July 29, 2005

Wake and Light Therapy for BP Depression

A new review article from a special committee from the International Society for Affective Disorders (ISAD) discusses the evidence for chronotherapeutics (light and wake therapy) in treating both unipolar and bipolar depression. The suggestions of this review article concerning the efficacy of chronotherapeutics could lead to new, larger research trials of these therapies for bipolar patients.

According to the article, about 60% of depressive patients (either bipolar or unipolar subtype) improve rapidly with sleep deprivation therapy. This can involve a single night of total sleep deprivation, or a partial (second half of the night) deprivation period. Similar numbers of positive responders to sleep deprivation therapy were also reported in a 2002 review article (Sleep Med Rev. 2002 Oct;6(5):361-77 ).

However, the dangers of sleep deprivation therapy include high reported rates of relapse, and, for bipolar patients, the possibility of induced hypo-mania or mania.

Despite this, the review from ISAD indicates that the beneficial effects of sleep deprivation therapy can be maintained through combination with daily light therapy, or certain pharmacological treatments (for bipolar patients, lithium or a serotonergic 5-HT1A autoreceptor have been used in studies with positive results).

A small but promising placebo-controlled trial from 1999 seems to corroborate this statement. In the study, 40 bipolar I subjects in a depressive episode were randomly assigned to either 3 alternating nights of total sleep deprivation (TSD) plus concurrent treatment with pindolol (a serotonergic autoreceptor blocker known to enhance the effects of SSRI antidepressants), or 3 alternate nights of total sleep deprivation (TSD) alone.

Out of the 20 subjects in each group, 75% of those treated with TSD + pindolol responded with significant improvement, as compared to 3 out of the 20 subjects undergoing only TSD. The responsive subjects were given lithium after the 11 day experimental treatment period, and there were no reports of manic episodes during the follow-up period (although one subject did relapse back into depression). The article specifically mentioned that serotonergic autoreceptors given alone have not been shown to improve depression; thus, it appears to be the effects of sleep deprivation plus the serotonergic-enhancing effects of the pindolol that caused the improvement.

Although well-designed, this was a small study, and thus the results cannot necessarily be generalized. Moreover, the dangers of sleep disturbance triggering hypomania or mania for bipolar patients has also been extensively documented; this is reported to be especially true for rapid-cyclers. The following quote from the 2002 review article of sleep deprivation (SD) therapy describes the relative risk:

"Especially in bipolar but also in unipolar depressives SD may provoke hypomanic or manic reactions...It generally subsides spontaneously and only rarely needs treatment [according to one study. Hypomanic or manic reactions after therapeutic SD amount to 11±30% in bipolar depressives and up to 65% in rapidly cycling bipolars. There are only sparse data on unipolar depressives; here the frequency is certainly 46%. For the sake of comparison, the frequency of manic reactions in the course of pharmacologic treatment of bipolar depressed patients is given: tricyclic antidepressants 11.2%, selective serotonin reuptake inhibitors (SSRI) 3.7%, placebo 4.2%. In unipolar depressives all numbers are less than 1%." (Giedke and Schwaerzler, 2002).

Other side effects of sleep deprivation reported in literature include provoked epileptic seizures (in predisposed persons), headaches, and gastrointestinal complaints.

"Despite the potential dangers, we can hope to see more studies examining the efficacy of sleep- and light-therapies for bipolar depression. The authors of the 2002 review state that, to date, "we have the impression that there are more studies in which bipolar patients respond better to SD [sleep deprivation] than unipolars do..." (Giedke and Schwaerzler, 2002)

It seems that chronotherapeutics, if their benefits can be stabilized and maintained, may have the potential to help treat the notoriously difficult problem of bipolar depression.

Note: Please do not try any sort of sleep-deprivation therapy, or any other new treatment, without proper medical supervision. The potential for sleep disturbance to trigger mania has been well-documented; until chronotherapeutics for bipolar patients is better understood, we do not recommend attempting this treatment without specific advisement and supervision of your doctor.

Sources for this article:

Chronotherapeutics (light and wake therapy) in affective disorders.
Psychol Med. 2005 Jul;35(7):939-44.

Therapeutic use of sleep deprivation in depression.
Sleep Med Rev. 2002 Oct;6(5):361-77. Review.

Sustained antidepressant effect of sleep deprivation combined with pindolol in bipolar depression. A placebo-controlled trial.
Neuropsychopharmacology. 1999 Apr;20(4):380-5.

Posted by julia.d at 10:13 AM | Comments (1)

July 25, 2005

MRI & Early-Onset Bipolar Disorder

Magnetic resonance imaging studies in early-onset bipolar disorder: a critical review. Frazier JA, Ahn MS, DeJong S, Bent EK, Breeze JL, Giuliano AJ.

Not many studies use magnetic resonance imaging (MRI) to study bipolar disorder in children. There are advantages to focusing on bipolar disorder in adolescents and children. Unlike adult sufferers, children suffering from bipolar disorder are less likely (if at all) to experience a larger number of mood episodes (as compared to adults), substance abuse problems, "a lengthy duration of illness", etc. Further, focusing on bipolar disorder in children may help us figure out whether abnormalities unique to children or adolescent sufferers exist.

A recent study has examine early-onset bipolar disorder by using PubMed "to identify peer-reviewed publications from the past 15 years (January 1990 to January 2005) that used brain-imaging techniques (anatomic, functional, and biochemical) to research" bipolar disorder in children and adolescents.

The results of the study involve and include the following:

(1) Of the studies identified, "...eleven (used) anatomic magnetic resonance imaging (MRI), seven (used) magnetic resonance spectroscopy (MRS), and two (used) functional MRI (fMRI)..."

(2)The studies discovered structural abnormalities "...in total cerebral, white matter, superior temporal gyrus, putamen, thalamus, amygdala, and hippocampal volumes."

(3)"Deficits in cortical gray matter were also (discovered)."

(4)The use of magnetic resonance spectroscopy (MRS) yielded abnormalities "in the dorsolateral prefrontal cortex, anterior cingulate, and basal ganglia."

(5)"One fMRI study found increased activation in the putamen and thalamus of BD youths compared to controls, and a second found abnormal prefrontal-subcortical activation in familial pediatric BD."

Despite these results, it's important to remember that only a few published MRI studies exist on the topic of bipolar disorder in children and adolescents. Still, the study demonstrates a biological component of the disorder by identifying abnormalities in brain regions associated with the ability to "regulate mood and cognition." The authors of the study state that it may be difficult to create an "overall model" for the disorder because of problems with the studies such as the use of small samples, the lack of diversity in samples, etc. These problems make the results less generalizable. As a result, the authors have provided advice for future studies:

...(F)uture studies (should) reproduce prior findings and determine which findings are unique to early-onset BD, relative to adult-onset illness. In addition, studies will need to establish the extent to which early-onset BD may overlap with comorbid disruptive, mood, anxiety, or psychotic disorders.

More on Childhood Bipolar Disorder
More on MRI & Bipolar Disorder

Title: Magnetic resonance imaging studies in early-onset bipolar disorder: a critical review.
Authors: Frazier JA, Ahn MS, DeJong S, Bent EK, Breeze JL, Giuliano AJ.
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

Posted by at 11:49 PM | Comments (3)

Adolescents & Bipolar Disorder

MENTAL HEALTH; U of Pennsylvania researcher finds teen mental health declining in U.S.

A new article discusses the rising number of adolescents suffering from brain or mood disorders. Unfortunately, the article states that despite this rise in incidence, "getting...teens diagnosed and cared for is a challenge that is not being met...." A new book mentioned in the article discusses this issue. The book titled, "Treating and Preventing Adolescent Mental Health Disorders: What We Know and What We Don't Know - A Research Agenda for Improving the Mental Health of Our Youth," addresses the issue by "(detailing findings) in which 150 mental health specialists analyze recent research on teen mental health problems."

The researchers mentioned in the book claim that 1 in 5 adolescents may suffer from a brain or mood disorder. Despite this large number, there seems to be a major deficiency in the treatments available for adolescents. The article posits that treating adolescent brain or mood disorders "...is not a priority on the nation's public health agenda..." This and other contributing factors such as "limited knowledge" on how to treat adolescents results in the misdiagonsis and undiagnosis of suffering adolescents.

To aid this situation, "experts' recommendations" include:

...school-based services for the assessment, treatment, and prevention of adolescent mental health problems must be improved. Primary care physicians must improve their ability to recognize and diagnose mental health disorders, and refer teens to specialists for further help, and the healthcare system should allow treatment of different disorders by different practitioners.

More on Childhood & Adolescent Bipolar Disorder

Title: "MENTAL HEALTH; U of Pennsylvania researcher finds teen mental health declining in U.S."
Source: http://www.newsrx.com/
Date: July 25, 2005

Posted by at 10:17 AM | Comments (4)

July 20, 2005

Friendship House, Employment, & Bipolar Disorder

Desire to work strong in many of the (psychiatrically disabled); Programs exist to help them achieve that goal

A new article discusses the Friendship House. Located in New Jersey, the Friendship House, is a non-profit center which helps the psychiatrically disabled with employment. Such centers seem valuable considering the difficulties psychiatrically disabled people face while attempting to get a job. The center "offers behavioral health services, vocational training and employment support." A large number of the Friendship House's clients have disabilites such as schizoffective disorder, bipolar disorder, and depression. Despite their different disabilities, most clients share the common goal of gaining employment:

"Of the people we see here, no matter how low their functioning - three-quarters of them, their goal is to someday work," says Mala Spivack, clinical director of the North Jersey Friendship House."Clearly, across the board, it's an important value for people."...People with (psychiatric disabilities) find that the intricacies of "the system, " coupled with their debilitating health condition, can make a job seem out of reach...Friendship House aims to ease clients' transitions to work, tailoring goal-oriented treatment plans based on individual abilities and desires, which range from dog-grooming to clerical jobs, Spivack says. Last year, the agency placed 198 of its clients in jobs in the community."It gives them a place in society," Spivack says, "and it enhances self-esteem and self-worth."

The Friendship House is located 125 Atlantic Street, Hackensack. Phone: 201-488-2121.

To learn about related issues:
Psychiatric Disabilities and Unemployment
Social Ties, Recovery, & Psychiatric Disability

Title: "Desire to work strong in many of the mentally ill; Programs exist to help them achieve that goal"
Source: http://www.northjersey.com/ Author: Jessica Adler. Date: July 18, 2005.

