February 25, 2005

Mental Health Courts Spreading

With the number of people with bipolar disorder in jail skyrocketing in the past decade (while, coincidentally, hospital facilities and resources available to treat the mentally ill have fallen dramatically) its on a rare positive note that people are finally recognizing the special needs of the mentally ill when it comes to minor criminal offenses.

This week Harris County, Texas, judges may create a mental health court to provide specialized legal consideration and treatment for those with diseases such as schizophrenia, bipolar disorder and psychotic episodes.

Harris county's felony court judges have asked the Legislature for $236,000 for a full-time court coordinator and a mental health expert. The move is an attempt to expand an existing informal mental health program.

"We need to give appropriate treatment for people who are sick, and these people are just sick," state District Judge Jan Krocker told the Houston Chronicle. "They are not going to make their probation if they don't get extra encouragement and extra supervision. If we can help all these people on probation, they won't have to go to jail." The judge hopes the Harris County mental health court could be operational by September.

The mental health court would be similar to Harris County's drug court created in 2003. The judges are looking at the court as an alternative to save money and reduce crime in the face of dwindling prison and jail space in Texas.

In Idaho they are also setting up mental health courts. The Idaho court was started by Judge Brent Moss. He told ABC News that he "tired of seeing drug addicts sent to prison, without treatment, when many were trying to self-medicate to control a mental illness they did not understand."

The judge realized that mentally ill defendants were not getting the help they needed and he thought they were getting in prison.

"I was naive," Moss said to ABC News.


Well, there are still a lot of naive judges out there - in all countries of the world.

Advocates are starting to change this now. In the US, NAMI seems to have been pushing this as an issue hard (Thanks to Ron Honberg's and others in the NAMI legal group).

For more information, see the following web links:

Survey of Mental Health Courts

Google News on Mental Health Courts


Posted by szadmin at 6:03 PM | Comments (2)

February 23, 2005

Bipolar Disorder and Urban Poor

Bipolar Disorder is much more common with Urban Poor, Study Suggests

A study was recently published in the Journal of the American Medical Association, (conducted by Amar K Das, M.D., Ph.D., and colleagues), in which they estimate the lifetime prevalence of bipolar disorder for patients in an urban general medicine clinic and compare the demographic, clinical, and treatment characteristics of patients who screen positive for a history of bipolar disorder with those who do not.

The study included 1,157 patients between 18 and 70 years of age who were seeking primary care at an urban general medicine clinic serving a low-income population. The study was conducted between December 2001 and January 2003. A bipolar disorder diagnosis was determined by questionnaires and surveys and reviewing data on past mental health treatments and records.

According to a study, nearly 10 percent of patients screened at a general medicine clinic in an urban area were found to have a history of bipolar disorder. This is much higher than the average rate of approximately 1% to 1.5% that is typically quoted for nationwide statistics.

For more information, see:

JAMA - Screening for Bipolar Disorder in a Primary Care Practice

News-Medical.net story

Reuters Story

Posted by szadmin at 5:34 PM | Comments (3)

February 22, 2005

Family Tree & Bipolar Disorder

Given the significant roll that genetics play in bipolar disorder, and the significant benefits that can accrue to people who get early treatment, it makes particular sense for families where one or more people suffer from bipolar disorder to do some genetic analsysis and family tree analysis to better understand their risks and potential preventative actions (or early treatment options).

Today there is a good article on The Guardian's web site on this issue (of tracking geneology for health reasons). The article suggests that:

"GPs are used to asking whether heart disease or cancer runs in the family but are less good at asking about mental health problems, according to Vicky Lawson, training manager for the Bipolar Organisation (previously Manic Depression Fellowship).

The issue, and why it ties into family geneology is because of the frequent misdiagnosis (and delayed treatment) around brain disorders like bipolar disorder. The story accurately points this out, saying:

"Sufferers tend to go to their GP when they are depressed and are often misdiagnosed and prescribed antidepressants. But as someone's mood swings back into mania, antidepressants can be dangerous and may increase the risk of suicide. The cardinal pointers to a diagnosis of bipolar disease are a family history of the condition, drug and alcohol abuse, and periods of elation. "We need to push GPs to ask depressed people whether there is a family history of mental health problems or alcohol and drug abuse which people often turn to when their moods are fluctuating," says Lawson."

