Bipolar Disorder Daily News Blog

Two lead researchers in the area of geriatric bipolar disorder have written a book: Bipolar Disorder in Later Life, which is meant to help treat the increasing numbers of people afflicted with bipolar disorder in old age. The goal of the authors Martha Sajatovic from Case Western Reserve University and Frederic Blow from the University of Michigan, is to inform clinicians treating elderly bipolar disorder patients about new research in the field. For the book, Sajatovic and Blow asked for the participation of their peers in the field and according to a new review have produced a "... comprehensive, cohesive, and crisply written..." book. Though this book seems to be primarily for clinicians and researchers, we thought it important to mention it.

Complete Review of Book

We want to announce a short book of poems published recently by Vantage Press, Inc. The book titled, Soul: The Treasury of Anne-Patrice, consists of poetry written by author Anne-Patrice Whaley-Tandy. Whaley-Tandy suffers from bipolar disorder and though her poetry in this book focuses on spirituality, she covers other subjects as well, including poems about her psychiatrist, psychologist and children. Here are a few excerpts:

Nancy, Psychiatrist

Though I've known her just a
year
I come to her with no fear because
her questions pertain to not just
how are you mentally, but where
your life is leading actually.
. . .
It's difficult because when you are
in a hospital you have new doctors
you don't know at all
so it's important you bond with your doctor as an outpatient
and she with you---
there is so much you travel
together through.

Judith, Psychologist

Once upon a time you're
blessed
with someone unlike the rest
. . .
She has fought many years through
the cascade of my tears and never
criticized my wrongs

But led me gently laughing,
to aspire
to let my moral fibrer lead and
not give in to devastation . . .

Related Stories:
Creativity and Bipolar Disorder Correlated
Curing Oneself Through Writing

Researchers that sleep is connected to bipolar disorder. That is, past research has shown that bipolar patients have difficulty with sleep and often suffer from sleep-related problems. Now new research is showing that routine sleep schedules can actually be beneficial to the outcomes of bipolar disorder.

A new study which appears in this month's issue of the journal, American College of Neuropsychopharmacology (ANCP), examined two groups of adult bipolar patients receiving different treatment therapies and found that the group of patients who participated in interpersonal and rhythm therapies--these therapies involved the patients monitoring their daily routines--had longer periods without mania and depression. Researchers have believed for some time that bipolar disorder is greatly affected by the circadian rhythm or the body's internal clock, and these new findings only further support this idea.

It seems that sufferers of bipolar disorder tend to have more sensitive circadian systems than do others, and as a result, a change in routine or sleep schedule can throw the internal clocks of bipolar sufferers off (more so than with the healthy population), and result in more frequent manic and depressive episodes for bipolar patients.

Ellen Frank, Ph.D., who conducted the new study at the University of Pittsburgh School of Medicine had this to say about the findings:

Having already found that disruption in daily routines can make individuals with bipolar disorder vulnerable to new episodes of illness, we have now learned that working with patients to achieve and maintain regular social rhythms -- including regular sleep patterns and adequate physical activity -- will help to protect them against episodes of mania or depression, we have now learned that working with patients to achieve and maintain regular social rhythms -- including regular sleep patterns and adequate physical activity -- will help to protect them against episodes of mania or depression...

Full Article:Sleep helps in bipolar disorder treatment (United Press International)

Related Stories:
Dark Therapy: A Possible Treatment for Bipolar Disorder
Role of Serotonin in Modulating Circadian Rhythm

We recently covered a study which found that children suffering from bipolar disorder are more likely to misread facial expressions and experience certain moods such as irritability and excessive happiness. Now a new study, published in last month's issue of The Journal of Neuropsychiatry and Clinical Neurosciences, finds that the adults suffering from bipolar disorder are also prone to impaired emotional perception.

For the study, 19 patients suffering from bipolar disorder I and in remission were compared to 22 healthy individuals (both groups were matched for age, gender, education, etc.) . The participants were all given an Affective Prosody Test (APT). Taking this test usually means that participants listen to tapes where sentences expressing certain emotions are read (for example, the emotions: happy, sad, angry, etc.), and then asked to specify the emotions they believe were expressed. For this study, the researchers found that bipolar patients had "significantly lower scores on the APT" than did the other participants. In particular, female participants with bipolar disorder showed specific impairment in perceiving "certain emotions" for example: surprise and fear.

