text:
Both authors contributed equally to this work.
Original Article
Dimensions of manic symptoms in youth: psychosocial impairment and cognitive performance in the IMAGEN sample
Version of Record online: 28 MAY 2014
DOI: 10.1111/jcpp.12255
© 2014 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Journal of Child Psychology and Psychiatry
Volume 55, Issue 12, pages 1380–1389, December 2014
Additional Information
How to Cite
Stringaris, A., Castellanos-Ryan, N., Banaschewski, T., Barker, G. J., Bokde, A. L., Bromberg, U., Büchel, C., Fauth-Bühler, M., Flor, H., Frouin, V., Gallinat, J., Garavan, H., Gowland, P., Heinz, A., Itterman, B., Lawrence, C., Nees, F., Paillere-Martinot, M.-L., Paus, T., Pausova, Z., Rietschel, M., Smolka, M. N., Schumann, G., Goodman, R., Conrod, P. and the Imagen Consortium (2014), Dimensions of manic symptoms in youth: psychosocial impairment and cognitive performance in the IMAGEN sample. Journal of Child Psychology and Psychiatry, 55: 1380–1389. doi: 10.1111/jcpp.12255
Conflict of interest statement: See Acknowledgements.
Publication History
- Issue online: 17 NOV 2014
- Version of Record online: 28 MAY 2014
- Manuscript Accepted: 25 MAR 2014
Funded by
- European Union-funded FP6 Integrated Project IMAGEN (Reinforcement-related behaviour in normal brain function and psychopathology). Grant Number: LSHM-CT- 2007-037286
- FP7 project IMAGEMEND (Imaging Genetics for Mental Disorders)
- Innovative Medicine Initiative Project EU-AIMS. Grant Number: 115300-2
- Medical Research Council Programme. Grant Number: 93558
- Swedish funding agency FORMAS
- Bundesministerium für Bildung und Forschung. Grant Number: 01GS08152
- Deutsche Forschungsgemeinschaft (DFG): Reinhart-Koselleck Award. Grant Number: SP 383/5-1
- German Ministry of Education and Research. Grant Number: # 01EV0711
- Foundation de Recherché en Santé du Quebec (FRSQ)
- Mania;
- bipolar;
- intelligence;
- adolescents;
- creativity
- Top of page
- Abstract
- Introduction
- Methods
- Results
- Discussion
- Acknowledgements
- References
- Supporting Information
It has been reported that mania may be associated with superior cognitive performance. In this study, we test the hypothesis that manic symptoms in youth separate along two correlated dimensions and that a symptom constellation of high energy and cheerfulness is associated with superior cognitive performance.
We studied 1755 participants of the IMAGEN study, of average age 14.4 years (SD = 0.43), 50.7% girls. Manic symptoms were assessed using the Development and Wellbeing Assessment by interviewing parents and young people. Cognition was assessed using the Wechsler Intelligence Scale For Children (WISC-IV) and a response inhibition task.
Manic symptoms in youth formed two correlated dimensions: one termed exuberance, characterized by high energy and cheerfulness and one of undercontrol with distractibility, irritability and risk-taking behavior. Only the undercontrol, but not the exuberant dimension, was independently associated with measures of psychosocial impairment. In multivariate regression models, the exuberant, but not the undercontrolled, dimension was positively and significantly associated with verbal IQ by both parent- and self-report; conversely, the undercontrolled, but not the exuberant, dimension was associated with poor performance in a response inhibition task.
Our findings suggest that manic symptoms in youth may form dimensions with distinct correlates. The results are in keeping with previous findings about superior performance associated with mania. Further research is required to study etiological differences between these symptom dimensions and their implications for clinical practice.
- Top of page
- Abstract
- Introduction
- Methods
- Results
- Discussion
- Acknowledgements
- References
- Supporting Information
Bipolar disorder (BD) is a potentially lethal condition that can be associated with lifelong impairment and distress (Baldessarini & Tondo, 2003; Judd et al., 2005). Yet, people with BD are also said to show better than average outcomes in creativity and educational attainment. Indeed, it is a long- and widely held notion that BD, a serious mental illness, may also confer advantages to those who have it (Goodwin & Jamison, 2007) and there are several studies that suggest links between creativity and BD (Hurlow & MacCabe, 2011). Pioneering evidence in this field came from research into biographical records (Jamison, 1989) and selected populations (Andreasen, 1987; Andreasen & Glick, 1988; Andreasen & Powers, 1975; Jamison, 1989; Ludwig, 1994) (such as writers and artists). Such studies are, however, liable to selection and information biases. Nonetheless, in an epidemiological sample, which by design is not subject to such biases, it was also found that many more authors and artists were affected by BD compared to the population base rate (Kyaga et al., 2011). As creativity is difficult to operationalize (Hurlow & MacCabe, 2011), it is important to note that similarly paradoxical findings of superior achievements of people with BD are also found using outcomes that are easier to define. In the Dunedin cohort, participants with a lifetime history of mania stood out from patients with other psychiatric diagnoses by their higher than average IQ scores (Koenen et al., 2009); however, there were only a few participants with mania (n = 8) limiting the inferences that can be drawn. More recently, MacCabe et al. (2010) using a large Swedish national cohort study discovered a U-shaped relationship between school performance and BD: adolescents with either excellent or very poor school performance carried the risk for bipolar disorder in later life. By contrast, the relationship between school performance and schizophrenia was linear – low school grades conferred a higher risk (MacCabe et al., 2010).
Several hypotheses have been proposed to explain the link between BD and superior outcomes (Goodwin & Jamison, 2007). A broad set of explanations suggests that behaviors or symptoms, such as exuberance or positive affect more generally, may underlie creativity. For example, experimental evidence suggests that positive affect improves performance in tests of word associations (Isen, Johnson, Mertz, & Robinson, 1985). Additionally, a study of inpatients shows that full scale IQ scores may improve slightly during hypomania (Donnelly, Murphy, Goodwin, & Waldman, 1982). These studies therefore raise the question whether certain manic symptoms are more strongly linked with positive outcomes than others. Symptom heterogeneity has been proposed to explain differential etiological processes and outcomes in a number of disorders (Coghill & Sonuga-Barke, 2012). It is possible that our findings about two distinguishable dimensions of mania could underlie differences in mechanisms and clinical outcomes.
