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August 31, 2005

Unemployment Has Link to Mental Health

Apparently children of parents who are both unemployed are at a higher risk for developing a mental disorder. "Where neither parent was working, the figure was 20% compared with 8% where both were in employment, while it was 16% for families with a gross weekly income of £100 or less compared with 5% for those bringing in £600 or more" (DailyMail, 2005).

Those in single parent families were also at higher risk for having a mental disorder, at 16%. It was at 14% for children in families that had been "reconsituted," in other words, families in which kids were also living with stepsisters and stepbrothers. Kids in families with parental figures with no educational qualificiations were four times more likely to develop a mental illness at 17%. This is in comparison to 4% for kids who had parents with a degree.

Boys were more likely to have a mental illness than girls. The Office of National Statistics put the data together. The scores were similar to the data pulled together in 1999. This information holds important meaning for children of the unemployed, single parent families, and reconstituted families. It shows that the stresses that a parent endures puts similar stress upon the child. What is important is to find a way to combat this problem before it happens, rather than waiting for it to potentially affect one's children.

Original Source: Unemployment link to mental health. DailyMail (UK). August 31, 2005.

Posted by at 2:20 PM | Comments (1)

August 30, 2005

Anticonvulsants Safe for Kids With Bipolar Disorder?

Many of the drug trials for anticonvulsants and other mood stabilizers only have adults as their subjects. This creates a problem when deciding what is the safest medication to prescribe a child with bipolar disorder. This article goes over some of the risks and benefits of using anticonvulsants and other mood stabilizers in children diagnosed with bipolar disorder.

Lithium has been studied the most in regards to pediatric bipolar disorder (PBD) and is surprisingly the only FDA approved mood stabilizer for kids. It is currently approved for those 12 and over, although it is used for children younger than 12. "In an open-label study of 100 adolescents with type I bipolar disorder,4 63% met response criteria after 4 weeks of lithium and 26% showed manic symptom remission. Symptoms worsened in both groups, however, when 40 responders were randomly assigned to continue or discontinue lithium for 2 weeks" (Current Psychiatry Online, 2005). Lithium also has had a double-blind placebo controlled trial with adolescents.

Valproate has not had any double-blind placebo controlled studies done on it although open-label trials have been done on it. Its effectiveness in children and adolescents in the trials within this article ranged between 47%-80%. There are several serious side effects that could effect children. Special care must be taken when prescribing to adolescent girls with bipolar disorder due to some of these side effects.

Carbamazepine is often used as an adjunctive treatment for lithium, but is sometimes used as monotherapy. It cannot be used with monoamine oxidase inhibitors and has some sensitivity to tricyclic antidepressants. Its drug interactions should be taken into account when prescribing.

Oxcarbazepine has fewer drug interactions and similar efficacy when treating PBD. It also has less side effect risks, although it can alter ones estrogen and progestrone levels. This means it may make oral contraceptives (birth control pills) ineffective, so this should be considered when prescribing to teenage girls. It has no double-blind placebo controlled studies done on it.

Lamotrigine has been studied for kids with seizure disorders, but there are no controlled trials testing its effectiveness in kids with bipolar disorder. It can result in a severe rash, which seems to be age-related. This should be taken into consideration when prescribing for kids and adolescents.

Topiramate does not have much information available for use in children with bipolar disorder. It may have cognitive effects on users, some have reported having difficulty remembering words. It can result in weight loss, which is uncommon for a mood stablizer. This should be monitored by a physician when it is prescribed.

This article has useful information in regards side effects, benefits, and prescribing information for pediatric bipolar disorder. You can access this full article by clicking here.

Original Source: Are anticonvulsants safe for pediatric bipolar disorder? Current Psychiatry Online. August 2005. By Weller, E.B., Kloos, A.L., Hitchcock, S., Weller, R. A.

Posted by at 12:46 PM | Comments (1)

Self Help Support Groups

Creating websites and placing posters in schools are just some of the ways self-help support groups (SHSGs) could reach young people with a mental illness, according to a study just completed at the University of Western Sydney. Dr Ann Dadich spent three years researching such groups and found many were not being fully accessed by those who most needed them - young people.

Instead, young people were more likely to self-diagnose, research their illness through the Internet, or talk to friends about their problems.

"Collectively, SHSGs offered young people support...but not all young people regarded the groups as supportive," says Dr Dadich, who interviewed 53 young people for her research.

"At times, the support offered by the group did not meet the particular needs of the young person."

Dr Dadich conducted her research while studying for her PhD under the supervision of Associate Professor Meg Smith, from UWS' School of Applied Social and Human Sciences and President of the Mental Health Association, as well as Dr Natalie Bolzan, also of UWS' School of Applied Social and Human Sciences.

Dr Dadich is now working at the Social Policy Research Centre at the University of New South Wales.

The project attracted an annual stipend of $24,000 from the Australian Research Council and its findings will help raise awareness of SHSGs and improve the direction of social policy, the academics say.

For her project, Dr Dadich explored groups for people suffering mental health issues such as bipolar disorder, schizophrenia, eating disorders and substance use issues. This includes well-known 12 Step fellowships, like Alcoholics Anonymous and Emotions Anonymous.

"These non-profit support groups are run by and for people who come together on the basis of a shared experience," says Dr Dadich.

"While much research has been conducted on how adults utilise self-help support groups, there has been little investigation on the experiences of young people, despite the importance of youth mental health."

Such groups, according to Dr Dadich, are well supported by people aged between 40 and 50 who displayed significant symptoms of mental illness over a number of years.

However young people with a similar mental health issue tended to use the Internet to find out more about their illness and relied on conversations with friends.

"We also found that GPs were very important in helping these young people access information about their mental illness," says Dr Dadich.

When young people did access SHSGs, they found them a good support, offering a sense of belonging and the opportunity to identify with others suffering the same disorder.

"After all", says Dr Dadich, "we are more likely to believe the advice of someone who has 'been there.' Their advice may help us avoid some of difficulties they have experienced."

"Another issue for young people suffering a mental illness is actually being told they have such a condition and that they have to take medication," says Associate Professor Smith.

