Creativity and mental disorder: family study of 300,000 people with severe mental disorder

The role of bipolar disorder and family wealth in choosing creative occupations

Research in psychology and medicine has linked mental health disorders, and particularly bipolar disorder (BD), to employment in creative professions. Little is known, however, about the mechanisms for this link, which could be due to biology (primarily through a person's genes) or environmental (through socioeconomic status). Using administrative data on mental health diagnoses and occupations for the population of Denmark, we find that people with BD are more likely to be musicians than the population, but less likely to hold other creative jobs. Yet, we also show that healthy siblings of people with BD are significantly more likely to work in creative professions. Notably, people from wealthy families are consistently more likely to work in creative professions, and access to family wealth amplifies the likelihood that siblings of people with BD pursue creative occupations. Nevertheless, family wealth explains only a small share of the correlation between BD and creative employment.

Creative therapy in health and disease: Inner vision

Can we better understand the unique mechanisms of de novo abilities in light of our current knowledge of the psychological and neuroscientific literature on creativity? This review outlines the state-of-the-art in the neuroscience of creativity and points out crucial aspects that still demand further exploration, such as brain plasticity. The progressive development of current neuroscience research on creativity presents a multitude of prospects and potentials for furnishing efficacious therapy in the context of health and illness. Therefore, we discuss directions for future studies, identifying a focus on pinpointing the neglected beneficial practices for creative therapy. We emphasize the neglected neuroscience perspective of creativity on health and disease and how creative therapy could offer limitless possibilities to improve our well-being and give hope to patients with neurodegenerative diseases to compensate for their brain injuries and cognitive impairments by expressing their hidden creativity.

Functional Alterations in Patients with Bipolar Disorder and Their Unaffected First-Degree Relatives: Insight from Genetic, Epidemiological, and Neuroimaging Data

Bipolar disorder (BD) profoundly affects cognitive and psychosocial functioning, leading to a significant illness burden on patients and their families. Genetic factors are predominant in the onset of bipolar disorder and functional impairments. This disorder exhibits a strong family aggregation, with heritability estimates reaching up to 80%. Individuals with BD often experience impaired functioning, especially in significant areas such as physical performance, sleep, cognition, interpersonal interactions, socioeconomic status, family and marital relationships, work and school performance, well-being, and life expectancy. However, patients with different subtypes exhibit significant heterogeneity in social functioning, cognition, and creativity levels. There are notable differences in psychosocial and cognitive function in their unaffected first-degree relatives (UFR) who do not suffer but may carry susceptibility genes compared to healthy control (HC) without a family history. The observations indicate common genetic structures between BD patients and their UFR, which results in varying degrees of functional abnormalities. Therefore, this article mainly provides evidence on cognition, creativity, and psychosocial functioning in patients with BD and their UFR to provide a more comprehensive understanding of this critical topic in the field of BD. By integrating various findings, including clinical data and neuroimaging studies, our article aims to provide insights and valuable information for a deeper exploration of the pathogenesis of BD and the development of more targeted therapeutic strategies in the future.

Navigating the multiple dimensions of the creativity-mental disorder link: a Convergence Mental Health perspective

BACKGROUND

This paper discusses a paradox in mental health. It manifests as a relationship between adverse "bad" effects (suffering, clinical costs, loss of productivity) in individuals and populations and advantageous "good" aspects of mental disorders. These beneficial aspects (scientific, artistic and political accomplishments) emanate at the societal level through the frequently unprecedented creativity of people suffering from mental disorders and their relatives. Such gains can contribute to societal innovation and problem-solving. Especially in times of accelerated social-ecological change, approaches are needed that facilitate best-possible mental health care but also recognize creative ideas conducive to beneficial clinical and social-ecological innovations as soon as possible.

DISCUSSION

This paper emphasizes the need to account for creativity as a crucial component in evolving mental health systems and societies. It highlights the need for wide-ranging approaches and discusses how research targeting multiple facets (e.g., brain level, cognitive neuroscience, psychiatry, neurology, socio-cultural, economic and other factors) might further our understanding of the creativity-mental disorder link and its importance for innovating mental health systems and societies.

CONCLUSION

Our discussion clarifies that considerable research will be needed to obtain a better understanding of how creativity associated with mental disorders may help to create more sustainable societies on a fast-changing planet through innovative ideas. Given the current-state-of-the-art of research and healthcare management, our discussion is currently speculative. However, it provides a basis for how pros and cons might be studied in the future through transdisciplinary research and collaborations across sectors of society.

Psychotic and autistic traits among magicians and their relationship with creative beliefs

BACKGROUND

There is a common perception that creativity is associated with psychopathology. Previous studies have shown that members of creative groups such as comedians, artists and scientists scores higher than the norm on psychotic traits, and scientists in STEM (science, technology, engineering and mathematics) fields score highly on autistic traits.

AIMS

To test whether magicians, a creative group that has not been studied before, also score highly on psychopathological traits and autism, and to test the associations of creative self-efficacy and creative identity with schizotypal and autistic traits among magicians.

METHOD

A sample of 195 magicians and 233 people from the general population completed measures of schizotypal traits (Oxford-Liverpool Inventory of Feelings and Experiences) and autism (Abridged Version of the Autism-Spectrum Quotient), as well as the Short Scale of Creative Self. Magicians were also compared with other creative groups with respect to schizotypal traits, based on previously published data.

RESULTS

Magicians scored lower than the general population sample on three of the four schizophrenia measures (cognitive disorganisation, introvertive anhedonia and impulsive nonconformity) but did not differ with respect to unusual experiences or autism scores. Magicians scored higher on creative self-efficacy and creative personal identity than the general sample. Magicians' scores on schizotypal traits were largely lower than those of other creative groups. Originality of magic was positively correlated with unusual experiences (r = 0.208), creative self-efficacy (r = 0.251) and creative identity (r = 0.362).