Recently, we have shown that manic symptoms in children and adolescents can be separated along two correlated dimensions, one of episodic undercontrol and one of episodic exuberance (Stringaris, Stahl, Santosh, & Goodman, 2011). Symptoms of the undercontrol dimension include distractibility, irritability, and poor inhibition, whereas high energy levels, cheerfulness, and a heightened sense of achievement were part of the exuberance dimension. Symptoms of undercontrol are strongly correlated with psychopathology, particularly attention deficit hyperactivity disorder (ADHD) and disruptive behavior disorders, whereas symptoms of exuberance are not associated with other psychopathology once symptoms of undercontrol have been taken into account (Stringaris et al., 2011). In addition, undercontrol symptoms are significant predictors of social impairment independently of the presence of other psychopathology (Stringaris et al., 2011). Similar findings have been obtained by others investigating the structure of manic symptoms in adolescents and adults. Holtmann et al. (2009) distinguished between 'active-elated' symptoms that were associated with good psychosocial adjustment, in contrast to dimensions of 'irritable-erratic' and 'disinhibited' symptoms that were related to disruptive behavior disorders in adolescents. Likewise, young adults scoring high on an 'active-elated' dimension of symptoms also scored high on measures of wellbeing, whereas those scoring high on 'irritable/risk-taking dimensions' experienced psychopathology and distress (Brand, Gerber, Puhse, & Holsboer-Trachsler, 2011). In an epidemiological study of adults with pure hypomania, high energy levels and positive affect were particularly common. Importantly, those with pure hypomania had higher incomes and were more likely to be married and reports less distress than controls (Gamma, Angst, Ajdacic-Gross, & Rossler, 2008).
These findings point to a possible heterogeneity within manic symptoms that could explain the apparent paradox of a devastating illness that is also associated with high achievements. Establishing such heterogeneity would carry important implications for understanding the pathophysiology of BD.
For this purpose, we use a dimensional approach in a community-based sample. We adopt a dimensional approach to manic symptoms, rather than a diagnostic approach. This is in keeping with the approach promoted by the National Institute of Health, Research Domain Criteria (RDoC) (Morris and Cuthbert, 2012). In this approach, domains or constructs such as positive valence or frustrative nonreward are probed in their relationship with different units of analysis, such as cognitive circuits or physiology. This is intended to remove the constraints of typically arbitrary diagnostic boundaries and help bridge the gap between clinical phenotypes and underlying mechanisms (Insel et al., 2010). It should be clear that the extent to which manic symptoms are on a continuum with bipolar disorder is an outstanding empirical question. It has been shown in US clinic samples that a high rate of manic symptoms in adolescents – typically falling short of meeting BD diagnostic criteria due to shorter duration – increases risk for subsequent BD (Birmaher et al., 2009). In addition, subthreshold manic symptoms in adolescents are associated with white-matters microstructure abnormalities in brain regions involved in mood disorders (Paillère Martinot et al., 2014). However, subthreshold manic symptoms have not been shown to predict later bipolar disorder in a Danish cohort (Päären et al., 2013). In this paper, we use a community-based sample; we avoid referral and other selection biases. In addition, we use easy to operationalize outcomes, namely intelligence and cognitive inhibition. Also, we test the robustness of our findings by analyzing first using self-report and then confirm by using parent-report and we test hypotheses about the relationship between dimensions of manic symptoms and cognitive outcomes. We use a large community-based sample of adolescents. There are several reasons to focus on this young age group. First, around half of adults with bipolar disorder report onset of their problems in childhood and adolescence (Perlis et al., 2009), yet we still know little about the structure and correlates of manic symptoms in youth. Research into early manic symptoms will be important for early recognition and prevention. Second, from an aetiological perspective, it is important to examine mechanisms of early manic symptoms. Recent results suggest that there may be developmental moderation in the pathomechanisms of bipolar disorder, such that for example deficits in response inhibition may be due to different mechanisms in adolescents than in adults (Weathers et al., 2012). Third, while there has been increasing research into bipolar disorder in youth, this is the first study to examine heterogeneity within manic symptoms and how this relates to cognition.
We test three hypotheses:
- First, in keeping with previous work (Brand et al., 2011; Holtmann et al., 2009; Stringaris et al., 2011) we expect that manic symptoms in adolescents can be parsed into two correlated dimensions: one of undercontrol, characterized by irritable and disinhibited symptoms that is associated with psychosocial impairment, and an exuberant dimension that does not contribute independently to psychosocial impairment.
- Second, we hypothesize that symptoms of exuberance will be positively associated with IQ scores, whereas symptoms of undercontrol will be negatively correlated with IQ. We expect that the exuberant dimension will be specifically associated with verbal IQ but not performance IQ, in keeping with suggestions about superior verbal performance in mania (Hurlow & MacCabe, 2011). To ensure that our findings are specific, we will also adjust for personality characteristics, such as sensation seeking or extraversion, as these have been suggested to correlate positively with intelligence in young people (Raine, Reynolds, Venables, & Mednick, 2002) and can also be related to manic symptoms (Bagby et al., 1997).
- Third, we expect that only symptoms of undercontrol, but not of exuberance, will be associated with measures of poor response inhibition as has been previously described for bipolar disorder (Bora, Yucel, & Pantelis, 2009). To ensure that this association is specific for manic symptoms, we will also control for hyperactivity or conduct problems, as these are known to be associated with poor inhibition in young people.
- Top of page
- Abstract
- Introduction
- Methods
- Results
- Discussion
- Acknowledgements
- References
- Supporting Information
Sample and procedure
A community-based sample of young adolescents (N = 2000) and their parents were recruited via high-schools in eight European sites as part of the IMAGEN Study (Schumann et al., 2010). The geographical areas were selected to maximize ethnic homogeneity (in light of the genetic component of the IMAGEN Study). However, private and state-funded schools were targeted in order to obtain a diverse sample of socioeconomic status, emotional and cognitive development. Parents gave informed written consent and adolescent's written assent. Local institutional ethics committees approved all study procedures. The IMAGEN study included a home assessment using an online computer platform and one or two study-center visits. Complete and reliable data sets of personality, psychiatric symptoms, IQ, and cognitive variables were available for 1755 participants (average age of 14.4 years (SD = 0.43), 50.7% girls.
Development and well-being assessment (DAWBA)
The DAWBA (Ford, Goodman, & Meltzer, 2003) is a structured interview that also records verbatim accounts of problems. The questions are closely related to DSM-IV(APA, 2000) diagnostic criteria and focus on current problems. Adolescents were assigned a diagnosis only if their symptoms were causing significant distress or social impairment. The DAWBA interview was administered to all parents and to all adolescents. Manic symptoms were assessed as previously described (Stringaris et al., 2011) and as recently used to demonstrate white-matter abnormalities in subthreshold adolescent bipolarity (Leboyer, Henry, Paillere-Martinot, & Bellivier, 2005): The parents of adolescents themselves were presented with the following preamble: 'Some young people have episodes of going abnormally high. During these episodes they can be unusually cheerful, full of energy, speeded up, talking fast, doing a lot, joking around, and needing less sleep. These episodes stand out because the young person is different from their normal self.' They were then asked: 'Do you [Does X] ever go abnormally high?', to which they had the options of answering: 'No', 'A little', 'A lot'. For this screening question, answering 'A little' was associated with significantly more comorbidity and social impairment than answering 'No'. In the interest of having as broad as possible a representation of subjects, we chose to include as 'screen positive' those who answered 'A little' as well as those who answered 'A lot'—enquiring whether 26 specific symptoms of mania (including those stipulated by DSM-IV(APA, 2000) occurred during such episodes of going high. For each individual symptom, the participants had the option of choosing between one of the following answers: 'No', 'A little', 'A lot'. The complete bipolar section of the interview can be seen at http://www.dawba.info/Bipolar/.