Posted by at 10:51 PM | Comments (6)

Pilots & Bipolar Disorder

U.S. Says 46 Pilots Lied To Obtain Their Licenses

Recently, the news has covered the case of 46 pilots who are being charged by prosecutors for "lying to federal authorities to obtain airplane licenses." This coverage is relevant to not only bipolar disorder but also to other mood or brain disorders. The pilots are being accussed of hiding "debilitating illnesses" which, if revealed would have "kept them (the pilots) grounded."

The pilots, who were indicted this week by grand juries in the eastern and northern federal districts of California, were identified during an 18-month criminal air traffic safety investigation by the Department of Transportation and the Social Security Administration that looked into licensed pilots who were also receiving disability benefits and payments from the government.The investigation, initiated in July 2003, included a review of more than 40,000 pilot licenses issued in Northern California to determine whether there had been any misuse or abuse of Social Security numbers. The authorities reviewed licenses held by both commercial and private pilots and found that some license applicants claimed to be medically fit to fly an airplane yet were simultaneously receiving disability benefits.

Charles H. Lee Jr., an assistant inspector general for investigations at the Department of Transportation, said the reviewers first focused their investigation on 48 pilots, most of whom were receiving disability payments for illnesses like paranoid schizophrenia, bipolar disorder and disabling heart conditions.

This story touches on a very important issue: How often do people suffering from brain or mood disorders falsify their conditions to get hired. It is important to note that the coverage of this story does not advocate the possible behavior of the pilots. Rather, this coverage is meant to bring to attention the larger issue that this story seems to be encompassed by: employment and brain or mood disorders. That is, research has demonstrated the importance of social ties for those suffering from brain and/or mood disorders. Surely, employment is involved in this issue. Surveys reveal that people suffering from bipolar disorder still experience a large amount of social stigma because of their affliction. Further, it seems that "getting hired" is much more unlikely if you disclose suffering from a brain or mood disorder. On a positive note, some programs and employers are aiding this situation by hiring those with psychiatric disablities.

Title: "U.S. Says 46 Pilots Lied To Obtain Their Licenses" Author: Carolyn Marshall. Date: July 19, 2005. Source: http://www.nytimes.com

Posted by at 10:06 PM | Comments (1)

Radio Program on Kids with BP

American RadioWorks is running an hour-long segment on the current situation of children with bipolar disorder. The program includes how to recognize if a child may have bipolar disorder, what the treatment options are, and how these children interact with their world. The host talks with various experts, and with children diagnosed with bipolar disorder and their families.

Check with your local public radio station listings to see if they are airing this American RadioWorks documentary, or listen online to a streaming audio file archived on the American Radioworks website.

Posted by julia.d at 9:32 AM | Comments (3)

July 14, 2005

New Device Helps Manage Bipolar Disorder

'Health Buddy' helps home patients manage their care

A new electronic device named "Healthy Buddy" is helping patients at the South Mississippi Home Care and Hospice. The device which can be plugged into a telephone line and electrical outlet costs nothing to use and is quite convenient in that it can be used "any time of the day." Further, the device provides 16 "different programs individualized to the patient's need." The device currently helps monitor conditions such as "heart failure, hypertension, diabetes, asthma, artery disease, bipolar disorder, cystic fibrosis and others."Not only does the device help patients feel more secure by enabling them to easily connect to a case manager, but it also helps them manage their condition.

Donna Buckles, a case manager, demonstrated the device, explaining that it had been programmed for a patient with congestive heart failure.Four buttons below a small screen give the patient options for answering questions that appear on the screen. "Did you weigh yourself today?" If the patient answers yes, the Health Buddy responds with other questions, "What is your weight?" and "Is it more or less than last time you weighed?"The questions are simple and easy to follow, Buckles said. However, they are appropriate to the patient's case and provide a good look at his or her condition at the time. The Health Buddy prompts the patient to make calls to the case manger or the pharmacist or gives other instructions.
"I get on the Internet on a secure sight and can look at the questions and how they answered them," Buckles said. "I can call patients or have a nurse follow up with some further information when necessary."The Internet site is color coded, Huffines said. "The case manager's eye is drawn to the red on the screen, which tells her something is amiss" when the patient's information gets to the site.

Imagine the possible positive implications of this device in connection to bipolar disorder? It can remind a patient to take their meds., alert a case manager when the patient has not taken their meds., and even inform the case manager if the patient is feeling for example, suicidal. Of course this device takes for granted that the patient will answer the questions honestly, That is, there could be a tendency for patients to misrepresent their situation by answering the questions dishonestly. For example, a patient could answer "yes" to taking their meds. when in fact they haven't done so. Still, the device appears to be effective if the patient is willing to use it. As of now, only 73 patients are using the device. This may be due to the fact that the device only became available in January of this year.

Although the article did not mention the manufacturer of the device, this California-based company (Health Hero Network) looks like it is the source. More information about the Health Buddy product

Source: http://www.natchezdemocrat.com
Title: "'Health Buddy' helps home patients manage their care"
Author: Joan Gandy
Date: July 3, 2005.

Posted by at 10:03 PM | Comments (5)

VCFS & Brain Disorders in Children

Brain Scans May Predict Mental Illness in Children with VCFS

Children diagnosed with VCFS - Velo-Cardio-Facial Syndrome known also as Shprintzen Syndrome have a one in four chance of developing psychiatric disabilities. VCFS is "linked to the deletion of small piece of chromosome 22 that...can cause cleft palate, heart defects, and abnormal facial appearance and learning problems." It is thought to be the "second most common genetic syndrome in humans." The prevalence of this disorder is 1 in 2,000. Unfortunately, children suffering from this disorder already face a number of medical problems, but now recent studies have shown that they might also have to face the possible development of psychiatric disabilities.

Wendy Kates, Ph.D., and associate professor of psychiatry at SUNY Upstate Medical University and her colleagues are attempting "to advance understanding of the link between VCFS and mental illness."

Kates and her research team, supported by more than $2 million in federal funds, are comparing brain scans of children with VCFS with those of healthy children to discover whether abnormal brain development may be a predictor of mental illness in VCFS sufferers. Her team is also investigating several other potential predictors, such as deficits in eye tracking and neuropsychological function. Follow-up assessments, including repeat brain scans, will be undertaken over the next three years."We believe that there will be some children whose psychological functioning has deteriorated,” Kates said. “By viewing conducting fine-grained measurements of brain regions on these brain scans we hope to identify the changes in the brain that occur in these children.”

Not only will this research aid scientists comprehend the relationship that exists between VCFS and psychiatric disorders, but also, it may enhance clinicians' abilities to predict the development of psychiatric disorders among VCFS patients. Kates believes such an understanding would allow for earlier treatment.

Already, Kates and her team have performed a related study in which they give children with and without VCFS neuropsychological tests, eye-tracking exercises, and computer-tracking exercises. Through these tests and exercises they are able "to compare the performance between the two groups of children." Kates and her researchers have discovered that “(c)hildren with VCFS have difficulty sustaining attention, and have deficits in memory and sensitive functioning, planning and organization..." Kates states that, “(b)y analyzing the relationship between brain growth...and a child's performance...on these tests, we may begin to see a common link between the two that will give us a clearer understanding of what causes these deficits in function.”

Though this information has been focused mainly on VCFS, the study of its relation to psychiatric disabilities has implications on brain disorders as a whole. Kates sums of these implications by stating: “The more we explore how the deleted genes in VCFS are linked to the various abnormalities children and adults have with this diagnosis, the closer we can come to developing, in our case, a model for human (brain disorders) and how the brain structure contributes to that..."

VCFS has not only been linked to pediatric psychiatric disorders in general, but also specifically to the onset of bipolar disorder. Demitri Papolos, author of The Bipolar Child, has conducted studies of VCFS children at the Albert Einstein college of medicine. He found "in a mixed group of twenty-five VCSF children, adolescents, and adults, 68% met DSM-IV criteria for some form of bipolar disorder" (Papolos, The Bipolar Child, p. 172). The researchers observed that many began with mood swings and night terrors, which escalated into full-blown episodes of mania. Papolos comments: "Remarkably, these patients were showing the same developmental patterns of symptoms that we were later to observe in the bipolar children in our study" (p. 173).

One hypothesis for this link between VCFS and bipolar disorder is the fact that one of the genes commonly deleted on chromosome twenty-two in VCSF children is the COMT gene, which codes for an enzyme responsible for the breakdown of three neurotransmitters -norepinephrine, dopamine, and epinephrine. These chemicals are important for regulating mood and emotion in the brain. The COMT gene has also been identified as a candidate gene that predisposes some individuals to schizophrenia. It may be the common link that helps to explain the significant overlap of symptoms between schizophrenia and bipolar disorder.

Source: http://www.newswise.com
Title: "Brain Scans May Predict Mental Illness in Children with VCFS"
Date: July 14, 2005.

Posted by at 6:31 PM | Comments (2)

July 12, 2005

Book Examines Family, Search for Treatment

Bebe Moore Campbell, author of the popular children's book "Sometimes my Mommy Gets Angry" explaining the difficulties of a bipolar parent, has just released a new novel that deals again with the difficulties of mental illness.

In "72 Hour Hold", mom and main protagonist Keri Whitmore struggles to find adequate treatment for her teenage daughter Trina, who begins to show symptoms of bipolar disorder in her senior year of high school. In her quest, Keri encounters other parents in local support groups who are dealing with similar crises. Encouraged by one parent in particular, and frustrated with the inadequacies of the standard health care system, Keri finally decides to make the bold move of entrusting herself and her daughter to a different sort of treatment program. The following two paragraphs from the book review in the Boston Globe describe the provocative and secret program:

"...Quickly, Keri finds that the Program is modeled on the Underground Railroad, Harriet Tubman's system of moving slaves from safe house to safe house until they could reach immunity in the North. Brad, one of the ''conductors" of the Program, tells Keri that ''mental illness is a kind of slavery. Our movement is about freeing people too."

Keri and Bethany [the other parent] entrust the well-being of their daughters to Brad and other members of the Program, and set off with them on a journey that takes them from site to site without their knowing where they are at any given time. The goal, as Brad has described, is to make the young women medication-compliant and enhance their recovery through nutrition, therapy, exercise, and love."

