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Friday, November 18, 2011

QD: News Every Day--Mental illness sparks creativity among sufferers and their families

People with schizophrenia or bipolar disorder and their first-degree relatives more frequently work in creative professions, suggesting some truth to the long-mythologized link between artists and madness. The way the link plays out along family lines suggests a genetic cause, researchers reported.

While smaller studies have looked specifically at small groups of creative populations such as artist's workshops and their rates of mental illness, researchers in Sweden conducted a population-based study of how often mental illness occurs among people and their relatives, and its association with creative and non-creative professions.

The researchers performed a nested, case- control study using longitudinal Swedish total population registers and compared it with occupational census data. Creative professions included visual artists such as photographers and non-visual artists such as performers and writers, as well as members of the scientific professions among university academics. Accountants and auditors acted as a control group.

Results appeared in The British Journal of Psychiatry. Overall, the registries reported 54,042 people (29,479 men and 24,563 women) with schizophrenia, 29,644 people (11,910 men and 17,734 women) with bipolar disorder and 217,771 people (84,352 men and 133,419 women) with unipolar depression.

Compared with the control group, those with schizophrenia demonstrated no difference in having a creative profession (odds ratio [OR]=0.98; 95% confidence interval [CI], 0.88 to 1.08) but were significantly less likely to be scientists (OR=0.63; 95% CI, 0.51 to 0.79), researchers reported. They were significantly more likely to be an artist, (OR=1.14; 95% CI, 1.01 to 1.28), mainly because of a trend in the visual arts (OR=1.30; 95% CI, 1.13 to 1.49).

Parents and siblings of people with schizophrenia were significantly more likely to hold a creative profession across all domains compared with the control group (parents OR=1.55; 95% CI, 1.43 to 1.67; siblings OR=1.36; 95% CI 1.26 to 1.48). Offspring were not more likely to be in a creative profession overall, but were more likely to be in the visual arts (OR=1.38; 95% CI 1.18 to 1.62), a finding that is in line with the individuals with schizophrenia, the authors noted.

Those with bipolar disorder were significantly overrepresented in creative professions compared with the control group (OR=1.35; 95% CI 1.22 to 1.48). There was an increased likelihood of both visual (OR=1.42; 95% CI 1.23 to 1.64) and non-visual (OR=1.44; 95% CI 1.20 to 1.73) artistic occupations, researchers reported. First-degree relatives of those with bipolar disorder were more likely than those in the control group to hold a creative profession in general, with higher odds ratios for scientific than artistic occupations.

Individuals with unipolar depression were not more likely to be involved in creative professions (OR=0.94; 95% CI, 0.90 to 0.99). Those with bipolar disorder and their first-degree relatives were not more likely to become auditors or accountants, and those with schizophrenia or unipolar depression and their first-degree relatives were significantly less likely to do so.

"This Swedish total population case-control study is several magnitudes larger than previous studies and demonstrates an increased likelihood for both people with schizophrenia and bipolar disorder, as well as for their respective relatives, to work in a creative occupation, compared with controls," the authors wrote.

They continued, "Even though the present study does not explain what mechanisms may underlie the observed association between mental disorder and creative occupations, it is noteworthy that the likelihood of creative occupations in relatives of those in the case group was highest among healthy first-degree relatives and this gradually decreased with increasing familial distance to these individuals. Additionally, there were no significant differences between the maternal and paternal half-siblings. These results hence suggest a genetic rather than environmental explanation."

The study did not control for the more open environment found in many creative professions, which might allow those with mental illnesses to function successfully, compared to the more structured, 9-to-5 atmosphere found in auditing and accounting careers. The study's lead author, Simon Kyaga, told ACP Internist "Generally traits associated with creative behavior are openness, non-conformity, contrarianism, sensitivity, etc. that are unlikely to go hand in hand with 9-to-5 atmosphere."

He continued, "Two important aspects of creativity are divergent thinking and motivation. It is likely that these aspects will be present to a differing degree in patients with different psychiatric disorders. Studies have for instance shown patients with schizophrenia being able to 'think outside of the box' or actually less restrained by common sense, while patients with bipolar disorder have been shown to be more ambitious than the general population."

An editorial commented that mental illness is counterintuitive to be linked with creative success because of symptoms, including impaired concentration, short-term memory deficits and impaired executive function.

But, the editorial noted, other symptoms boost the creative mind. Elevated mood and rapidity of thought often facilitate creativity. Mania and hypomania increase the types of thought important in creativity. Bipolar illness can lead to risk-taking, grandiosity, restlessness and discontent. Illness-induced introspection and a need to make meaning of or ameliorate suffering inspire imagination and creativity as well, the editorialist wrote.

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Members of the American College of Physicians contribute posts from their own sites to ACP Internist and ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

CasesBlog
Ves Dimov, MD, ACP Member, is an allergist/immunologist and Assistant Professor of Medicine and Pediatrics at the University of Chicago, where he evaluates and treats both pediatric and adult patients.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
ACP Member Mike Aref, MD, PhD, ACP Member, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, ACP Member, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Musing of an Internist
Justin Penn, MD, ACP Associate Member, attended medical school at the University of Washington School of Medicine and trained in internal medicine at the University of Rochester, where he is serving as Chief Resident.

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

White Coat Underground
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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