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Bipolar Spectrum Disorders and Intelligence

Bipolar Disorder is a mood disorder characterized by periods of elevated mood known as mania or hypomania and periods of depression. There is significant anecdotal and biographical evidence that suggests that sufferers of bipolar disorder are more creative and posses higher IQs than that of the average population[1]. The concept of a relationship between creativity and mental illness dates back to ancient Greece were philosophers like Plato and Socrates described madness as a gift from heaven that enabled great artistic and intellectual achievement[2]. However, current research has found both evidence linking creativity, IQ and manic depression as well as evidence suggesting that manic depression is more often associated with lower IQs[3]

Bipolar disorder is relatively rare affecting only 2.5% of the population. The uncommon nature of the disorder and rarity of high IQ makes it difficult to have a large enough sample to be able to properly assess the relationship between very bright individuals and bipolar disorder. Nevertheless, one study using individual compulsory school grades of Swedish pupils between the ages of 15 and 16 found that individuals with excellent school performance had a nearly four times increased rate to develop a variation of bipolar disorder later in life than those with average grades[4]. The same study also found that students with lowest grades were at a moderately increased risk of developing bipolar disorder with nearly a twofold increased compared to pupils with average grades[5]. Another famous study suggesting a relationship between bipolar and intelligence comes from New Zealand, were 1,037 males and females representative members of the 1972-1973 birth cohort of Dunedin were followed until the age of 32 and assessed for intelligence for IQ using the WISC-R IQ at ages 7, 9,11 and the DSM for mental health disorders at age 18, 21, 26 and 32[6]. Findings from the study suggest that lower childhood IQ were associated with an increased risk of developing schizophrenia spectrum disorder, adult depression, and adult anxiety; whereas, higher childhood IQ predicted a higher rate of mania[7]. It is important to note however, that this study only included eight cases of mania, which is too few to draw any significant conclusions[8].

Although these studies imply a relationship between very high intelligence and bipolar disorder, there is also significant amount of controversy regarding this topic. Mental health illnesses such as bipolar disorder are characterized by self-destructive behavior and often associated with extensive periods of distress in person’s life such as irregular sleep patterns, unhealthy lifestyles, financial stress, alcohol and substance abuse[9]. Leading theories of intelligence suggest that higher IQ is associated with higher financial stability, higher levels of conscientiousness and higher overall well-being[10]. One possible explanation to this apparent paradox is that bipolar disorder is often found in conjunction to other mental health disorders that may counteract any positive relationship to intelligence such as schizophrenia spectrum disorders, personality disorders, and attention deficit hyperactivity disorder[11]. In the largest study yet published analyzing the relationship between bipolar disorder and intelligence, Edinburgh University researchers looked at the link between intelligence and bipolar disorder of over 1 million Swedish men during a mean follow-up period of 22.6 years[12]. Risk of hospitalization for bipolar disorder with comorbidity to other mental health illnesses decreased in a linear pattern with an increase in intelligence[13]. However, when researchers restricted the analysis to men without any psychiatric comorbidity the relationship between bipolar disorder and intelligence followed a J-curve. These findings suggest that men of extremely high intelligence are at a higher risk of experiencing bipolar in its purest form[14].

Additional support to a link between intelligence and bipolar disorder comes from biographical and anecdotal evidence, and primarily focus on the relationship between creativity and bipolar disorder. Doctor Kay Redfield Jamison has been a prolific writer on the subject publishing several articles and an extensive book analyzing the relationship between the artistic temperament and mood disorders[15]. Although a link between bipolar disorder and creativity has been established, there is no confirming evidence suggesting any significant relationship between creativity and intelligence[16].