"Some people told them they were a 'problem' to their families, and this makes the young person suffering the disorder reluctant to seek help."

Associate Professor Smith says it is important for SHSGs to "re-pitch" themselves to young people.

"Organising activities aimed at young people, such as going for a coffee, or watching a video together, would also help the groups attract more young people," she says.

Adds Dr Dadich: "The Internet is a great way of attracting young people to a group - it offers a lot of anonymity to someone investigating personal issues.

"Schools are also an important environment to disseminate information to young people. It's important for SHSGs to get themselves known by local schools through the use of promotional material or visiting the school."

Dr Dadich is passionate about SHSGs and recognises their unique place in the community. She also acknowledges the tireless efforts of volunteers who keep the groups in existence.

"They serve as lifelines to many people who would otherwise feel isolated and perhaps be misinformed about their personal experiences," she says.

For details, contact:
Lydia Roberts
Tel: +61 (0) 415 374 983
Email: lydiaroberts@unwired.com.au
Source: Research Australia

Posted by at 12:40 PM | Comments (0)

August 29, 2005

Treatment Considerations in Reproductive Health

Having children while on any form of medication is something that many women try to avoid. But some medications are more necessary than others, for example the medications used to treat bipolar disorder. One study looked at the effects that pregnancy and hormonal treatments had on women suffering from bipolar disorder.

The issues looked at were "teratogenicity [things that cause/ relate to developmental malformations], breastfeeding, polycystic ovarian syndrome, weight gain and obesity, and medication interactions with oral contraceptives." Postpartum depression is a significant risk in women with bipolar disorder and they are at heightened risk to have mood episodes during and after pregancy. Mood stabilizers must be picked carefully because of the chance that they could cause any developmental malformations in the child.

The highest risk (while pregnant) seems to come from using valproate in terms of potential malformations of the child. While breastfeeding lithium was the mood stabilizer that was "of highest concern" for the infants health.

The researchers stated that the effects of mood stabilizers on perimenopause and polycycstic ovarian syndrome must be examined in future studies to make sure that they are safe for women.

Original Source: Treatment considerations affected by reproductive events in bipolar women. NewsRX.net. 2005.

This research study was published in Acta Psychiatrica Scandinavica (Bipolar disorder in women: reproductive events and treatment considerations. Acta Psychiatr Scand, 2005;112(2):88-96

Posted by at 12:56 PM | Comments (1)

Chromosomes Linked to Bipolar Disorder

There have been several studies over the years focused on identifying the genes responsible for bipolar disorder. Recent research in Canada, Scotland, and the US have found multiple chromosomes that give one a genetic predisposition to develop bipolar disorder. This article covers three of the studies that have given us insight into this complicated link - while the information is very technical, the general message the average reader should get from this is that significant progress is being made to identify all the genes that predispose a person to developing bipolar disorder.

The first study shows that Chromosome 12A has a connection to bipolar disorder. This Canadian study also stated that chromosomes 2, 5, 7, 9, 10, 17 and 20," were of potential interest, but not to the degree that chromosome 12A is. Their initial findings showed an interest in chromosomal region 12q23 -q24. After adding an additional 18 families for analysis the researchers determined a susceptibility for bipolar disorder on chromosome 12q24.

"Shink and colleagues published their study in Molecular Psychiatry (A genome-wide scan points to a susceptibility locus for bipolar disorder on chromosome 12. Mol Psychiatry, 2005;10(6):545-552). For additional information, contact N. Barden, CHU Laval, Research Center, CHUQ Pavillon, 2705 Blvd. Laurier, Quebec City, PQ G1V 4G2, Canada"

In the second study, done in Scotland, a susceptibility was found on chromosome 1q42. The susceptibility was found with the help of 13 families and this was followed up by using 22 families that were affected by schizophrenia or bipolar disorder. "Macgregor and colleagues published the results of their research in Molecular Psychiatry (A genome scan and follow-up study identify a bipolar disorder susceptibility locus on chromosome 1q42. Mol Psychiatr, 2004;9(12):1083-1090). For additional information, contact S. Macgregor, University Edinburgh, Institute Cell Animal & Population Biology, Kings Bldg, Edinburgh, Midlothian, Scotland"

In a study done in the US, a link between chromosome 21q22 and bipolar disorder was found. Allele 2 was found to be a significant area, although it seems as if the results were not definitive. "Stopkova and colleagues published their study in Psychiatry Research (Analysis of SYNJ1, a candidate gene for 21q22 linked bipolar disorder: a replication study. Psychiat Res, 2004;127(1-2):157-161).

Posted by at 12:15 PM | Comments (1)

August 28, 2005

Colorado Jails House Most of Mentally Ill

Colorado has a public mental health system that has suffered from numerous budget cuts leading to many of the mentally ill being housed in jails instead of some type of rehabilitative psychiatric housing. The number of beds available at the two state mental hospitals have dropped and the percentage of jail inmates with a psychiatric illness has increased. According to the statistics, 1 in 5 prison inmates have a mental illness, and 1 out of 4 in county jails have a mental illness.

The statistics affecting the mentally ill in Colarado are not encouraging:
"- In 2004, the state cut funding for treatment of serious mental illness by 25 percent, which led to 14,000 fewer people receiving treatment.

- At the two state mental hospitals, the number of beds has dropped from 552 at Pueblo and 220 at Fort Logan in 1999 to 438 and 173 this year. Thirty years ago, when the state’s population was half what it is today, the two hospitals had more than 6,000 beds.

- The percentage of Colorado Department of Corrections inmates diagnosed with a serious mental illness has increased from 3 percent in 1991 to 11 percent in 1999 to 18 percent — 3,750 inmates — in 2004" (Rappold, 2005).

This obvious disparity in mental health funding has not seemed to be at the forefront of any politicians agenda as it has not received much attention in years. The amount of mentally ill being put in the Colarado prison system has only grown over the years. It will take some time to fix this problem, as well as a lot of funding. Its a difficult road ahead, but its a road that needs to be travelled sooner rather than later.

