MHM Magazine

Introduction Bipolar disorder is a prevalent psychiatric disorder and presents with high rates of recurrences, relapses, comorbidities, co- occurring pathology and functional impairments. Genetic and environmental factors are assumed to be present in the onset and course of bipolar disorder. In this regard bipolar disorder is considered one of the most genetically mediated disorders. Although there are high concordance rates of bipolar disorder in identical twins, the concordance rates are 50-60%, leaving room for other influences such as psychosocial stress. Bipolar disorder tends to run in families, but approximately 50% of patients with bipolar disorder don’t have a family history of bipolar disorder. It appears that the role of the environment and psychosocial stress are markedly underestimated. It’s therefore important to explore the role of psychosocial stressors in the onset, development, and course of bipolar disorder. Psychosocial Stress Psychosocial stress plays an important role at various junctures in the onset and course of bipolar disorder. Furthermore, an array of psychosocial stressors may be relevant not only to the onset, recurrence, and progression of mood episodes, but the high prevalence of substance use disorder in bipolar disorder as well. Various studies have indicated that patients with bipolar disorder reports the presence of stressful life events prior to episodes of depressed and manic mood dysregulation compared to euthymic mood in patients and control groups. Psychosocial stress related to achieving goals, the disruption of social rhythms, high expressed emotions and seasonal factors impact on bipolar disorder negatively. Psychosocial Stress and Relapse Psychosocial stress independent of bipolar psychopathology occurring within one year prior to bipolar mood dysregulation resulted in faster relapses and slower recovery. In this regard there is a bidirectional influence, namely that psychosocial stress impacts on the course of bipolar disorder and that mood dysregulation generally leads to psychosocial stress especially within relationships with significant others and work colleagues. It is interesting to note that patients with bipolar disorder are exposed to significantly more stressful psychosocial life events than the physically ill. Data shows that patients with bipolar disorder experience an increased number as well as higher intensity of psychosocial stress events prior to an acute mood episode. Childhood and Trauma Traumatic life events in childhood causes a dysregulation of the inflammatory immune system and may be a risk factor for vulnerability to psychiatric and physical illnesses. Studies have shown that patients with bipolar disorder who had experienced early severe environmental adversity, such as physical or sexual abuse as children, had an earlier age of onset of bipolar disorder compared with non-abused patients, and presented with an overall more serious, complicated, and treatment-resistant course once bipolar disorder manifested. These patients also present with faster cycling frequencies (four By Gerhard Grundling Clinical Psychologist in Private Practice Benoni PSYCOSOCIAL STRESS AND RELAPSE IN BIPOLAR DISORDER Issue 1 | 2024 | MENTAL HEALTH MATTERS | 15 MHM