Throughout the novel, Campbell often likens the experience of mental illness to the experience of slavery. She says she hopes to invoke conversation about mental illness in African American communities in particular, which sometimes may teach less helpful things about mental illness treatment due to religious fundamentalism.

The review concludes: "'72 Hour Hold" is an absorbing and poignant portrait of the relationship between a mother and daughter illuminated by the light of hope Keri holds up in the dark shadow of Trina's disease."

Ordering information for "72 Hour Hold"
- go to http://www.amazon.com

Original Source Article: "Mother and daughter, divided by the shadow of disease." Boston Globe (http://www.bostom.com), July 10 2005.

Posted by julia.d at 8:06 AM | Comments (1)

July 10, 2005

Male Depression Comes With Stigma

Depression in males is something that often comes with an unnecessary amount of shame attached to it. Sadly, this shame alone can often cause men to commit suicide instead of getting the help needed to deal with their feelings. Although more women attempt suicide, more men actually carry it out, leading to men's suicide rates to be four times higher than females.

"Depression can even increase the risk of coronary heart disease, and though the risk of contracting the disease itself is the same for men and women, more men die as a result. The U.S. National Institute of Mental Health (NIMH) estimates that about three or four million men show clinical signs of depression. But the number of men who are actually diagnosed and treated is much smaller. Men feel there is a social stigma attached to being depressed, that it is a sign of weakness or lack of discipline" (Spurling, 2005).

Bipolar disorder, major depressive disorder, and dysthymic disorder are the three main depressive disorders and should be looked for in men when they are showing symptoms of depression. Men more often mask their depression with some kind of substance abuse, such as alcohol or drugs. Sometimes working very long hours can be a sign of depression as well. Spurling (2005) states that "men with depression tend to be more irritable and angry. Encouragement from friends and family is key to helping men with depression admit they have it, and seek treatment." By hiding from the problems of depression those problems will only get more severe.

Getting help from a physician is the first step because depression can sometimes be caused by medical conditions, medications, or substance abuse itself. Eventually seeing a psychologist or psychiatrist is ideal for those that do not have a physical cause for their symptoms of depression.

Unfortunately we live in a society that puts a stigma on men who feel sadness or depression. It is more accepted for a man to be aggressive or angry, emotions that are seen as more "masculine." Ironically many women complain of being allowed and encouraged to be open with feelings of sadness, but not their feelings of anger. Hopefully we will someday live in a society that does not put such a stigma on the emotions of people based on sex, simply because of how masculine or feminine each emotion is considered to be. We all have the capability to feel every emotion and being a man does not solve as an immunization from feelings of depression. If so, I'm sure most people would prefer to be men, myself included.

For more information on how bipolar disorder is distinguished from major depression (usually by the presence of at least one manic episode), see the Symptoms and Diagnosis section

Resources on preventing suicide, the most tragic outcome of unidentified and untreated affective disorders.

The source of this article was The Bermuda Sun, written there by Grant Spurling. You can access this article at: http://www.bermudasun.bm/archives/2005-07-08/01News12/

Posted by at 2:31 PM | Comments (4)

FDA Warns of Antipsychotic Use For Elderly

The FDA issued a warning recently to the elderly who are using antipsychotic medication. It appears that those who were taking an antipsychotic for dementia had a higher mortality rate than those taking a placebo in studies that have been done. When the antipsychotics were used to treat the elderly for disorders such as schizophrenia or mania there were similar results; a higher death rate for the elderly using an antipsychotic.

"FDA wants the manufacturers of the drugs in questions to add a boxed warning to the drugs' labels describing this risk and noting that these drugs are not approved for the treatment of behavioral symptoms in elderly patients with dementia. FDA says patients receiving these drugs for the treatment of behavioral disorders associated with dementia should have their treatment reviewed by their healthcare providers" (D'Amore, 2005).

This public health advisory includes many of the commonly known antipsychotics. Those included are (listed only by their marketed name): Abilify, Zyprexa, Seroquel, Risperdal, Clozaril, Geodon, and Symbyax. Atypical antipsychotics from all three drug classes are considered to have similar effects which leads researchers to believe that the increase in mortality rates is linked to their "pharmacologic effects".

The causes of death varied, although a substantial amount of them were from heart failure, sudden death, or infections like pneumonia. The mortality rates in elderly patients taking antipsychotics for dementia was about 1.6 to 1.7 times higher than the placebo group.

The source of this article was Euromoney Institutional Investor PLC. Med Ad News, by David D'Amore.

More information on medications used to treat bipolar disorder (including antipsychotics), and some other side effects.

To see a different version of this article, (although from a different source than this article) go to: http://abcnews.go.com/Health/wireStory?id=661088

Posted by at 1:45 PM | Comments (0)

Role of Serotonin in Modulating Circadian Rhythm

Mood Lighting: Penn Researchers Determine Role of Serotonin in Modulating Circadian Rhythm

(Philadelphia, PA) - Researchers at the University of Pennsylvania School of Medicine have determined how serotonin decreases the body's sensitivity to light and that exposure to constant darkness leads to a decrease in serotonin levels in the brain of fruit flies. These findings suggest that serotonin may play a role in maintaining circadian rhythm, as well as modulating light-related disorders such as seasonal affective disorder (SAD). Senior author Amita Sehgal, PhD, Professor of Neuroscience at Penn and a Howard Hughes Medical Institute (HHMI) Investigator, and colleagues report their findings in the July 7 issue of Neuron.

The body’s 24-hour (circadian) clock controls cycles of wakefulness and sleep, as well as the rhythm of other physiological functions, such as body temperature and blood pressure. Although the body functions on roughly a 24-hour schedule, this cycle is capable of being reset by environmental disturbances. In Sehgal’s lab, fruit flies provide the model system for examining entrainment, the synchronization of the internal clock to the environment.

“In humans, a light pulse in the early evening delays rhythm-if it stays light later, you stay up later,” says Sehgal. “Disturbances in the late evening advance the body clock-an early dawn leads to an early rise.”

Entrainment was tested in flies by exposing them to a pulse of light during the dark period. Closely resembling the body clock adjustment seen in humans, Sehgal’s flies reset their body clock following the “night-time” disturbances. However, this adjustment was lessened when the flies were treated with serotonin prior to the test.

Sehgal speculates that serotonin is acting to protect the body clock from being over-responsive to light disturbances. “You do not want your clock to be so supersensitive to light that small fluctuations are going to throw it out of whack,” she explains. “Serotonin appears to modulate the response of the body clock to light.”

In flies, a protein called cryptochrome drives the response of the body clock to light. Under normal circumstances, light excites cryptochrome located within the brain, which in turn, interacts directly with the clock protein to reset the clock. Sehgal and colleagues discovered that serotonin works by attaching to the serotonin 1B receptor, altering the activity of another protein, GSK3bß, which further changes the cascade of events leading to the resetting of the clock.

Sehgal points to the clinical implications for understanding the interaction between GSK3ß and serotonin. Lithium, a drug commonly prescribed to treat bipolar disorder, targets GSK3ß. “Lithium resets the clock in all organisms that have been examined,” explains Sehgal. “Assuming that the mechanism works the same way for mammals, the implication would be that antidepressants other than Lithium can also affect the clock.”

Sehgal and colleagues also studied the role of serotonin in dark adaptation, the experience of increased sensitivity to light following long periods of darkness. After seven days in constant darkness, flies demonstrated significantly reduced levels of serotonin compared to flies exposed to the normal light-dark cycle. Interpreting the relationship of serotonin as it influences circadian rhythm, Sehgal suggests, “In situations of dark adaptation, you may become more sensitive to light because serotonin goes down.”

The reduction of serotonin levels in flies kept in constant darkness may provide scientists with insight into the etiology and treatment of SAD, a mood disorder related to reduced sunlight during winter. “People with seasonal affective disorder will respond to medications such as Prozac to increase serotonin,” says Sehgal. “Patients also respond to light therapy. We now believe that light is also increasing serotonin-perhaps this is why both of these treatments are effective.”

By identifying the mechanism of interaction between serotonin and the body clock, as well as the environmental factors influencing the levels of serotonin in the brain, Sehgal and colleagues hope to be able to shed light on the possible role of circadian activity on affective disorders. The interplay of serotonin, light, and the circadian system suggests a close relationship between circadian regulation and mental health.

Sehgal’s co-authors are Quan Yuan, Fangju Lin, and Xiang Zhong Zheng, all from Penn and HHMI. The research was funded by the Howard Hughes Medical Institute.

This press release was issued by the University of Pennsylvania Health System.

Posted by at 12:32 PM | Comments (2)

July 9, 2005

Valproic Acid Has Bad Interaction With Meropenem

Valproic acid, more commonly known as Depakote or Depakene, has been shown to have negative drug interactions with Meropenem, (Merrem). Valproic acid is normally used as either a monotherapy or combined with another drug to treat those with bipolar disorder. When used with Meropenem it can cause a loss of seizure control and sometimes "lower the concentration of Valproic acid". Meropenem is an antibiotic which is commonly used to treat meningitis or "intra-abdominal infections."

One patient (a 21-year-old female) was looked at who had an adverse reaction when using the two drugs. This case study gives insight into the negative side effects that can come from the simultaneous use of valproic acid and meropenem. "Consistent with other reports of interaction between valproic acid and other carbapenem antibiotics such as panipenem and imipenem (Primaxin), the temporal relationship between the valproic acid concentration changes and meropenem therapy in this patient suggests a probable interaction between the two drugs. Literature reports of interactions between valproic acid and carbapenem antibiotics document a decrease in valproic acid concentration ranging from 45% to 95%. Most cases also reported the occurrence of seizure activity associated with the lower concentrations" (Lam, 2005).

The woman's antibiotic drugs were changed to ceftazidime (Fortaz) and ciprofloxacin (Cipro). This resulted in her valproic acid levels increasing and reaching a therapeutic level. She did not have anymore seizures and was eventually allowed to go home from the hospital, with a continued dose of valproic acid.

The link between these two drugs and the negative side effects that the combination elicits should be taken into account when prescribing medication for an individual using one or the other. Those who must take both of the medications should be watched closely to make sure that they do not have a negative reaction.