Original Source: Locking up the sick. The Gazette. August 28, 2005. By R. Scott Rappold.

Posted by at 1:30 PM | Comments (3)

August 27, 2005

Postpartum Depression in Bipolar Disorder

Postpartum depression is a disorder that 1 in 10 mothers will have to deal with during or after pregnancy. Having a prior history of depression increases this risk, whether it be unipolar depression, or bipolar depression. Those with bipolar disorder appear to be at an even higher risk of developing postpartum depression than those with unipolar depression.

One study examined 2,340 women who went to Massachusetts General Hospital between the years of 1996 and 1999. Of these women, 1,814 of them filled out a mood disorder questionnaire while in their second trimester. Using these results women were able to be diagnosed with bipolar disorder and a score of 16 or more on the Epidemiologic Studies Depression Scale was used to diagnose unipolar depression. The average age of all the women in this study (both with depression and without) was 32.5 years old, for 61% of them it was their first child.

"In the second trimester, the prevalence of depression was about 52% among women with a history of bipolar disorder, about 34% among those with a history of unipolar depression, and about 8% among women with no history of a mood disorder.... At the sixth week post partum, the prevalence of depression was 50% among women with a history of bipolar disorder, about 32% among women with a history of unipolar depression, and about 6% among women with no history of mood disorders" (Zoler, 2005).

The effects of lithium on children via breast milk was also looked at. There were minimal traces of lithium in breast milk and 9 out of 10 children showed no negative affects from the lithium. The one baby that did have a negative reaction only had elevated levels of TSH and the levels went back to a normal range after 2 weeks of the child not being exposed to lithium. TSH is thyroid stimulating hormone, having too much or too little can have negative effects on your body. Babies of lithium-treated mothers should "be monitored by serum assays of TSH, blood urea nitrogen, and serum creatinine every 6-8 weeks during breastfeeding" (Zoler, 2005). In most cases, lithium does not have a detrimental effect on children via breast milk.

Original Source: Bipolar history boosts depression in pregnancy; women with a history of unipolar depression or bipolar disorder are at increased depression risk. Philadelphia Bureau Family Practice News. August 1, 2005. By Mitchel L. Zoler.

Posted by at 11:55 AM | Comments (0)

Bipolar Disorder Has Link to Energy Deficiency

Belmont, MA - Is bipolar disorder related to an energy deficiency in the brain? Can researchers find ways to stabilize this deficiency in order to help those suffering from the illness? These questions and other issues are addressed in a revolutionary new study (abstract) from McLean Hospital published in the March 1, 2004 Archives of General Psychiatry.

The study reveals that the mitochondria, cell organelles in the brain important for energy conversion, might not function as effectively in the brains of individuals with bipolar disorder as they do in the brains of controls or those with schizophrenia. The discovery of this dysfunction could have significant implications for the diagnosis and treatment of bipolar disorder, a psychiatric illness characterized by recurrent episodes of depression and mania, which affects nearly 2.3 million adult Americans.

According to the study's lead investigator, Christine Konradi, PhD, mitochondria are the body's "power plants," helping to convert the energy we get from food (glucose) into a form our bodies can use. Much like the way an oil refinery processes crude oil, mitochondria take the raw materials from our nutrients and "refine" them so that our cells can use the energy. However, in individuals with bipolar disorder, something in this energy conversion appears to go awry.

When Konradi, director of McLean Hospital's Neuroplasticity Laboratory, and her colleagues compared gene levels in the brains of 27 subjects with bipolar disorder to those with schizophrenia and to controls, they discovered the genes that make the proteins involved in energy transfer were significantly "down-regulated" in the brains of subjects with bipolar disorder.

"The reduction of these genes indicates that either there are not enough of these 'power plants' in the cells or that these power plants are not efficient," Konradi said. "Our study therefore suggests a causal relationship between bipolar disorder and decreased energy transfer. If this is the case, it could completely refocus our approach to the treatment of bipolar disorder."

Konradi's research concentrated primarily on the hippocampus, one of the brain areas indicated in bipolar disorder. Energy deficits were also evident in the brain's cortex.

While bipolar disorder affects nearly 2.3 million adult Americans, little is known about the disease's etiology or function. Studies indicate a hereditary component, but no gene or gene expression has been linked conclusively to the illness. Because it indicates decreased levels of mitochrondrial genes, the McLean study provides further evidence that the abnormal expression of genes involved in energy metabolism is closely related to bipolar disorder.

"Our hope is that this research will attract the pharmaceutical industry to explore new treatment approaches," Konradi said. "While there are many diseases related to mitochondrial dysfunction, they are so rare that there is little incentive to fund research. But bipolar disorder affects a huge population. If drug companies can support efforts to stabilize energy conversion in these individuals, we could potentially help millions of people."

McLean Hospital maintains the largest research program of any private psychiatric hospital in the nation. It is the largest psychiatric clinical care, research and teaching facility of Harvard Medical School, an affiliate of Massachusetts General Hospital and a member of Partners HealthCare.

CONTACT:
Cindy Lepore
617/855-2110
leporec@mclean.harvard.edu
Source: McLean Hospital, a Harvard Medical School affiliate.

Posted by at 11:48 AM | Comments (2)

August 25, 2005

Half of Those w/ Bipolar Disorder Had Childhood Abuse?

Severe childhood trauma or childhood abuse appears to have occurred in about half of people with bipolar disorder, according to one new study of 100 patients from the USA published in the February 2005 British Journal of Psychiatry. This is of course according to this one small survey (so don't put too much value on it yet). This study seems to have a number of weaknesses that make it difficult to generalize from - including the small sample size, and the "self-reported" nature of the study.

Childhood trauma or abuse has been associated with many different types of adult psychiatric disorder, including suicidality, substance misuse and dependence, and psychosis. This study set out to examine the prevalence and types of childhood abuse reported by adult patients with bipolar disorder, and to relate them to the complexity of the current illness.

100 patients were studied at an academic specialty centre for the treatment of bipolar disorder in New York. Histories of severe childhood abuse were identified in about half of the sample and were associated with onset of illness at an early age, as well as with more severe manic symptoms, compared with patients without a history of abuse.