The sample size of this study was small, thus if it is repeated, the future results may be more generalizable. Nevertheless, the issue of impaired emotional perception for bipolar patients is an important one, not just because it enables outsiders to better understand the experience of bipolar sufferers but also because it may lead to newer, more effective treatments.

Impaired Perception of Affective Prosody in Remitted Patients With Bipolar Disorder Bozikas et al. J Neuropsychiatry Clin Neurosci.2007; 19: 436-440

Goodwin, Frederick K. and Jamison, Kay Redfield. Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, 2nd Edition. Oxford University Press, USA. March 9, 2007

The long awaited Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, Second Edition, by Frederick K. Goodwin and Kay Redfield Jamison is finally in stores.

A new study published in this month's issue of the American Journal of Psychiatry, examined three groups of pregnant women suffering from bipolar disorder. The goal of the study was to examine the course of bipolar disorder during pregnancy.

Past studies have demonstrated that mothers suffering from bipolar disorder are at an increased risk for relapse during the postpartum period, i.e., the period of time immediately following childbirth. This risk has been shown to be higher for women (suffering from bipolar disorder) who aren't on mood stabilizers while pregnant, as compared to women who are on mood stabilizers while pregnant. Unfortunately, the issue of being on medication while pregnant is a complicated one for women who suffer from bipolar disorder. On the one hand, there are known risks for the fetus associated with medication. According to the study, some of these teratogenic risks include neural tube defects associated with the mood stabilizers valproate and carbamazepine, as well as, an increased risk for cardiovascular malformations--the authors of the study provide an example of this: Ebstein's anomaly--associated with lithium. On the other hand, abrupt cessation of medication for people suffering from bipolar disorder, particularly pregnant women, can be extremely harmful to the sufferer, and in the case of pregnant women, also to the fetus.

The study focused on three groups of a total of 89 women who suffered from bipolar disorder and who were in the process of planning for pregnancy. The participants were:

seeking psychiatric consultation in a specialized perinatal psychiatry program. Pregnant women were enrolled prior to 24 weeks gestation and included if they 1) were euthymic for at least 1 month prior to conception, 2) were receiving treatment with a mood stabilizer, or 3) had discontinued pharmacotherapy at least 6 months prior to pregnancy or within the first trimester. Women were followed through pregnancy and the postpartum year, and patients decided themselves whether to continue or discontinue medication. A majority of women experienced at least one mood episode during pregnancy (70.8%). The risk of recurrence was significantly higher in women who discontinued treatment with mood stabilizers. Women who discontinued medication also spent more time ill during pregnancy compared with women who continued medication. Several history of illness and treatment factors were associated with relapse during pregnancy. One of the treatment factors associated with increased relapse rates was rapid mood stabilizer discontinuation. The only pregnancy-related predictor of relapse was if the pregnancy was unplanned.

The researchers bring up the important point with regards to these results that most psychiatrists and other mental health professionals treating female sufferers of bipolar disorder don't consider the probability of pregnancy for their patients. Thus when pregnancy does occur, both patient and mental health professional, surprised and unequipped with preparation panic, which sometimes results in abrupt discontinuation of meds for the patient. The problem with this is, as the researchers point out, and the study's results demonstrate, pregnant women suffering from bipolar disorder are more likely to have unhealthy pregnancies and postpartum periods if their meds are abruptly discontinued. Another point the researchers make is that the risks for the fetus associated with most medications used to treat bipolar disorder are concentrated around the first trimester, when most women don't know that they are pregnant. So cessation of medication may not occur until the second trimester, when this increased risk is much less severe.

There is no clear-cut solution to this problem. For now, the researchers encourage that both sufferers and treatment professionals be aware that a large number of bipolar patients are women in their reproductive years, thus the probability of pregnancy is likely. The researchers also stress the importance of discussing a possible pregnancy with your mental health professional as soon as possible and coming up with a plan of dealing with both the pregnancy and the illness as a combined effort between patient and practitioner.