The source of this article was Jossey-Bass, an Imprint of Wiley Brown University Psychopharmacology Update, written by Lam, Y.W. Francis

For more information on the side effects associated with valproic acid (Depakote, Depakene) and other bipolar medications go to: http://www.moodswing.org/meds.html#side

Posted by at 2:13 PM | Comments (0)

Son's Mental Disorder Led Mother to Start Group

Charlotte Davis has three sons and one of them was diagnosed with a mental disorder in 1998. Charlotte reacted to her sons disorder by creating a group that provides support to people and their families that are dealing with mental illness.

Charlotte Davis joined the Louisville chapter of NAMI, but found that there was little help where she lived. "Davis said the group was helpful, but its activities were focused on mental-health resources on the Louisville side of the Ohio River, so she gathered support for a Southern Indiana version of the group. It was launched in March 2003 and became an affiliate of the national organization in January 2004.

The group has more than 50 members and draws people to its monthly meetings from as far away as Salem, Scottsburg and New Washington. One of its core offerings, a 12-week course for relatives and friends of people with a mental illness, has drawn more than 60 participants" (Davis, 2005).

One of the board members of the chapter's board, Joan Kemper, said that Charlotte Davis was the main thing that led to the new group being made in southern Indiana. Without Charlotte there probably would not be a chapter there today. She is one of the few who has taken direct action to help those with mental illness in her area.

This article mentions that Charlotte is an avid reader of information on mental disorders, educating herself while helping others get the information that they need. One of the pamphlets in a stack at her home is titled "Understanding Bipolar Disorder". It is obvious that Charlotte Davis' commitment to helping others in her community is a needed and appreciated support.

The source of this article was The Courier-Journal by Alex Davis.

You can access the article at: http://tinyurl.com/a4uhf

Posted by at 1:33 PM | Comments (5)

Genetic Makeup of Aggression & Bipolar Disorder

Mice have long been used for studying human diseases, behavior, and our biology due to the fact that they have a surprisingly similar genetic makeup to us. Scientists have gone even farther now by studying the ability to change one's behavior due to genetic manipulation. In 2002, researchers at the University of British Columbia's Centre for Molecular Medicine and Therapeutics accidentally made a form of highly aggressive mice. The scientists unintentionally deleted a gene that influences their brain development. The absence of this gene led to the mice becoming vicious towards their caretakers as well as the other mice that they were with. Some even killed their mates, others chewed on their siblings' tails.

Now scientists attempted to give the mice their "niceness" back by giving them the gene that they were missing, except this time, from humans. Researchers gave the aggressive mice's embryos the "human version" of the gene that was currently absent from their makeup. Abraham (2005) stated, "Simpson said that gene, called NR2E1, is found on a region of chromosome 6 in humans and has been associated with bipolar disorder, a serious mental illness resulting in dramatic mood swings. The gene produces molecules that regulate other genes, suggesting it plays multiple roles in the human body, including those involved in brain development and function. That a similar version exists in the mouse suggests the gene is a primitive one, passed down to mice and people from a common ancestor many millennia ago." Once the human version of the gene was implanted into the embryos they became normal and lost their aggressive behavior.

This study shows that behavior can be manipulated by the absence or presence of particular genes. The use of human genes being added to the mice (which led them to become "nicer") exemplifies the potential that the absence or presence of that gene in humans could lead to similar affects. This could lead to our discovery of how to alter aggressive behavior in humans and potentially alter the disorders that lead to aggression, supposing that gene NR2E1 or another gene is involved. But the possibility of changing human behavior by manipulating one's genetic makeup is as scary as it is promising.

The source of this article was The Canadian Press & Globe and Mail.com, written by Carolyn Abraham.

You can access the full article from Globe and Mail at: http://tinyurl.com/bzll5

The Globe and Mail homepage is at: http://www.theglobeandmail.com/

Posted by at 12:52 PM | Comments (5)

July 7, 2005

New Gene-Scanning Technique

A team out of the University of Southampton recently announced that they have successfully applied a cost-effective technique to scan the human genome for genetic mutations.

The scanning device, meltMADGE, "combines thermal ramp electrophoresis with microplate array diagonal gel electrophoresis."

A team of British medical researchers used meltMADGE to scan the genes of about 10,000 individuals for mutations associated with cholesterol blood levels.

According to the original article in Science Daily: "This is the first time that it has been possible to find out whether there may be unknown rare genetic variations in the population which may cause mild forms of a particular disease or feature in just one or two individuals, or may even protect them against disease."

Although it is currently only being used for research, the team reports that this technology has the potential to be used in clinical practice. If it becomes mainstream, it could be revolutionary for diagnosis, family planning, and drug prescribing practices. Although schizophrenia and psychiatric disorders do not have single genes associated with them, gene-scanning for identified susceptibility genes could give someone a more accurate idea of what their hereditary risk is. This could be especially important for bipolar disorder, which seems to have an even greater genetic component to it than schizophrenia (see the current estimates of how much genetics contributes to bipolar - http://www.moodswing.org/causes.html)

Moreover, scientists have already determined through some research studies that the unique genome of an individual can affect how their body reacts to medications (see schizophrenia.com Newsblog item 'Gene Profiling for Meds'). A gene-scanning technique that becomes commonplace in clinical practice could help speed up the clumsy trial-and-error process of determining dosages for different individuals, which could then increase beneficial effects sooner and reduce unwanted side-effects.

Original article: New Gene Scanning Technology Marks A Major Advance In Disease Research. Science Daily (http://www.sciencedaily.com), July 7 2005.

Posted by julia.d at 8:03 PM | Comments (0)

July 6, 2005

Hypomania May Have Its Benefits

Psychiatrist John Gartner has an interesting outlook on hypomania, one that is much more positive than the average viewpoint. Gartner has a lot to say in his book "The Hypomanic Edge: The Link Between (a little) Craziness and (a lot of) Success in America." He believes that many of the most influential people in the past have been people who were actually hypomanic.

Hypomania is the milder form of mania, different in that it usually does not interfere with one's functioning and does not result in hallucinations or delusions. Those with Bipolar II disorder alternate between depression and hypomania.

Those included in his diagnosis of hypomania are Christopher Columbus, William Penn, Andrew Carnegie, Alexander Hamilton, David Selznick, and Craig Venter. But this is only a portion of those who Gartner has diagnosed as hypomanic.

Some argue against Gartner's claims that hypomania gives way to success. "'Is the suffering of the illness necessary in order to motivate or inspire great art?' asked Dr. Michael Thase, a professor of psychiatry at UPMC's Western Psychiatric Institute and Clinic. 'It is fair to say that if people have illnesses that are placing their lives in danger, they should be treated'" (Semuels, 2005).

Gartner also claims that America, due to its high influx of immigrants has a greater population of hypomanics. The idea is that immigrants made a great risk when choosing to move to America, and therefore many of them may have hypomanic tendencies. It is a good hypothesis, but it also lacks the scientific data needed to make it factual.

As Semuels (2005) puts it "It's that mentality -- that hypomanics are an elite bunch who hold the future of America in the palms of their always-moving hands -- that has caused Gartner the most trouble, by giving an excuse to people with strange and often irritating habits to hold onto them as part of their genius."

As astounding as the potential link between hypomania and success is, it should be noted that hypomania can often be destructive rather than creative. Having one's hypomania treated should come first and foremost. There has been no scientific evidence that shows that taking medication for hypomania reduces one's creativity; creativity is something within oneself, a part of your personality. Hypomania may sometimes just highlight how creative a person is, but it does not manifest creativity out of nothingness. I would argue that creativity comes from the individual, not the illness, although I admit that this is a debatable fact.

Despite the cracks in Gartner's argument he raises many interesting points. Maybe the world does owe a lot of its success to hypomania. Unfortunately we won't truly know until hypomania and its effects on "success" are studied.

The source of this article was the Pittsburgh Post-Gazette and was written there by Alana Semuels. You can read the full length story at: http://www.post-gazette.com/pg/05187/533173.stm

The homepage for the Pittsburgh Post-Gazette can be located at: http://www.post-gazette.com/

Posted by at 8:15 PM | Comments (2)

Many With Mental Disorders Are Not Receiving Help

The mental health charity SANE, has a helpline for those in need within Australia. The helpline receives about 16,000 calls a year and a lot of the people calling are not receiving help for their disorder; 43% of the 16,000 were not receiving help.

Most of the people had depression, 15% had schizophrenia and 11% had bipolar disorder. Many of those who called came from rural and remote communities. 40% of callers came from these rural/remote areas; this is a lot considering the fact that they only make up about 14% of the population.

Health Minister Jim McGinty stated that $173 million will be designated to improving mental health services.

"SANE director Barbara Hocking said the statistics revealed that the Government's care-in-the-community strategy wasn't working. 'Once someone is diagnosed, it is very easy for them to slip out of the system,' she said. 'More and more people are just being told to go to the GP. So they go off the files, they don't appear at the GP and nobody follows them up. The most ill people slip off the radar until they get acutely ill'" (Madden, 2005).

Mrs. Hocking went on to say that having early and ongoing treatment available to those with mental disorders could save millions. In Australia alone, 6-million working days were lost due to depressive disorders. This resulted in a $3.3 billion loss of productivity.

The source of this article is the Nationwide News Pty Limited Sunday Times from Perth, Australia.

The SANE website can be found at: http://www.sane.org

The SANE helpline can be contacted at 1800 688 382

Posted by at 7:10 PM | Comments (2)

Outpatient Psychiatric Treatment

Outpatient psychiatric care is usually something that is up to the patient, but in certain cases it is not. Most states have a law that allows for a judge to make the decision for the patient in extreme cases.

As Steele (2005) stated, "Somewhere in the pile of proposed programs waiting to get funded in the new state budget is one for which Maine state legislators should just write the check. It is the outpatient commitment program (OCP) that allows a judge working with mental health professionals to require some patients with severe mental illness to comply with a community-based treatment program or face involuntary treatment in a psychiatric hospital. Maine was one of only eight states in the country without an OCP law until the Maine Legislature passed one overwhelmingly this year.

However, in order for the law to go into effect Maine legislators must appropriate $520,000 to staff a pilot OCP in the Augusta area, provide housing for the mentally ill patients in the program, and monitor program effectiveness. The OCP program would be focused on patients who have been hospitalized frequently because their mental illness was poorly controlled, often in part because the patient was not taking his or her medications."