Severe emotional abuse or neglect was significantly associated with substance misuse or dependence. Rapid cycling between manic and depressive mood in the last year was significantly linked to severe emotional abuse or neglect, or physical abuse.

There was also a significant association between a lifetime suicide attempt and severe childhood sexual abuse (though not emotional or physical abuse).

Multiple forms of abuse in childhood - which occurred in about a third of the people studied - showed a graded increase in risk for both suicide attempts and rapid recycling between manic and depressive mood in adulthood.

The prevalence of severe childhood abuse found in around half of the sample is consistent with the findings of previous studies, and is only slightly higher than that found among patients with major depression.

Also consistent with the findings of this study are reports suggesting that multiple forms of child maltreatment often occur together, and may contribute additively or synergistically to psychiatric disorders and suicidality seen in adulthood.

The authors of the study comment that in the light of the high prevalence of childhood abuse in their sample, coupled with its influence on suicide risk, it would seem prudent for clinicians routinely to evaluate histories of childhood trauma in patients with bipolar disorder.

Consideration of the nature and extent of abuse in childhood may also bear directly on suicide risk assessment among these patients.

Further prospective studies are needed to confirm and extend the findings of this study.

For further information, or a press copy of the full paper, please contact Deborah Hart or Thomas Kennedy in the External Affairs Department.
Telephone: 020 7235 2351 Extensions. 127 or 154
E-mail: dhart@rcpsych.ac.uk or tkennedy@rcpsych.ac.uk

Posted by at 2:28 PM | Comments (2)

Depression Survey: People Often Don't Adhere to Treatment

Findings Highlight Importance of Physician/Patient Communication in depression (and similar issues are common with bipolar disorder)

Results of a new national survey reveal a disparity between what people with depression say they know about their illness and how they manage it. Although 91 percent of those surveyed say it is very important to take their antidepressant medication exactly as prescribed, at some point approximately 40 percent stopped taking their medication without the advice of their health care professional because they personally believed they were no longer experiencing symptoms of depression. These insights come from an online survey of 1,086 people with depression sponsored by NAMI (National Alliance for the Mentally Ill) and funded by Wyeth Pharmaceuticals.

"These findings are of great concern because people who prematurely discontinue antidepressant therapy are much more likely to experience another episode," said Ken Duckworth, M.D., Medical Director of NAMI, the nation's voice on mental illness. "If patients are unsatisfied with their treatment or believe they no longer need medication because their symptoms are improving, they may stop treatment too early and slip back into the cycle of depression. If this cycle continues, people with depression may eventually give up all hope of ever getting better. What this means to physicians is that we must select appropriate therapies and provide the education and support necessary to help patients understand their illness and achieve success."

People with depression who are well informed about the illness stand a much better chance of achieving the treatment goals of having little or no symptoms. Yet the results of this survey suggest that there are gaps in awareness among people with depression about their illness and treatment goals. In fact, only 53 percent of respondents in this survey feel well informed about their illness, and only 22 percent have ever been told that it is possible to achieve a state of having little or no symptoms of depression. In addition, less than 25 percent are aware of the difference between a partial and full response to medication. And while the majority of respondents report they have experienced six or more episodes of depression in their lifetime, only 34 percent of people with depression have ever discussed their risk of relapse with their physician.

These findings are important because clinical research shows that the longer people with depression experience symptoms, the less likely they are to achieve their treatment goals. In fact, those who experience one episode of depression have a 50 percent chance of relapse, while those who continue to experience subsequent episodes have up to a 90 percent chance of relapse.

"As a physician, I know that lack of awareness of treatment goals and low expectations can undermine treatment, resulting in people with depression continuing to experience symptoms or relapse," says Dr. Duckworth. "The majority of people with depression can achieve success with medication, talk therapy or a combination of both. What this survey helps to illustrate is the important role physicians must play in helping people with depression understand what they should expect from treatment and providing monitoring to help them stick with it."

Depression is one of the most prevalent mental health conditions in the United States, affecting nearly 19 million American adults each year. People with depression can learn more about their illness and how to manage symptoms through organizations such as NAMI, which advocates for expanded access to information, services and treatment.

About the Survey

Harris Interactive, an independent survey research provider, administered an online survey between April 8 and April 22, 2005 to 1,086 people with depression who are taking antidepressants. Respondents answered questions about their treatment regimen, depression-related perceptions or misperceptions, quality of life, as well as symptomology and treatment efficacy.

Respondents were screened to ensure they were at least 25 years of age, had been diagnosed with depression, were currently taking a prescription antidepressant, and had not taken a depression-related survey in the past six months. Figures for age, sex, race, region, education and income were weighted where necessary to align them with their actual proportions in the population. The survey was sponsored by NAMI (National Alliance for the Mentally Ill) and funded by Wyeth Pharmaceuticals.

Source: National Alliance for the Mentally Ill

Posted by at 2:10 PM | Comments (1)

August 24, 2005

New Kids Book on Bipolar Disorder

A new childrens book has come out that gives kids a better understanding of bipolar disorder and how to deal with the knowledge of this disorder. The authors of the book are three women named Dr. Lisa Lewandowski, 35, Shannon M.B. Trost, 35, and Kimberly Shaw-Peterson, 31. They are in the process of trying to make sure that professionals, teachers, and parents have knowledge of its existence so that children can have access to it.

The book is called "Darcy Daisy and the Firefly Festival" and was published in June of 2005. The setting of the book is in a community of different flowers, with the main character being Darcy Daisy. Over the course of the book she learns to accept another flower person who has bipolar disorder. The authors in the book state that it is not presented in a "scary way", but rather at such an angle that it is easily accessible to children.

Darcy Daisy Bipolar Kids Book.jpg

The book has several main ideas that are presented to kids who read it. "Lewandowski said that the book has three concepts that she wants children to pick up: Gossip is wrong. You should talk to someone you trust when you're scared or confused. You should accept people in your community even if they're different" (Stanley, 2005).