See This Editorial: Bipolar Disorder and Pregnancy: Risks Revealed (American Journal of Psychiatry)

Related Reading:
Valproate Used During Pregnancy Linked To Lower IQ in Children
Bipolar Drug Lamictal Tied to Birth Defects
Treatment Considerations in Reproductive Health
Postpartum Depression in Bipolar Disorder

Johns Hopkins University, Department of Psychiatry and the National Institute of Mental Health have teamed together to create a new, innovative and free database, which researchers are saying is going to increase their ability to pinpoint genes linked to bipolar disorder. The database, called The Bipolar Disorder Phenome Database, is revolutionary in its ability to offer "...detailed descriptions of symptoms and course of disease on more than 5,000 people with bipolar (disorder)..."

Because DNA samples are available for this group, the database will let researchers correlate specific symptoms with sequences of genetic material. The new database...is meant to complement the massive bodies of genetic data generated already by the Human Genome Project, the International HapMap Consortium and the Genetic Analysis Information Network.

"This database describes the clinical picture of bipolar disorder in the fullest detail possible," said James Potash, who led the Johns Hopkins portion of efforts to assemble the site. "It also lets us pick out meaningful clusters of symptoms that will ultimately help identify genes."

These clusters of symptoms enable scientists to notice DNA and genes that stand out. For example, if they group together patients who developed bipolar disorder early or patients who experience panic attacks, then they're more likely to notice DNA that stands out in those groups. Apparently, scientists have used this same clustering to find genes that are now known to be associated with conditions such as breast cancer and Alzheimer's disease.

Another advantage The Bipolar Disorder Phenome Database has is that it cuts down the costs of collecting data from patients. The database already stores data collected from two large national studies conducted over a twenty-year period. Thus researchers are able to tap into this data when using the database without the cost of collecting new data.

Full Story: New Databases Put Wings on Search for Bipolar Risk Genes (The JHU Gazette)
More Information: Mood Disorders at Johns Hopkins Psychiatry

As we've covered in the past, children with bipolar disorder often misread facial expressions. Now new research further supports this finding:

Children with bipolar disorder respond differently to facial expressions than children without psychiatric disorders, according to a new study led by a Bradley Hospital researcher. These findings provide additional insight into the neurobiology of pediatric bipolar disorder.

"Although we know a great deal clinically about bipolar disorder in kids, our understanding of its neurobiology is quite limited, making it difficult to design targeted treatments," said lead author Daniel P. Dickstein, M.D., director of the pediatric mood, imaging and neurodevelopment program at Bradley Hospital. "We used neuroimaging technology to study the brain-behavior interactions of children with bipolar disorder in hopes of shedding some light on this relatively unknown area."

The study included 23 children with bipolar disorder and 22 typically developing children without psychiatric disorders between the ages of 7 and 17. Dickstein and his team used functional magnetic resonance imaging (MRI), a non-invasive technique that localizes regions of the brain activated during cognition and experience, to scan the children while they "encoded" different facial expressions.

During the MRI scan, the children viewed photos of 32 different actors -- eight actors each displaying one of four emotions (angry, fearful, happy and neutral) -- from standard gray-scale photograph sets of facial expressions. After seeing the photos four times, they rated each face by answering questions such as "How afraid are you?" "How hostile is the face?" and "How wide is the nose?"

Thirty minutes after the MRI scan, children were given a surprise out-of-scanner memory task, during which they viewed 48 actors (half of which were seen previously during the MRI and half that were not previously viewed). They were then asked whether they recalled seeing the face during the earlier test.

During the encoding of "happy" faces, researchers observed increased activity in the region of the brain (striatum) associated with rewards in the children with bipolar disorder. Increased activity was also found in the part of the brain (orbitofrontal cortex) linked to irritability when the same children encoded "angry" faces. Brain activity in both instances was significantly greater than in children without bipolar disorder.

Based on the number of correct identifications during the memory task, Dickstein and colleagues also found that children with bipolar disorder demonstrated reduced memory for emotional faces as compared to children without bipolar disorder -- particularly with "fearful" faces.