CONCLUSIONS

This is the first study to show a creative group with lower scores than norms on psychotic traits. The results highlight the unique characteristics of magicians and the possible myriad associations between creativity and mental disorders among creative groups.

Creative writing as a means to recover from early psychosis- Experiences from a group intervention

BACKGROUND

In this paper, we explore the subjective experiences of a group intervention in creative writing (CW) for young adults being treated for psychosis.

METHOD

A qualitative and exploratory design was applied. Five out of eight patients who were offered a course in CW with two-hour weekly sessions for 12 weeks took part in this study. The five participants who followed through were interviewed after project termination. Systematic text condensation was applied to the transcribed interviews.

RESULTS

The analysis revealed three overarching themes: a) the group was valued as a creative community, b) there was safety in the structured yet flexible framing of the course, c) the participants experienced creative freedom that enabled a feeling of mastery.

CONCLUSION

CW was well conceived. The feelings of connectedness and mastery were prominent. The participants experienced growth on several levels. Our findings support previous work on arts therapy as a means to recovery.

Risk of suicide and self-harm in university students entering different university programs - a national register-based cohort study in Sweden

PURPOSE

It is not known whether the elevated suicide risk in certain occupations, such as health care professionals, is partly attributable to a selection of individuals with prior vulnerability. We aimed to determine the risk of suicide and self-harm already in students entering different university programs.

METHODS

We used national registers to identify 621,218 Swedish residents aged 18-39 years with registration for a university program 1993-2013. Outcomes were suicide and self-harm within three years. We applied logistic regression analyses to calculate odds ratios (OR) and 95% confidence intervals (CI) of risk of suicide and self-harm, with the Education program category as a reference. Results were adjusted for sex, age, time period and for history of hospitalization due to mental disorder or self-harm, as a measure of previous vulnerability. In the second step, we stratified results by sex.

RESULTS

There was a higher risk of suicide (OR 2.4) in female nursing students and natural science students (OR 4.2) and of self-harm in female and male Nursing/Health care students (OR range 1.2 -1.7). Subcategorization into nursing students only strengthened the association with self-harm for both sexes. Prior vulnerability did not fully explain the increased risk.

CONCLUSION

The elevated risk of suicide in nursing and health care occupations partly has its onset in vulnerability factors present before or emerging during university studies. Increased efforts in identifying and treating mental disorders and preventing self-harm in university students could be an important step in preventing future suicides.

Is an elevated family-genetic risk for major psychiatric disorders specific to creative occupations?

BACKGROUND

Despite a large descriptive literature linking creativity and risk for psychiatric illness, the magnitude and specificity of this relationship remain controversial.

METHODS

We examined, in 1 137 354 native Swedes with one of 59 3-digit official and objective occupational codes in managerial and educated classes, their familial genetic risk score (FGRS) for ten major disorders, calculated from 1st through 5th degree relatives. Mean FGRS across disorders were calculated, in 3- and 4-digit occupational groups, and then controlled for those whose disorder onset preceded occupational choice. Using sequential analyses, p values were evaluated using Bonferroni correction.

RESULTS

3-digit professions considered to reflect creativity (e.g. 'artists' and 'authors') were among those with statistically significant elevations of FGRS. Among more specific 4-digit codes, visual artists, actors, and authors stood out with elevated genetic risks, highest for major depression (MD), anxiety disorders (AD) and OCD, more modest for bipolar disorders (BD) and schizophrenia and, for authors, for drug and alcohol use disorders. However, equal or greater elevations in FGRS across disorders were seen for religious (e.g. ministers), helping (e.g. psychologists, social workers), and teaching/academic occupations (e.g. professors). The potential pathway from FGRS → Disorder → Occupation accounts for a modest proportion of the signal, largely for MD and AD risk.

CONCLUSIONS

While traditional creative occupations were associated with elevated genetic risk for a range of psychiatric disorders, this association was not unique, as similar, or greater elevations were seen for religious, helping and teaching professions and was stronger for internalizing than psychotic disorders.

The Manic Idea Creator? A Review and Meta-Analysis of the Relationship between Bipolar Disorder and Creative Cognitive Potential

Even though a relationship between psychopathology and creativity has been postulated since the time of ancient Greece, systematic meta-analyses on this topic are still scarce. Thus, the meta-analysis described here can be considered the first to date that specifically focuses on the relationship between creative potential, as measured by divergent thinking, and bipolar disorder, as opposed to psychopathology in general. An extensive literature search of 4670 screened hits identified 13 suitable studies, including a total of 42 effect sizes and 1857 participants. The random-effects model showed an overall significant, positive, yet diminutively small effect (d = 0.11, 95% CI: [0.002, 0.209], p = 0.045) between divergent thinking and bipolar disorder. A handful of moderators were examined, which revealed a significant moderating effect for bipolar status, as either euthymic (d = 0.14, p = 0.043), subclinical (d = 0.17, p = 0.001), manic (d = 0.25, p = 0.097), or depressed (d = -0.51, p < 0.001). However, moderator analyses should be treated with caution because of the observed confounding of moderators. Finally, none of the employed methods for publication-bias detection revealed any evidence for publication bias. We discuss further results, especially regarding the differences between subclinical and clinical samples.

