A literature search, supplemented by an expert survey and selected reanalyses of existing data from epidemiological studies was performed to determine the prevalence and associated burden of bipolar I and II disorder in EU countries. Only studies using established diagnostic instruments based on DSM-III-R or DSM-IV, or ICD-10 criteria were considered. Fourteen studies from a total of 10 countries were identified. The majority of studies reported 12-month estimates of approximately 1% (range 0.5–1.1%), with little evidence of a gender difference. The cumulative lifetime incidence (two prospective-longitudinal studies) is slightly higher (1.5–2%); and when the wider range of bipolar spectrum disorders is considered estimates increased to approximately 6%. Few studies have reported separate estimates for bipolar I and II disorders. Age of first onset of bipolar disorder is most frequently reported in late adolescence and early adulthood. A high degree of concurrent and sequential comorbidity with other mental disorders and physical illnesses is common. Most studies suggest equally high or even higher levels of impairments and disabilities of bipolar disorders as compared to major depression and schizophrenia. Few data are available on treatment and health care utilization.

Objective: Prospective study designs ideally allow patients to be followed from the first manifestations of the illness or even from an at-risk stage. It can thus provide data on the predictive value of changes in clinical symptomatology, cognition or further biological markers to broaden our understanding of the etiopathology and symptomatic trajectory of bipolar disorders. The scope of this narrative review is to summarize evidence from prospectively collected data on psychopathological and other clinical and biological changes in the early developmental course of bipolar disorders. Methods: The narrative review was based on a literature search conducted in February 2016 within the PubMed library for prospective study data of persons in antecedent and early manifest stages of manifest bipolar disorder published within the last 15 years. Results: A total of 19 prospective studies were included. Regarding psychopathological features; personality, temperament and character traits as well as changes in sleep and circadian rhythm, the evidence suggests that risk factors for the development of bipolar disorder can already be described and should be studied further to understand their interaction, mediation with other factors and timing in the developmental process of bipolar disorder. Apart from the positive family history, childhood anxiety, sleep problems, subthreshold (hypo)manic symptoms and certain character traits/emotionality should be identified and monitored already in clinical practice as their presence likely increases risk of bipolar disorder. Up to date no substantiated evidence was found from prospective studies addressing cognitive features, life events, immunological parameters and morphological central nervous system changes as potential risk factors for bipolar disorder. Conclusion: For an improved understanding of episodic disorders, longitudinal data collection is essential. Since the etiology of bipolar disorders is complex, a number of potential risk factors have been proposed. Prospective studies addressing this spectrum and resilience factors are critical and will be best conducted within multi-site research networks or initiatives.

Background: The mood stabilizer lithium has long been reported to be associated with reduced suicide risks, but many studies reporting associations between lithium and reduced suicide risks also have been nonrandomized and lacked adjustment for many potential confounders, active controls, uniform follow-up, or intent-to-treat samples. Concerns also have been raised that medications being considered as potential suicide preventative might increase risks of nonsuicide mortality while reducing risks of suicide. Methods: Three studies of Veterans Health Administration (VHA) patients were conducted combining high-dimensional propensity score matching with intent-to-treat analyses to examine the associations between lithium and valproate and one-year suicide and nonsuicide mortality outcomes. Results: In intention-to-treat analyses, initiation of lithium, compared to valproate, was associated with increased suicide mortality over 0-365 days among patients with bipolar disorder (Hazard Ratio (HR) 1.50 [95% Confidence Interval 1.05, 2.15]) Nonsuicide mortality among VHA patients with or without bipolar disorder was not significantly associated with the initiation of lithium compared to valproate ( HR 0.92 [0.82-1.04]). Rates of treatment discontinuation, however, were very high (≈ 92%). Longitudinal analyses revealed that the increased suicide risks associated with initiating lithium among patients with bipolar disorder occurred exclusively after discontinuation of lithium vii treatment. In secondary analyses restricted to patients still receiving their initial treatment, there was no difference in suicide risk between the initiation of lithium or valproate. Conclusions: Significantly increased risks of suicide were observed at one year among VHA patients with bipolar disorder initiating lithium compared to valproate, related to risks observed after the discontinuation of lithium treatment Since these studies are nonrandomized, confounding may account for some or all of our findings, including the risks observed after lithium discontinuation. Nevertheless, these results suggest that health systems and providers consider steps to minimize any potential lithium discontinuation-associated risk. Approaches might include educating patients about possible risks associated with discontinuation and closely monitoring patients after discontinuation if feasible. Given the obvious importance of any substantive difference between lithium and valproate in suicide or nonsuicide mortality risk, our studies also suggest that further research is needed, especially research that can further minimize the potential for confounding.