Strengths and difficulties questionnaire (SDQ)
We administered the parent- and youth-rated version of the SDQ, a questionnaire with robust psychometric properties (Goodman, 2001) that separately inquires about symptoms (hyperactivity/inattention; behavior problems; emotional symptoms; and peer problems) and impact in the form of psychosocial impairment (Stringaris & Goodman, 2013).
Estimates of intelligence were derived from several subtests of the Wechsler Intelligence Scale for Children – Fourth Edition [WISC-IV; Wechsler, 2003 (Wechsler, 2003)]. To estimate verbal and spatial IQ the vocabulary, similarities, matrix reasoning and block design subtests were used. Verbal and Spatial IQ scores were then standardized by age.
Response inhibition
Response inhibition was assessed with a Go – no-Go task (Newman & Kosson, 1986). Participants learn by trial and error to respond to active stimuli or 'good' numbers for monetary reward and withhold response to passive stimuli or 'bad' numbers to avoid punishment (loss of previously gained rewards). Participants completed three conditions: a mixed condition of 'punishment-reward', a 'punishment' condition, and a 'reward' condition. The main dependent measure for this task was commission errors (i.e. failures to inhibit responses to passive stimuli) averaged across conditions, indicating a general deficit in response inhibition (Patterson & Newman, 1993). Average commission errors across conditions, as opposed to three separate condition-dependent measures, were used because commission errors across conditions were well correlated (r ≥ .50) and we had no specific hypotheses regarding reward or punishment sensitivity affecting response inhibition.
Statistical analysis
Analytic strategy
To ensure that our findings are not due to specific informant effects, we conducted all our analyses for self-report and repeated them using parent-report.
To test our first hypothesis, we used a Confirmatory factorial analyses (CFA) to compare two alternative models: a one-factor solution where all symptoms of mania are part of a single dimension of symptoms; a two-factor model with two correlated but separable dimensions, one of undercontrol and one of exuberance, as previously described (Stringaris et al., 2011). Goodness-of-fit was compared on the basis of the Akaike information Criteria (AIC) and Bayesian information Criteria (BIC)-on both indices lower values indicate better fit. In addition, we tested our first hypothesis in a structural equation model with the SDQ score of the impact supplement (psychosocial impairment) as a dependent variable and the two latent dimensions of manic symptoms (undercontrol and exuberance) as predictors.
To test our second hypothesis, we used a structural equation model with either verbal IQ or performance IQ as the dependent variable and the two latent dimensions of manic symptoms (undercontrol and exuberance) as predictors. To test our prediction of specificity, we also ran the same models with verbal IQ as the outcome adjusting for performance IQ, and vice versa (with performance IQ as the outcome adjusting for verbal IQ). To ensure that our findings were not better explained by underlying personality dimensions, we also ran models with IQ as the dependent variable and the two latent dimensions of manic symptoms (undercontrol and exuberance) as predictors adjusted for either sensation seeking or extroversion. As a sensitivity test that is also free of distributional assumptions, we have repeated analyses for the main results of this paper using bootstrap estimation (20,000 iterations) and obtained a similar pattern of results.
To test our third hypothesis, we used a structural equation model with commission errors on the response inhibition task as the dependent variable and the two latent dimensions of manic symptoms (undercontrol and exuberance) as predictors. To test our prediction of specificity, we also we ran the same models with commission errors as the outcome adjusting for hyperactivity and conduct problems. All these analyses were controlled for sex (see below) and recruitment Center, as some of the outcome variables varied according to the site of data collection.
Missing values
After passing the screen question about episodic changes in mood described above, young people or their parents went on to respond to questions about manic symptoms: according to self-report: n = 986, parent-report: n = 699, or both: n = 440 (see online supporting information, Table S1 for demographic characteristics and comorbidities of the sample). For the analyses on verbal and performance IQ, data were available on n = 919 (93.2%) by self-report and n = 663 (94.8%) by parent-report. For the analyses on commissioning errors, data were available on n = 951 (96.5%) by self-report and n = 663 (96.3%) by parent-report. We present analyses using full-information maximum likelihood as implemented in MPlus version 5.32 (Muthén & Muthén, Los Angeles, CA). The pattern of results did not differ when analyses were done using list wise deletion approach in STATA, Version 11.2 (Stata Corp, College Drive, TX).
- Top of page
- Abstract
- Introduction
- Methods
- Results
- Discussion
- Acknowledgements
- References
- Supporting Information
Our first hypothesis was that manic symptoms in adolescents could be parsed into two correlated dimensions each with different associations to psychosocial impairment. Indeed, a two-factor solution was preferable over a one-factor solution by self as well as by parent-report, on the basis of information criteria (self-report: two-factor solution AIC = 34,614, BIC = 34,898; self-report: one-factor solution AIC = 34,960, BIC = 35,239), (parent-report: two-factor solution AIC = 26,081, BIC = 26,385; parent-report one-factor solution AIC = 26,521, BIC = 26,820).
Table 1 shows the frequency of each item for the two dimensions by parent- and self-report. Only items that have previously been shown to be associated reliably with each informant are shown; therefore some items do not overlap between informants. Overall, items in the exuberant dimension were more common than items in the undercontrol dimension by either reporting source and adolescents endorsed symptoms more frequently than did parents about their children. Note that the over-sexed item fit with other exuberant items by self-report, but with other undercontrol items by parent-report.
|Self-reported manic symptoms n = 986
|Parent-reported manic symptoms n = 699
|Item loading
|Item loading
|Fast talk
|Gets more done
|Full of energy
|Not concerned
|Constant changes
|Talks to strangers
|Invades space
|Risk taking
|Less self-control
|Poor concentration
|Flight of ideas
Because self-reported exuberance was higher in girls than boys (boys = 8.77, SD boys = 3.63; girls = 9.31, SD girls = 3.41; t = 2.50, df (984), p < .05) and parent-reported undercontrol higher in boys than girls (boys = 5.87, SD boys = 4.51; girls = 5.87, SD girls = 4.51; t = 3.30, df (697), p < .05), we adjusted for sex in all subsequent analyses. Age was not significantly associated with any of the dimensions (all p > .20; data available upon request).
In keeping with our first hypothesis, the undercontrol but not the exuberant dimension was significantly and positively associated with psycho-social impairment as judged by self-report on the SDQ impact score (self-report: undercontrol β = .28, SE = 0.05, p < .001; exuberance β = −.01, SE = 0.05, p > .5). By parent-report, only the undercontrol dimension was positively and significantly associated with impact, whereas the exuberant dimension had a weakly negative relation with impact (undercontrol β = .43, SE = 0.06, p < .001; exuberance β = −.12, SE = 0.06, p < .05).
