Press Release

5/ 22/05
ATTACKING BIPOLAR DISORDER IN YOUNG ADULTS BOOSTS OUTCOME

STANFORD, Calif. –College students with bipolar disorder appear to function well if properly diagnosed and treated, although those with a family history of the disease may be more difficult to treat, according to a recent analysis led by Terence Ketter, MD, associate professor of psychiatry and behavioral sciences at the Stanford University School of Medicine. “It’s possible for this group of patients to do very well,” said Ketter, who examined the medical and treatment histories of college students treated at Stanford’s Bipolar Disorders Clinic. “It’s important to realize that these students can function well if they get accurate diagnosis and treatment.” Researchers on Ketter’s team are presenting their findings during two sessions at the annual meeting of the American Psychiatric Association Meeting in New York. According to the National Alliance for the Mentally Ill, 2.3 million American adults have bipolar disorder, which is marked by episodes of mania and depression that typically begin in adolescence or early adulthood and can last from days to months. Family history is a powerful indicator; Ketter said a member of the general population on average has a 2 percent chance of having bipolar disorder while a person with a family history of the disease has a 20 percent risk. Misdiagnosis is common because its symptoms – which include mood swings into euphoria or irritability as well as deep depression – resemble those of other disorders, such as unipolar depression or attention-deficit/hyperactivity. Ketter noted that the average time between a patient’s onset of symptoms and accurate diagnosis is 10 years. Yet early and accurate diagnosis is important in preventing disease-related episodes, which potentially lead to illness progression. “It’s much easier to treat patients who have had fewer than three episodes; after that it gets incrementally more difficult to treat,” said Ketter. “If we don’t let episodes occur, patients can do exceedingly well.” Research has been done on adolescent and adult bipolar disorder, but few studies have focused specifically on the college-age population. Ketter said he believes adults shouldn’t be considered a monolithic group; unlike middle-aged and older adults, patients in early adulthood haven’t had decades of episodes and may be easier to treat. His team conducted a review to assess the illness severity and prognosis of this often overlooked group. They examined the cases of 42 bipolar college students, each of whom was enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder, the largest treatment study ever conducted for the disease. The average age of the patients was just under 22 and the average age of illness onset was just over 16. Prior hospitalizations (64 percent) and anxiety disorders (63 percent) were common; in addition, 43 percent had a history of heavy marijuana use, 37 percent had a history of alcohol abuse and 26 percent had attempted suicide. The research team found that the patients’ average scores on the Clinical Global Impression, or CGI scale (a marker of a person’s mental illness) and on the Global Assessment of Function scale (which rates overall psychological, social and occupational functioning) improved significantly during treatment. It also found the percentage of patients with “syndromal episodes,” which are clinically significant episodes of depression or mood elevation, fell from 48 percent to 12 percent. The patients were on an average of 2.4 medications – fewer than the general adult average of four drugs. “In general this group wasn’t on a lot of medications and had a good prognosis,” said Ketter. “The patients were responsive to medication and relatively easy to treat.” Researchers also identified a subset of 13 patients with a first-degree (parent or sibling) family history of bipolar disorder, and found less favorable outcomes. When compared with patients who had no family history of the disease, these patients had more severe prior illness with earlier onset and more hospitalizations, suicide attempts, alcohol abuse and anxiety disorders. The group’s average improvement on the CGI was poorer than the other group’s, despite being on more medications (3.1 on average) and having been treated for a similar period of time (just under two years). “When compared to students without a first-degree family history, students with a family history appear to be associated with more severe prior illness, and a poorer longitudinal course,” said Ketter. “Further studies are needed to explore these preliminary observations.” Ketter, who received support for his work from the National Institute of Mental Health and the Holland Foundation, is continuing studies on the disorder and plans to investigate the use of brain imaging to predict patients’ responses to medications and the use of psychotherapies as alternatives to mood stabilizers. Ketter’s co-investigators in this chart review include Cecylia Nowakowska, MD, PhD; Anna Sapozhnikova; Rebecca Chandler; Andrea Alarcon; Po Wang, MD; and Wendy Marsh, MD.

