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03-02-2010 | Mental health | Article

Excellent school performance warns of bipolar disorder risk


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MedWire News: Students who gain higher than average grades at school are at increased risk for developing bipolar disorder, study findings suggest.

The results support the hypothesis that “exceptional intellectual ability is associated with bipolar disorder,” say James MacCabe, from King’s College London in the UK, and colleagues.

They report that individuals with excellent scholastic achievement, defined as grades of two or more standard deviations above the mean, at age 15–16 years old were almost four times more likely to develop bipolar disorder between the ages of 17 and 31 years than individuals with average grades.

Students with the poorest grades, at two or more standard deviations below the mean, were also at increased risk for bipolar disorder compared with average-grade students, but the risk was only moderately increased at almost two fold.

The study involved 713,596 individuals who finished compulsory schooling in Sweden between 1988 and 1997. The students’ scholastic achievement was assessed alongside hospital admission for bipolar disorder.

The researchers note in the British Journal of Psychiatry that the increased risk for bipolar disorder associated with scholastic achievement remained after accounting for factors such as parental education and socioeconomic status.

Interestingly, they also found that the association between A grades and a heightened risk for bipolar disorder was particularly evident for pupils achieving this grade in subjects such as humanities and Swedish and Music.

“This provides support for the biographic literature which consistently finds associations between linguistic and musical creativity and bipolar disorder,” say MacCabe et al.

They discuss possible explanations for the associations between scholastic achievement and bipolar disorder. Hypomania may be one factor, as it is thought to enhance access to vocabulary, memory and other cognitive resources, helping individuals link successive ideas in innovative ways. It also gives people extraordinary stamina and can considerably enhance concentration. Also, people with bipolar disorder often show exaggerated emotional responses, which may facilitate their talent in art, music, and literature.

Conversely, a predominance of depressive symptoms may explain why individuals with low scholastic achievement might be at increased risk for bipolar disorder, the team suggests.

The study indicated that the association between high grades and risk for later bipolar disorder may be stronger in men than women, but this association did not reach statistical significance and needs further study.

MacCabe makes the important point that, “although having A grades increases your chance of bipolar disorder in later life, we should remember that the majority of people with A grades enjoy good mental health.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Lucy Piper

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