms of the depressive phase of bipolar disorder include:

    • Persistent sadness
    • Lack of interest in engaging in pleasurable activities.
    • Apathy or indifference.
    • Anxiety or social anxiety.
    • Chronic pain or irritability.
    • Lack of motivation
    • Guilt, hopelessness, social isolation.
    • Lack of sleep or appetite. nine0072
    • Suicidal thoughts
    • In extreme cases, there may be psychotic symptoms: delusions or hallucinations are usually unpleasant.

    Manic symptoms

    Mania can occur in varying degrees:

    Hypomania

    This is the least severe degree of mania and lasts at least 4 days. This does not result in a noticeable decrease in a person's ability to work, communicate, or adapt.

    He also does not require hospitalization and does not have psychotic characteristics. nine0005

    In fact, overall functioning may improve during a hypomanic episode and is considered a natural anti-depression mechanism.

    If an event of hypomania is not accompanied by or precedes depressive episodes, it is not considered a problem if the state of mind is uncontrollable.

    Symptoms may last from several weeks to several months.

    It is characterized by:

    • Great energy and activity.
    • Some people may be more creative, while others may be more irritable. nine0072
    • A person may feel so good that he denies that he is experiencing a state of hypomania.
    Mania

    Mania is a period of euphoria and high mood for at least 7 days. If left untreated, a manic episode can last 3 to 6 months.

    It is characterized by displaying three or more of the following behaviors:

    • Talk quickly and smoothly.
    • Accelerated thoughts.
    • Agitation.
    • Light condition. nine0072
    • Impulsive and risky behavior.
    • Excessive monetary expenses
    • Hypersexuality.
    • A person with mania may also experience lack of sleep and inadequate judgment.
    • On the other hand, maniacs may have problems with alcohol or other substance abuse.

    In extreme cases, they may experience psychosis, so that contact with reality is broken, having a high state of mind.

    It is common for a manic person to feel incomparable or indestructible and to feel chosen to realize a goal. nine0005

    Approximately 50% of people with bipolar disorder experience hallucinations or delusions, which can lead to violent behavior or admission to a psychiatric hospital.

    Mixed episodes

    In bipolar disorder, a mixed episode is a condition in which mania and depression occur simultaneously.

    People who experience this condition may have thoughts of grandiosity while having depressive symptoms such as suicidal thoughts or feelings of guilt. nine0005

    People who are in this state are at high risk of committing suicide because they confuse depressive emotions with mood swings or difficulty controlling impulsivity.

    Causes

    The exact causes of bipolar disorder are unclear, although they are thought to be largely genetic and environmental.

    Genetic factors

    It is believed that 60-70% of the risk of developing bipolarity depends on genetic factors. nine0005

    Several studies have shown that certain genes and chromosomal regions are associated with susceptibility to develop the disorder, with each gene being more or less important.

    The risk of bipolar disorder in people with family members with the same diagnosis is 10 times higher than in the general population.

    Studies indicate heterogeneity, meaning that different genes are involved in different families.

    Environmental factors

    Studies show that environmental factors play an important role in the development of bipolar disorder, and psychosocial variables may interact with genetic dispositions. nine0005

    Recent life events and interpersonal relationships contribute to manic and depressive episodes.

    30-50% of adults diagnosed with bipolar disorder have been found to report abuse or trauma in childhood, which is associated with an earlier onset of the disorder and more suicide attempts.

    Evolutionary factors

    From evolutionary theory one might think that the negative effects that bipolar disorder can have on the ability to adapt cause genes not to be selected by natural selection. nine0005

    However, there is still a high incidence of BD in many populations, so there may be some evolutionary benefit.

    Doctors of evolutionary medicine suggest that high rates of BR throughout history suggest that the change between depressive and manic states suggested some evolutionary advantage in ancestral humans.

    In highly stressed individuals, depressed mood can serve as a defense strategy to escape external stress, store energy, and increase sleep hours. nine0005

    Mania could benefit from her relationship with creativity, confidence, high energy levels and greater productivity.

    Physiological, neurological and neuroendocrine factors

    Brain imaging studies have shown differences in the volume of various brain areas between patients with bipolar disorder and healthy patients.

    An increase in the volume of the lateral ventricles and an increase in the rate of white matter hyperintensity were found. nine0005

    Magnetic resonance studies have shown that there is an abnormal modulation between the abdominal prefrontal region and the limbic regions, especially the amygdala. This will contribute to poor emotional regulation and mood-related symptoms.

    On the other hand, there is evidence of an association between early stressful experiences and dysfunction of the hypothalamic-pituitary-adrenal axis, leading to hyperactivation.

    Less common bipolar disorder can result from trauma or a neurological condition: brain injury, stroke, HIV, multiple sclerosis, porphyria, and temporal lobe epilepsy. nine0005

    The neurotransmitter responsible for regulating mood, dopamine, has been found to increase its transmission during the manic phase and decrease during the depressive phase.

    Glutamate increases in the left dorsolateral prefrontal cortex during the manic phase.

    Diagnosis

    A patient must have at least two episodes of affective disorder to be diagnosed with bipolar disorder. At the same time, at least one of them must be either manic or mixed. For the correct diagnosis, the psychiatrist must take into account the characteristics of the patient's history, information received from his relatives. Currently, it is believed that the symptoms of bipolar disorder are characteristic of 1% of people, and in 30% of them the disease becomes a severe psychotic form. Determination of the severity of depression is carried out using special scales. The manic phase of bipolar disorder must be differentiated from arousal caused by the use of psychoactive substances, lack of sleep, or other causes, and the depressive phase from psychogenic depression. Psychopathy, neurosis, schizophrenia, as well as affective disorders and other psychoses due to somatic or nervous diseases should be excluded. nine0005

    Methods of treatment

    The main goal of the treatment of bipolar disorder is to normalize the mental state and mood of the patient, to achieve long-term remission. In severe cases of the disease, patients are hospitalized in the psychiatric department. Mild forms of the disorder can be treated on an outpatient basis. Antidepressants are used to relieve a depressive episode. The choice of a specific drug, its dosage and frequency of administration in each case is determined by a psychiatrist, taking into account the age of the patient, the severity of depression, and the possibility of its transition to mania. If necessary, the appointment of antidepressants is supplemented with mood stabilizers or antipsychotics. Antidepressants help to stop depressive states in bipolar disorder. Drug treatment of bipolar disorder in the stage of mania is carried out by normotimics, and in severe cases of the disease, antipsychotics are additionally prescribed.

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