The colorful illustrations and the simple wording of what could be a difficult and complex disorder to explain makes this book a great read for children who have friends, family, or siblings suffering from bipolar disorder. Even if a child does not have someone close to them suffering from the disorder it gives them a great way to understand bipolar disorder and to therefore be more accepting of it.

You can find the book at Amazon.com.

Original Source: Kids book explains bipolar disorder. Detroit Free Press. August 9, 2005. By Kameel Stanley.

Posted by at 2:11 PM | Comments (0)

Bipolar Disorder Increases Anxiety Disorder Risk

Adolescent bipolar disorder has been found to significantly correlate with an increased risk of having an anxiety disorder when one grows older. The researchers note that bipolar disorder and anxiety disorders are not treated the same and therefore it is important to diagnose them both and have a treatment plan that will work to alleviate both problems.

This relationship was studied by examining 1,397 adolescents who were all under the age of 18. Of these, 297 were diagnosed with bipolar disorder and 1100 were diagnosed with disruptive behavior disorder. Those who had bipolar disorder were more likely to have more anxiety syndromes, and multiple anxiety syndromes that were not simply linked to a specific type of anxiety disorder. Those with bipolar disorder had anxiety syndromes at a level of 2.0 whereas those with behavior disorders were at a level of 1.1.

There are many distinctly different anxiety disorders and it seems that bipolar disorder increased the risk of developing nearly all of them. "Indeed, among the bipolar disorder participants, the risk of developing post-traumatic stress disorder was 5.4-times higher than for those with disruptive behavior disorders, while increased risks were also seen for obsessive–compulsive disorder (odds ratio [OR]=2.0), separation anxiety (OR=2.3), social phobia (OR=2.1), overanxious disorder (OR=2.2), agoraphobia (OR=2.6 fold), and panic disorder (OR=3.2)" (PsychiatrySource.com, 2005).

Researchers concluded from their findings that bipolar disorder increased the risk of developing many anxiety disorders when bipolar disorder appeared in one's youth. Previously a link was found solely between bipolar disorder and panic disorder, but this study shows that its affects are not limited to only that anxiety disorder.

Original Source: Pediatric bipolar disorders increase anxiety disorder risk. PsychiatrySource.com. August 24, 2005.

This research report has been published in: J Affect Disord 2005; 88: 19–26.

Posted by at 1:09 PM | Comments (1)

New Jail Diversion Program in Florida

The Tampa Tribune reported this week that that city has an expanded Jail Diversion Program Proposed at a cost of $500,000 for the 2005/06 budget year. This is good news for the mentally ill, especially people with bipolar disorder as they represent a significant number. The jail diversion program will likely reduce the number of people suffering in jail and we hope to see these programs in every city in the US eventually.

Reporter Todd Leskanic wrote, in the story, that:

"A program to treat mentally ill defendants in Pinellas County has been proposed for Pasco.

"This is a growing problem nationwide," Dillinger said. "Jails these days have become mental health facilities because most of the mental health facilities are either closed or overcrowded."

Last year, Dillinger started Jail Diversion in Pinellas using a $1 million federal grant.

The program helps mentally ill defendants find treatment and services while their cases wind through the courts. To be eligible, a defendant must be diagnosed with a serious mental health condition.
...

Duncan McCormack, who runs the program in Pinellas, said another goal of the arrangement is to help defendants find treatment once their cases are resolved.

Many times, treatment and medications stabilize the mentally ill and keep them from re-entering the legal system.

So far, he said, the program has worked. In Pinellas, it has served more than 550 defendants, and 203 have completed the program, meaning ideally they are off probation and back in society. Many remaining defendants are still in treatment.

...The program also keeps the mentally ill out of county jails, which are not equipped or staffed to treat such inmates, thereby easing jail overcrowding.

Pasco officials said they would welcome the program. Billy Major, a social worker who works with the public defender's office in Pasco, estimated that as many as 44 percent of jail inmates take medication for mental afflictions.

Most common, Major said, are bipolar disorder and depression."

Posted by szadmin at 12:14 PM | Comments (8)

August 23, 2005

Mixed States Increases Girl Suicide Risk

Having mixed states apparently increases the suicide risk in girls, but does not do so for boys. It has been suggested in the past that using antidepressants can increase the suicide risk in those with bipolar disorder, but this study shows that there may be more to the issue. Perhaps it is mixed states and their often unrecognized nature combined with antidepressants that increases the suicide risk.

The potential correlation between suicidality and mixed states was studied by researchers. The participants in the study were 247 individuals at the average age of 14.7 years old, all of which had been diagnosed with bipolar disorder. The article stated that 100 of these subjects had either bipolar I or II disorder. Those participating in the study were also examined for "concurrent intra-major depressive episode hypomania/mania." Their past and current suicide attempts and ideation were looked at and taken into account when doing this study.

Of all of the participants 82% of them had mixed states, of which 46 were boys and 36 were girls. The girls in the study were over twice as likely to currently be having thoughts of suicide. Girls were also 3 times more likely to have had a past attempt at suicide. Researchers stated that mixed states did not forecast suicidal thoughts or attempts. "Its presence did, however, contribute independently to suicidal behavior among the female patients. Girls in mixed states were approximately four times as likely to have attempted suicide as those without mixed states, Dilsaver and team report in the Journal of Affective Disorders. This relationship remained true even after taking into account age, presence of psychotic features, and family history of mood disorder" (PsychiatrySource.com, 2005).

The researchers involved in this study stated that their findings had relevance to the controversy over suicide and antidepressant use in adolescents. They believe that the failure to classify mixed states and recognizing them may be the root problem of antidepressants increased suicidality.

Original Source: Mixed states increase suicide risk in girls. PsychiatrySource.com. July 26, 2005.

This comes from the research article: Gender, suicidality and bipolar mixed states in adolescents published in J Affect Disord 2005; 87: 11–16.

Posted by at 11:31 AM | Comments (5)

August 20, 2005

Cognitive Impairment Common in Bipolar Disorder

Cognitive impairment is something that is common in those suffering from bipolar disorder, but apparently it is not reported in many of the cases in which it is apparent. Some of the potential reasons for it not being reported were: inability to notice it in oneself, trying to hide them, or "subthreshold affective symptoms."

