International Impact of Bipolar Disorder Highlights Need for Recognition and Better Treatment Availability

The severity and impact of bipolar disorder and bipolar-like symptoms are similar across international boundaries, according to a study partially funded by NIMH. The results were published in the March 2011 issue of the Archives of General Psychiatry. Marriage and Family Therapist Continuing Education

Background
Although several studies report prevalence rates of mental disorders on an international level, the numbers have varied because each study tends to use different methodology and definitions. To remedy this, the World Health Organization’s World Mental Health (WMH) survey initiative used consistent data collection methods in 11 countries in the Americas, Europe, Asia, the Middle East and New Zealand. The survey also applied common diagnostic definitions for mental disorders found in the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV).

NIMH researcher Kathleen Merikangas, Ph.D., and colleagues used WMH data to track prevalence rates of three subtypes of bipolar spectrum disorder—bipolar I, bipolar II and bipolar disorder not otherwise specified (BD-NOS). Bipolar I disorder is considered the classic form of the illness, in which a person experiences recurrent episodes of mania and depression. People with bipolar II disorder experience a milder form of mania called hypomania that alternates with depressive episodes. People with BD-NOS, sometimes called subthreshold bipolar disorder, have manic and depressive symptoms as well, but they do not meet strict criteria for any specific type of bipolar disorder noted in the DSM-IV. Yet, BD-NOS can significantly impair those who have it.

Results of the Study
The prevalence rates of bipolar I, bipolar II and BD-NOS were 0.6 percent, 0.4 percent, and 1.4 percent, respectively, with an overall bipolar spectrum rate of 2.4 percent. The United States had the highest prevalence rate of bipolar spectrum (4.4 percent), while India had the lowest rate (0.1 percent). More than half of those with bipolar disorder in adulthood note that their illness began in their adolescent years.

Across all countries studied, 75 percent of those who had bipolar symptoms met criteria for having at least one other disorder. Anxiety disorders, especially panic disorder, were the most common coexisting disorders, followed by behavior disorders and substance use disorders. Patterns of coexisting conditions were similar across countries.

Less than half of those with bipolar symptoms received mental health treatment. In low income countries, only 25 percent reported having contact with a mental health professional.

Significance
This study provides the first international prevalence data on bipolar disorder using reliable, standardized methodology. It highlights the international impact of bipolar disorder and the need for better recognition and treatment availability. The findings also support the notion that, given its multi-dimensional nature, bipolar disorder may be better characterized as a spectrum disorder.

In addition, because so many people note that their illness began in adolescence — a critical time of life for educational, occupational and social development — early detection, intervention, and possibly prevention of subsequent coexisting disorders and complications should be emphasized.

What’s Next
More research is needed to better define the thresholds and boundaries of bipolar symptoms. In addition, further research is needed to better understand why and how the disorder tends to originate in adolescence and persist into adulthood, and how it intersects with coexisting mental disorders.

Reference
Merikangas KR, Jin R, He J, Kessler RC, Lee S, Sampson NA, Viana MC, Andrade LH, Hu C, Karam EG, Mora MEM, Browne MO, Ono Y, Posada-Villa J, Sagar R, Zarkov Z. Prevalence and correlates of bipolar spectrum disorder in the World Mental Health Survey Initiative. Archives of General Psychiatry. March 2011. 68(3):241-251.

Holiday Season May Raise Anxiety For People With Social Phobia

Who’s always missing at your holiday party? Aunt Betty? Your reclusive neighbor? They may have declined your invitation because they are among the millions of Americans living with social phobia. For these people, the holiday season can spark such intense feelings of anxiety and dread that they avoid social gatherings altogether.

"A lot of people have anxiety in social situations, such as when meeting new people at a holiday party, but the fear is not severe and typically passes," said Una McCann, M.D., chief of the Unit on Anxiety Disorders at the National Institute of Mental Health (NIMH). "For people with social phobia, however, the fear of embarrassment in social situations is excessive, extremely intrusive and can have debilitating effects on personal and professional relationships."

People with social phobia have an overwhelming and disabling fear of disapproval in social situations. They recognize that their fear may be excessive or unreasonable, but are unable to overcome it. Symptoms of social phobia include blushing, sweating, trembling, rapid heartbeat, muscle tension, nausea or other stomach discomfort, lightheadedness, and other symptoms of anxiety.

To uncover the biological and behavioral causes of social phobia, NIMH is conducting and supporting research on this disorder.

"Without treatment, social phobia can be extremely disabling to a person’s work, social and family relationships. In extreme cases, a person may begin to avoid all social situations and become housebound," said Dr. McCann. "But the good news is that effective treatment for social phobia is available and can be tremendously helpful to people living with this disorder."

Effective treatments include medications, a specific form of psychotherapy called cognitive-behavioral therapy, or a combination. Medications include antidepressants called selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), as well as drugs known as high-potency benzodiazepenes. People with a specific form of social phobia, called performance phobia, can be helped with drugs called beta-blockers. Cognitive-behavioral therapy teaches patients to react differently to the situations and bodily sensations that trigger anxiety symptoms. For example, a type of cognitive-behavioral treatment known as "exposure therapy" involves helping patients become more comfortable with situations that frighten them by gradually increasing exposure to the situation.

At least 7.2 million Americans experience clinically significant phobias in a given year, many of them have social phobia. Phobias are persistent, irrational fears of certain objects or situations; they occur in several forms.

While social phobia is a fear of embarrassment, humiliation, or failure in a public setting, specific phobias involve fear of an object or situation. These include small animals, snakes, closed-in spaces, or flying in an airplane.

Phobias are one of five major anxiety disorders that are being addressed in a national education program conducted by NIMH. In addition to phobias, these disorders include:

Panic Disorder -- Repeated episodes of intense fear that strike often and without warning. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal distress, feelings of unreality, and fear of dying.

Obsessive-Compulsive Disorder -- Repeated, unwanted thoughts or compulsive behaviors that seem impossible to stop or control.

Post-Traumatic Stress Disorder – Persistent symptoms that occur after experiencing a traumatic event such as rape or other criminal assault, war, child abuse, natural disasters or crashes. Nightmares, flashbacks, numbing of emotions, depression and feeling angry, irritable, distracted and being easily startled are common.

Generalized Anxiety Disorder -- Constant, exaggerated worrisome thoughts and tension about everyday routine life events and activities, lasting at least six months. Almost always anticipating the worst even though there is little reason to expect it; accompanied by physical symptoms, such as fatigue, trembling, muscle tension, headache, or nausea. Marriage and Family Therapist Continuing Education Ca http://www.aspirace.com
For more information about social phobia and other anxiety disorders, see the NIMH Anxiety Disorders Web site at http://www.nimh.nih.gov /anxiety or call NIMH’s toll-free number, 1-88-88-ANXIETY, for a free packet of information. The National Institute of Mental Health is part of the National Institutes of Health (NIH), the Federal Government's primary agency for biomedical and behavioral research. NIH is a component of the U.S. Department of Health and Human Services.