Bakgrund: Bipolär sjukdom orsakar ett stor lidande för individen med återkommande återfall i depression eller hypomani/mani. Omvårdnad som stödjer individen till att aktivt bedriva egenvård kan stärka individen till att bli mer självständig och aktiv i behandlingen av bipolär sjukdom. Det saknas en systematisk översikt över kvalitativa studier om individers erfarenheter av att genomföra egenvård vid bipolär sjukdom. Syfte: Belysa individers erfarenheter av att genomföra egenvård relaterat till bipolär sjukdom. Metod: Den kvalitativa metoden metaetnografi användes vid studien. Sökning i databaser resulterade i 22 kvalitativa artiklar. Syntetisering av artiklarna resulterade i tre metaforer med en modell över hur metaforerna är sammanlänkade. Resultat: Studiens resultat består av metaforerna "Egenvård som balansakt", "Sjukvårdens erbjudande av en balanspinne" samt "Risker för fall av linan". Slutsats: Resultatets tre metaforer skapar tillsammans en metaforisk modell som visar att egenvård vid bipolär sjukdom kan ses som att individen behöver "balansera på en lina" för att inte "falla ner från linan" i depression eller mani. Den metaforiska modellen åskådliggör att egenvård vid bipolär sjukdom är ett komplext fenomen som sträcker sig längre än utförandet av egenvård. Specialistsjuksköterskan inom psykiatrin bör aktivt uppmuntra individer med bipolär sjukdom till att aktivt bedriva egenvård för att stärka deras självständighet och inge en ökad möjlighet att erhålla en förbättrad hälsa och välbefinnande. Studiens resultat stärks av att det går teoretisk anknytas till Orems egenvårdsteori. / Background: Bipolar disorder causes a great deal of suffering for the individual with recurrent depression or hypomania/mania. Nursing that supports the individual to actively pursue selfcare can strengthen the individual to become more independent and active in the treatment of bipolar disorder. There is no systematic review of qualitative studies on individuals' experiences of performing self-care in bipolar disorder Aim: Highlight individuals' experiences of conducting self-care related to bipolar disorder. Method: The qualitative method of meta-ethnography was used in the study. Searching databases resulted in 22 qualitative articles. Synthesizing the articles resulted in three metaphors with a model of how the metaphors are interconnected Results: The study's results consist of the metaphors "Self-care as a balancing act", "Health care's offering of a balancing stick" and "Risks for falls of the line". Conclusion: The three metaphors of the result together create a metaphorical model that shows that self-care in bipolar disorder can be seen as the individual having to "balance on a line" so as not to "fall off the line" in depression or mania. The metaphorical model illustrates that self-care in bipolar disorder is a complex phenomenon that goes beyond self-care. The specialist nurse in psychiatry should actively encourage individuals with bipolar disorder to actively pursue self-care to strengthen their independence and to provide an increased opportunity to grant improved health and well-being. The study's results are strengthened by the fact that it is theoretically linked to Orem's self-care theory.