Analysis of Educational Attainment in a Mexican Psychiatric Patient Population with Bipolar or Psychotic Disorders

Schizophrenia has been associated with premorbid poor educational performance and low educational attainment (EA). However, some studies have found positive associations between psychotic disorders and excellent scholastic performance. In the present study, we examined the association between EA and several clinical and nonclinical characteristics in psychiatric patients diagnosed with psychotic or bipolar disorders. Data were obtained from the files of 1132 patients who entered a major Mexico City psychiatric hospital during the years 2009-2010 for the treatment of psychotic symptoms and who were subsequently diagnosed with schizophrenia, bipolar, schizoaffective, or another psychotic disorder. Chi-squared tests, t-tests, and Cox regression analysis were applied to explore associations between EA and factors including gender, familial history of mental illness, premorbid personality characteristics, age of symptom onset, diagnosis, civil status, and current employment. Family history of mental illness decreased the hazard of having lower EA (B = -0.137, p = 0.025, ExpB = 0.872, 95% CI = 0.774-0.983), while a schizophrenia diagnosis independently increased it (B = 0.201, p = 0.004, ExpB = 1.223, 95% CI = 1.068-1.401). In male patients (but not in females), family history of mental illness was significantly associated with higher EA, while in female patients, premorbid schizoid-like personality characteristics were associated with lower EA. For both genders, lower EA was associated with having more children and being employed in manual labor, while higher EA was associated with professional employment. Conclusions: Compared with bipolar disorder, a schizophrenia diagnosis is associated with lower EA; however, familial history of mental illness and premorbid schizoid-like characteristics independently favor higher and lower EA in males and females, respectively. Since lower EA is generally associated with a lower economic status, special preventative attention should be given to students at high risk for schizophrenia, particularly those displaying a schizoid-like personality.

Perceived public stigma and perceived public exposure by persons living with bipolar disorder: A qualitative study

BACKGROUND

Stigma impact the lives of persons living with bipolar disorder.

AIM

The aim of this study was to explore how perceived public stigma is described by people living with bipolar disorder and examine the links between perceived public stigma and perceived public exposure.

METHOD

Face-to-face in-depth interviews were conducted in a purposive sample of euthymic people living with bipolar disorder recruited in a mood disorder ambulatory unit.

RESULTS

Thematic analysis of the transcript yielded five independent themes that were related to perceived public stigma. Perceived public stigma of bipolar disorder was modeled as comprising the three elements of public stigmas (stereotype, prejudice, and discrimination), with the addition of public exposure as a core component.

CONCLUSION

The representation of bipolar disorder in society via newspapers, films/TV series, conferences, and celebrity self-disclosures is considered to have multiple impacts. People living with bipolar disorder have also reported a perceived public stigma of bipolar disorder that has both specific features and characteristics of general mental illness.

Ontological Adaptation in Transition to Adulthood: A Theoretical Framework for Integrating Phenomenology and Neuroscience in Psychosis Research

In this theoretical review, the neurodevelopmental model of psychotic disorders is considered within the framework of ontological development, referring to the individual-level construction of a sense of reality regarding identity and worldview. Following Erikson's theory of development, the challenge of forging a personal and social identity is a developmental process typical of late adolescence and early adulthood. Accompanying this process is a developmentally normal increase in exploratory and risk-taking behavior, which sometimes includes challenging and defying cultural norms. Although many aspects of ontological adaptation are developmentally appropriate, we argue that psychopathology such as psychosis can be rooted in an abnormal deviation of this process, in which aberrant salience accelerates the typical drive to develop a meaningful sense of identity, leading to delusion formation. By placing psychosis onset within a broader context of normal development, this model offers a humanistic approach for understanding experiences of new onset of psychotic disorders.

A comprehensive investigation into the genetic relationship between music engagement and mental health

While music engagement is often regarded as beneficial for mental health, some studies report higher risk for depression and anxiety among musicians. This study investigates whether shared underlying genetic influences (genetic pleiotropy) or gene-environment interaction could be at play in the music-mental health association using measured genotypes. In 5,648 Swedish twins with information on music and sport engagement, creative achievements, self-reported mental health and psychiatric diagnoses based on nationwide patient registries, we derived polygenic scores for major depression, bipolar disorder, schizophrenia, neuroticism, sensitivity to environmental stress, depressive symptoms and general musicality. In line with phenotypic associations, individuals with higher polygenic scores for major depression and bipolar disorder were more likely to play music, practice more music and reach higher levels of general artistic achievements, while a higher genetic propensity for general musicality was marginally associated with a higher risk for a depression diagnosis. Importantly, polygenic scores for major depression and bipolar remained associated with music engagement when excluding individuals who experienced psychiatric symptoms, just as a genetic propensity for general musicality predicted a depression diagnosis regardless of whether and how much individuals played music. In addition, we found no evidence for gene-environment interaction: the phenotypic association between music engagement and mental health outcomes did not differ for individuals with different genetic vulnerability for mental health problems. Altogether, our findings suggest that mental health problems observed in musically active individuals are partly explained by a pre-existing genetic risk for depression and bipolar disorder and likely reflect horizontal pleiotropy (when one gene influences multiple traits), rather than causal influences of mental health on music engagement, or vice versa (referred to as vertical pleiotropy).

Genome-wide association study of school grades identifies genetic overlap between language ability, psychopathology and creativity

Cognitive functions of individuals with psychiatric disorders differ from that of the general population. Such cognitive differences often manifest early in life as differential school performance and have a strong genetic basis. Here we measured genetic predictors of school performance in 30,982 individuals in English, Danish and mathematics via a genome-wide association study (GWAS) and studied their relationship with risk for six major psychiatric disorders. When decomposing the school performance into math and language-specific performances, we observed phenotypically and genetically a strong negative correlation between math performance and risk for most psychiatric disorders. But language performance correlated positively with risk for certain disorders, especially schizophrenia, which we replicate in an independent sample (n = 4547). We also found that the genetic variants relating to increased risk for schizophrenia and better language performance are overrepresented in individuals involved in creative professions (n = 2953) compared to the general population (n = 164,622). The findings together suggest that language ability, creativity and psychopathology might stem from overlapping genetic roots.