Our second hypothesis was that exuberance would be positively associated with verbal IQ score, whereas undercontrol would be negatively correlated with verbal IQ. Figures 1 and 2 present the relationship between the two dimensions of manic symptoms and verbal IQ as the outcome. As shown in Figures 1 and 2, self- and parent-reported exuberance was positively associated with verbal IQ; conversely, undercontrol was negatively associated with verbal IQ only by parent but not by self-report. Table 2 shows that exuberance was associated with performance IQ in simple models, but the association became nonsignificant after adjusting for verbal IQ. By contrast, exuberance was significantly associated with verbal IQ even after adjusting for performance IQ.
|Verbal IQ
|Performance IQ
|Verbal IQ adjusted for performance IQ
|Performance IQ adjusted for verbal IQ
|Verbal IQ adjusted for sensation seeking
|Verbal IQ adjusted for extraversion
|Self (n = 919)
|0.27*** (0.06)
|0.20** (0.06)
|0.18** (0.06)
|0.09ns (0.06)
|0.26*** (0.06)
|0.28*** (0.06)
|−0.08ns (0.06)
|−0.16** (0.06)
|−0.01ns (0.05)
|−0.01ns (0.05)
|−0.08ns (0.06)
|−0.08ns (0.06)
|Parent (n = 663)
|0.21** (0.06)
|0.18** (0.07)
|0.13* (0.06)
|0.09ns (0.06)
|0.20** (0.06)
|0.20** (0.06)
|−0.18** (0.06)
|−0.22*** (0.06)
|−0.09ns (0.06)
|−0.14* (0.06)
|−0.19** (0.06)
|−0.18** (0.06)
Adjusting for the personality characteristics of sensation seeking and extraversion did not impact the association between the two dimensions of manic symptoms and verbal IQ, as shown in Table 2.
Our third hypothesis was that undercontrol but not exuberance would be associated with measures of response inhibition. As illustrated in Figure 3, self-reported undercontrol was positively associated with commission errors in a response inhibition task (i.e. pressing a button in no-go trials), whereas exuberance was negatively associated with commission errors. By parent-report, the associations went in the same direction, but were not statistically significant, as shown in Table 3. The association between self-reported undercontrol and commission errors was not confounded by hyperactivity or conduct problems: Table 3 shows that even after adjusting for hyperactivity and conduct scores, self-reported undercontrol was positively and significantly associated with commission errors, whereas exuberance was negatively and significantly associated with commission errors.
|Commission errors
|Commission errors adjusted for hyperactivity and conduct symptoms
|Self (n = 951)
|−.20*** (.06)
|−.19** (.07)
|.18** (.06)
|.16** (.08)
|Parent (n = 663)
|−.6ns (.07)
|−.7ns (.07)
|.5ns (.07)
|.07ns (.09)
- Top of page
- Abstract
- Introduction
- Methods
- Results
- Discussion
- Acknowledgements
- References
- Supporting Information
We used a general population sample to study the associations between manic symptoms in young people and cognitive performance.
In keeping with our first hypothesis, we found that manic symptoms in youth, can be parsed into two correlated dimensions (Stringaris et al., 2011): one of episodic undercontrol, characterized by irritable and disinhibited symptoms that is associated with social role impairment, and one of episodic exuberance that does not contribute independently to impairment. This is consistent with data from another general population sample (Stringaris et al., 2011). We also found that such manic symptoms are common in the general population of young people, although cases of bipolar disorder were rare (at or <0.1%), as shown in large population-based studies in the United States (Costello, Angold, & Keeler, 1999) and United Kingdom (Stringaris, Santosh, Leibenluft, & Goodman, 2010).
Consistent with our second hypothesis, we found that the exuberant, but not the undercontrolled, dimension was positively and specifically associated with verbal intelligence. This finding is in keeping with suggestions about superior verbal performance in mania (Hurlow & MacCabe, 2011). We also showed that this association could not be explained by other personality characteristics, namely sensation seeking and extroversion. However, we note that next to accumulating evidence about superior cognitive performance in people at risk for BD (Hurlow & MacCabe, 2011), there are also studies that show no evidence of such an association (Zammit et al., 2004).
As predicted in our third hypothesis, symptoms of undercontrol but not of exuberance were associated with measures of poor inhibition, as has been previously described for bipolar disorder (Bora et al., 2009); this association was not mediated by coexisting conduct or hyperactivity symptoms.
Our findings have several research and clinical implications. It is recognized that childhood conditions can encompass correlated dimensions, as in autism spectrum disorder (Ronald et al., 2006) and oppositionality (Stringaris, Zavos, Leibenluft, Maughan, & Eley, 2012). Our findings suggest that the same may apply to manic symptoms in childhood. Taking account of the heterogeneity reflected in the two dimensions could help refine the search for underlying mechanisms in BD. If further validated, such a dimensional approach to symptoms may be useful to clinicians. For example, treating clinicians may choose to target the symptoms of episodic undercontrol as opposed to the apparently more innocuous – or even beneficial – symptoms of episodic exuberance. As psychopathologists, we mainly study the negative outcomes of symptoms. Here, we show a striking example of symptoms that are associated with superior outcomes. Perhaps this is a more widespread phenomenon, with other apparently disadvantageous psychiatric symptoms persisting in the population because they are closely related to potentially beneficial traits (Williams and Taylor, 2006). Highlighting the positive correlates may make the adverse symptoms more tolerable to the individuals and their families. Having said that, we should stress again that the degree to which the mania symptoms reported in this study are part of a spectrum with manic episodes of people with bipolar disorder has yet to be established.
Our study has a number of strengths, such as the use of a large epidemiological study, the assessment of a broad range of manic symptoms by two reporting sources, and the use of standardized cognitive measures. Our study also has limitations. First, the design of our study does not allow us to determine direction of effect between manic symptoms and cognition. Intellectual endowment and response inhibition are commonly thought of as stable traits, in which case they would precede symptoms of mania. However, response inhibition may be impaired during a manic episode and positive affect has been reported to boost IQ (Donnelly et al., 1982). A second limitation is that we use the WISC to examine superior verbal performance in our study. This has the advantage of being a widely used, standardized and well-validated measure of verbal intelligence, which has previously been implicated in psychopathology (Hurlow & MacCabe, 2011). However, future studies in this area should ideally use a broad set of measures of verbal performance that also capture aspects of creativity, capacity for use of abstract or figurative language and generation of novel semantic constructs (Giora, 2003, Stringaris and Giora, 2011). A third limitation is that the design of our study does not allow us to prove that the symptoms reported here are of the same nature as manic symptoms reported by patients in clinical settings and we note that patients with BD who present to clinics may have impaired IQ and that it may further decrease with increasing number of episodes (Hellvin et al., 2012).