See the entire story at:

Source: The Guardian: Tree of Life


Posted by szadmin at 9:50 PM | Comments (0)

The Unscious Mind and Bipolar

A story on the unconsious mind in US News and World report this week touches upon bipolar disorder and schizophrenia, stating that research has:

"revealed fascinating activity out of conscious awareness that may eventually provide clues to more effective treatments."

The story goes further to suggest that in barely conscious patients that have been studied, language centers of the brain show high amounts of activity when they hear personal stories recounted by a family member. Similarly, research on schizophrenia reveals that most who are afflicted have an impaired ability to smell, which researchers think may provide some clue to understanding why they have such difficulty perceiving social cues.

Source: US News and World Report, story "Mysteries of the Mind"

Posted by szadmin at 9:40 PM | Comments (4)

Childhood Bipolar Guidlines

Treatment guidelines for kids with bipolar disorder published

A Cincinnati Children's Kowatch led effort

Early diagnosis and treatment is important for children and adolescents with bipolar disorder, according to new treatment guidelines. The guidelines were sponsored by the Child & Adolescent Bipolar Foundation (CABF), a national parent advocacy group, and were drafted by a scientific consortium led by Robert Kowatch, M.D., director of the Pediatric Mood Disorders Center at Cincinnati Children's Hospital Medical Center.

"These new guidelines were formulated by a group of leading experts in child psychiatry and are the most up-to-date and comprehensive set of guidelines for the treatment of children and adolescents with bipolar disorder," said Dr. Kowatch. "They represent a major step towards practicing evidence-based medicine in this difficult to treat group of patients. Many of these patients require several types of medications to stabilize their moods, and these guidelines offer several treatment options that are useful for clinicians and families."

It is often necessary to use several medications in combination because these kids are very ill, often suicidal or too manic and depressed to attend school. Stabilizing their moods and allowing them to return to school as soon as possible is critical if they are to lead normal lives, said Dr. Kowatch.

"Doctors are getting somewhat better at recognizing bipolar disorder in children, but there wasn't much to guide them in terms of treatment," added Dr. Kowatch.

The guidelines are designed to help doctors identify the classic form of the illness (called Bipolar-I) in children ages 6 to 17, and suggest strategies for treatment of mania and depression, with or without psychosis, in young patients. The recommendations are based on evidence from research studies done in children and adults, case reports published in medical journals, and consensus by a group of experts as to current clinical practices.

The guidelines will be published in the March issue of the Journal of the American Academy of Child and Adolescent Psychiatry but are currently available to the public on their website at www.jaacap.com.

"Far too little research has been done on the treatment of bipolar disorder in youth," said Mina Dulcan, M.D., editor-in-chief of the journal. "The guidelines represent a consensus of existing research results and clinical experience to guide clinicians and families. We hope that the guidelines will not only facilitate clinical care but also inform and enhance new research."

Bipolar disorder (formerly called manic-depressive illness) is a heritable illness that can be diagnosed in teenagers and even in young children. Symptoms include grandiose delusions, irritable mood often accompanied by aggression and self-injury, decreased need for sleep without daytime fatigue, speech that is difficult to interrupt, racing thoughts, distractibility that varies with mood, increased goal-directed activity, hypersexuality, and in some cases, hearing voices.

"The disorder runs in families, and children with the illness are at extremely high risk of attempting suicide," said Martha Hellander, research policy director at CABF and co-author of the guidelines. "These kids suffer so badly, and deserve to have evidence-based treatment as early in life as possible. Many respond quickly to mood stabilizing medication, and parents tell us that 'we have our child back.'"

Bipolar disorder is a lifelong condition that can often be managed with medication, psychotherapy and lifestyle changes such as stress reduction, regular sleep, accommodations at school, and avoidance of caffeine, alcohol, and drugs of abuse.

"The sections on the treatment of comorbid psychiatric disorders are very helpful because having two or more disorders at the same time is common among children and adolescents with bipolar disorder," said Daniel Nelson, M.D., medical director of the Child Psychiatric Unit at Cincinnati Children's. "By far, a majority of the children we care for with bipolar disorder have high comorbidities."

Among the other disorders specific to children who have bipolar disorder, children can also suffer from ADHD, oppositional-defiant disorder, conduct disorder, anxiety and tic disorders, and substance abuse. The comorbid disorders and common side effects from treatment medications are also discussed in the guidelines.