The sexual selection of creativity: A nomological approach

Cultural innovations, such as tools and other technical articles useful for survival, imply that creativity is an outcome of evolution. However, the existence of purely ornamental items obfuscates the functional value of creativity. What is the functional or adaptive value of aesthetic and intellectual ornaments? Recent evidence shows a connection between ornamental creativity, an individual's attractiveness, and their reproductive success. However, this association is not sufficient for establishing that creativity in humans evolved by sexual selection. In this critical review, we synthesize findings from many disciplines about the mechanisms, ontogeny, phylogeny, and the function of creativity in sexual selection. Existing research indicates that creativity has the characteristics expected of a trait evolved by sexual selection: genetic basis, sexual dimorphism, wider variety in males, influence of sex hormones, dysfunctional expressions, an advantage in mating in humans and other animals, and psychological modules adapted to mating contexts. Future studies should investigate mixed findings in the existing literature, such as creativity not being found particularly attractive in a non-WEIRD society. Moreover, we identified remaining knowledge gaps and recommend that further research should be undertaken in the following areas: sexual and reproductive correlates of creativity in non-WEIRD societies, relationship between androgens, development, and creative expression, as well as the impact of ornamental, technical and everyday creativity on attractiveness. Evolutionary research should analyze whether being an evolved signal of genetic quality is the only way in which creativity becomes sexually selected and therefore passed on from generation to generation. This review has gone a long way toward integrating and enhancing our understanding of ornamental creativity as a possible sexual selected psychological trait.

School performance and later diagnoses of nonaffective psychoses, bipolar disorder, and depression

OBJECTIVE

It is unclear whether there are differences between specific school subject performance and later psychiatric disorders. We examined whether mean grade point average (MGPA) and specific school subjects associated with diagnoses of nonaffective psychoses, bipolar disorder and depression.

METHODS

In this register-based study, we studied the Finnish population born in 1987 who had available MGPA and six specific school grades (age = 15.4-16.4 years; n = 50,508). Grades were analyzed with smoothing splines. Covariates included sex, urbanicity, parental education level and parental diagnosed psychiatric disorders. Outcomes were incident nonaffective psychosis, bipolar disorder and depression diagnosed in specialized services until year 2015 (age = 28.0-28.9 years).

RESULTS

During the follow-up, 727 individuals were diagnosed with nonaffective psychoses, 489 with bipolar disorder and 3492 with depression. MGPA was inversely associated with all outcomes. In multivariate models including specific school subjects and covariates, the school subject with largest risk ratios (RR) was Physical Education (RR and Bonferroni-corrected confidence interval [CI] at -1.5 SD: nonaffective psychoses 1.63, 1.36-1.95; bipolar disorder 1.64, 1.30-2.05; depression 1.72, 1.53-1.93). Higher grades in Art were associated with nonaffective psychoses and depression (RR and Bonferroni-corrected CI at +1.5 SD: nonaffective psychoses 1.48, 1.11-1.96; depression 1.22, 1.07-1.38).

CONCLUSION

There was a robust association between poorer scores on Physical Education and risk for psychosis, bipolar disorder and depression. Higher grades in Art were also associated with risk for later disorders. Subject specific school performance may be more informative about mental disorder risk than overall school performance.

Examining associations between social anhedonia and convergent thinking using the Remote Associates Test

Introduction: Social anhedonia (SocAnh) predicts increased risk of schizophrenia-spectrum disorders, with evidence that these disorders are associated with increased creativity. However, it is still largely unknown whether SocAnh is associated with one central aspect of creative thinking, convergent thinking.Methods: In two studies, college students with either extreme levels of SocAnh (n = 44 and n = 70) or controls with an average level of SocAnh (n = 111 and n = 100) completed a convergent thinking task, the Remote Associates Test, and also completed measures of current affect. In the second study, participants also completed a divergent thinking task.Results: In both studies, the SocAnh group had better performance than controls on the convergent thinking task. Further, this group difference remained after removing shared variance with current affect. In Study 2, groups did not differ on divergent thinking.Conclusions: Overall, consistent with research linking schizophrenia-spectrum disorders and creativity, the current research suggests that SocAnh is associated with increases in some aspects of creativity.

Bipolar spectrum traits and the space between Madness and Genius: The Muse is in the Dose

Creativity has long been associated with the bipolar spectrum, particularly among unaffected first-degree relatives and those with milder expressions of bipolar traits, suggesting that some aspects of the bipolar spectrum may confer advantages for creativity. Here we took a multifaceted approach to better define the shared vulnerability between creativity and bipolar disorder. We recruited 135 individuals with bipolar disorder, 102 creative controls, and 103 non-creative controls for a total of 340 participants. All participants completed a comprehensive assessment battery that included several self-report temperament and personality questionnaires, a computerized test of cognitive function across multiple domains, and an evaluation of creative performance and achievement. Significant group differences were observed for the hypothesized shared vulnerability traits of hypomanic personality, cyclothymic temperament, impulsivity, and positive schizotypy. While both the creative and bipolar groups demonstrated superior creative ability, the creative group alone revealed enhanced cognitive performance. Accounting for intercorrelations between traits, a combination of openness, hypomanic personality, divergent thinking, and reasoning ability emerged as the strongest predictors of creativity, collectively explaining 34% of the variance in creative achievement and correctly classifying 85% of individuals with high achievement irrespective of diagnosis. These results confirm and extend earlier observations of a shared vulnerability between creativity and bipolar disorder and suggest that mild to moderate expressions of bipolar spectrum traits are associated with enhanced cognitive functioning and creative expression. Further investigation of these traits is needed to clarify the nature of this shared vulnerability and suggest individualized treatment strategies to improve clinical outcomes in bipolar disorder.