- Top of page
- Abstract
- Introduction
- Methods
- Results
- Discussion
- Acknowledgements
- References
- Supporting Information
This work was supported by the European Union-funded FP6 Integrated Project IMAGEN (Reinforcement-related behaviour in normal brain function and psychopathology) (LSHM-CT- 2007-037286), the FP7 project IMAGEMEND (Imaging Genetics for Mental Disorders) and the Innovative Medicine Initiative Project EU-AIMS (115300-2), Medical Research Council Programme Grant 'Developmental pathways into adolescent substance abuse' (93558), as well as the Swedish funding agency FORMAS. Further support was provided by the Bundesministerium für Bildung und Forschung (NGFN Plus; FKZ: 01GS08152) and the Deutsche Forschungsgemeinschaft (DFG): Reinhart-Koselleck Award SP 383/5-1. This research was also supported by the German Ministry of Education and Research (BMBF grant # 01EV0711) and the Foundation de Recherché en Santé du Quebec (FRSQ). Argyris Stringaris gratefully acknowledges the support of the Wellcome Trust.
Disclosures: T.B. has served in an advisory or consultancy role for Hexal Pharma, Lilly, Medice, Novartis, Otsuka, Oxford outcomes, PCM scientific, Shire and Viforpharma; received conference attendance support and conference support or received speaker's fee by Lilly, Medice, Novartis and Shire; is/has been involved in clinical trials conducted by Lilly, Shire & Viforpharm; but declares the present work is unrelated to the above grants and relationships. G.B has declared that he acts as a consultant for IXICO and receives honoraria for teaching from General Electric. A.L.W.B. was funded by the Stokes Programme of the Science Foundation Ireland. All other authors have declared that they have no competing or potential conflicts of interest in relation to this work.
The authors thank Rosie Acklom for coordinating author correspondence and declarations of interest in relation to this manuscript.
- Bipolar may be a heterogeneous construct, with some people showing superior premorbid adjustment and intelligence.
- This heterogeneity may be due different symptom dimensions underlying mania.
- In a community sample, we found support for the hypothesis that an exuberant dimension of symptoms characterized by cheerfulness and increased energy was positively and significantly associated with verbal IQ.
- An undercontrol dimension, characterized by distractibility, irritability and risk taking was associated with poor response inhibition.
- The two dimensions may have different aetiological underpinnings. Clinicians should be alert to the possibility that some manic symptoms may be related with higher than average abilities.
- Standardized (beta) regression coefficients and their standard errors are presented from gender-adjusted models with either verbal IQ or performance IQ as outcomes, unadjusted or adjusted for sensation seeking with exuberance and undercontrol as predictors. ***p < .001; **p <.01; *p <.05; ns = non significant at p < .05.
- Top of page
- Abstract
- Introduction
- Methods
- Results
- Discussion
- Acknowledgements
- References
- Supporting Information
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- 2009). Cognitive endophenotypes of bipolar disorder: A meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. Journal of Affective Disorders, 113, 1–20. , , & (
- 2011). 'Bright side' and 'dark side' hypomania are associated with differences in psychological functioning, sleep and physical activity in a non-clinical sample of young adults. Journal of Affective Disorders, 131, 68–78. , , , & (
- 2013). Sensitivity and specificity of a brief personality screening instrument in predicting future substance use, emotional, and behavioral problems: 18-month predictive validity of the Substance Use Risk Profile Scale. Alcoholism, Clinical and Experimental Research, 37 (Suppl. 1), E281–E290. , , , & (
- 2012). Annual research review: Categories versus dimensions in the classification and conceptualisation of child and adolescent mental disorders–implications of recent empirical study. Journal of Child Psychology and Psychiatry, 53, 469–489. , & (
- 1992). Revised NEO personality lnventory (NEO-PI-R) and NEO five-factor inventory (NEO-FFI) professional manual. Odessa, FL: Psychological Assessment Resources. , & (
- 1999). Adolescent outcomes of childhood disorders: The consequences of severity and impairment. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 121–128. , , & (
- 1982). Intellectual function in primary affective disorder. British Journal of Psychiatry, 140, 633–636. , , , & (
- 2003). The British Child and Adolescent Mental Health Survey 1999: The prevalence of DSM-IV disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1203. , , & (
- 2008). Are hypomanics the happier normals? Journal of Affective Disorders, 111, 235–243. , , , & (
- 2003). On our mind: Salience, context, and figurative language. New York: Oxford University Press. (
- 2001). Psychometric properties of the strengths and difficulties questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1337. (
- 2007). Epidemiology manic depressive illness (vol. Second, pp. 155). Oxford: Oxford University Press. , & (
- 2012). Neurocognitive functioning in patients recently diagnosed with bipolar disorder. Bipolar Disorders, 14, 227–238. , , , , , , & (
- 2009). Validation of the Hypomania Checklist (HCL-32) in a nonclinical sample of German adolescents. Journal of Adolescence, 32, 1075–1088. , , , , , & (
- 2011). Paradoxes in creativity and psychiatric conditions. The paradoxical brain. Cambridge: Cambridge University Press. , & (
- 2010). Research domain criteria (RDoC): Toward a new classification framework for research on mental disorders. American Journal of Psychiatry, 167, 748–751. , , , , , , … & (
- 1985). The influence of positive affect on the unusualness of word associations. Journal of Personality and Social Psychology, 48, 1413–1426. , , , & (
- 1989). Mood disorders and patterns of creativity in British writers and artists. Psychiatry, 52, 125–134. (
- 2005). Psychosocial disability in the course of bipolar I and II disorders: A prospective, comparative, longitudinal study. Archives of General Psychiatry, 62, 1322–1330. , , , , , , … & (
- 2009). Childhood IQ and adult mental disorders: A test of the cognitive reserve hypothesis. American Journal of Psychiatry, 166, 50–57. , , , , , , … & (
- 2011). Creativity and mental disorder: Family study of 300,000 people with severe mental disorder. British Journal of Psychiatry, 199, 373–379. , , , , , & (
- 2005). Age at onset in bipolar affective disorders: A review. Biopolar Disorders, 7, 111. , , , & (
- 1994). Mental illness and creative activity in female writers. American Journal of Psychiatry, 151, 1650–1656. (
- 2010). Excellent school performance at age 16 and risk of adult bipolar disorder: National cohort study. British Journal of Psychiatry, 196, 109–115. , , , , , , … & (
- 2012). Research domain criteria: Cognitive systems, neural circuits, and dimensions of behavior. Dialogues in Clinical Neuroscience, 14, 29–37. , & (
- 1986). Passive avoidance learning in psychopathic and nonpsychopathic offenders. Journal of Abnormal Psychology, 95, 252–256. , & (
- 2013). Hypomania spectrum disorders from adolescence to adulthood: A 15-year follow-up of a community sample. Journal of Affective Disorders, 145, 190–199. , , , , , & (
- 2014). White-matter microstructure and gray-matter volumes in adolescents with subthreshold bipolar symptoms. Molecular Psychiatry, 19, 462–470. , , , , , , & (
- 1993). Reflectivity and learning from aversive events: Toward a psychological mechanism for the syndromes of disinhibition. Psychological Review, 100, 716–736. , & (
- 2009). Retrospective age at onset of bipolar disorder and outcome during two-year follow-up: Results from the STEP-BD study. Bipolar Disorders, 11, 391–400. , , , , , , … & (