Schizophrenia and Intelligence

Schizophrenia is chronic and disabling mental illness that is characterized by abnormal behavior, psychotic episodes and inability to recognize between reality and false beliefs. Even though schizophrenia can severely handicap its sufferers, there has been a great interest between the relationship of this disorder and intelligence. Much of the interest in the relationship of intelligence and schizophrenia steams from the perceived association between schizophrenia and creativity, and posthumous research of famous intellectuals that may have suffered from the disorder. This connection between schizophrenia and intelligence has been widespread partly due the misattribution of schizophrenia to individuals that instead have suffered from bipolar disorder[17] and the popularization of stories of bright schizophrenic individuals such as that of Nobel Laureate, John Nash in the film A Beautiful Mind[18].

Studies analyzing the correlation between schizophrenia and intelligence overwhelmingly suggest that schizophrenia is linked to lower intelligence and decreased cognitive functioning[19]. Since the manifestation of schizophrenia often includes a variety of cognitive declines, current research focuses on understanding the relationship between premorbid IQ and schizophrenia[20]. In the most comprehensive meta-analysis published since the groundbreaking study by Aylward et al in 1984, researchers at Harvard University found a medium-sized deficit in global cognition prior to the onset of schizophrenia[21]. The mean premorbid IQ estimate for schizophrenia samples was 94.7 or 0.35 standard deviations below the mean, and at therefore at the lower end of the average IQ range[22]. Additionally, all studies containing reliable premorbid and post-onset IQ estimates found significant decline in IQ from premorbid to post-onset in testing of schizophrenia samples [23]. However, while the decline in IQ over the course of the onset of schizophrenia is consistent with theory[24], some alternative explanations may include the clinical state of the patients or side effects of antipsychotic medications [25].

Newest research in the relationship between IQ and schizophrenia, not only suggests that there is no relationship between higher IQ and schizophrenia, but that a high IQ may instead be protective against the illness[26]. Researchers from the Virginia Commonwealth University analyzed IQ data from over 1.2 million Swedish males born between 1951 and 1975 at ages 18 to 20 years old to investigate future risk of schizophrenia as a function of IQ scores. The researchers created stratified models using pairs of relatives to adjust for family cluster and later applied regression models to examine the interaction between IQ and genetic predisposition to schizophrenia. Results from the research suggest that subjects with low IQ were more sensitive to the effect of genetic liability to schizophrenia than those with high IQ and that the relationship between IQ and schizophrenia is not a consequence of shared genetic or familial-environmental risk factors, but may instead be causal[27][28]


Substance Abuse and Intelligence

Substance abuse is a patterned use of drug consumption in which a person uses substances in amounts or with methods that are harmful to themselves or to others. Substance abuse is commonly associated with a range of maladaptive behaviors and social issues that are in turn often related with criminal behavior, lower social economic status and presumably lower IQ. However, research in the relationship between IQ and substance abuse suggests strong links between higher intelligence, higher alcohol consumption and drug experimentation.