The Benefits and Challenges of Employment for Working Professionals Diagnosed with Mental Illness

The purpose of this study is to explore how professional employment impacts mental health among people with mental illness, and how having a mental illness impacts job performance, both positively and negatively. The research is based on in-depth interview data from 56 professionals diagnosed with mental illness, and the interview transcripts are analyzed in accordance with the flexible coding model of qualitative data analysis. We find that working conditions of professional jobs pose challenges to managing symptoms of mental illness, including the pressures of responsibility and exposure to secondary trauma. However, professional employment also provides benefits such as social connections and feeling accountable. Similarly, symptoms cause problems at work like having angry outbursts, yet experience with mental illness informs job performance such as by increasing empathy with others. We use these findings to recommend new directions for research and argue for inclusion of people with mental illness in the workplace.

Mental Illness of Management Educators: Does Holding Multiple Academic Jobs Play a Role? A Qualitative Study

Through addressing management educators in four public business schools in Egypt, the authors of this paper aim to uncover the impact of holding multiple academic jobs on the mental health of management educators. The paper asserts that management educators do not perceive the holding of multiple academic roles as a stimulant of any form of mental illness (e.g., anxiety, depression, stress) if it is accompanied by a sense of autonomy (proper teaching loads, rational time for supervising theses, reasonable requests for research production) a feeling of competence (relevant monthly salary, available training and learning opportunities) and a sense of relatedness (feeling of involvement, flexible work hours, option to work from home).

Children and young people's beliefs about mental health and illness in Indonesia: A qualitative study informed by the Common Sense Model of Self-Regulation

BACKGROUND

Mental illness is a leading cause of disease burden amongst children and young people (CYP). This is exacerbated in low- and middle-income (LMIC) countries which often have embryonic care structures. Understanding and targeting illness beliefs is a potentially efficacious way of optimising the development of health prevention interventions. These beliefs remain relatively underexplored in CYP in LMIC contexts. Aim: To develop an in-depth understanding of CYPs beliefs about mental health and illness in Indonesia.

METHODS AND FINDINGS

Semi-structured interviews (n = 43) combined with photo elicitation methodology were undertaken with CYP aged 11-15 from Java, Indonesia. Our sample comprised those living with (n = 19) and without (n = 24) high prevalence mental health conditions, specifically anxiety or depression. Data were analysed using framework analysis, informed by the Common Sense Model of Self-Regulation of Health and Illness. Positive mental health and illness were dichotomised in accounts with mental health typically characterised as an absence of mental disturbance. This contributed to attributions of abnormality and the marginalisation of those with mental illness. Mental illness was conceptualised as a single entity, commonly arising from individual failings. This prompted feelings of self-stigma in those with lived experience of mental illness. Analysis identified marked differences in the perceived time dimensions of positive mental health and illness with mental illness conceived as less transient than episodes of positive mental health. Illness beliefs appeared relatively consistent across the two groups of CYP although some nuanced differences were identified. CYP with anxiety and depression were less likely to believe that mental illness could be diagnosed visually, more likely to uphold multiple causal factors and endorse the potential efficacy of professional input.

CONCLUSIONS

Public health interventions to increase understanding may be necessary to develop healthcare systems to reduce treatment barriers, optimise return on investment and enhance population health effect.

Clinical Risk Constellations for the Development of Bipolar Disorders

The early recognition of psychiatric disorders has been a focus of research in the last decades and has led to improvements in clinical care, especially in the area of early psychosis. Like non-affective psychosis, bipolar disorders are often diagnosed with a delay that can lead to long periods of untreated illness and impact long-term outcomes. This article presents the rationale for early recognition in bipolar disorder and presents the current evidence for the identification of risk factors, their assessment and validity in predicting the onset of bipolar disorder.

Depression and Creativity During COVID-19: Psychological Resilience as a Mediator and Deliberate Rumination as a Moderator

Purpose: The pandemic of coronavirus disease 2019 (COVID-19), which has had a significant impact on people’s lives, has apparently increased the incidence of depression. Although the topic of how depression affects creativity is contested, previous research has revealed a significant relationship between the two. The purpose of this study is to further investigate the relationship and the mechanisms that operate between depression and creativity.

Methods: A total of 881 students at an independent college in China completed a questionnaire consisting of the Self-Reported Depression Scale, Runco Ideational Behavior Scale, Psychological Resilience Scale, Deliberate Rumination Scale and demographic information. Among the respondents, 317 (36.0%) were male and 564 (64.0%) were female, all of whom were from the same grade. Correlation analyses were conducted, and then the researchers carried out mediation analysis and developed a moderated mediation model.

Results: The results indicated that (a) depression was positively related to creativity (r = 0.085, p < 0.05); (b) psychological resilience mediated the relationship between depression and creativity; specifically, psychological resilience was negatively related to depression (r = −0.462, p < 0.01), which in turn was positively related to creativity (r = 0.198, p < 0.01); and (c) deliberate rumination moderated the relationship between depression and psychological resilience, showing a significant negative correlation with depression (r = 0.138, p < 0.01), psychological resilience (r = 0.078, p < 0.05), and creativity (r = 0.288, p < 0.05); specifically, higher levels of deliberate rumination strengthened the negative correlation between psychological resilience and depression.

Conclusion: The results suggest that depression is a positive predictor of creativity and may promote creativity to some extent. Further, individuals with greater psychological resilience are more creative than those with less psychological resilience, as it is a question of whether they can and to what extent they can effectively use depression as an emotional resource. Last, an individual’s level of deliberate rumination moderates the mediating process, especially at the stage where depression is associated with psychological resilience. These findings advance understanding of the mechanisms that operate between depression and creativity.

Spatial working memory, not IQ or executive function, discriminates early psychosis and clinically vulnerable creative individuals

AIM

While associations between creativity and psychopathology have been well researched, the specific cognitive processes that distinguish highly creative from those with psychopathology warrant further investigation. This study will examine whether IQ, executive function, cognitive inhibition or spatial working memory differentiate individuals with early psychosis, clinically vulnerable creative individuals, creative controls and non-creative controls.