- 2002). Stimulation seeking and intelligence: A prospective longitudinal study. Journal of Personality and Social Psychology, 82, 663–674. , , , & (
- 2006). Genetic heterogeneity between the three components of the autism spectrum: A twin study. Journal of the American Academy of Child & Adolescent Psychiatry, 45, 691–699. , , , , , , … & (
- IMAGEN consortium (2010). The IMAGEN study: Reinforcement-related behaviour in normal brain function and psychopathology. Molecular Psychiatry, 15, 1128–1139. , , , , , , … &
- 2011). Neural substrates of metaphor. In P. Hogan (Ed.), The Cambridge encyclopedia of the language sciences. New York: Cambridge University Press. , & (
- 2013). The value of measuring impact alongside symptoms in children and adolescents: A longitudinal assessment in a community sample. Journal of Abnormal Child Psychology, 41, 1109–1120. , & (
- 2010). Youth meeting symptom and impairment criteria for mania-like episodes lasting less than four days: An epidemiological enquiry. Journal of Child Psychology and Psychiatry, 51, 31–38. , , , & (
- 2011). Dimensions and latent classes of episodic mania-like symptoms in youth: An empirical enquiry. Journal of Abnormal Child Psychology, 39, 925–937. , , , & (
- 2012). Adolescent Irritability: Phenotypic associations and genetic links with depressed mood. American Journal of Psychiatry, 169, 47–54. , , , , & (
- 2012). A developmental study of the neural circuitry mediating motor inhibition in bipolar disorder. American Journal of Psychiatry, 169, 633–641. , , , , , , … & (
- 2003). Wechsler intelligence scale for children-fourth edition. St Antonio, TX: Pearson Education. (
- 2006). The evolution of hyperactivity, impulsivity and cognitive diversity. Journal of the Royal Society Interface, 3, 399–413. , & (
- 2009). The Substance Use Risk Profile Scale: A scale measuring traits linked to reinforcement-specific substance use profiles. Addictive Behaviors, 34, 1042–1055. , , , & (
- 2004). A longitudinal study of premorbid IQ Score and risk of developing schizophrenia, bipolar disorder, severe depression, and other nonaffective psychoses. Archives of General Psychiatry, 61, 354–360. , , , , , , & (
Supporting Information
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- Abstract
- Introduction
- Methods
- Results
- Discussion
- Acknowledgements
- References
- Supporting Information
|Table S1. Description of the subsamples reporting manic symptoms by either parent- or self-report. [PDF file].
Please note: Wiley Blackwell is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.


text:
Risk Management and Profit Taking in Binary Options
Ask any professional trader what the most important concept in trading is and they will tell you that it's risk management. Continue reading here.
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subset: commoncrawl


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List all words starting with sticks
3 words found.
List all words starting with sticks sorted by length or by how common the words are.
Some random words: pya ikat juba ajuga gweduc dwarf daunder
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India, Sri Lanka to deepen trade, tourism and investment relations
Tue, Jan 22, 2013, 08:07 pm SL Time, ColomboPage News Desk, Sri Lanka.
Jan 22, Colombo: Sri Lanka and India, recognizing the need to build a special economic partnership framework to achieve the common goals of poverty alleviation, job creation and economic development for the people of the two countries, have agreed to deepen the trade, tourism and investment relations.
In this context, the two countries at the 8th India-Sri Lanka Joint Commission held Tuesday in New Delhi agreed to take measures to double the bilateral trade to US$ 10 billion within the next three years.
During the Joint Commission Meeting (JCM), co-chaired by the External Affairs Minister of Sri Lanka Prof. G.L. Peiris and his Indian counterpart Salman Khurshid, the two sides comprehensively reviewed the entire spectrum of bilateral relations.
Following today's meeting, the two countries have signed two agreements to "Combat International Terrorism and Illicit Drug Trafficking" and to revise the Double Taxation Avoidance Agreement.
Both countries as a measure to expand bilateral trade agreed to initiate a dialogue between the Commerce Secretary of India and the Secretary of the Ministry of Finance and Economic Development of Sri Lanka at an early date to evolve a framework for a special economic partnership between the two countries.
The Joint Commission expressed satisfaction with the progress made in implementation of the projects funded by India to relief, resettlement and rehabilitation of Internally Displaced Persons (IDPs) and livelihood generation and reconstruction efforts in the Northern and Eastern Provinces of Sri Lanka.
Both sides, noting the impressive growth of two-way tourism traffic between the two countries, agreed to meet at the earliest to finalize and sign a revised Air Services Agreement and to restart the ferry services between Thalaimannar and Rameswaram.
The Joint Commission also decided to hold the meeting of the Joint Working Group on Tourism in the first quarter to 2013 to identify potential areas of cooperation, including marketing and capacity-building.
The two sides also agreed to speed up and complete the India -funded Sampur Power Project to build a coal power plant in the Trincomalee district of Eastern Sri Lanka by 2016.
The Joint Commission noted that both sides are committed to decrease incidents pertaining to fishing on the International Maritime Boundary Line (IMBL) and decided to encourage senior officials of the Joint Working Group on Fishing to meet regularly to continue the dialogue to strengthen cooperation on fishing related issues.
Both sides agreed to enhance cooperation in the energy sector and to promote dialogue on security and defence issues of relevance to the bilateral relationship.
The Joint Commission noted that the trilateral cooperation mechanism between India, Sri Lanka and the Maldives was an important initiative to promote maritime security in the region.
During his visit to New Delhi, Minister Peiris has also met with the Prime Minister of India and had a separate meeting with the External Affairs Minister of India.
Minister Kurshid has accepted an invitation extended by Minister Peiris to visit Sri Lanka in the first half of 2013 on a date to be worked out through diplomatic channels.
The next session of the Joint Commission would be held in Sri Lanka in the first half of 2014 on a date to be mutually agreed upon between the two sides.
ColomboPage - Recent 10 Stories
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Sri Lanka International Gem and Jewellery show, FACETS 2016 in September
Deputy Minister Eran Wickramaratne speculated to be next Central Bank Governor


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Photocatalytic water
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Migraine Miracle!!!! True Story
Posted in the Migraine Forum
#1 Feb 27, 2009
I have been suffering from migraines for 15 years 3 to 4 times per week. I have been to every specialist and tried Immitrex, Fiorcet and everything else you could think of with minimal resluts.
I have started using this family doctor about a year ago and discussed my headaches and how dibilitating they are. He mention that he has had great success with numerous patients using another medication "off label" and has had near if not 100% success. Since being on this medication I have not had a SINGLE migraine for over 6 months!! I can not even begin to explain the difference in my life as you all would like yourself.
#2 Mar 9, 2009
Please tell me more. I am very interested in your results.
South Africa
#3 Mar 21, 2009
I live in South Africa.
