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Excellent school performance at age 16 and risk of adult bipolar disorder: national cohort study

  • James H. MacCabe (a1), Mats P. Lambe (a2), Sven Cnattingius (a2), Pak C. Sham (a1), Anthony S. David (a1), Abraham Reichenberg (a1), Robin M. Murray (a1) and Christina M. Hultman (a2)...
Abstract
Background

Anecdotal and biographical reports suggest that bipolar disorder may be associated with high IQ or creativity, but evidence for any such connection is weak.

Aims

To investigate possible associations between scholastic achievement and later bipolar disorder, using prospective data, in a whole-population cohort study.

Method

Using individual school grades from all individuals finishing compulsory schooling in Sweden between 1988 and 1997, we tested associations between scholastic achievement at age 15–16 and hospital admission for psychosis between ages 17 and 31, adjusting for potential confounders.

Results

Individuals with excellent school performance had a nearly fourfold increased risk of later bipolar disorder compared with those with average grades (hazard ratio HR = 3.79, 95% CI 2.11–6.82). This association appeared to be confined to males. Students with the poorest grades were also at moderately increased risk of bipolar disorder (HR = 1.86, 95% CI 1.06–3.28).

Conclusions

These findings provide support for the hypothesis that exceptional intellectual ability is associated with bipolar disorder.

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Copyright
Corresponding author
James H. MacCabe, Department of Psychiatry, Institute of Psychiatry, King's College London, London SE5 8AF, UK. Email: j.maccabe@iop.kcl.ac.uk
Footnotes
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J.H.M. was funded by a joint Department of Health/Medical Research Council Special Training Fellowship in Health of the Population Research (No. G106–1213). The Swedish Council for Working Life and Social Research (grant No. 2013/2002) supported the study.

Declaration of interest

None.

Footnotes
References
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Excellent school performance at age 16 and risk of adult bipolar disorder: national cohort study

  • James H. MacCabe (a1), Mats P. Lambe (a2), Sven Cnattingius (a2), Pak C. Sham (a1), Anthony S. David (a1), Abraham Reichenberg (a1), Robin M. Murray (a1) and Christina M. Hultman (a2)...
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eLetters

Extreme Performance and Bipolar Affective Disorder

Shweta Saraswat, ST3- Psychiatry
03 March 2010



Thank you for publishing such a beautiful paper. It has always been an interesting topic and I agree that evidence between high performance and Bipolar has not been strong in the previous studies.

This article provides a stronger base for the link between extreme performance and Bipolar Affective Disorder and it has a lot of strengths:

- Large sample and reliable source of data collection.

- Clear inclusion and exclusion criteria with an attempt to avoid the influence of most of the possible confounders on the results.

- Interesting findings in relation to performance, both excellent and poor, and Bipolar which is in contrast with the similar studies for Schizophrenia as clearly depicted from the graph (Fig 1)

Mean follow up time was 9.8years with mean age of 26.5years at the end of follow up. I understand that the data for this study was collected until the end of December 2003, which is quite good at this time. Having said that, I believe, it will be worthwhile to carry out a similar study on the same sample with a longer follow up and including Family History as it could have influenced the outcome.

We will wait for the next study from MacCabe et al with longer follow up in the coming next years. It has been my pleasure to read most of the articles based on this sample and different outcomes linking IQ/Performance/Creativity to Schizophrenia and Bipolar Affective Disorder.

Declaration of Interest: None

References:

1. MacCabe JH, Lambe MP, Cnattingius S, Torrang A, Bjork C, Sham PC, et al. Scholastic achievement at age 16 and risk of schizophrenia and other psychoses: a national cohort study. Psychol Med 2008; 38: 1133 –40.[Medline]

2. By Randall Parker at 2005 November 10 Brain Creativity.

3. Zammit S, Allebeck P, David AS, Dalman C, Hemmingsson T, Lundberg I, et al. A longitudinal study of premorbid IQ Score and risk of developing schizophrenia, bipolar disorder, severe depression, and other non-affective psychoses. Arch Gen Psychiatry 2004; 61: 354 –60

4. MacCabe JH, Koupil I, Leon DA. Lifetime reproductive output over two generations in patients with psychosis and their unaffected siblings: the Uppsala 1915–1929 Birth Cohort Multigenerational Study. Psychol Med 2009; 39: 1667 –76.[CrossRef][Medline]
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Conflict of interest: None Declared

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