METHODS

The study sample consisted of 110 participants: early psychosis (n = 21); clinically vulnerable creative controls (n = 25); creative controls (n = 30) and non-creative control (n = 34). The Diagnostic Interview for Psychosis assessed early psychosis participants and the Mini Neuropsychiatric Interview was used to screen for psychopathology in the remaining groups. Several cognitive tests were administered: IQ, neurocognitive measures of executive function and spatial working memory. Creativity was assessed using the Torrance Test of Creativity and Creative Achievement Questionnaire. A measure of vividness of mental imagery was also given.

RESULTS

Across all cognitive tests, spatial working memory differentiated the early psychosis group from both creative and non-creative control groups. Spatial working memory predicted group membership but vivid imagery was a better predictor of creative achievement. The early psychosis, clinically vulnerable creative and creative groups all recorded significantly higher results on creative achievement and creative cognition compared to non-creative controls.

CONCLUSIONS

Our results provide further support for spatial working memory as an early neuro-cognitive marker for early psychosis. Spatial working memory, rather than IQ or executive function, may also be an early protective factor for clinically vulnerable young creative individuals.

Genomic Variation, Evolvability, and the Paradox of Mental Illness

Twentieth-century genetics was hard put to explain the irregular behavior of neuropsychiatric disorders. Autism and schizophrenia defy a principle of natural selection; they are highly heritable but associated with low reproductive success. Nevertheless, they persist. The genetic origins of such conditions are confounded by the problem of variable expression, that is, when a given genetic aberration can lead to any one of several distinct disorders. Also, autism and schizophrenia occur on a spectrum of severity, from mild and subclinical cases to the overt and disabling. Such irregularities reflect the problem of missing heritability; although hundreds of genes may be associated with autism or schizophrenia, together they account for only a small proportion of cases. Techniques for higher resolution, genomewide analysis have begun to illuminate the irregular and unpredictable behavior of the human genome. Thus, the origins of neuropsychiatric disorders in particular and complex disease in general have been illuminated. The human genome is characterized by a high degree of structural and behavioral variability: DNA content variation, epistasis, stochasticity in gene expression, and epigenetic changes. These elements have grown more complex as evolution scaled the phylogenetic tree. They are especially pertinent to brain development and function. Genomic variability is a window on the origins of complex disease, neuropsychiatric disorders, and neurodevelopmental disorders in particular. Genomic variability, as it happens, is also the fuel of evolvability. The genomic events that presided over the evolution of the primate and hominid lineages are over-represented in patients with autism and schizophrenia, as well as intellectual disability and epilepsy. That the special qualities of the human genome that drove evolution might, in some way, contribute to neuropsychiatric disorders is a matter of no little interest.

An evolutionary life history approach to understanding mental health

In recent years, evolutionary life history theory has been used as a heuristic framework to understand mental health. This article reviews the life history theory and its integration with mental disorders and then introduces representative research methods and related empirical studies in the field of evolutionary psychopathology. In the end, this article concludes with future directions for further research examining and developing the evolutionary psychopathological framework.

Genome-wide Association Study of Creativity Reveals Genetic Overlap With Psychiatric Disorders, Risk Tolerance, and Risky Behaviors

Creativity represents one of the most important and partially heritable human characteristics, yet little is known about its genetic basis. Epidemiological studies reveal associations between creativity and psychiatric disorders as well as multiple personality and behavioral traits. To test whether creativity and these disorders or traits share genetic basis, we performed genome-wide association studies (GWAS) followed by polygenic risk score (PRS) analyses. Two cohorts of Han Chinese subjects (4,834 individuals in total) aged 18-45 were recruited for creativity measurement using typical performance test. After exclusion of the outliers with significantly deviated creativity scores and low-quality genotyping results, 4,664 participants were proceeded for GWAS. We conducted PRS analyses using both the classical pruning and thresholding (P+T) method and the LDpred method. The extent of polygenic risk was estimated through linear regression adjusting for the top 3 genotyping principal components. R2 was used as a measurement of the explained variance. PRS analyses demonstrated significantly positive genetic overlap, respectively, between creativity with schizophrenia ((P+T) method: R2(max) ~ .196%, P = .00245; LDpred method: R2(max) ~ .226%, P = .00114), depression ((P+T) method: R2(max) ~ .178%, P = .00389; LDpred method: R2(max) ~ .093%, P = .03675), general risk tolerance ((P+T) method: R2(max) ~ .177%, P = .00399; LDpred method: R2(max) ~ .305%, P = .00016), and risky behaviors ((P+T) method: R2(max) ~ .187%, P = .00307; LDpred method: R2(max) ~ .155%, P = .00715). Our results suggest that human creativity is probably a polygenic trait affected by numerous variations with tiny effects. Genetic variations that predispose to psychiatric disorders and risky behaviors may underlie part of the genetic basis of creativity, confirming the epidemiological associations between creativity and these traits.

The blind men and the elephant: What is missing cognitively in the study of cumulative technological evolution

I describe and explain (1) evidence regarding a key role for autism spectrum cognition in human technology; (2) tradeoffs of autistic cognition with social skills; and (3) a model of how cumulative technological culture evolves. This model involves positive feedback whereby increased technical complexity selects for enhanced social learning of mechanistic concepts and skills, leading to further advances in technology.

Creativity and Bipolar Disorder: A Shared Genetic Vulnerability

Bipolar disorder is a lifelong mood disorder characterized by extreme mood swings between mania and depression. Despite fitness costs associated with increased mortality and significant impairment, bipolar disorder has persisted in the population with a high heritability and a stable prevalence. Creativity and other positive traits have repeatedly been associated with the bipolar spectrum, particularly among unaffected first-degree relatives and those with milder expressions of bipolar traits. This suggests a model in which large doses of risk variants cause illness, but mild to moderate doses confer advantages, which serve to maintain bipolar disorder in the population. Bipolar disorder may thus be better conceptualized as a dimensional trait existing at the extreme of normal population variation in positive temperament, personality, and cognitive traits, aspects of which may reflect a shared vulnerability with creativity. Investigations of this shared vulnerability may provide insight into the genetic mechanisms underlying illness and suggest novel treatments.

