Life events

Bipolar disorder usually begins in early adulthood and affects approximately 1% of the population. The cause of the disorder is largely unknown although hereditary factors play an important part, and major life events often precede the onset of the first episode of the disorder, and less obviously subsequent episodes. 

The development of coping skills is designed to help patients cope with life events, daily stressors, and managing painful affects. 

These data show that for three psychotic disorders (schizophrenia, bipolar disorder and unipolar depression) the genetic contribution is over 50% but for reactive depression (in response to a traumatic life event ) and tuberculosis, an infectious disease caused by a species of Mycobacterium, environmental factors account for over 90% of the variance. 

Stressful early life events, involving abuse or neglect, can have a life-long influence on the stress response, and lead to elevated levels of allostatic load for the lifespan. Overactivity of the stress hormone axis has been linked to prenatal stress or poor maternal care in rodent models, and this overactivity contributes to increased rates of brain and body aging [39]. 

Although clinical observation suggests that ulcer patients are adversely affected by stressful life events, controlled studies have failed to document a cause-and-effect relationship. 

Stressful life events often precede mood episodes and can increase recurrence rates and prolong time to recovery from mood episodes. 

Psychosocial or physical stressors that may precipitate an episode and strategies for coping with stressful life events / Limiting substances and drugs that can trigger mood episodes / Development of a crisis intervention plan Other nonpharmacologic approaches include ... 

Work or financial stress, major life events, interpersonal conflicts... 

Bums, V.E. et al., Life events, perceived stress and antibody response to influenza vaccination in young, healthy adults, J. Psychomat. Res., 55, 569, 2003. 

Three words come to mind when I recall my meeting with then-fifteen-year-old Alanna Ahern articulate, mature and delightful. This young woman clearly views difficult life events as challenges rather than problems. Suffering from asthma and allergies since birth could easily have resulted in poor self-esteem and a self-image associated with illness. Instead she has developed a picture of herself as a person who is powerful and effective, and one who overcomes adversity. 

The study of stressful life events is a nice example of the type of variable studied in the second domain of environmental measures mentioned previously. Psychologists have for years studied the influences of a wide variety of life events, family interaction patterns, etc., under the hypothesis that they were proximal causal variables with regard to a variety of psychological outcomes. The now discredited hypothesis of the refrigerator mother is a classic example. 

Hudgens, R. W. (1974). Personal catastrophe and depression A consideration of the subject with respect to medically ill adolescents, and a requiem for retrospective life-event studies. In B. S. Dohrenwend B. P. Do-hrenwend (Eds.), Stressful life events Their nature and effects (pp. 119-134). New York Wiley. 

Kendler, K. S., Neale, M., Kessler, R., Heath, A., Eaves, L. (1993). A twin study of recent life events and difficulties. Archives of General Psychiatry , 50, 789-796. 

Lichtenstein, P., Pedersen, N. L. (1995). Social relationships, stressful life events, and self-reported physical health Genetic and environmental influences. Psychology and Health, 10, 295—319. 

Moster, M. (1991) Stressful life events Genetic and environmental components and their relationship to affective symptomatology. Ph.D. Dissertation, University of Minnesota. 

Nevertheless, there is strong evidence that some mental illnesses are partly inherited. One prevailing theory is the two hit hypothesis. The first of these two hits is a genetic trait that leaves one vulnerable to the illness. The second hit is some stressful life event or environmental insult (e.g., infection or toxic exposure) that triggers the onset of the illness in the vulnerable individual. 

Female gender Prior history of depression Family history of depression Active substance abuse Recent stressful life event Poor social supports Previous suicide attempt Postpartum period Chronic medical illness... 

Brief Psychotic Disorder. This disorder occurs in the immediate aftermath of a markedly stressful event (or series of events). It is marked by emotional turmoil in conjunction with one or more psychotic symptoms such as delusions, hallucinations, disorganization, or catatonia. On presentation, a brief psychotic disorder can be difficult to distinguish from psychotic depression or mania. The presence of a precipitating stressor is not always helpful, because episodes of psychotic mood disorders (especially early in the course of illness) are also commonly triggered by stressful life events. Careful evaluation for symptoms of emerging depression or... 

Trauma is unfortunately and remarkably common in the modern world. At least 40% of adults in the United States have been exposed to a traumatic life event. The prevalence of PTSD is also considerably higher than typically assumed with an overall lifetime rate in the United States of approximately 8%. 

In view of the fact that at least 40% of American adults have experienced a traumatic life event, screening for trauma should yield a large number of patients with PTSD. Screening for trauma is typically a straightforward exercise, though it should obviously be conducted with sensitivity. 

The diagnosis can be clarified by collecting a retrospective history both from the patient and from a collateral source, such as a friend or family member. A history of bipolar disorder will include episodes of illness that typically arise spontaneously, last for days or weeks, and often result in a decreased need for sleep during times of hypomania or mania. The periods of affective lability in the patient with a Cluster B personality generally do not arise in this spontaneous fashion but are instead triggered by a stressful life event. In addition, they seldom last as long as the typical... 

The risks of d)dng in any particular year (Table 15.1) from a variety of causes gives some idea of the relative risks of a variety of life events, but in the case of drugs it is not only death that is a concern it is the possibility of survival with long-term or permanent disability. The mortality risks from a number of diseases (Table 15.2) make useful comparisons when considering the relative risks of taking medication. Similar tabulations of the risks associated with life events (Table 15.3) in the United States shows the estimated effects of certain common activities when continued for defined periods of time. 

It is important to point out that deletion of individual genes is not providing animal models for certain behavioral pathologies that are caused by a manifold of minor changes in a series of so-called susceptibility genes. To make a clinical phenotype overt, a number of exogenous factors, e.g., stressful life events and a susceptible genetic endowment, need to interact in at least most of the cases... 

---