In addition to Dr. Kowatch, other authors of the guidelines include Mary Fristad, Ph.D., director of Research & Psychological Services at Ohio State University; Boris Birmaher, M.D., head of the Children's Mood Disorders Center at Western Psychiatric Institute and Clinic in Pittsburgh; Karen Dineen Wagner, M.D., director of the division of Child and Adolescent Psychiatry at the University of Texas Medical Branch in Galveston; Robert Findling, M.D. professor of psychiatry and pediatrics at University Hospitals of Cleveland; and Martha Hellander. Participants included sixteen other experts on pediatric bipolar disorder and three family representatives from CABF.

Source: Cincinnati Children's Hospital and CABF
###
The Cincinnati Children's vision is to be the leader in improving child health. Additional information can be found at www.cincinnatichildrens.org.
CABF is a national, not-for-profit organization of more than 25,000 families raising children diagnosed with, or at risk for, bipolar disorder.

Posted by szadmin at 8:24 PM | Comments (3)

February 18, 2005

Carrie Fisher story in top 10

"The Best Awful" a fictional book by Carrie Fischer has been voted as one of the top 10 audio books of 2004 by the Library Journal. In its recent issue, it states that in the Audio Book Fisher's "perfect" voice gives this story of bipolar disease "depth and resonance." It's the tale of a woman out of control, to whom the listener gives "full attention and in the end full admiration."

S. & S. Audio. 4 cassettes. 5 hrs. ISBN 0-671-88538-3. $26.

Source: Library Journal

"The Best Awful" audio book may be purchased at Amazon.com and other Internet retailers.

Posted by szadmin at 5:09 PM | Comments (0)

Children Overdiagnosed with BP

The Washington Post interviewed a dozen psychiatrists and child psychologists for a February 15 story on child diagnosis of bipolar disorder.

The story suggest that there have been sharp increases in child diagnosis of bipolar disorder during the past decade. As a result, some preschoolers barely out of diapers are being treated for bipolar disorder with powerful drugs, few of which have been tested in children.

An associate professor of psychiatry at the University of Washington, Jon McClellan, thinks there may be a rush to diagnose kids as a result of bipolar disorder's status as a cultural phenomenon.

In follow-on letters to the editor, a number of people have written in to agree and disagree.

Source: Washington Post "Going to Extremes" (Free Registration Required).

Posted by szadmin at 4:52 PM | Comments (0)

Omega 3 helps with Depression (Study)

Another study was recently completed that supports the theory that consuming higher than average levels of Omega-3 fatty acids (as found in Salmon, walnuts, sugar beets, etc.) helps to lessen depression.

In fact, this new research at Harvard-affiliated McLean Hospital indicates some food ingredients may be as effective as traditional antidepressants in bolstering mood.

Although the connection has so far only been explored in rats, the results are encouraging and shouldn't be too surprising, according to Dr. Bruce Cohen, president and psychiatrist in chief at McLean Hospital.

In a similar study released in 1999, Dr. Andrew Stoll, director of the psychopharmacology research laboratory at McLean, suggested in a that megadoses of fish oil could dramatically improve the course of severe bipolar disorder. Stoll has also found omega-3 fatty acids can sharpen memory and aid concentration.

For more information on the study see:

Foods Like Fish May Buoy Your Mental Health (ABC News)

Posted by szadmin at 4:41 PM | Comments (0)

February 7, 2005

Blood Test for Bipolar Disorder

The science magazine "New Scientist" reported on February 5, 2005 on a new blood test being developed for bipolar disorder and schizophrenia, as reported in a genetics journal (American Journal of Medical Genetics B , vol 133, p 1)

The early results suggest a 95% to 97% accuracy level - which could help a great deal in early diagnosis and even potential prevention. Of course - this is just one early test, on a small number of people - so it remains to be seen if it proves to be effective when the study is validated by an independent group with larger sample sizes.

The story mentioned that:

"A BLOOD test that measures the activity of genes can accurately detect mental illnesses such as schizophrenia, a small trial suggests.

RNA molecules are produced whenever a gene is active and, by measuring levels of these molecules in the blood, a team led by Ming Tsuang, at the University of California in San Diego has distinguished healthy individuals from patients with either schizophrenia or bipolar disorder (manic depression).