School success in childhood and subsequent prodromal symptoms and psychoses in the Northern Finland Birth Cohort 1986

BACKGROUND

Low IQ is a risk factor for psychosis, but the effect of high IQ is more controversial. The aim was to explore the association of childhood school success with prodromal symptoms in adolescence and psychoses in adulthood.

METHODS

In the general population-based Northern Finland Birth Cohort 1986 (n = 8 229), we studied the relationship between teacher-assessed learning deficits, special talents and general school success at age 8 years and both prodromal symptoms (PROD-screen) at age 15-16 years and the occurrence of psychoses by age 30 years.

RESULTS

More prodromal symptoms were experienced by those talented in oral presentation [boys: adjusted odds ratio (OR) 1.49; 95% confidence interval 1.14-1.96; girls: 1.23; 1.00-1.52] or drawing (boys: 1.44; 1.10-1.87). Conversely, being talented in athletics decreased the probability of psychotic-like symptoms (boys: OR 0.72; 0.58-0.90). School success below average predicted less prodromal symptoms with boys (OR 0.68; 0.48-0.97), whereas above-average success predicted more prodromal symptoms with girls (OR 1.22; 1.03-1.44). The occurrence of psychoses was not affected. Learning deficits did not associate with prodromal symptoms or psychoses.

CONCLUSIONS

Learning deficits in childhood did not increase the risk of prodromal symptoms in adolescence or later psychosis in this large birth cohort. Learning deficits are not always associated with increased risk of psychosis, which might be due to, e.g. special support given in schools. The higher prevalence of prodromal symptoms in talented children may reflect a different kind of relationship of school success with prodromal symptoms compared to full psychoses.

Mediating role of cognition and social cognition on creativity among patients with schizophrenia and healthy controls: Revisiting the Shared Vulnerability Model

AIM

As suggested by the Shared Vulnerability Model, impairment in executive functions could lead to worse creative performance among individuals with schizophrenia. Another impaired function in schizophrenia, previously related to creativity in healthy people, is theory of mind. However, little is known about the effect of theory of mind in creativity in schizophrenia. Therefore, the aim of this study was to analyze differences in creativity among patients with schizophrenia compared to healthy controls (HC) and to explore the potential role of executive functions and theory of mind as mediators of this relation.

METHODS

Forty-five patients with schizophrenia and 45 HC underwent a neuropsychological assessment, including executive functions (cognitive flexibility and working memory), theory of mind, and verbal and figural creativity.

RESULTS

As expected, patients with schizophrenia obtained lower scores in creativity, cognitive flexibility, working memory, and theory of mind compared to HC. Path analysis showed that theory of mind mediated the relation between group (schizophrenia or HC) and both figural (Z = 2.075, P = 0.037) and verbal creativity (Z = 2.570, P = 0.010). Working memory mediated the relation between group and figural creativity (Z = 2.034, P = 0.041) and was marginally significant for verbal creativity (Z = 1.930, P = 0.053). Finally, cognitive flexibility mediated between group and figural creativity (Z = 2.454, P = 0.014).

CONCLUSION

Results suggest that the lower performance in creativity among patients with schizophrenia was partly due to an impairment in executive functions and theory of mind. The involvement of theory of mind opens up a new field of research as a possible risk factor in the Shared Vulnerability Model.

Becoming a Character: Dissociation in Conservatory Acting Students

Actors must realistically portray imagined characters in imaginary circumstances by "becoming" their characters. What is it that allows them to do this? We suggest that acting is related to dissociation, a trait typically related to psychopathology. We measured dissociation in 53 conservatory acting students before and after six months of training, using the Dissociative Experiences Scale-II (DES-II). Although no significant changes occurred over time, acting students scored significantly higher than the general population on the DES-II. These scores were driven by just one of the subscales - absorption and imaginative involvement. We argue here that this subscale measures a trait central to the creative process. Furthermore, although the DES-II was designed to measure psychopathology, we found that it is also related to flow (a positive experience). Certain flow dimensions were predictive of dissociation and of its absorption and imaginative involvement subscale. We conclude that total DES-II scores may not necessarily indicate psychopathology in actors. At the very least, these results suggest that clinicians should take extra precaution when diagnosing dissociation in actors using the DES-II.

How Does Affective Disorder Relate to Creativity? The Pathography of the Chinese Writer Yu Dafu

BACKGROUND

Yu Dafu, arguably one of the greatest writers in modern Chinese history, is characterized by critics as having a sentimental and decadent style. His life is clearly marked by mood bipolarity, and it seems that his creativity was affected by extreme emotional states. However, this link remains unclear.

METHODS

Yu's self-assessments in his works and letters are analyzed from the perspective of current psychiatric classifications. Examples are extracted from his writing career and habits to help illuminate the relationship between mental disorders and literary creativity.

RESULTS

Yu's writing career seems to be divided into four blocks. He was in a deep depression when he studied abroad and taught in China and experienced a hypomanic episode afterward, when he created a magazine and fell in love. The pattern of his mood changes is consistent with the symptoms of bipolar II disorder. His maintenance of a high degree of literary productivity alongside his anguish during depressive episodes may suggests mixed states.

CONCLUSIONS

Mood changes shaped Yu's life and writing career. Depressive and hypomanic moods enhanced his creativity in several ways, and some situations in his life indicate that writing and literary pursuits also have reverse effects on one's mental state. The perspective that mental disorders are seen as a certain profile of literary career can help us to better understand the writers.