"This study suggests a neural basis for mania in children, which typically involves unusually irritable or excessively happy moods, and raises questions about whether treatments, therapy or medication could address these brain changes," Dickstein said.

The authors say further research is required to determine the impact of mood state, medication and the presence of an additional illness, such as attention deficit hyperactivity disorder, on these findings.

Full Story: Facial Expressions Have Greater Impact On Kids With Bipolar Disorder (ScienceDaily)

A new study out of the UK shows that people who suffer from bipolar disorder and who also have a family history of suicide, may be at a higher risk for committing suicide themselves. Specifically, bipolar patients with a family history of suicide are three times more likely to attempt suicide than is the rest of the population.

Yet this increased risk of suicide isn't concentrated around just bipolar patients. As Dr. Eduard Vieta, one of the study's authors states, a family history of suicide also increases the risk of suicide for people who suffer from other mental illnesses. He's careful to point out though, that this genetic risk for suicide doesn't make the act inevitable. Rather, knowledge of your family history should lead to engaging in preventative behavior and education about suicide.

Prior to this study, two other studies also found an increased risk of suicide in bipolar sufferers with a family history of suicide. However, the data collected for these studies were from hospital records. To ensure more reliability, Dr. Vieta and his colleagues performed their study by "evaluat(ing) 374 men and women, ranging in age from 19 to 88 years, who met standard criteria for a diagnosis of bipolar illness. Forty-eight of these patients had a family member who had committed suicide." They found that "(p)eople with a family history of suicide were more likely to have anxiety-related personality traits than those who did not. More than 52 percent of the family-history patients reported a suicide attempt compared with 26 percent of patients with no family history of suicide."

The researchers stress that the main thing to take away from these findings is the importance of preventative efforts, i.e., they think the focus should be on first identifying patients who suffer from mental illness and who have an increased risk for suicide and then to educate these patients on the prevention of suicide. Dr. Vieta provides the following analogy to better understand suicide in the context of mental illness: "Suicide should be thought of as a complication of mental illness, just as death from a heart attack is seen as a risk for people with cardiovascular disease..."

Dr. Vieta also emphasizes the importance of choice and prevention, highlighted in the following quote:

There is a lot of room for prevention if clinicians are aware and people are aware that some people are at higher risk of suicide than others," Vieta said. Even though genes may largely be responsible for the inheritability of suicidal tendencies, he added, "we still have some free will. Genetics doesn't mean that you are impelled to do what your genes tell you to do.

Full Story: Some bipolar patients have higher suicide risk (Reuters)

Abstract: Relevance of Family History of Suicide in the Long-Term Outcome of Bipolar Disorders
(Journal of Clinical Psychiatry, 2007)

Some Past Stories on Suicide:
1. New National Suicide Prevention Hotline
2. Suicide Among Youth - Treatment Responses
3. Environmental Stressors Increase Suicide Risk

We've covered past research that demonstrates how high levels of certain kinds of expressed emotion have negative effects on the mental health of children. Recently, researchers at the University of Colorado discussed current research supporting this past research on bipolar disorder. A new story highlights their findings:

Bipolar disorder is "a highly recurrent and debilitating illness." Research has demonstrated that certain types of expressed-emotion affect the development of bipolar disorder. Basically, certain negative attitudes in the home or from peers (such as critical ones, i.e., criticism) can increase not only the risk of developing bipolar disorder, but also the risk of relapsing after development. [Read More About the Effects of Expressed Emotion Here.]

Symptoms of bipolar disorder are primarily treated by medication but can also benefit from simultaneous therapy. Past research has demonstrated that a combination of family-focused therapy and medications can "...delay...relapses and reduce... symptom severity among patients followed over the course of 1 to 2 years..." [Read More About Family-Focused Therapy Here.]

The researchers further stated that the effectiveness of family-focused therapy on delaying the development and relapse of bipolar disorder, specifically in the case of adolescents and children at high risk for the illness, are currently being investigated.

This discussion of up-to-date research findings brings up the important psychological factors at play in the development of mental illness in children and adolescents. Knowledge about these factors is essential to preventing the possible development or relapse of bipolar disorder.