There are two sides to this argument. Those who are against the OCP program, and laws like it, say that forcing someone into treatment and then forcing them to take medication is taking away a basic freedom that people should have. What you do with yourself and your body should be to your own discretion. They also believe that this is just a way for the government to get around paying for more expensive outpatient care that may be better for the mentally ill individual.

Those in favor of the OCP program cite its success in other parts of the country. There is also the fact that many patients with mental disorders are unaware of their illness and therefore deny treatment because they do not believe they have a problem. Sometimes patients refuse treatment because the illness itself causes them to be suspicious of others, it can make them believe that those around them are not looking out for their best interests.

When one has a severe mental disorder such as bipolar disorder or schizophrenia, its important for their sake that they receive treatment. Obviously it is also important that every individual receives the rights that he or she has a human being. When those rights should be altered for the sake of the individual, is something that everyone has a hard time discerning.

The source of this article was the Bangor Daily News Viewpoints section. The original article was written by Dr. Erik Steele on July 5, 2005. You can access the full article at: http://tinyurl.com/cpu8y

Bangor Daily News can be accessed at: http://www.bangornews.com/

Posted by at 5:41 PM | Comments (4)

July 5, 2005

Antidepressants for bipolar depression

Antidepressants for bipolar depression: Tips to stay out of trouble

There is a good article on Current Psychiatry Online that talks about bipolar depression and treatment issues with antidepressants. The article is written for doctors, but most people can probably follow it.

The story states:

"In clinical practice, 50% to 80% of bipolar patients receive long-term antidepressants,1 although potential benefits probably outweigh risks in 20% to 40%. This gap suggests that psychiatrists could do more to stay out of trouble when prescribing antidepressants for patients with bipolar depression.

Antidepressants have not shown efficacy in long-term treatment, and evidence of their effectiveness in acute bipolar depression is limited. They appear to pose greater risk of switching and mood destabilization for some patients and certain types of bipolar illness, and some antidepressant classes are more worrisome than others.

Because carefully analyzing risks and benefits is essential when considering antidepressants for a patient with bipolar illness, this article clarifies that delicate balance and offers evidence-based recommendations for using antidepressants in bipolar depression."

See Full Story: Antidepressants for bipolar depression: Tips to stay out of trouble

Posted by szadmin at 10:58 PM | Comments (1)

Topiramate: Reducing Cognitive Side Effects

As with any medication topiramate comes with a host of side effects that are sometimes difficult for the user to deal with. Topiramate is an anticonvulsant medication that has been cited by some to lead to cognitive impairment which does not make it attractive to some who would like to use it.

"The precise mechanism of cognitive impairment is not yet fully understood; however, preclinical evidence links them to their action on GABA potentiation and glutamate receptor antagonism at the N- methyl-Daspartate (NMDA) receptors the potentiating action of this medication at the level of the neurotransmission system of GABA, a substance that produces inhibitory actions in the frontal lobe (Petty, 1995; LaRoche & Helmers, 2004).

Although the majority of clients exposed to topiramate are adults with partial-seizure disorders, growing data indicate its efficacy in treating bipolar disorders. A major problem with these data was the rapid titration of topiramate, with an initiation dose of 100 mg/ day with weekly increments of 100 to 200 mg/day to dosages as high as 1000 mg/day" (RedNova News, 2005).

It is hypothesized that administering the medication in lower doses and gradually increasing it could eliminate the cognitive side effects. The precise dose that should be administered to those with bipolar disorder has not been established although studies are estimating a range of 100mg-400mg/day to be best for treating bipolar patients.

This article includes a list of recommendations on dosage and titration at the bottom of the story. To access the full article go to: http://tinyurl.com/c3s9o

The source of this article was RedNova News at: http://www.rednova.com/

To learn more about Topiramate go to: http://tinyurl.com/9ccjw

Posted by at 2:54 PM | Comments (0)

Explaining Differences in Identical Twins

For years we have wondered why identical twins, who have the same genetic composition, can sometimes end up so differently. Why is it that sometimes one twin will develop schizophrenia, bipolar disorder, or cancer, and the other will remain perfectly healthy? Part of the reason is just due to unexplainable environmental factors, but there is more to it.

As Wade (2005) puts it, "a whole new level of explanation has been opened up by a genetic survey showing that identical twins, as they grow older, differ increasingly in what is known as their epigenome. The term refers to natural chemical modifications that occur in a person's genome shortly after conception and that act on a gene like a gas pedal or a brake, marking it for higher or lower activity."

Identical twins are born with the same epigenetic marks, but as they grow older those marks begin to change. Why they change has two different explanations. One is that personal experiences and the differing environments may result in altered epigenetic marks. The other is that since epigenetic marks are "lost" as one grows older, they would obviously manifest themselves differently in each of the twins. More likely it is a combination of these two factors. The article showed a picture of Chromosome 1 of a pair of 3-year-old twins next to a picture of Chromosome 1 in a pair of 50-year old twins. It was obvious that Chromosome 1 was much more similar between the 3-year-olds than between the 50-year-olds. The more time spent in different environments will lead the epigenome of twins to differ to a greater degree.

There is currently a discussion to start an international human epigenome project which would possibly be even more complex than the Human Genome Project; this is due to the fact that the human genome is the same in every cell of an individual's body, whereas the epigenome is different for the "250 or so human cell types."

"Among the most important components of the epigenome are small chemical handles known as methyl groups, which are added directly to the chemical units of DNA. A wave of demethylation occurs in a sperm's genome shortly after an egg is fertilized, followed by the extensive readdition of methyl groups in early embryonic development" (Wade, 2005).

Having a fuller knowledge of the epigenome could help scientists discover what role the epigenome has in many diseases and afflictions, such as schizophrenia, bipolar disorder, and the many forms of cancer.

The source of this article was The New York Times.

To learn more about epigenetics go to these 2 sites:

Posted by at 1:41 PM | Comments (0)

Eli Lilly Proposes New Strategy

The pharmaceutical company Eli Lilly has planned a new strategy for the development of future drugs. Many complain that drug companies spend less time searching for new drugs and more time making sure that they are overmarketed and overprescribed. Critics also complain that drug companies try to play-down side effects in order for their drugs to seem more attractive to the consumer.

Recently, the chief executive of Eli Lilly--Sidney Taurel--delivered a speech to shareholders in which he stated "'the right dose of the right drug to the right patient at the right time.'' In other words, Lilly sees its future not in blockbuster medicines like Prozac that are meant for tens of millions of patients, but rather in drugs that are aimed at smaller groups and can be developed more quickly and cheaply, possibly with fewer side effects" (Berenson, 2005).

Of course, this is just a statement that may or may not actually come into effect. Some people state that Eli Lilly has a bad track record of exaggerating the potential that its medications have.

On the upside, since 2001 Eli Lilly has created five truly new drugs. They also spend nearly 20% of their sales on research, whereas the average drug company spends about 16%. The cost of developing new drugs has steadily increased over the years and is still increasing. This means it is only going to become more difficult for drug companies to discover and manufacture new medications.

To change this trend, Eli Lilly plans to, "[focus] its research efforts on finding biomarkers -- genes or other cellular signals that will indicate which patients are most likely to respond to a given drug. Other drug makers are also searching for biomarkers, but Lilly executives are the most vocal in expressing their belief that this area of research will fundamentally change the way drugs are developed" (Berenson, 2005).

We can only judge the truth of Eli Lilly's promises by what they deliver in the future. Hopefully they will hold true to their claims.

The source of this article was The New York Times by Alex Berenson.

Posted by at 12:34 PM | Comments (1)

July 4, 2005

Creativity and Bipolar Disorder Correlated

The link between creativity and psychopathology has long been debated. It seems as if there is some sort of correlation between the two but there has been little scientific evidence to support such a claim. This research article brings up some interesting facts as well as a hypothesis as to why there is a link between mental illness and creativity.

Psychological illness has been found historically more often in "eminent creators" than in the general mass of people. This paper estimates that mental disorders are twice as common in those that are highly creative. It is hypothesized that the "rate and intensity" of mental disorders such as bipolar disorder in the creative population differs based on what kind of creative area they are involved in. It seems that artistic creators are more likely than scientific creators to have a mental disorder.

Much evidence has pointed to the fact that creativity and psychopathology run in the same families, suggesting a genetic link between the two. Simonton (2005) suggests that "higher than average scores on psychoticism are associated with independence and nonconformity, features that lend support to innovative activities(Eysenck, 1995). In addition, elevated scores on psychoticism are associated with the capacity for defocused attention (e.g., reduced negative priming and latent inhibition), thereby enabling ideas to enter the mind that would normally be filtered out during information processing (Eysenck, 1993). This less restrictive mode of information processing is also associated with openness to experience, a cognitive inclination that is positively associated with creativity (Peterson and Carson, 2000; Peterson et al., 2002)."

This paper goes on to say that intelligence and creativity are not linked although a certain amount of intelligence is required to be creative in most cases. Usually an IQ of 120 or higher is required, which is in the "gifted" range.

Creativity and madness are not the same thing though. A large majority of creative people are not plagued by a psychological illness. Therefore, creativity does not necessitate psychopathology, and psychopathology does not necessitate creativity.

This paper simply exemplifies the evidence that shows that creativity and psychopathology (e.g. bipolar disorder) are correlated and have a link that we are just beginning to understand.

The source of this article was the Psychiatric Times at: http://psychiatrictimes.com

This research article was written by Dean Keith Simonton, Ph.D. with the headline Are Genius and Madness Related? Contemporary Answers to an Ancient Question Copyright (c) 2005 CMP Media LLC.

Posted by at 1:41 PM | Comments (4)

Help Through a Support Group

A woman from Lillydale named anonymously as "Christine" says that she found her support group to be the most helpful thing when dealing with a diagnosis of bipolar disorder. Christine has been going to a support group called GROW for the last eight years and says that it helped her make the most out of her life.

The first step was to accept that she had a mental disorder which helped her begin to cope with it. It is hard to start the therapeutic process if one is in denial. Christine states that going to meetings is an important part of her weekly routine. She says that it helped her "intellectually, socially, and spiritually. Having a support group gives one a community that they are a part of.

"North-eastern regional field worker Kathy Bright said GROW was a 12-step program of personal growth aimed at building individual self-worth.

'We look at mental health strategies rather than dwell on mental illness,' Ms Bright said. 'Many don't realise this support is available. We want to get the message out to people that you can do it, but you cannot do it alone'" (Lillydale Express).