References

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  1. ^ Mientka, Matthew. "Why Smarter People Are More Likely To Be Mentally Ill". Medical Daily. Retrieved 7 April 2015.
  2. ^ Plato (1974). Phaedrus. p. 46-47.
  3. ^ Gale, C R; Batty, G D; McIntosh, A M; Porteous, D J; Deary, I J; Rasmussen, F (3 April 2012). "Is bipolar disorder more common in highly intelligent people? A cohort study of a million men". Molecular Psychiatry. 18 (2): 190–194. doi:10.1038/mp.2012.26.
  4. ^ MacCabe, J. H.; Lambe, M. P.; Cnattingius, S.; Sham, P. C.; David, A. S.; Reichenberg, A.; Murray, R. M.; Hultman, C. M. (29 January 2010). "Excellent school performance at age 16 and risk of adult bipolar disorder: national cohort study". The British Journal of Psychiatry. 196 (2): 109–115. doi:10.1192/bjp.bp.108.060368.
  5. ^ MacCabe, J. H.; Lambe, M. P.; Cnattingius, S.; Sham, P. C.; David, A. S.; Reichenberg, A.; Murray, R. M.; Hultman, C. M. (29 January 2010). "Excellent school performance at age 16 and risk of adult bipolar disorder: national cohort study". The British Journal of Psychiatry. 196 (2): 109–115. doi:10.1192/bjp.bp.108.060368.
  6. ^ Koenen, Karestan C.; Moffitt, Terrie E.; Roberts, Andrea L.; Martin, Laurie T.; Kubzansky, Laura; Harrington, HonaLee; Poulton, Richie; Caspi, Avshalom (January 2009). "Childhood IQ and Adult Mental Disorders: A Test of the Cognitive Reserve Hypothesis". American Journal of Psychiatry. 166 (1): 50–57. doi:10.1176/appi.ajp.2008.08030343.
  7. ^ Koenen, Karestan C.; Moffitt, Terrie E.; Roberts, Andrea L.; Martin, Laurie T.; Kubzansky, Laura; Harrington, HonaLee; Poulton, Richie; Caspi, Avshalom (January 2009). "Childhood IQ and Adult Mental Disorders: A Test of the Cognitive Reserve Hypothesis". American Journal of Psychiatry. 166 (1): 50–57. doi:10.1176/appi.ajp.2008.08030343.
  8. ^ Koenen, Karestan C.; Moffitt, Terrie E.; Roberts, Andrea L.; Martin, Laurie T.; Kubzansky, Laura; Harrington, HonaLee; Poulton, Richie; Caspi, Avshalom (January 2009). "Childhood IQ and Adult Mental Disorders: A Test of the Cognitive Reserve Hypothesis". American Journal of Psychiatry. 166 (1): 50–57. doi:10.1176/appi.ajp.2008.08030343.
  9. ^ Jamison, Frederick K. Goodwin, Kay Redfield (2007). Manic-depressive illness : bipolar disorders and recurrent depression (2nd [rev. and exp.] ed. ed.). New York [etc.]: Oxford University Press. p. 381. ISBN 9780195135794. {{cite book}}: |edition= has extra text (help)CS1 maint: multiple names: authors list (link)
  10. ^ Ali, A.; Ambler, G.; Strydom, A.; Rai, D.; Cooper, C.; McManus, S.; Weich, S.; Meltzer, H.; Dein, S.; Hassiotis, A. (24 September 2012). "The relationship between happiness and intelligent quotient: the contribution of socio-economic and clinical factors". Psychological Medicine. 43 (06): 1303–1312. doi:10.1017/S0033291712002139.
  11. ^ Gale, C R; Batty, G D; McIntosh, A M; Porteous, D J; Deary, I J; Rasmussen, F (3 April 2012). "Is bipolar disorder more common in highly intelligent people? A cohort study of a million men". Molecular Psychiatry. 18 (2): 190–194. doi:10.1038/mp.2012.26.
  12. ^ Gale, C R; Batty, G D; McIntosh, A M; Porteous, D J; Deary, I J; Rasmussen, F (3 April 2012). "Is bipolar disorder more common in highly intelligent people? A cohort study of a million men". Molecular Psychiatry. 18 (2): 190–194. doi:10.1038/mp.2012.26.
  13. ^ Gale, C R; Batty, G D; McIntosh, A M; Porteous, D J; Deary, I J; Rasmussen, F (3 April 2012). "Is bipolar disorder more common in highly intelligent people? A cohort study of a million men". Molecular Psychiatry. 18 (2): 190–194. doi:10.1038/mp.2012.26.