Related Reading: CU professor to pioneer new bipolar disorder study

Listen to this Podcast (audio recording): Click on the following link and then scroll down to the podcast named: BIPOLAR DISORDER; Scientists at University of Colorado discuss research in bipolar disorder.

Researchers at the Stanford University School of Medicine (in Palo Alto, California) are seeking volunteers for several research studies on bipolar disorder, which affects more than 10 million American adults.

The illness typically requires lifelong treatment, and researchers have been studying which medications are the most effective. "We're aiming to enhance the treatment of bipolar disorder by exploring agents with greater efficacy for mood symptoms and/or greater physical tolerability," said Terence Ketter, MD, professor of psychiatry and behavioral sciences and chief of the Bipolar Disorders Clinic, who is leading the studies.

Participants in each study must be ages 18 to 65 and have a diagnosis of bipolar disorder, an illness that is marked by episodes of mania and depression that can last from days to months.

Study 1: This study is examining the effectiveness of armodafinil as an add-on therapy for bipolar patients experiencing major depression.

Who is eligible: Volunteers for this study must be suffering from depression and currently taking divalproex sodium, lithium and/or olanzapine.

What is required: Participants will be carefully evaluated and assigned by random to receive either armodafinil or a placebo for a period of eight weeks. They will be monitored by a psychiatrist and be compensated for time and travel expenses.

For additional information, please contact Shelley Hill at (650) 498-4801 or shill@stanford.edu.

Study 2: This study focuses on the use of quetiapine to treat bipolar patients with both hypomania and depression.

Who is eligible: Volunteers for this study must be experiencing both hypomania -- a distinct period of elevated mood, lasting for at least four days -- and depressive symptoms.

What is required: Participants will be carefully evaluated and assigned by random to receive either quetiapine or a placebo for a period of eight weeks. They will be monitored by a psychiatrist and be compensated for time and travel expenses.

For additional information, please contact Kristine Keller at (650) 498-4968 or klkeller@stanford.edu.

Study 3: During this study, researchers are looking at the use of olanzapine to treat patients experiencing increases in symptoms of bipolar disorder.

Who is eligible: Volunteers for this study must be experiencing an obvious increase of bipolar symptoms, including hypomania and depression. They must have been on medication for at least two weeks.

What is required: Participants will be carefully evaluated and assigned by random to add olanzapine or a placebo to their other medications for one week. At the end of this period, all participants will receive olanzapine for one week while being monitored by a psychiatrist. Volunteers will be compensated for time and travel expenses.

For additional information, please contact Kristine Keller at (650) 498-4968 or klkeller@stanford.edu.

The researchers are also continuing to recruit volunteers for an ongoing study on the use of ziprasidone to treat bipolar patients experiencing weight gain, a common side effect of some medications. Over a 12-week period, participants will be carefully evaluated and treated with ziprasidone, and efforts will be made to decrease or discontinue medications implicated in weight gain. For additional information, please contact Kristine Keller at (650) 498-4968 or klkeller@stanford.edu.

A new study out of Australia which will appear in the journal Psychological Medicine has found that over a third of relatives of people with bipolar disorder are afraid to have children. The reason for their fear seems mainly to be stigma associated with the disorder.

Despite a lower risk as compared to other genetic disorders, bipolar disorder aroused a more negative attitude from the 200 people who participated in the study, which was conducted at University of New South Wales. Even more surprising is that over half of the participants suffer from bipolar disorder themselves. Researchers state that studies on other hereditary diseases such as cancer do not demonstrate any significant difference of attitudes toward having children even though the genetic risks are much higher than for bipolar disorder. They state the importance of education for people suffering from and/or with a family history of bipolar disorder. One researcher states that "(p)roviding families with genetic risk information is important, but this study suggests that society as a whole needs to be better educated about mental health disorders, and in particular the effective treatments available for these."

Full Story:The Sydney Morning Herald, Too scared to have children

Related Research Article:Attitudes towards childbearing, causal attributions for bipolar disorder and psychological distress: a study of families with multiple cases of bipolar disorder, MEISER B et al(2007). Psychological Medicine, 37: 1601-1611.