5/21/02
MEDIA CONTACT: Michelle Brandt at (650) 723-0272 (mbrandt@stanford.edu) BROADCAST MEDIA: M.A. Malone at (650) 723-6912 (mamalone@stanford.edu) http://mednews.stanford.edu/

STANFORD RESEARCHERS ESTABLISH LINK BETWEEN CREATIVE GENIUS AND MENTAL ILLNESS

STANFORD, Calif. - For decades, scientists have known that eminently creative individuals have a much higher rate of manic depression, or bipolar disorder, than does the general population. But few controlled studies have been done to build the link between mental illness and creativity. Now, Stanford researchers Connie Strong and Terence Ketter, MD have taken the first steps toward exploring the relationship.

Using mood, creativity, personality, intelligence, and temperament tests, they found healthy artists to be more similar in personality to individuals with manic depression than to healthy people in the general population. "My hunch is that emotional range, having an emotional broadband, is the bipolar patient's advantage," said Strong. "It isn't the only thing going on, but it gives people with manic depression a creative edge."

Strong is a research manager in the Department of Psychiatry and Behavioral Science's bipolar disorders clinic and a doctoral candidate at the Pacific Graduate School. She is presenting preliminary results during a poster presentation today (May 21) at the annual meeting of the American Psychiatric Association Meeting in Philadelphia.

The current study is groundbreaking for psychiatric research in that it used separate control groups made up of both healthy, creative people and people from the general population.

Researchers administered standard personality, temperament and creativity tests to 47 people in the healthy control group, 48 patients with successfully treated bipolar disorder and 25 patients successfully treated for depression. They also tested 32 people in a healthy, creative control group. This group was comprised of Stanford graduate students enrolled in prestigious product design, creative writing and fine arts programs, including Stegner Fellows in writing, students in the Joint Program in Design in the Department of Mechanical Engineering, and studio arts master's students from the Department of Art & Art History. Bipolar patients and healthy controls were matched for age, gender, education, and socioeconomic status.

Preliminary analysis showed that people in the control group and recovered manic depressives were more open to new ideas and experiences, and more likely to be moody and neurotic than healthy controls. Moodiness and neuroticism are part of a group of characteristics researchers are calling "negative-affective traits" which also include mild, nonclinical forms of depression and bipolar disorder.

Though the data are preliminary, they provide a roadmap for psychiatric researchers looking to solve the genius/madness paradox depicted in the movie A Beautiful Mind, which tells the story of Nobel Laureate John Nash.The existing data need further review, Strong said. "And, we need to expand this to other groups".

How mood influences the performance of artists and genius scientists will be the subject of future research at Stanford. "We need to better understand the emotional side of what they do," Strong said.

The study was funded by grants to Ketter, principal investigator and associate professor of psychiatry and behavioral science at Stanford, from the Stanley Foundation for Bipolar Research, the National Alliance for Research on Schizophrenia and Depression, and Abbott Laboratories.

For more information, please visit the Web site of the medical center's Office of News and Public Affairs at http://mednews.stanford.edu.

Courses on Creativity

We are currently teaching a Sophomore Seminar (winter quarter, 2002), a Continuing Studies Symposium (April 6, 2002), and a Continuing Studies course (April 11 - June 6) on Mood, Temperament, and Creativity. Dr. Ketter was a featured panelist on the Alumni Association's Think Again tour in Chicago, May 4, 2002.

American Psychiatric Association Annual Meeting, Philadelphia, May 18 - 23.

Stanford Bipolar Disorders Clinic researchers presented five posters of new research at psychiatry's largest convention.

Mental Illness Stigma Article Accepted for Publication

"Examining Cues that Signal Mental Illness Stigma," an article based on Matthew Schumacher's thesis research, will be published soon in the Journal of Social and Clinical Psychology.

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