  14. ^ Gale, C R; Batty, G D; McIntosh, A M; Porteous, D J; Deary, I J; Rasmussen, F (3 April 2012). "Is bipolar disorder more common in highly intelligent people? A cohort study of a million men". Molecular Psychiatry. 18 (2): 190–194. doi:10.1038/mp.2012.26.
  15. ^ Jamison, Kay Redfield (1996). Touched with fire : manic-depressive illness and the artistic temperament (1st Free Press Paperback ed. ed.). New York: Free Press Paperbacks, Published by Simon & Schuster. ISBN 9780684831831. {{cite book}}: |edition= has extra text (help)
  16. ^ Jauk, Emanuel; Benedek, Mathias; Dunst, Beate; Neubauer, Aljoscha C. (July 2013). "The relationship between intelligence and creativity: New support for the threshold hypothesis by means of empirical breakpoint detection". Intelligence. 41 (4): 212–221. doi:10.1016/j.intell.2013.03.003.
  17. ^ Post, F (July 1994). "Creativity and psychopathology. A study of 291 world-famous men". The British journal of psychiatry : the journal of mental science. 165 (1): 22–34. PMID 7953036.
  18. ^ Cosgrove, Victoria E; Suppes, Trisha (2013). "Informing DSM-5: biological boundaries between bipolar I disorder, schizoaffective disorder, and schizophrenia". BMC Medicine. 11 (1): 127. doi:10.1186/1741-7015-11-127.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  19. ^ Aylward, E; Walker, E; Bettes, B (1984). "Intelligence in schizophrenia: meta-analysis of the research". Schizophrenia bulletin. 10 (3): 430–59. PMID 6382590.
  20. ^ Kremen, William S.; Vinogradov, Sophia; Poole, John H.; Schaefer, Catherine A.; Deicken, Raymond F.; Factor-Litvak, Pam; Brown, Alan S. (May 2010). "Cognitive decline in schizophrenia from childhood to midlife: A 33-year longitudinal birth cohort study". Schizophrenia Research. 118 (1–3): 1–5. doi:10.1016/j.schres.2010.01.009.
  21. ^ Woodberry, Kristen A.; Giuliano, Anthony J.; Seidman, Larry J. (May 2008). "Premorbid IQ in Schizophrenia: A Meta-Analytic Review". American Journal of Psychiatry. 165 (5): 579–587. doi:10.1176/appi.ajp.2008.07081242.
  22. ^ Woodberry, Kristen A.; Giuliano, Anthony J.; Seidman, Larry J. (May 2008). "Premorbid IQ in Schizophrenia: A Meta-Analytic Review". American Journal of Psychiatry. 165 (5): 579–587. doi:10.1176/appi.ajp.2008.07081242.
  23. ^ Woodberry, Kristen A.; Giuliano, Anthony J.; Seidman, Larry J. (May 2008). "Premorbid IQ in Schizophrenia: A Meta-Analytic Review". American Journal of Psychiatry. 165 (5): 579–587. doi:10.1176/appi.ajp.2008.07081242.
  24. ^ Heinrichs, RW; Zakzanis, KK (July 1998). "Neurocognitive deficit in schizophrenia: a quantitative review of the evidence". Neuropsychology. 12 (3): 426–45. PMID 9673998.
  25. ^ Woodberry, Kristen A.; Giuliano, Anthony J.; Seidman, Larry J. (May 2008). "Premorbid IQ in Schizophrenia: A Meta-Analytic Review". American Journal of Psychiatry. 165 (5): 579–587. doi:10.1176/appi.ajp.2008.07081242.
  26. ^ Kendler, Kenneth S.; Ohlsson, Henrik; Sundquist, Jan; Sundquist, Kristina (March 2015). "IQ and Schizophrenia in a Swedish National Sample: Their Causal Relationship and the Interaction of IQ With Genetic Risk". American Journal of Psychiatry. 172 (3): 259–265. doi:10.1176/appi.ajp.2014.14040516.
  27. ^ McGrath, J J; Wray, N R; Pedersen, C B; Mortensen, P B; Greve, A N; Petersen, L (22 July 2014). "The association between family history of mental disorders and general cognitive ability". Translational Psychiatry. 4 (7): e412. doi:10.1038/tp.2014.60.
  28. ^ Kendler, Kenneth S.; Ohlsson, Henrik; Sundquist, Jan; Sundquist, Kristina (March 2015). "IQ and Schizophrenia in a Swedish National Sample: Their Causal Relationship and the Interaction of IQ With Genetic Risk". American Journal of Psychiatry. 172 (3): 259–265. doi:10.1176/appi.ajp.2014.14040516.
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