Anxiety and Adverse Life Events in Professional Creative and Early Psychosis Populations

Objective: The association between creativity and psychopathology has intrigued researchers and recent studies have affirmed genetic and epidemiological links. In particular, epidemiological research highlights the need to study what aspects of the creative individual protect or provide risk for transition to psychosis. Two factors, associated with transition to psychosis, will be investigated, namely anxiety and adverse life events. Method: A diverse sample of 110 participants (18-35 years) was examined, including early psychosis (EP), creative professionals who are clinically vulnerable or "at-risk" (ARCC), those with no psychotic symptoms (CC), and non-creative (NCC) participants. Measures of anxiety (DASS) and adverse life events (ALE) were administered to the participants to determine whether these factors were positively or negatively associated with creativity and whether they were able to differentiate the EP from ARCC, CC and NCC participants. Results: Creative cognition and achievement were positively correlated with anxiety. The EP and ARCC groups were more closely aligned than expected on measures of anxiety and adverse life events. Childhood sexual/physical assault were the only variables that differentiated these two groups. Conclusions: These results provide further support for the association between creative professionals and those with early psychosis. It provides corroborating evidence of the vulnerability of creative individuals who appear to be aligned with the early psychosis group on anxiety, aspects of paranoia and overall trauma. The results provide possible innovative avenues for intervention in EP and ARCC.

Creativity in persons at-risk for bipolar disorder-A pilot study

AIM

The association between bipolar disorder and creativity may be related to symptoms of the disorder itself or personality traits present before the onset. To further explore the relationship between creativity and clinical risk for bipolar disorder, creativity among individuals with a history of depressive disorder and varying risk for future (hypo-)manic episodes was assessed and compared.

METHODS

Thirty-eight participants completed the diagnostic process, including Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Diagnosis, Hamilton Depression Scale and Young Mania Rating Scale. The early detection tools Bipolar Prodrome Symptom Interview and Scale-Prospective (BPSS-P), Early Phase Inventory for Bipolar Disorders (EPIbipolar) and bipolar-at-risk-(BAR) criteria were used to assign participants into different at-risk groups. Assessment of creativity included Barron-Welsh Art Scale (BWAS) and Creative Achievement Questionnaire (CAQ). Scores were compared between low- and high-risk groups for the development of bipolar disorder.

RESULTS

Participants meeting BAR criteria scored significantly higher on the BWAS than the non-BAR group (P = 0.03). EPIbipolar groups did not differ significantly in creativity scores. Participants with mood swings, especially when associated with increased activity and euphoric features, had significantly higher BWAS scores compared to individuals without mood swings (P = 0.04). Sleep disturbances, substance abuse, anxiety, ADHD and behavioural disturbances in childhood or adolescence had no effect on creativity level or achievement scores. Generalisability was reduced by small sample size and inclusion of depressive participants only considered at-risk for bipolar disorder.

CONCLUSIONS

There is evidence of increased creativity, but not of higher creative achievements, in persons at-risk of bipolar disorder. Mood swings are strongly associated with creativity.

Neurocognitive heterogeneity in young offspring of patients with bipolar disorder: The effect of putative clinical stages

BACKGROUND

Bipolar disorder (BD) is associated with significant cognitive heterogeneity. In recent years, a number of studies have investigated cognitive subgroups in BD using data-driven methods and found that BD includes several subgroups including a severely impaired and a neurocognitively intact cluster. Studies in offspring of BD (BDoff) are particularly important to establish the timing of emergence of cognitive subgroups but studies investigating cognitive heterogeneity in BDoff are lacking. Our aim was to investigate cognitive heterogeneity in BDoff and the relationship between cognitive heterogeneity and putative clinical stages of BD.

METHODS

Seventy-one euthymic BDoff and 50 healthy controls were assessed using clinical measures and a battery of neuropsychological tests. Neurocognitive subgroups were investigated using latent class analysis.

RESULTS

Three neurocognitive subgroups, including a severe impairment group, a good performance cluster, and a subgroup characterized by intermediate/selective impairment was found. Both severe and intermediate level impairment subgroups underperformed healthy controls in processing speed, verbal fluency, visual memory and working memory. Deficits in verbal memory and executive functions were only evident in severe impairment subgroup. The putative stage of the illness had no significant effect on cognitive clustering of BDoff. Trait impulsivity scores were significantly increased in severe and intermediate impairment clusters but not in the cognitively good functioning subgroup of BDoff.

LIMITATIONS

The cross-sectional nature of the study was the main consideration.

CONCLUSION

These results suggest that cognitive heterogeneity is premorbid characteristic of BD and cognitive subgroups of BDoff emerge prior to the onset of illness and prodromal symptoms.

The effects of playing music on mental health outcomes

The association between active musical engagement (as leisure activity or professionally) and mental health is still unclear, with earlier studies reporting contrasting findings. Here we tested whether musical engagement predicts (1) a diagnosis of depression, anxiety, schizophrenia, bipolar or stress-related disorders based on nationwide patient registers or (2) self-reported depressive, burnout and schizotypal symptoms in 10,776 Swedish twins. Information was available on the years individuals played an instrument, including their start and stop date if applicable, and their level of achievement. Survival analyses were used to test the effect of musical engagement on the incidence of psychiatric disorders. Regression analyses were applied for self-reported psychiatric symptoms. Additionally, we conducted co-twin control analyses to further explore the association while controlling for genetic and shared environmental confounding. Results showed that overall individuals playing a musical instrument (independent of their musical achievement) may have a somewhat increased risk for mental health problems, though only significant for self-reported mental health measures. When controlling for familial liability associations diminished, suggesting that the association is likely not due to a causal negative effect of playing music, but rather to shared underlying environmental or genetic factors influencing both musicianship and mental health problems.