We have a specialist who has made a first world break through for migraines and headaches - permanently. People from all over the world come to see him.
I personall suffered from severe migraines and severe headaches for over 6 and a half years all day every day - since I went to see this specialist I no longer have any pain whatsoever!!
I tried everything including seeing 16 specialists electric shock treatment nothing worked.
#5 May 9, 2009
it's funny how none of you mentioned what the hell the treatment is called.......go to hell money hungry jerks!
#6 May 23, 2009
Ditto what money said. This forum sucks too.
Hospitalet, Spain
#7 Jul 7, 2009
Hi! I know another treatment, but it's not pharmacological!!!
The name is "Migracalm", and it's a biofunctional device. It is a headband that applies controlled pressure on the point in the temples(the part of the cranium between the ear, the cheek and the eye) where most of the pain is focused, producing a sensation of relief.
Enter to their web site: http://www.migracalm.net
It only costs 39 in pharmacies and 19 online (facebook)!! It's incredible but really!
I have bought one via facebook!
#8 Jul 19, 2009
Hospitalet, Spain
#9 Jul 21, 2009
I'm looking forward to reading something in this website but I can't...
#10 Jan 27, 2010
Don't waste your money on the migraine relief guide.
#11 Jan 30, 2011
I have had migraine since I was 19, Im 34 now. When I moved to the US 3 years ago years ago it got worse and I had headache almost every day. I tried almost everything and nothing worked out.Bach home a friend of mine who was neurologist told me that try Amitriptyline I tried several days it made me very sleepy and unfortunately I didnt listen to his advise and stopped taking them. In the US I visited many doctors, I used topamax Im telling you this medication has many bad side effects and it is awful. Finally I suggested to my doctor that how if I tried Amitriptyline and this time I tried. At the beginning it made me sleepy but after 3 weeks no more sleepiness. I didnt get any headache for 2 months, even once! And then I start getting them more during my period and just a couple of time during the month. That was a success. I wish I listened to my friend several years ago because not even it helped my migraine, my mood is better now and I have more energy and no more negative thoughts. If you have not tried that yet I recommend you to try it.( I am taking 50mg of Amitriptyline every night)
#12 Feb 10, 2011
First: Doctor in South Africa stole my migraine surgery in my migraine pressure points. Second: Migraineclam device cant stop your migrainehheadaches because they did it to make pressure on the wrong migraine place. To make your migraine headaches last thing to worry about it you can free do at your home my migraine pressure points devices as shown step by step how to do and to use it in this video:http://medicalvideos.us/ videos-1719-HOW-TO-DO-MIGRAINE -DEVICE
#14 May 3, 2011
Hi Mina......I live in RI also and am wondering what doctor/neurologist you are using for treatment. My mom is suffering horribly from migraines and since you are local...just would like your recommendation. Thanks very much!
Boksburg, South Africa
#15 Dec 28, 2011
hi pauline
i live in sa as well ,, pllllease snd me details of the doctor
Boksburg, South Africa
#16 Dec 28, 2011
i even use a product called iceman and massage it into my temples and cheek. I use eardrops if th emigraine is from tense facial muscles.
i have also found a great migraine cocktail that works on my migraines 90% of the time --- its aat mellville pharmacy in johannesburg south africa - however i cant tak reit more than once a week tho'
recently i chew on betel leave - vwery bitter - this alleviates its for few hours
Newark, UK
#17 Mar 25, 2012
When i play football or soccer as you know it i get a migraine after about 20 mins. I have tried everything the doctors have suggested but last week i played for the first time in three years without any effects. This is not a joke i can assure you but i had half of a viagra before playing and seemed to do the trick. will keep you guys posted in future. Worth a try guys. feedback on this forum would be great.
Cape Town, South Africa
#18 May 15, 2014
Hi Dorothy, I too have suffered from migraines two to three times a week for about 20 years now and have had surgery for it, been on every conceivable preventative but all without any success, so please do share your miracle drug with me, so that i too can get some well deserved respite from this debilitating condition. i eagerly await your reply. Regards Rayne
Pretoria, South Africa
#19 Sep 18, 2014
Hi Dorothy, please let me know about this migraine success. I work long hours and cant affort to loose my job due to my migraines.
Please let me know.
Pretoria, South Africa
#20 Sep 18, 2014
Hi Pauline, think we know each other. Please email me regarding this specialist. I suffer from terrible migraine. Regrads Douleen
South Africa
#21 Nov 3, 2014
Hi Doujvr/Douleen
I am a South African based in Johannesburg. If you haven't gotten help with regards to your migraines I just want to suggest you check out www.theheadacheclinic.net .
Cape Town, South Africa
#24 Dec 12, 2014
Hi Rayne
I am based in Cape Town. A neuro in the US has developed a Natural Spray that has had a good success rate on Migraine sufferers. Not a cure, but when you feel the symptoms use it correctly to remove the effects. No Prescription is required.
Please email me should you be interested mitarimedical at telkomsa dot net
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List all words starting with gyroscopically
Only the word gyroscopically was found, nothing longer.
Some random words: igloo bheestie poaceous in mho refight mankind
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James Leverton struck out 10 and allowed two hits over seven innings Friday as Greensboro blanked the Hickory Crawdads, 2-0, to complete a sweep of its South Atlantic League semifinal series.
Leverton retired the first 11 Crawdads in order before Tomas Telis singled with two outs in the fourth. The 25-year-old left-hander also walked one before turning things over to the bullpen.
"It's one of those best outings I've seen in a long time, just due to the significance of the game and the lineup he faced," Grasshoppers manager Andy Haines said. "He just does his thing. He's a three-pitch guy and he can throw any pitch in any count. He's a confident guy and he can just dial it in."
Leverton was selected by the Cubs in the eighth round of the 2008 Draft but requested and was granted his release at the end of Spring Training. He signed with the Marlins last month after pitching in the independent Can-Am League.
"We saw glimpses of what he can do," Haines said. "He was hoping for an opportunity with a different organization and he has taken full advantage of it and he has shown a lot of people what he can do."
Leverton isn't the only comeback story on the club. After getting off to a poor start in the second half, the Grasshoppers caught fire down the stretch. They won 20 of their last 26 games, including four of five from the Kannapolis to conclude the regular season, to earn the Northern Division second-half title and their first trip to the playoffs since 1999.
"We were on a pretty remarkable run just to get here and we knew we had our hands full with Hickory," Haines said. "We were fortunate to come out on top."
In Game 1, 2010 first-rounder Christian Yelich hit a walk-off two-run homer in the 15th inning. That capped a game in which the Grasshoppers tied the game three times.
"We're certainly excited. We've been on this run for a while," Haines said. "We're aware that we're not done, there's still work to be done. We know we're going to have a tough series, but we're looking forward to it."
Grant Dayton and Michael Brady each pitched a perfect inning to close out the series for Greensboro.
Ryan Fisher hit a solo homer in the second to give the Grasshoppers an early lead and Noah Perio added an RBI single in the seventh.