These conditions are currently diagnosed by assessing patients' behaviour. "A laboratory test would enable earlier diagnosis and more timely treatment," Tsuang says."

The study examined the blood gene expression of 74 patients - 30 with schizophrenia, 16 with bipolar disorder and 28 controls. Eight gene blood biomarkers were identified and used to discriminate amongst the 3 groups, with an overall accuracy of 95% to 97%. The paper was co-authored by Dr. Ming T. Tsuang, Distinguished Professor of Psychiatry, and Director, Institute of Behavioral Genomics, Department of Psychiatry at the University of California, San Diego, and Director, Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Department of Epidemiology and Psychiatry, Harvard University and Dr. C.C. Liew, ChondroGene's Chief Scientist, Visiting Professor and Founder of The Cardiovascular Genome Unit at The Brigham and Women's Hospital, Harvard Medical School, and Professor Emeritus at The University of Toronto, and was responsible for conceiving the Sentinel Principle.

The data presented in the paper is a result of an initial collaborative research project between ChondroGene and Dr. Tsuang in which the Sentinel Principle was applied to these two psychiatric disorders. Additional studies to further validate disease-specific biomarkers in larger psychiatric populations are ongoing.

"At present there are no tests that can effectively diagnose psychiatric disorders early in their evolution. Using current methods, it can take months or even years to make a definitive diagnosis", stated Dr. K. Wayne Marshall, President and CEO of ChondroGene Limited. "Application of ChondroGene's Sentinel Principle to schizophrenia and bipolar disorder has generated unique blood-based molecular signatures for each disease. These molecular signatures can be used to develop disease-specific biomarkers that will enable earlier diagnosis and more timely treatment of these devastating disorders."

Rory Riggs, ChondroGene's Chairman and Managing Director of Balfour LLC, stated that "the Sentinel Principle is an extremely powerful tool that can provide a snapshot of what is happening throughout the body from a simple blood sample. So far ChondroGene has applied the Sentinel Principle to over 50 different diseases with very promising results."

The Sentinel Principle is used to identify unique molecular signatures in blood associated with a specific disease. These molecular signatures are then used to identify blood-based biomarkers that can be used for disease- specific diagnostic tests. ChondroGene is applying the Sentinel Principle in four main disease areas; cancer, central nervous system disorders, cardiovascular disease and arthritis. The Company currently works with research collaborators and organizations around the world in these various disease areas.

New Scientist magazine mentioned that "Peter Liddle, co-director of the Nottingham Institute of Neuroscience in the UK, warns that the similarities in gene expression in patients could be a coincidence or the result of their medication. Tsuang is already carrying out a second, larger study and hopes to start a third with patients not on medication, to rule out possible effects of prescription drugs on gene expression."

The paper entitled "Assessing the Validity of Blood- Based Gene Expression Profiles for the Classification of Schizophrenia and Bipolar Disorder: A preliminary Report" is available online on the American Journal of Medical Genetics Part B: Neuropsychiatric Genetics' website at http://www3.interscience.wiley.com/cgi-bin/abstract/109865056/ABSTRACT

The work is in part sponsored by a company called "ChrondroGene". ChondroGene is focussed on the application of functional genomics to enable early diagnosis and personalized therapeutic intervention based on disease-specific biomarkers. The Company has developed a novel approach, based on the Sentinel Principle, to detect and stage virtually any disease or medical condition from a simple blood sample. ChondroGene is currently applying the Sentinel Principle in major areas with unmet clinical needs such as cancer, arthritis, cardiovascular disease and neurological disorders. For more information on ChondroGene, visit http://www.chondrogene.com


Posted by szadmin at 6:23 PM | Comments (4)

February 3, 2005

Homeless Report

More Homeless Mentally Ill Than Expected According To UCSD Study: Interventions Urged

The prevalence of homelessness in persons with serious mental illness is 15 percent, a higher percentage than suggested in previous studies, according to new research by investigators at the University of California, San Diego (UCSD) School of Medicine.

Published in the February 2005 issue of the American Journal of Psychiatry, the study noted that homelessness in this population might potentially be reduced or prevented with substance abuse treatment and help in obtaining public-funded health benefits (Medicaid, or MediCal in California). Because homeless mentally ill were more than twice as likely to be hospitalized as non-homeless patients, the investigators said improved care for homeless persons with serious mental illness may be cost effective or at least result in improved patient outcomes with only moderate increases in total costs.