The purpose of this study was to understand the effects of pediatric bipolar disorder on child siblings. A quantitative quasi-experimental research design was used. According to family systems theory, which was used in the formation of this study, all family members are interconnected and affect each other in a variety of ways. The research questions investigated whether children demonstrated more emotional dysregulation and fewer adaptive skills when a bipolar sibling was living in the home than when there was no bipolar sibling. The matched comparison study used 2 groups of children: those with bipolar siblings and those without bipolar siblings. Parents completed the BASC-2 Parent Rating Scale in order to measure adaptive skills and emotional dysregulation in their non-bipolar children. Parents were recruited via social media parent support sites. Thirty-four families included in the study group had 1 bipolar child and at least 1 nonbipolar child living in the home; 31 families in the comparison group had no bipolar children. All children were under the age of 18, living together full time, had a biological or legal relationship, and did not have any other mental health diagnosis. A multivariate analysis of variance was used to test the hypotheses. The study found that children with bipolar siblings demonstrated significantly higher levels of emotional dysregulation (both externalization and internalization) than did children without bipolar siblings. There was no significant difference in reported adaptive skills between the 2 groups of children. This study has social change implications as it identifies the emotional needs of sibling children who are routinely overlooked as needing assistance. This study provides the groundwork for clinicians and educators working in the pediatric mental health field to begin exploring potential treatments and programs for siblings of bipolar children.

Denna kvalitativa studie syftade till att undersöka upplevelserna av att ha vuxit upp med en förälder som har bipolär sjukdom, med hjälp av intervjuer från sex deltagare. Med hjälp av Bronfenbrenners utvecklingsekologiska perspektiv har resultatet från intervjuerna analyserats tillsammans med begreppen ”risk- och skyddsfaktorer”. Det som framkom genom resultat och analys var att tiden som barn tillsammans med en förälder som har bipolär sjukdom präglades av ambivalenta känslor och instabilitet, samtidigt som det fanns trygghet i form av annan vårdnadshavare. Sällan eller aldrig fanns det stöd utöver den andra föräldern och inga insatser från samhället erbjöds dessa barn varken under tidig barndom eller tonår. Alla som deltog i studien uttryckte dock att de hade behövt fångas upp på ett eller annat sätt och att de som vuxna önskade att de fått någon typ av samtalsstöd för att kunna förstå och bearbeta sin förälders sjukdom, då detta påverkade deras barndom kraftigt. Upplevelserna var även att barndomen hade påverkat intervjupersonernas vuxenliv på olika sätt och ofta i negativ riktning. Under intervjuerna uttryckte dock intervjupersonerna att de i dagsläget befann sig på en plats i livet som kändes bra för dem, och att en del dessutom kände sig stärkta av sin barndom. / This qualitative study aimed to examine the experiences of what it is like to have grown up with a parent who has bipolar disorder, with help from interviews of six people. Together with Bronfenbrenners ecological systems theory the results have been analysed with the concept “risk- and protective factors”. What came out of the result and analysis was that being a child of a parent with bipolar disorder was featured by ambivalent emotions and instability, at the same time as there was safety in the shape of another guardian. Rarely or never were there any support beyond the other parent and no help from society was offered these children during either their childhood or youth. Everyone who participated in the study expressed that they felt the need to have been seen somehow and that as adults they wished that they had gotten some sort of counselling to be able to understand and process their parent´s disorder, since this affected their childhood vigorously. The experiences were also that the childhood had affected the participants adulthood in different ways and often in a negative direction. During the interviews though, the participants expressed that they were now in a place in life where they wanted to be and that some of them even felt strengthened by their childhood.