GROW is a group that helps those dealing with anxiety, depression, or low self esteem.

To find a support group for bipolar disorder in your area (only for the U.S.) go to: http://www.dbsalliance.org/info/findsupport.html You can check by zip code, it's very easy to use.

For more information on support groups for bipolar disorder go to: http://www.moodswing.org/supportgroups.html

Posted by at 1:07 PM | Comments (0)

Victory for Kendra's Law

Kendra's law will be going strong after the victory that it just had. This five year old program in New York gives outpatient treatment to those with severe mental illness, such as bipolar disorder.

The improvement and extension of Kendra's Law for five more years is a victory for mental health advocates throughout New York and an example of compassion and common sense trumping partisan politics.

But most importantly it is a victory for those in New York lost to the symptoms of severe untreated mental illnesses.

Kendra's Law is New York's five-year-old program allowing assisted outpatient treatment (AOT) for people with severe mental illnesses like schizophrenia or bipolar disorder who are too ill to recognize their need for, or incapable of maintaining, treatment. The program allows a court to order someone who meets very specific criteria into community-based mental health treatment. Kendra's Law serves only those in extreme distress caused by lack of treatment: when compared with a similar population of mental health service recipients, those placed in AOT were twice as likely to have been homeless and 50 percent more likely to have had contact with the criminal justice system prior to receiving a court order.

That the state legislature chose to retain control over Kendra's Law by extending it rather than making the exemplary program permanent is not a surprise, only a disappointment. The intense support across party lines (the vote was 60-0 in the Senate, 144-1 in the Assembly) shows how greatly Kendra's Law is valued in the Capitol.

This broadly supported renewal of the law means that current beneficiaries of New York's AOT program -- in the last five years they number more than 7,000 -- can continue their progress uninterrupted, including dramatic reductions of 74 percent or more in homelessness, psychiatric hospitalizations, arrests, and incarcerations.

Those who are getting help and support through the program came out in force over the last few months to testify about its value. To many of them, like Stephanie (see note) and her son John (see note), Kendra's Law is nothing short of a miracle.

"(John) has been hospitalized more than a dozen times," explains Stephanie. "(He) is unable to see that when he stops taking his medication he becomes psychotic and within a matter of days ... becomes so ill that he has to be rehospitalized. What (he) has been able to understand, however, is that when he is in the Assisted Outpatient Treatment Program and under a court order, if he violates it ... he will be rehospitalized ... (John) takes his AOT program and its court order very seriously. It is the only thing that has worked ...."

"Without AOT, my son would either be in jail or dead," said Susan (see note), another mother. "It alone has made a difference for him by helping him to stay on his meds."

When the law was first adopted six years ago, there was trepidation among some in the consumer and mental health provider communities. Those initial concerns were alleviated by the outcome data and experiences from the program's first five years, which showed that not only are participants gaining significant benefits in quality of life and reduction of negative consequences like arrests, but also that those who are actually receiving treatment via the court orders appreciate and understand their value. An extraordinary 75 percent of recipients interviewed said they valued assisted outpatient treatment for helping them regain control over their lives and 81 percent said that AOT helped them to get and stay well. Those results are too difficult to ignore for even the small but vocal group of opponents who initially opposed the law's passage in 1999 -- even most of them joined the call for the renewal of Kendra's Law.

Opponents and supporters alike agreed on extension -- and also on the fact that the law has been sporadically applied throughout the state. The counties that are using the law are seeing striking results -- so almost half of the improvements to the law wisely focus on ensuring its broader application so that others can also reap its benefits. The changes include creating new classes of authorized petitioners, slightly expanding the program's eligibility criteria, explicitly permitting the enforcement of an AOT order outside the issuing county, and creating a judicial education program that will teach judges and their staffs to more effectively administer the law.

Many people deserve kudos for recognizing the value of Kendra's Law and fighting to keep it. Governor George Pataki, the New York Office of Mental Health, and Attorney General Eliot Spitzer have all been strong and valiant advocates for the law, laboring -- often together -- over many of the improvements. Pataki and Spitzer are both to be lauded for putting party affiliations aside to support this commonsense piece of legislation.

The Treatment Advocacy Center commends the many family members and consumers, including members of NAMI-New York, who spoke out so passionately for the law, rising above the fear of stigma and opposition to share how Kendra's Law has made their often emotional journeys less rocky and more hopeful. For courage and bravery, nobody can match their voices, quivering as they talked about feeling the system had failed before Kendra's Law, moments when they feared death, situations when all seemed lost. And then sharing the difference AOT made and the changes they saw and are still seeing -- the improvements in medication adherence, quality of life, and interpersonal relationships that are harder to quantify but vital to acknowledge.

The Treatment Advocacy Center also commends those who bravely turned their private tragedies to public good, particularly Edgar Rivera, who lost his legs after being pushed in front of a subway train by a man with untreated schizophrenia, only weeks after the eerily parallel incident that claimed Kendra Webdale's life. His inspiring testimony for renewal made a big impression on legislators.

And, of course, our limitless admiration and gratitude goes as always to the Webdale family, led publicly by Kendra's mother, Pat, and supported by a large group of Webdales of every generation who have chosen to channel what could have been an unfathomable well of anger and grief into tenacious advocacy. Their fight is not just for the law that bears Kendra's name, but for a legacy of treatment that bears Kendra's spirit.

To view the full press release go to: http://tinyurl.com/bsf4z

This press release came from U.S. Newswire

Posted by at 12:57 PM | Comments (6)

July 3, 2005

Review of Meds Available for Bipolar Disorder

There are so many medications available to treat bipolar disorder that sometimes the idea of choosing your form of treatment can be daunting. Not only are there several medications, but each medication is under a different class. There are antipsychotics, anticonvulsants, SSRI's, benzodiazepines, and much more. This article is meant to be a quick review of the many kinds of medications available. The nice thing about it is that it is quick and easy to review. It does not go over side effects very extensively so make sure you research the medication and its "class" before determining that it is right for you. If you would like to see a more thorough list of the medications available for bipolar disorder go to: http://www.moodswing.org/meds.html

Approved by the FDA in 1970, Lithium has traditionally been the first line of treatment for mania.

Anticonvulsants in the treatment of mania was introduced when their therapeutic value was noted through improved mood stability of those with epilepsy. Initially they were used for those who were resistant to Lithium treatment. They are now an important alternative both as a monotherapy and as an adjunctive to other medications. Following are the primary anticonvulsants used for bipolar disorder.

Calcium Channel Blockers
This class of drugs (of which Verapamil, Diltiazem, Nifedipine and Nimodipine are examples) is only used to a very minor degree in managing the symptoms of mania associated with bipolar disorder. Their efficacy is limited.

Acute episodes of mania present psychosis in as many as two-thirds of those with this disorder. Thus, this class of meds is used to a great extent. They are also often used to decrease symptoms of mania until mood stabilizers such as those listed above can take full effect. In some cases, these may be used for long-term maintenance of stability.

The Benzodiazepines are central nervous system (CNS) depressants. They are used to produce sedation, induce sleep, relieve anxiety and muscle spasms, and to prevent seizures. For bipolar disorder, they are used to gain rapid control of manic symptoms so that mood stabilizers have time to take effect. They may also be used to help restore a normal sleep schedule. The most common medications in this class include alprazolam (Xanax), diazepam (Valium), lorzepam (Ativan), and Clonazepam (Klonopin).

This article goes over some of the individual medications and it can be found at: http://tinyurl.com/cmunl

The source of this article was the MedBlog which can be found at: http://medblog.us/

Posted by at 3:00 PM | Comments (0)

Mixed Mania Results in Poor Diagnosis

Having mixed manic symptoms can often result in a poor diagnosis. Mixed mania is when one has a full manic episode concurrently with a full depressive episode for at least one week. Specifically, "the simultaneous occurrence of both manic and depressive features bears nosologic, therapeutic, and prognostic implications for the treatment and management of recurrent mood disorders".

"The distinction between mixed states and agitated depression has long been a source of controversy in the literature. It has been suggested that the psychomotor activation of mixed mania typically involves behaviors that are goal-directed,[8] while agitated depressions more often involve hyperarousal, inner tension, and fidgeting or pacing in the absence of goal-directedness.[9] Hostility and cognitive impairment have been observed more often in mixed/dysphoric mania than in agitated depression.[10] Still others argue for closer nosologic links between agitated depression and mixed mania than many clinicians often appreciate.[11,12] The consistency, or reliability, with which practitioners recognize mixed states appears more variable than is the case with pure manias.[13] However, phenomenologic studies indicate that the qualitative features of mania during pure vs mixed manic episodes may differ, with a greater prevalence of grandiosity and diminished need for sleep in the former rather than latter.[14] Moreover, mixed-state features have been shown to recur across subsequent episodes in a substantial subgroup of patients with bipolar disorder" (Goldberg & Ernst, 2005).

Having mixed manic episodes not only makes it more difficult for a physician to diagnose you, it also makes it harder for him to prescribe you something that will be effective for your episodes. It is easier to prescribe someone medication when their manic symptoms are separate from their depressive symptoms because there are drugs that are specifically made to individually fight against them. This article states that "Optimal clinical management involves the use of pharmacotherapies that target both manic and depressive features without inducing mood instability. Combination therapy approaches, typically involving divalproex with an atypical antipsychotic, alongside the elimination of antidepressants, currently represent the most evidence-based strategy for achieving and sustaining symptomatic remission" (Goldberg & Ernst, 2005). Finding what is right for the individual patient with mixed mania will often require different kinds of medicinal treatment.

For the full research article go to: http://tinyurl.com/9macn To access this article you must set up a free account with Medscape.

The source of this article was Medscape.

Posted by at 1:57 PM | Comments (1)

Mania Linked Enzyme Impairs Thinking

An errant enzyme linked to bipolar disorder, in the brain's prefrontal cortex, impairs cognition under stress, an animal study shows. The disturbed thinking, impaired judgment, impulsivity, and distractibility seen in mania, a destructive phase of bipolar disorder, may be traceable to overactivity of protein kinase C (PKC), suggests the study, funded by the National Institutes of Health's (NIH) National Institute of Mental Health (NIMH) and National Institute on Aging (NIA), and the Stanley Foundation. It explains how even mild stress can worsen cognitive symptoms, as occurs in bipolar disoder, which affects two million Americans.