37 patients with bipolar disorder participated in the study. "More than 75% of the patients, even those who were affectively nonsyndromal, displayed some cognitive deficits, most notably in verbal learning and memory. The results showed that the patients' self-reports of impairment did not reliably predict objective neuropsychological deficits. There was a tendency for patients to over report cognitive problems, although this was not consistent across all three measures" (PsychiatryMatters.MD, 2005).

The measures used were the Cognitive Difficulties Scale (CDS), Cognitive Failures Questionnaire (CFQ), as well as the Patient's Assessment of Own Functioning (PAOF). Complaints of cognitive impairment should be payed attention to as they can often lead to a patient not following treatment guidelines.

Cognitive impairment may make the patient not want to take their medication for bipolar disorder or it could make them feel like their treatment is not working. One's rating on mania scales and depression scales did not have a correlation with one's score on neuropsychological tests or any complaints they had of their own.

Original Source: Cognitive impairment common among bipolar disorder patients. PsychiatryMatters.MD. 2005.

This research article was originally published in: Psychiatry Res 2005; 136: 43-50.

Posted by at 1:01 PM | Comments (2)

Suicide Prevention Walk

Saturday, September 10th, World Suicide Prevention Day, Jeff Alt, author of A Hike For Mike, and his wife, Beth will lead a "Hike to the Hill," to Capitol Hill to bring attention to-and help prevent-the national and global suicide epidemic. They want to stop the 31,000 American deaths each year to suicide and help the 19 million Americans suffering from depression.

(PRWEB) August 19, 2005 -- Saturday, September 10th, World Suicide Prevention Day, from 10a.m.-12p.m., Jeff Alt, author of A Hike For Mike, and his wife, Beth will lead a "Hike to the Hill," from Freedom Plaza (across from the White House) to Capitol Hill. This event is sponsored by the Suicide Prevention Action Network USA (SPAN USA) to bring attention to—and help prevent—the national and global suicide epidemic. After losing a brother (Mike) to suicide, these hikers learned that Mike’s suicide might have been prevented by treating his depression (Most suicides are attributed to untreated depression). No one knew Mike was depressed. These hikers decided to climb every mountain—and hill—necessary to make the symptoms and treatment options of depression common knowledge. The Alt’s walked the Sierra Nevada John Muir Trail as a depression awareness campaign and now they have taken their journey to Capitol Hill. They want to stop the 31,000 American deaths each year to suicide and help the 19 million Americans suffering from depression.

Alt can share with your audience:

* How one family chose a proactive way to cope with the tragic loss of a loved one to suicide. 180,000 family members experience the loss of someone to suicide each year.

* How every family can learn to detect symptoms of depression. With plenty of treatment options and professionals to treat mental illness, the issue is awareness and educating everyone on what to look for and how they can help.

* How taking a hike can help the healing process. Doctors agree that exercise is beneficial both physically and mentally. Taking a stress free break from cell phones, road raged traffic, e-mail, and a work load can be very soothing. Although hiking is not for everyone, experiencing the wonders of our national parks can be healing.

Jeff Alt, author of the award-winning A Walk For Sunshine, has been an expert hiking commentator for ESPN’s Inside America’s National Parks and his adventures have been widely featured in media across the country. More about Jeff (http://www.awalkforsunshine.com/jeffaltmedia.htm).

Jeff Alt, is sequencing the release of his second book, A Hike For Mike, with “Hike to the Hill” to help bring awareness to this important cause. After losing a brother to suicide, Jeff Alt, and his wife trekked the 218-mile John Muir Trail to create awareness of the deadly outcome of untreated depression. Their adventure is recounted in A Hike For Mike: An Uplifting Adventure Across the Sierra Nevada for Depression Awareness (ISBN: 0-9679482-1-5, $14.95). A Hike For Mike takes you vicariously along the Alts’ journey. This heartwarming, humbling, humorous, true-life adventure story personifies perseverance, and models ways of overcoming adversity. After leading a Hike to Capitol Hill, Alt will then hike to the Barnes & Noble Booksellers (555 12th St. NW, Washington DC; 202-347-0176), at 2:30p.m. where he will sign the first publicly available copies of A Hike For Mike, kicking off his book’s national release.

“...written with clarity, precision, compassion, and an incredible respect for life…”—Jerry Reed, Executive Director, Suicide Prevention Action Network USA, from the book’s foreword.

“...Alt’s conversational writing style makes one feel like a participant rather than an observer…”—Library Journal.

“Hike to the Hill” is part of the Suicide Prevention Action Network USA’s (SPAN USA) Annual National Awareness Event (NAE). SPAN USA is a national nonprofit organization with the largest grassroots advocacy network of suicide survivors in the United States. For “Hike to the Hill” Details, to schedule an interview, or get a quote from SPAN USA, please contact Allison Gilmore at (202) 775-1401 or e-mail protected from spam bots.

To request a review copy of A Hike For Mike, arrange an interview with Jeff Alt, or any additional information, please contact: Kate Bandos, 800-304-3269, e-mail protected from spam bots, Fax: 616-676-0759.

Posted by at 12:56 PM | Comments (2)

August 19, 2005

Misdiagnosing Narcissism-Bipolar I Disorder

Bipolar patients in the manic phase exhibit many of the signs and symptoms of pathological narcissism - hyperactivity, self-centeredness, lack of empathy, and control freakery. During this recurring chapter of the disease, the patient is euphoric, has grandiose fantasies, spins unrealistic schemes, and has frequent rage attacks (is irritable) if her or his wishes and plans are (inevitably) frustrated.

The manic phases of the Bipolar Disorder, however, are limited in time - NPD is not. Furthermore, the mania is followed by - usually protracted - depressive episodes. The narcissist is also frequently dysphoric. But whereas the Bipolar sinks into deep self-deprecation, self-devaluation, unbounded pessimism, all-pervasive guilt and anhedonia - the narcissist, even when depressed, never forgoes his narcissism: his grandiosity, sense of entitlement, haughtiness, and lack of empathy.