Bakgrund: Vid bipolär sjukdom är de framträdande symtomen perioder av manier och depressioner och risken för suicid kan vara hög. Forskning har visat att när en person drabbas av bipolär sjukdom påverkas inte bara individen utanäven deras närstående. I familjefokuserad omvårdnad inkluderas närstående i vården och ses som en viktig resurs i återhämtningen. Det behövs mer kunskap inom den psykiatriska vården om närståendesupplevelser och deras behov. Syfte: Syftet var att beskriva närståendes upplevelser av att leva med personer som har bipolär sjukdom. Metod: Kvalitativ litteraturöversikt med systematisk ansats där Thomas och Hardens metod för tematisk analys använts vid datanalysen. Primärpublikationer söktes i databaserna PubMed, CINAHL samt PsycINFO. Fjorton artiklar med kvalitativ ansats inkluderades i resultatet. Resultat: Analysen av inkluderade studier utmynnade i tre teman med tillhörande subteman. Teman var ”Ett förändrat liv, ”Kontakten med sjukvården” och ”Att överleva själv”. Slutsats: Slutsatsen är att närstående till personer med bipolär sjukdom upplever att livssituationen påverkas av sjukdomen. En ständig oro, känsla av ensamhet och att sätta sina egna behov åt sidan kan leda till att den egna hälsan riskeras. För att minska på bördan har närstående behov av att känna sig delaktiga i vården och behöver stöd från både sjukvården och andra i deras omgivning. Sjukvården behöver därför bjuda in närstående och ge adekvat information och erbjuda anpassat stöd. / Background: The prominent symptoms in bipolar disorder are periods of mania and depression, and the risk of suicide can be high. Research has shown that when someone suffers from bipolar disorder, others close to them are also affected. In family-focused nursing relatives are included and are seen as an important resource in the recovery process. More knowledge is needed in psychiatric care about family experiences and their needs. Aim: The aim was to describe family experiences of living with people who have bipolar disorder. Method: Qualitative literature review with a systematic approach where Thomas and Harden's method for thematic analysis was used. Primary publications were searched in the databases PubMed, CINAHL and PsycINFO. 14 qualitative studies were included in the result. Results: The analysis of included studies resulted in three themes and associated subthemes. The themes were “An altered life”, “The contact with healthcare” and “To survive oneself”. Conclusion: The conclusion is that family to persons with bipolar disorder experience that the disease can have a substantial impact on life. Constant worry, a feeling of loneliness and putting one's own needs aside can lead to one's own health being risked. To reduce the burden, family members need to feel involved in the care and need support from both health services and others around them. Therefore, healthcare professionals need to invite those close to the patient and provide adequate information and offer customized support.

No description available.

Syftet med arbetet är att undersöka vuxna barns upplevelser av att växa upp med en förälder som har bipolär sjukdom. Studien har utgått från en kvalitativ ansats och semistrukturerade intervjuer med åtta vuxna deltagare för att undersöka deras upplevelser under uppväxten, påverkan över vuxenlivet och skyddsfaktorer under uppväxten. Tematisk analys användes för att analysera respondenternas utsagor och de teman som identifierades var: utmaningar under uppväxten, trauma, skyddsfaktorer och uppväxtens påverkan på vuxenlivet. Resultatet visar att sju av åtta respondenter upplevt uppväxten som mer eller mindre traumatisk samt att de upplever att uppväxten på olika sätt påverkat dem i deras vuxenliv, både gällande deras psykiska hälsa och i deras relationsskapande. Särskilt framträdande för alla respondenter har varit deras upplevelser av skam, tabu och isolering till följd av förälderns diagnos, vilket har medfört att inga respondenter erhållit stöd från myndighet eller skola trots de trauman som uppstått i barndomen. Slutsatsen är att uppväxten med en förälder som har bipolär sjukdom påverkar barn på flertalet sätt, de barn som har ett stort skyddsnät mår ofta bättre i vuxen ålder medan för de barn som levt mer isolerat har det ofta påverkat deras psykiska mående på ett negativt sätt. / The aim of the work is to investigate adult children's experiences of growing up with a parent who has bipolar disorder. The study has been based on a qualitative approach and semi-structured interviews with eight adult participants to investigate their experiences during childhood, impact over adulthood and protective factors during childhood. Thematic analysis was used to analyze the respondents' statements and the identified themes were: challenges during growing up, trauma, protective factors and the childhood’s impact on adulthood. The results show that seven out of eight respondents experienced their upbringing as more or less traumatic and that their upbringing has affected them in different ways in adulthood, both in terms of their mental health and in their relationship building. Particularly prominent for all respondents have been their experiences of shame, taboo and isolation as a result of the parent's diagnosis, which has meant that none of the respondents received support from authorities or schools despite the traumas that occurred in their childhood. The conclusion is that growing up with a bipolar parent affects children in several ways. Children who have a large safety net more often feel better in adulthood, while for those children who have lived more isolated, it has often affected their mental well-being in a negative way.

No description available.