The research was conducted among an ethnically diverse population of 10,340 San Diegans with serious mental illness (both homeless and those with housing) who were treated by San Diego County Adult Mental Health Services (AMHS). While one-fourth to one-third of homeless persons are estimated to have a serious mental illness, this is one of the first studies to document and describe the other side of the picture – the number of mentally ill who are homeless.

"Homelessness is more common in patients with serious mental illness than I would have guessed," said the study's first author, David Folsom, M.D., co-director of the UCSD Combined Family Medicine-Psychiatry Residency Program and the assistant medical director of St. Vincent de Paul Village's Family Health Center, a free medical clinic located in one of San Diego's largest homeless service agencies.

According to the UCSD researchers, homelessness was most frequently associated with people who were diagnosed with schizophrenia or bipolar disorder, who were substance abusers, and who had no public-funded health care. Men were also more likely to be homeless than women, as were African Americans. Latinos and Asian Americans were less likely to be homeless.*

"Homelessness is an increasingly important public health issue, with seriously mentally ill persons most at risk for homelessness," said the study's senior author, Dilip Jeste, M.D., UCSD Estelle and Edgar Levi Chair in Aging, professor of psychiatry and neurosciences, director of the UCSD Sam and Rose Stein Institute for Research on Aging, and a geriatric psychiatrist at the VA San Diego Healthcare System. "In addition to the trauma experienced by these individuals, there is also a cost to society. Homeless persons have a significantly more-frequent use of expensive emergency services** and are more likely to spend more time in jail."

The study noted that in San Diego, African Americans comprise 5 percent of the general population, 11 percent of the AMHS population with serious mental illness, and 16 percent of the homeless patients with serious mental illness treated in AMHS. Latinos contribute 23 percent of the general population, 19 percent of the AMHS patients, and 12 percent of the homeless.

"It is possible that the higher rate of homelessness among African Americans may be in part due to fewer community resources for this group of patients, whereas the larger Latino community may be able to provide more resources to protect against homelessness," the study said. "However, African Americans have been found to be at higher risk of homelessness in other cities with larger African American populations, such as New York and Philadelphia***."

The authors also said that an investigation of homeless persons in Los Angeles, only some of whom had mental illness, found lower rates of homelessness in Caucasians and Latinos than in African Americans.

Noting that treatment for substance abuse has been reported to improve outcomes, the researchers said "access to substance abuse treatment is more difficult for homeless persons with serious mental illness than for other homeless persons. Similarly, patients who did not have MediCal insurance were twice as likely to be homeless as patients with MediCal; homeless persons with psychotic disorders have been reported to have greater difficulty obtaining and maintaining entitlement benefits than non-psychotic homeless persons."

The authors concluded that "although it would be naïve to assume that treatment for substance use disorders and provision of MediCal insurance could solve the problem of homelessness among persons with serious mental illness, further research is warranted to test the effect of interventions designed to treat dually diagnosed patients and to assist homeless persons with SMI obtain and maintain entitlement benefits."

###

The study was funded by the National Institute of Mental Health and by the Department of Veterans Affairs. Additional authors were William Hawthorne, Ph.D., Laurie Lindamer, Ph.D., Todd Gilmer, Ph.D., Anne Bailey, M.S., Shahrokh Golshan, Ph.D., Piedad Garcia, Ed.D., Jurgen Unutzer, M.D., and Richard Hough, Ph.D.

* Patients with schizophrenia were 2.4 times more likely, and those with bipolar disorder 1.6 times more likely to be homeless than those with major depression. Substance users were more than 4 times as likely to be homeless as non-users. Homelessness was twice as common among patients lacking MediCal insurance compared to MediCal beneficiaries.

** see http://health.ucsd.edu/news/2004/04_01_Jeste.html (previous study) The current study found that homeless patients were 10 times more likely to use crisis residential treatment and 4 times more likely to use inpatient psychiatric hospitalization than non-homeless persons.

*** American Journal of Public Health, 1995, 85:1153-1156; American Journal of Public Health 1994, 84:265-270; and Psychiatric Services 1997, 48:390-392

Posted by szadmin at 9:45 PM | Comments (1)