Bipolar disorder is a relatively common form of mental illness that depends strongly on genetic inheritance for expression. The author of this study has sought to evaluate whether the gender of subjects influences which genetic variants are associated with the disease. A portion of the cases from a previously published study were analyzed using PLINK software and the association of single-nucleotide polymorphisms was evaluated separately for all cases, for female subjects alone, and for male subjects alone. The results obtained for male subjects alone reached higher levels of statistical significance than when both genders were evaluated together or when female subjects were evaluated alone. The most significantly scoring polymorphisms were distinctly different for the 2 genders. In particular, a site downstream of the ion exchanger SLC24A3 and upstream of the Rab5-interacting protein RIN2 gene on chromosome 20 (rs6046396) yielded very high significance in men (p=3.91 X 10-9).

This thesis presents research investigating the relationship between, and methods of, measuring circadian rhythms in mood disorders in a population of currently depressed and euthymic individuals with both depression and bipolar disorder. This was first assessed by comparing group differences in subjective sleep and circadian measures with objective sleep and circadian measures. The objective circadian measures involved actigraphy and melatonin profiling. This analysis showed group differences in subjective sleep and circadian parameters compared to controls, however no robust differences between mood groups. Objective melatonin profiling showed a mild agreement with subjective circadian parameters. Next, we studied the external validity of a subjective rating scale measuring biological rhythm disturbance, the Biological Rhythms Interview for Assessment in Neuropsychiatry (BRIAN), against objective measures of sleep and circadian activity rhythmicity. The BRIAN demonstrated some promising external validity, namely correlations with wake after sleep onset (WASO) and sleep efficiency, as well as melatonin levels in each group. These studies provide evidence of the extent to which a self-report may help in assessing parameters of sleep and circadian rhythms in the clinical setting. In doing so, it is expected that the use of subjective ratings will provide insight into the impact of biological rhythms disturbances and mood disorders. Lastly, we conducted an overview of the preclinical and clinical literature investigating the impact of circadian disturbance on cognitive performance. The results from this literature review yielded patterns of rhythmicity in specific parameters in each of the attention, memory, and executive function domains in humans, whereas attention and memory are more of a primary focus in animal studies. However, we also found that there are significant gaps in the understanding of how disturbances in circadian rhythms may influence cognitive function. This review also highlights the importance of cross-species translational validity from a methodological perspective, in order to generate positive clinical results beginning at the preclinical stage in neuropsychiatric disorders. / Thesis / Master of Science (MSc)

In this thesis I set out to show that the bioethical literature concerning the treatment of chronic suicidal ideation occupies a serious omission: it does not discuss the critical function that self-trust serves in the recovery process. Self-trust is a core component of autonomy, and therefore plays a pivotal role in the shaping of one’s sense of self and his or her capacity to effectively engage in therapeutic interventions. I begin by discussing the relationship between agency and self-trust, and how this influences one’s ability to make decisions and self-advocate. Secondly, I evaluate how self-trust relates to aspects of the suicidal mind, including existential distress and negative urgency. Finally, I will offer recommendations as to how the explicit (re-) development of self-trust skills can significantly enhance the effectiveness and timeliness of contemporary dialectical treatment practices. / Thesis / Master of Arts (MA)

Bakgrund: Bipolär sjukdom är en psykisk sjukdom där individen pendlar mellan episoder av maniska/hypomaniska och depressiva skov som kan resultera i funktionella och kognitiva förändringar. Sjukdomen är mycket komplex och påverkar både den drabbade och omgivningen i hög utsträckning. Syftet: Att undersöka närståendes erfarenhet av att leva nära någon som har bipolär sjukdom. Metod: En litteraturstudie baserat på elva kvalitativa studier. Pubmed och Cinahl användes vid databassökningar. Analysen genomfördes med hjälp av Fribergs analysmodell. Resultat: Analysen resulterade i fyra kategorier och 10 underkategorier. Kategorierna var: “Bli psykologiskt och fysiskt påverkad”, “Bli socialt isolerad och balansera tillvaron”, “Använda hanteringsstrategier” och ”Samarbeta med hälso- och sjukvården”.  Konklusion: Närstående till personer med bipolär sjukdom upplevde många svårigheter kopplat till sjukdomens oförutsägbara natur. De kände ett ensamt ansvar och upplevde ett bristfälligt stöd från samhället, det sociala nätverket och vården. Det är därför av stor vikt att hälso- och sjukvården inkluderar närstående och erbjuder dem ett anpassat stöd. / Background: Bipolar disorder is a mental illness where the individual oscillates between episodes of manic/hypomanic and depressive episodes that can result in functional and cognitive impairments. The disease is highly complex and affects both the affected individual and their surroundings to a high extent. Aim: To investigate the experience of relatives living with individuals who have bipolar disorder. Method: A literature study based on eleven qualitative studies. Pubmed and Cinahl were used for database searches. The analysis was conducted using Friberg's analysis model. Result: The literature study shows that bipolar disorder has a significant impact on the lives of relatives. The results are presented in four categories; 1) Being psychologically and physiologically affected, 2) Becoming socially isolated and balancing life, 3) Using coping strategies and finally 4) the role of health care. Conclusion: Relatives of individuals with bipolar disorder experienced many difficulties related to the disease's unpredictable nature. They felt a lonely responsibility and experienced inadequate support from society, social networks, and health care. It is therefore essential that health care includes relatives and offers them tailored support.

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