Former second-round pick Will Lamb (0-1) took the loss after allowing a run on four hits and fanning eight over five innings.
In other South Atlantic League playoff action:
Sand Gnats 3, GreenJackets 2
Pinch-hitter Blake Forsythe delivered an RBI double in the eighth inning as Savannah avoided a sweep. Former Cy Young Award winner Johan Santana made a rehab start for the Sand Gnats and allowed an unearned run on two hits over three innings. Taylor Whitenton fanned six and gave up a run on three hits in three frames. Box score
Today on MiLB.com
Top Stories on MiLB.com
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- Benintendi ties career high in hits for Portland
- Yanks' Kaprielian suffers flexor tendon strain
- Plutko making quick strides with Columbus


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My husband, my 91 year old father and I will be in Buenos Aires at the end of January 2013 after being on a 20-day South America Antarctica cruise. We will have seven days to explore BA. We want to take a trip to Iguazu Falls. Can anyone tell me how to plan this ourselves or have a recommendation for a tour company?
Any other tips on enjoying our time in Buenos Aires would be most appreciated. My dad is very healthy for his age but he does use a cane to help him with his balance. My husband and I are in our early fifties. We are all experienced travelers. Thank you.
Recent ActivityView all South America activity »
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- 18 Itinerary Help Brazil 10 days
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- 20 Peru in December
- 21 Time in Lima, then Guayaquil, Manta
- 22 Tarapoto
- 23 Some Nature/Bird Lodges in Colombia
- 24 Buenos Aires/Argentina 10+ Day, Solo Woman Traveler
- 25 A brief encounter with Ecuador
Iguazu Falls
My husband, my 91 year old father and I will be in Buenos Aires at the end of January 2013 after being on a 20-day South America Antarctica cruise. We will have seven days to explore BA. We want to take a trip to Iguazu Falls. Can anyone tell me how to plan this ourselves or have a recommendation for a tour company?
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Suggested steps:
1) Go to: http://tinyurl.com/nw9f4
2) Then type "Isabel" in their search feature.
3) Draw your own conclusions.
Have a great time in our country with your father and DH.
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You can certainly plan a visit to Iguazu on your own. I would suggest flying, and you can buy your tickets online. I stayed at the Pension la Sorgente and liked it, but there is also a pricey Sheraton actually in the National Park. You don't need a guide for the falls, you just follow the trails. If you don't stay in the park there are buses that go directly there.
I recommend seeing both sides, but I don't know your nationality WRT visa requirements for Brazil.
Another option from BsAs is the ferry to Colonia or Montevideo.
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While the Sheraton is more expensive than other hotels, it is the only one inside the national park. You can't beat it for convenience. Some prefer falls view rooms, but If we ever return, we would opt for a cheaper, jungle view room. The reason is that you are not in your room enough hours to really benefit from the great view. In addition, the restaurant downstairs (where you have your free breakfast) has large picture windows with a magnificent view - at no cost whatsoever.
I recommend two nights at Iguazú. It is truly awe inspiring.
Vic's travels: http://my.flightmemory.com/vogilvie
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I've been up to Iguazu twice for 2 night stays and loved it. I stay at the Orquideas Palace, which is about 1/2 way between town and the park. The local bus stops in front for easy access. Your dad should have no problem with the walkways, but if he does, there are golf carts which might help him on some of the pathways.
I've only been on the Argentine side as I thought the price for the Brazilian visa was too much for a daytrip.
Do make sure your dad is very careful of the sidewalks in Buenos Aires - they can be a nightmare for someone with balance issues with many holes and missing grates.
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Just visited Iguazú three days ago. Did both sides with the Brasilian side first. (Already had a Brasilian visa.) Took the Cataratas bus from the central bus terminal. $60ARS round trip. Sorry to say that I was under-whelmed. Diddo for the Bird Park.
Disappointed that inclement weather prevented us from experiencing the Paseo de Luna Llena (Full moon walk). Check the full moon calendar dates against your travel plans. There are only four or five days a month that the park is open at night.
However, the Argentian side was glorious! There is a LOT of walking and if the heat and humidity are oppressive (probably will be) it could prove to be difficult for your Father.
Unless you take a private tour (unnecessary), you will need to "keep up" with the group and that may mean moving through the park at a pretty good clip. That being said, I was on a group tour, Aguas Grandes Tours with guide Junior Cesar Rodriguez. He easily went back and forth between Spanish and English. Junior was very accommodating with questions from the group...lots of history which I enjoyed.
Had no problem with insects during my two days. Bring sunblock, sunglasses, water, hat and consider having something with long sleeves (not tight). I am fair skinned of Irish descent and found the sun to be too much. My travel companion couldn't get enough sun. Food is no problem as there are many concessions.
Enjoy your time at this magical place.
Do consider the day trip to Colonia del Sacramento, UR from Buenos Aires. Had Beatrix Rivas (099 521 060) give us a tour and she was wonderful. Someone from the Visitors' Center can call her upon your arrival on the ferry. Buy your ferry tickets online from SeaCat Colonia or call them when you arrive in BsAs for a fraction of the price from Buquebus. Everyone travels on the same boat anyway.
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We are booked on the same cruise and also have booked the 4 day Viatour bus tour to Igauza.. However, because of the Brazilian visa requirements we are probably going to cancel. Now we are scrambling and looking for an alternative..such as the possibility of doing the Viator and skipping the Brazilian side of the falls.or doing it independently.
Hopefully, we will meet on the cruise. If you come up with any concrete ideas for the Igauza Falls trip, please consider sharing them. Bon voyage.
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Click on my name for my TR for a possible way to see the Brazilian side without a visa. Likely only for independent travelers, though.
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Thank you all for your replies. I have been so busy with Christmas that it is only now that I am reading the last replies.
We have booked a flight from BsAs to the falls. We are booked at the Sheraton since my dad may not want to do much walking he can still enjoy the falls from the hotel. Since we had planed to stay in BsAs for a week after the cruise we are going to the falls February 5-7. The Sheraton was booked earlier in the week so that is why we will go just before we fly home from BsAs.
Bourlamaque, are you on the roll call through Cruise Critic? If not, it is a great tool to hook up with people. There will be a "Meet and Greet" which will give people a chance to meet at the beginning of the cruise.
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Just wanted to give an update. We LOVED Iguazu Falls! We had the best weather. No problems with bugs either. We stayed at the Sheraton and loved being right in the park. It was so worth it. We took the boat ride that takes you right up to the falls. You get drenched but it was so fun. My dad loved it! Lots of stairs to walk up and down to do the boat ride but he did it. We bought the video afterwards and love reliving the experience! Highly recommend going to Iguazu Falls. It was breathtaking!
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Thanks for reporting back. Glad you had a good time - although i can't imagine NOT enjoying the falls.
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Well done, Terry - good planning and good weather - great combination to enjoy your visit to this incredible site; not impossible for any age or most situations. Thank you for posting back.
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