Abnormalities in the cascade of events that trigger PKC have also been implicated in schizophrenia. Amy Arnsten, Ph.D. and Shari Birnbaum, Ph.D. of Yale University, and Husseini Manji, M.D., of NIMH, and colleagues, report on their discovery in the October 29, 2004 issue of Science.

“Either direct or indirect activation of PKC dramatically impaired the cognitive functions of the prefrontal cortex, a higher brain region that allows us to appropriately guide our behavior, thoughts and emotions,” explained Arnsten. “PKC activation led to a reduction in memory-related cell firing, the code cells use to hold information in mind from moment-to-moment. Exposure to mild stress activated PKC and resulted in prefrontal dysfunction, while inhibiting PKC protected cognitive function.”

“In the future, drugs that inhibit PKC could become the preferred emergency room treatments for mania,” added Manji, currently Director of NIMH’s Mood and Anxiety Disorders Program, who heads a search for a fast-acting anti-manic agent. “All current treatments — lithium, valproate, carbamazepine and antipsychotics — take days, if not weeks, to work. That’s because they’re likely acting far upstream of where a key problem is, namely in the PKC pathway. Since PKC inhibitors could act more directly, they might quench symptoms more quickly. Patients could carry PKC inhibitors and take them preventively, as soon as they sense a manic episode coming on.”
Clinical trials of a PKC inhibitor, the anti-cancer drug tamoxifen, are currently underway in bipolar disorder patients. However, these may be more important for proof-of-concept than therapeutic utility, according to Manji, who says side effects will likely rule out tamoxifen itself as a practical treatment for mania. “While there are likely other pathways involved, PKC appears to be very important for bipolar disorder,” he noted.

The fact that the current anti-manic drugs ultimately reduce PKC activity suggests that PKC may be a final common target of these treatments and may play a key role in bipolar disorder. Studies have also found signs of increased PKC activity in bipolar patients’ blood platelets and in the brain cells of deceased patients. Susceptibility to bipolar disorder may involve variants of genes that code for a key PKC precursor and for a stress-sensitive signaling protein that normally puts the brakes on PKC activity.

The new study shows how PKC triggers cognitive symptoms in response to stress. When the stress-sensitive messenger chemical norepinephrine binds to receptors on cell membranes in the prefrontal cortex, it activates PKC through a cascade of events. The enzyme then travels out to the cell membrane, opening ion channels that heighten the cell’s excitability, and stoking protein machinery that propels neurotransmitters into the synapse. PKC also moves into the cell’s nucleus, where it turns-on genes.

To tease out PKCs role, the researchers selectively targeted the prefrontal cortex in rats and monkeys performing working memory tasks with PKC activators, inhibitors, norepinephrine-like and stress inducing drugs — alone and in combination. They also found that by blocking PKC, the anti-manic drugs lithium and carbamazepine protected monkeys’ prefrontal cortex functioning from impairment by a norepinephrnine-like drug. The researchers traced impairment to a reduction in memory-related firing of single cells in the prefrontal cortex, which was reversible by a PKC inhibitor.

Genetic and biochemical studies indicate that PKC may also be overactive in the brains of patients with schizophrenia. Antipsychotics, which are used to treat bipolar disorder as well as schizophrenia, block receptors in the brain that activate PKC.
Also participating in the study were: Dr. Peixiong Yuan, NIMH; Dr. Min Wang, Susheel Vijayraghavan, Allyson Bloom, Douglas Davis, Kevin Gobeske, Yale University; Dr. David Sweatt, Baylor College of Medicine.

This article's source was the National Institute of Health News. The full article can be viewed at http://tinyurl.com/cduj2

Posted by at 1:38 PM | Comments (0)

July 2, 2005

FDA Safety Labeling Changes

The FDA has approved revisions to the labeling on three drugs, Ellence, Abilify, and Kaletra. Each of the three drugs is associated with an increased risk of certain conditions.

Ellence is linked with a "cumulative risk" of leukemia. "Secondary AML with or without a preleukemic phase has been reported in patients treated with anthracyclines and is more common after dose escalations, heavy pretreatment with cytotoxic agents, or when they are used in combination with DNA-damaging antineoplastic agents. The leukemias can have a short one- to three-year latency period" (Waknine).

Abilify is associated with an increased risk of stroke in elderly patients who have dementia. "Results of three placebo-controlled clinical studies (one fixed-dose and two flexible-dose studies) showed that aripiprazole was associated with an increased incidence of cerebrovascular adverse events (eg, stroke, transient ischemic attack), including fatalities, in elderly patients (mean age, 84 years; range, 78 - 88 years) with dementia-related psychosis" (Waknine). Ironically, Abilify is not approved for treating "dementia-related psychosis. It is approved for treating schizophrenia and bipolar disorder.

The FDA warned against using Kaletra at the same time that one is using fluticasone propionate. "Results of a drug interaction study in healthy adults have shown that the ritonavir component of the combination drug significantly increases plasma fluticasone propionate exposures, resulting in significantly decreased serum cortisol concentrations. In addition, the FDA has received postmarketing reports of systemic corticosteroid effects, including Cushing's syndrome and adrenal suppression, in patients receiving ritonavir and inhaled or intranasally administered fluticasone propionate" (Waknine). It is recommended that the coadministration of these two drugs should only be used when the benefits to the patient outweigh the risk of systemic corticosteroid adverse effects.

The source of this article is Medscape, the homepage is at: http://www.medscape.com/homepage

The article can be found at http://www.medscape.com/viewarticle/505805 Although you do have to create a free account at Medscape to view the article.

Posted by at 2:35 PM | Comments (0)

Slower Titration of Lamotrigine Reduces Risk of Rash

Those taking lamotrigine for bipolar disorder sometimes get a rash as one of the side effects from taking the drug. But getting the rash can potentially be avoided if the drug is administered in small amounts and increased gradually.

The research study attempted to prevent rashes on the 100 patients with bipolar disorder upon their initiation of lamotrigine.

"Treatment with lamotrigine was not started within 2 weeks of a rash, viral syndrome, or vaccination. The medication was titrated more gradually than is recommended in the prescribing information. Subjects not taking enzyme inducers or inhibitors were started at 25 mg/d for 2 weeks. This was increased to 50 mg/d for 2 weeks, and then increased weekly by 25 mg/d as necessary and tolerated. The targeted dose was 200 mg/d, and could by increased gradually up to 500 mg/d" (www.medscape.com).

None of the participants developed a serious rash, although five developed a "benign rash" that was more mild. Three of the five stopped taking lamotrigine, in which case the rash went away, the other two continued to take lamotrigine and their rashes eventually disappeared. Of the 5 that developed benign rashes, 2 of them did not follow the precautions that were a part of the study.

"'The observed rate of benign rash was lower than the 10% incidence in other clinical studies,' the team concludes. However, they're unable to determine the relative contribution of dermatologic precautions and slow titration" (www.medscape.com).

The source of this article was Medscape, their homepage is at: http://www.medscape.com/homepage

The article can be reached on Medscape at: http://tinyurl.com/9gbkk Although you have to create a free account to view it first.

Posted by at 1:54 PM | Comments (0)

Melatonin Agonist For Bipolar Disorder

A melatonin agonist may be able to treat those suffering from bipolar disorder. Agomelatine (Valdoxan) is the first melatoninergic antidepressant and it has been shown to be effective in treating major depressive disorder. This has led researchers to the conclusion that it might be useful in treating bipolar disorder.

"The new agent works on the melatonin 1 and melatonin 2 receptors and also has 5-HT2c antagonist properties, as do selective serotonin reuptake inhibitors (SSRIs), said Dr. Calabrese, a professor of psychiatry, at Case Western Reserve University, Cleveland, Ohio. He added that the hope is that a melatoninergic agent would be less likely to cause hypomania and rapid cycling than are SSRIs" (www.medscape.com).

Ideally, this drug would be used along with a mood stabilizer. It has been sent to the European Agency for the Evaluation of Medical Products, and is expected to be approved by early to mid-2006.

21 patients with bipolar I disorder who were having a major depressive episode were used in this study. They were given agomelatine along with a mood stabilizer. The patients depression was measured by the Hamilton Rating Scale for Depression-17 (HAM-D17). All of the patients used had an initial measure of at least 18. A reduction in their symptoms was defined as a 50% reduction in their original score. Remission was defined as a score of 6 or below on the HAM-D17.

"All patients received 0.25 mg of agomelatine daily during an initial six-week acute period, in which 47% of patients responded during the first week of treatment, and in which 85% had responded by the end of the acute phase. Afterward, 19 patients continued for an extension phase from weeks 6 to 52; 11 patients completed the study. Among those who continued, 10 were in remission by the end of the study. Among the eight discontinuations, two were for lack of efficacy, three were for adverse events, and of the remaining three, one had recovered by week 18 and did not feel the need for ongoing therapy, one had withdrawn consent, and one had poor compliance. Fifteen adverse events occurred, including two manic or hypomanic episodes" (www.medscape.com).

Although the results look promising, agomelatine most be studied further before it can be concluded that it is effective in treating bipolar disorder.

The source of this article was Medscape at: http://www.medscape.com/homepage

You can access the article at http://www.medscape.com/viewarticle/506989 You must create a free account through Medscape if you want to view the full article.

If you do not have a Medscape account or do not want to set one up go to: http://tinyurl.com/dyh67 The same article has been re-posted there by someone else.

Posted by at 1:05 PM | Comments (4)

Low Birth Weight a Risk for Bipolar Disorder

More evidence that below-normal fetal birth weight is a risk factor for "increased psychological stress" later in life has just been published in the British Journal of Psychiatry. Results indicated that "children born full term but weighing less than 5.5 lbs (almost 3% of the total sample) had a 50% increased risk of psychological distress in later life." The risk was not associated with premature babies (those born before 38 weeks) - just below-weight babies born at full term.

In the study from the University of Bristol, Dr. Nicola Wiles and others examined data on 5572 participants in a 1950s study that included information on neonatal birthweight. They analyzed the data for possible connection between birth weight and later mental health problems in adult life.

Previous studies that have looked retrospectively at correlations between birth weight and adult mental health have been confounded by childhood factors such as IQ. It has been difficult in such studies to determine whether birth weight had a direct effect on adult mental health, or whether it simply marked children with problematic childhood factors that then caused them to have mental health problems as adults (thus making birthweight an indirect rather than a direct factor).