Narcissistic dysphorias are much shorter and reactive - they constitute a response to the grandiosity gap. In plain words, the narcissist is dejected when confronted with the abyss between his inflated self-image and grandiose fantasies - and the drab reality of his life: his failures, lack of accomplishments, disintegrating interpersonal relationships, and low status. Yet, one dose of narcissistic supply is enough to elevate the narcissists from the depth of misery to the heights of manic euphoria.

Not so with the Bipolar. The source of her or his mood swings is assumed to be brain biochemistry - not the availability of narcissistic supply. Whereas the narcissist is in full control of his faculties, even when maximally agitated, the Bipolar often feels that s/he has lost control of his/her brain ("flight of ideas"), his/her speech, his/her attention span (distractibility), and his/her motor functions.

The Bipolar is prone to reckless behaviors and substance abuse only during the manic phase. The narcissist does drugs, drinks, gambles, shops on credit, indulges in unsafe sex or in other compulsive behaviors both when elated and when deflated.

As a rule, the Bipolar's manic phase interferes with his/her social and occupational functioning. Many narcissists, in contrast, reach the highest rungs of their community, church, firm, or voluntary organization. Most of the time, they function flawlessly - though the inevitable blowups and the grating extortion of narcissistic supply usually put an end to the narcissist's career and social liaisons.

The manic phase of Bipolar sometimes requires hospitalization and - more frequently than admitted - involves psychotic features. Narcissists are never hospitalized as the risk for self-harm is minute. Moreover, psychotic microepisodes in narcissism are decompensatory in nature and appear only under unendurable stress (e.g., in intensive therapy).

The Bipolar's mania provokes discomfort in both strangers and in the patient's nearest and dearest. His/her constant cheer and compulsive insistence on interpersonal, sexual, and occupational, or professional interactions engenders unease and repulsion. Her/his lability of mood - rapid shifts between uncontrollable rage and unnatural good spirits - is downright intimidating. The narcissist's gregariousness, by comparison, is calculated, "cold", controlled, and goal-orientated (the extraction of narcissistic supply). His cycles of mood and affect are far less pronounced and less rapid.

The Bipolar's swollen self-esteem, overstated self-confidence, obvious grandiosity, and delusional fantasies are akin to the narcissist's and are the source of the diagnostic confusion. Both types of patients purport to give advice, carry out an assignment, accomplish a mission, or embark on an enterprise for which they are uniquely unqualified and lack the talents, skills, knowledge, or experience required.

But the Bipolar's bombast is far more delusional than the narcissist's. Ideas of reference and magical thinking are common and, in this sense, the Bipolar is closer to the Schizotypal than to the Narcissistic.

There are other differentiating symptoms:

Sleep disorders - notably acute insomnia - are common in the manic phase of Bipolar and uncommon in narcissism. So is "Manic speech" - pressured, uninterruptible, loud, rapid, dramatic (includes singing and humorous asides), sometimes incomprehensible, incoherent, chaotic, and lasts for hours. It reflects the Bipolar's inner turmoil and his/her inability to control his/her racing and kaleidoscopic thoughts.

As opposed to narcissists, Bipolar in the manic phase are often distracted by the slightest stimuli, are unable to focus on relevant data, or to maintain the thread of conversation. They are "all over the place" - simultaneously initiating numerous business ventures, joining a myriad organization, writing umpteen letters, contacting hundreds of friends and perfect strangers, acting in a domineering, demanding, and intrusive manner, totally disregarding the needs and emotions of the unfortunate recipients of their unwanted attentions. They rarely follow up on their projects.

The transformation is so marked that the Bipolar is often described by his/her closest as "not himself/herself". Indeed, some Bipolars relocate, change name and appearance, and lose contact with their "former life". Antisocial or even criminal behavior is not uncommon and aggression is marked, directed at both others (assault) and oneself (suicide). Some Biploars describe an acuteness of the senses, akin to experiences recounted by drug users: smells, sounds, and sights are accentuated and attain an unearthly quality.

As opposed to narcissists, Bipolars regret their misdeeds following the manic phase and try to atone for their actions. They realize and accept that "something is wrong with them" and seek help. During the depressive phase they are ego-dystonic and their defenses are autoplastic (they blame themselves for their defeats, failures, and mishaps).

Finally, pathological narcissism is already discernible in early adolescence. The full-fledged Bipolar Disorder - including a manic phase - rarely occurs before the age of 20. The narcissist is consistent in his pathology - not so the Bipolar. The onset of the manic episode is fast and furious and results in a conspicuous metamorphosis of the patient.

This press release comes from Sam Vaknin, visit Sam's Web site at http://samvak.tripod.com

Posted by at 12:00 PM | Comments (3)

Acute Bipolar Mania Shows Improvement w/ Geodon

Geodon Improved Symptoms Within Two Days, Was Well Tolerated -

The following information looks like it comes (either directly, or indirectly) from Pfizer's marketing department - so, as with any marketing material from any company, we think you should be skeptical of the information. It looks interesting, but all company marketing departments tend to highlight the positive points of their products, while avoiding mention of any possible negative aspects, and pharmaceutical companies are no different in this respect. The most reliable information is generally from independent sources (with no monetary ties to the medication), such as NIMH (National Institute of Mental Health) – sponsored studies.

Patients with bipolar mania experiencing manic or mixed (simultaneous symptoms of mania and depression) episodes showed significant improvements by day two of treatment with Pfizer Inc's Geodon® (ziprasidone HCl), according to the findings from a multicenter study reported in the August issue of the Journal of Clinical Psychopharmacology. These findings confirm the rapid onset of efficacy and sustained improvement seen in a previous placebo-controlled study of Geodon in acute bipolar mania.

In this study, Geodon was well tolerated. Treatment-related discontinuations due to adverse events were not significantly different for Geodon compared to placebo (5.8 percent vs. 1.5 percent, respectively, p = NS). Importantly, Geodon did not produce clinically significant increases in body weight, cholesterol and triglycerides, which are commonly seen with other atypical agents.

