A recent study from Sweden, published in the British Journal of Psychiatry (1), appears to confirm a link between high ability and bipolar disorder. Over seven hundred thousand teenagers were followed up to see if they were admitted to psychiatric hospital in their twenties and thirties. Then their school examination grades at 16 years were compared with those of the other students who had not developed such severe mental and behavioural problems.
The adults with bipolar disorder had done better in exams as teenagers, especially in humanities subjects such as Swedish and History (but not Art). Those who had been good at Sport seemed to have a lower chance of developing bipolar disorder later.
This is an interesting study which is in keeping with the suggested link between bipolar disorder and creative ability. However, it does not mention the possibility that adult ADD / ADHD, which also can sometimes lead to hospital admission, may have been the real problem in many cases. Like much research of this kind, the diagnosis was made a long time ago (1988 – 1997), when there was even more scepticism about adult ADD / ADHD than there is now (2).
(1) Excellent school performance at age 16 and risk of adult bipolar disorder: national cohort study. http://bjp.rcpsych.org/cgi/content/abstract/196/2/109
(2) For an example of how creative ability may be linked to ADD / ADHD, see my Blog piece on Vincent Van Gogh: http://drnmblog.wordpress.com/2010/02/05/vincent-van-gogh-did-he-have-add-adhd/
Unlike the BBC’s Panorama (1), The British Medical Journal (BMJ) gives space to a wide range of views on mental health and behavioural disorders. An article on adult ADD / ADHD last week is an example of how polarized debates can become. One side repeated, as fact, Panorama’s “unfair and not open-minded” opinion on the poor long-term outcome for medication in ADD / ADHD (2).
The BMJ published my own comment online (3), pointing out the need to test and monitor new nurse-led adult ADD / ADHD diagnosis and treatment (4). Of course, the Department of Health is quite right to look for the most cost-effective ways of delivering services, and nurses bring their own distinct and valuable skills to a wide range of clinical settings. But I have already had two conversations with specialist NHS nurses working with children and teenagers, who were concerned at being pushed into taking on too much responsibility too soon.
“Critical Psychiatry” is generally skeptical about all “medicalisation” of problem emotions and behavior. So it seems a bit odd to me that the authors of this piece attacking adult ADD / ADHD suggest that “more established diagnoses…depression, anxiety, and modern conceptions of bipolar and bipolar spectrum disorder” be kept in preference.
This does, though, raise a further question about clinical specialists. Why should adults with “non-established” ADD / ADHD have less direct access to NHS psychiatrists and clinical psychologists, than people with “established” conditions? Surely it is more logical that they have more?
(1) See my last two Blog postings