Authors of this study took into account these childhood factors. They found that an IQ of less than 100 at age seven was indeed associated with "greater psychological distress" in adulthood. But the independent association between low birth weight at full term and adult mental health problems was not weakened, even after correcting for child IQ and behavioral factors.

This study lends support to the theory that schizophrenia, bipolar disorder, and other serious brain disorders are neurodevelopmental, meaning that some biological factors are in place or take place before or at birth. Throughout life, these predisposition factors may be exacerbated or not depending on the environment one is exposed to. Low birth-weight at term is a marker that fetal growth (including brain development) has been somehow slowed. More research is needed to determine how exactly this might happen, and whether some of the genes that have been linked to schizophrenia and bipolar disorder may somehow contribute to such growth retardation.

Prospective mothers can help lower their child's risk of having serious mental health problems by getting early and regular pre-natal care, taking pre-natal vitamins, and taking steps to avoid birth complications. If a baby is born with a low birth weight, this does NOT mean that the child is condemned to mental health problems - but it does mean that the parents might want to take extra care ensuring that the child grows up with an enriched social and nutritional environment, and that he/she is protected as much as possible from other risk factors (see http://www.schizophrenia.com/hypo.html) for mental illnesses.

Source: Low Birth Weight Linked to Psychological Distress in Adulthood. Science Daily (http://www.sciencedaily.com), July 2 2005.

View the study abstract free at: http://bjp.rcpsych.org/cgi/content/abstract/187/1/21

Posted by julia.d at 8:49 AM | Comments (0)

July 1, 2005

Alcohol Abuse Accompanies Bipolar Disorder

Bipolar disorder is often accompanied with a substance abuse disorder, very often it is alcohol abuse. Why these two disorders accompany one another has not been well researched, although there are several hypotheses as to why they are co morbid. Five of the most common theories were stated in this clinical update.

"(1) "kindling," or the neuronal sensitization created by one condition increasing susceptibility to the other; (2) a common genetic pathway for alcoholism and mood instability, resulting in shared neurochemical pathways that become dysfunctional; (3) long-term substance abuse, which may in fact cause bipolar disorder, although there is no clear-cut data to support this; (4) the belief that patients with bipolar disorder have thrill-seeking personalities drawn to high-risk behavior and are more likely to resort to alcohol and/or stimulant abuse; and (5) a form of self-medication where patients try to medicate themselves out of their depression and/or continue their mania or hypomania. Whatever the explanation, it is clear from the high rate of co-occurrence of these conditions that the association cannot be due to mere chance" (www.medscape.com).

Many of those who have an alcohol abuse problem are not screened for a mood disorder, although it is common for them to co-occur. Family physicians are usually the first to see the symptoms of either a substance abuse disorder or a mood disorder, but many have not received the education necessary to take action when such symptoms are present.

In one survey that was given to the patients and their families, it was discovered that it took an average of 7 to 10 years before they were diagnosed with bipolar disorder. Alcohol abuse is not commonly diagnosed in teens because abusing alcohol may sometimes be seen as part of growing up. General physicians may notice signs of depression, but not bipolar disorder because it is more difficult to diagnose. Unfortunately, many people that have a dual diagnosis often end up having a doctor that only focuses on one or the other problem. Dual diagnosis is when someone has both a psychiatric disorder and a substance abuse disorder. These two problems, although interrelated, need to be individually addressed if one is to receive successful treatment.

For more information on dual diagnosis go to: http://tinyurl.com/exz2z

Or you can go to this other great Dual Diagnosis site at: http://tinyurl.com/dvntk

The source of this story is Medscape.

Posted by at 2:36 PM | Comments (2)

FDA Warns Of Suicide Risks

The FDA recently posted a new warning on their website of the link between suicidal tendencies and adult usage of antidepressant medication. The FDA cited numerous publications that highlight the risk of suicide when taking antidepressant medication.

The FDA also posted information on a specific drug that may potentially have a link to increased suicidal tendencies. According to Mathews and Tesoriero (2005), "the FDA also last night posted information about patients who displayed suicidal tendencies during trials of one antidepressant, Eli Lilly & Co.'s Cymbalta, being tested for stress-related urinary incontinence. The site says a "higher-than-expected rate of suicide attempts was observed" in the studies after the formal portion of the trials had concluded.

The agency took the action despite earlier objections from Lilly. "Eli Lilly has questioned our legal authority under the Food, Drug and Cosmetic Act to post some information about drug safety on our Web site," Dr. Galson said, adding that Lilly "raised legal issues including our use of confidential commercial data." Lilly withdrew its application to market Cymbalta for the incontinence condition in January, but the drug is approved as an antidepressant and to treat pain suffered by diabetics."

Most of the FDA's warnings have been specifically for children and teens taking antidepressants but this article specifically highlighted the risks that such drugs held for adults. Eli Lilly states that the amount of patient who had such tendencies while taking Cymbalta is no more than there is in the general population. The placebo group supposedly had equal levels of suicidal tendencies.

The FDA has not passed judgement on whether this is a causal relationship. They only want to make sure that those taking the drug are aware of research that shows a potential link between the two so that they can take the precautions that they feel are necessary to take.

For the FDA website go to: http://www.fda.gov/default.htm

To access the FDA article go to: http://tinyurl.com/cdcuh

The source of this article was The Wall Street Journal.

Posted by at 1:40 PM | Comments (1)

Survey Reveals Bipolar Disorder's Impact

A survey distributed to those with bipolar disorder has revealed new clues on the influence that bipolar disorder has on people's lives. The survey was distributed by the World Federation for Mental Health (WFMH) and AstraZeneca, the pharmaceutical company.

The World Federation for Mental Health (WFMH) today announced results of a global bipolar disorder consumer survey, Thinking Ahead, at the World Congress of Biological Psychiatry. The survey revealed that almost half (47%) of all people with bipolar disorder - or 'consumers' as many mental health patients prefer to be referred to as - feel that their disease has had a highly negative impact on their quality of life. Further to this, more than a third (35%) of respondents stated they have been discriminated against as a result of their condition, usually within the context of everyday social relationships.

"Many people who successfully treat and manage their bipolar disorder are highly functioning individuals who sustain jobs, relationships, and lead full lives", commented Preston Garrison, Chief Executive Officer of the WFMH. "Unfortunately, however, there is a critical need to improve awareness and remove the social stigma associated with this growing condition so that others, who do not feel comfortable seeking medical support, can obtain appropriate treatment and, as a result, dramatically improve their quality of life."

The WFMH partnered with AstraZeneca to implement this survey of 687 bipolar disorder consumers across seven countries (Canada, Germany, Greece, Italy, Spain, United Kingdom, United States). The findings from the Thinking Ahead survey add a compelling consumer voice to the WFMH mission and AstraZeneca's commitment to reducing damaging stigma associated with mental disorders and improving outcomes for people living with mental disorders and their families.

The survey also revealed:

- 26% of respondents NEVER tell people they have bipolar disorder. Fear of social stigma is a key reason why people do not share this information with others.

- The vast majority (79%) of respondents in all countries say successful treatment would lead to significant quality of life changes in terms of increased functionality/improved lifestyle such as, maintaining a job, having relationships, living independently, and achieving goals.

- 71% of people with bipolar disorder who were surveyed believe that the public does not understand their illness. This ignorance may be causing the stigma that many feel.

Eduard Vieta, Director of the Bipolar Disorders Program of the Hospital Clinic at the University of Barcelona, Spain, commented, "The results of this survey reflect my everyday practice in psychiatry: consumers want and need treatments that will successfully manage and treat their condition and allow everyday functioning. The development in recent years of drugs which have reduced side effects whilst remaining highly effective are a key factor in enabling people with bipolar disorder to maintain a good quality of life."

The Thinking Ahead survey interviewed people living with bipolar disorder to better understand how their disease impacts their lives and that of their families, and how treatment can help ensure their disease has as limited impact as possible on their quality of life. The Thinking Ahead theme was chosen to highlight the need for long term strategies to treat and manage bipolar disorder to ensure that consumers achieve full quality of life benefits, as opposed to short term fixes that only add to the stigma and mismanagement of mental illness.

The survey was developed by AstraZeneca and the World Federation for Mental Health, overseen by an independent panel of bipolar disorder physicians and advocacy group representatives, and conducted by Research International, an independent marketing research firm. 687 people with bipolar disorder were interviewed via the internet and face-to-face, across seven countries: U.S (203 consumers), Canada (99 consumers), U.K. (100 consumers), Germany (102 consumers), Spain (75 consumers), Italy (100 consumers) and qualitative in Greece (8 consumers). AstraZeneca was the financial sponsor of the survey.

The WFMH was founded in 1948 to advance, among all peoples and nations, the prevention of mental and emotional disorders, the proper treatment and care of those with such disorders, and the promotion of mental health. AstraZeneca is a major international healthcare business engaged in the research, development, manufacture and marketing of prescription pharmaceuticals and the supply of healthcare services.

For more information regarding the WFMH international activities, including World Mental Health Day (October 10), visit www.wfmh.org

To view the full press release please go to: http://www.prnewswire.co.uk/cgi/news/release?id=149241

Posted by at 1:20 PM | Comments (7)

Crime influenced by substance abuse

One of the most harmful stereotypes of people with mental illness is that they are more likely to be criminals, particularly violent ones. Statistics show that this is incorrect - people with mental disorders who are in treatment are no more likely than the average citizen to commit a violent crime.

However, a study from the Yale University School of Medicine highlights a factor that may often be ignored - substance abuse. The study showed that of the subjects with rapid-cycling bipolar disorder, 56% had substance-related criminal activity. Moreover, women who had abused cocaine were almost twice as likely to have a criminal history than those who had not. Although it is easy to confound inter-related factors such as substance abuse and mental illness, due to the fact that people who cannot get the treatment they need may self-medicate with alcohol or drugs, this sort of study underlines the important fact that a simple diagnosis of bipolar disorder (or any other mental illness) does not make a person more likely to commit a crime. Other factors (substance abuse among them) which affect the general population in the same way are much more influential on someone's tendency to break the law.

Access the study abstract at the following site: http://www.jaapl.org/cgi/content/full/33/2/196

Resources for dealing with a dual-diagnosis of mental illness and substance abuse: http://users.erols.com/ksciacca/

Posted by julia.d at 9:21 AM | Comments (6)