The three-week, double-blind, placebo-controlled study involved patients with acute bipolar mania experiencing manic symptoms (including irritability, restlessness, high energy, and/or euphoria) with 40 percent of patients experiencing a mixed manic episode: simultaneous depressive symptoms (including sadness, crying, sense of worthlessness, loss of energy, loss of pleasure and/or sleep problems).

“A primary goal in treating acute bipolar mania is rapid symptom reduction, and our study shows that Geodon is effective in achieving that,” said lead author Steven Potkin, MD, professor, Department of Psychiatry and Human Behavior, University of California, Irvine. “This is good news for practitioners as well as patients, who need fast and effective treatment options for this complex illness.”

The study was a multicenter, double-blind, placebo-controlled trial involving 23 sites in the United States, Brazil and Mexico. A total of 206 patients experiencing manic or mixed episodes were given 21 days of treatment with either Geodon (beginning at 80 mg/d and flexibly dosed up to 160 mg/d) or placebo. The investigators assessed the patients at baseline and days 2, 4, 7, 14, and 21, or the last day of treatment for patients who discontinued early, using standard tests for bipolar disorder symptoms.

The findings showed that the average improvement, from baseline to the end of the 21-day study, was significantly greater for Geodon compared to placebo on the primary efficacy measure, a test called the Mania Rating Scale (MRS) (-11.1 vs. -5.6 points on this scale, respectively, p < 0.01). In addition, there were significantly more responders, defined as those demonstrating at least a 50 percent improvement (decrease) in MRS scores from the beginning to the end of the study, in the Geodon group than in the placebo group: 46 percent vs. 29 percent (p < 0.05).

Geodon was also associated with significantly greater improvements in other standard assessments, designated as secondary endpoints, including the Clinical Global Impression-Severity (CGI-S) Scale (p < 0.001), Manic Syndrome (p < 0.01) and Behavior and Ideation Subscales (p < 0.001), Positive and Negative Syndrome Scale Total (p < 0.01) and Positive Subscale (p < 0.001), and Global Assessment of Functioning (p < 0.001).

Discovered and developed by Pfizer, Geodon is a serotonin and dopamine antagonist. The most common side effects were somnolence, headache, extrapyramidal syndrome and dizziness. There were no significant changes in either group from the beginning to the end of the study in median weight gain, serum triglyceride or serum cholesterol levels.

Full Geodon prescribing information is available at http://www.geodon.com.

Pfizer Inc
235 East 42nd Street
New York, NY 10017
http://www.pfizer.com
Contact: An Phan
212-733-7657

Posted by at 11:47 AM | Comments (0)

August 18, 2005

Concurrent Alcohol Abuse: Age of Onset Influences Course

Bipolar disorder often co-occurs with a substance abuse disorder, most commonly alcohol abuse. Alcohol abuse in bipolar patients is often associated with a bad outcome for the course of the illness. Researchers decided to look at the age of onset for this co-occuring disorder to see if/how that influenced the course of the illness.

The participants in the study were 33 people with bipolar disorder who developed an alcohol abuse problem after their bipolar diagnosis and 27 people whose alcohol abuse problems started before their bipolar disorder diagnosis. There were 83 people with bipolar disorder who did not have an alcohol abuse problem, and acted as controls for the study.

It was found that those who had an alcohol abuse disorder prior to their bipolar disorder diagnosis, developed it at an older age than the other patients with bipolar disorder. They also had a less severe form of bipolar disorder and had a better chance of recovering and recovering quickly. Those who developed an alcohol abuse problem after their initial bipolar diagnosis had more "affective episodes" and had to deal with more of the symptoms of an alcohol abuse disorder.

"Both groups of patients with comorbid alcohol-use and bipolar disorders exhibited very high rates of recovery from the alcohol-use disorder in the period immediately following hospitalization, the researchers note in the Archives of General Psychiatry. This suggests that hospitalization for acute mania initiates a period of sobriety in many patients, they explain. However, the team adds that both patient groups also exhibited relatively rapid and common recurrences, highlighting the period immediately after hospitalization as a possible therapeutic window to decrease rates of alcohol abuse relapse" (PsychiatrySource.com, 2005).

The researchers stated that due to their findings, it is apparent that the age of onset for an alcohol use disorder and bipolar disorder affects the course of their illness and how soon they will recover.

Original Source: Age at onset influences co-occurring alcohol abuse and bipolar illness course. PsychiatrySource. August 16, 2005.

This research study was originally published in: Arch Gen Psychiatry 2005; 62: 851–858

Posted by at 12:29 PM | Comments (3)

Family Support Helps Bipolar Teens

University of Colorado at Boulder Study Suggests Strong Family Support Helpful in Treating Teen Bipolar Disorder

Bipolar adolescents, saddled with mood swings far more severe than the raging hormones and mood changes common to healthy teens, may have a strong ally in their fight to control the disease.

Preliminary results from studies conducted at the University of Colorado at Boulder show that teen-agers who were treated with a combination of mood-stabilizing medication and family-focused therapy showed improvements in depression and mania symptoms. Behavioral problems also improved during the combined treatment, according to CU-Boulder psychology Professor David Miklowitz, who led the study.

Miklowitz discussed the results during the American Psychological Association's annual convention held in Washington, D.C., Aug. 18-21. Medication is the first line of defense against bipolar disorder, also called manic depression. The disease is caused by a biochemical imbalance in the brain and affects an estimated three million Americans, 20 to 40 percent of whom have their first onset in childhood or adolescence.

Bipolar disorder in teen-agers often rears its head in the form of extreme irritability, according to Miklowitz. "It's tough to diagnose in teen-agers, because teens are often moody anyway," Miklowitz said. "But teens with bipolar disorder have extreme irritability, so these can be very trying times for them and their families."

The goal of the family-focused therapy is for the patient and his or her parents and siblings to understand the disease and to learn to cope with it, Miklowitz said. He said this includes recognizing early warning signs that an episode may be about to occur.

Keeping the family unit on the same page through communication and problem solving is also part of it, as well as learning to manage stress and take medications appropriately. Uncontrolled, all of these factors can lead to more severe episodes.

"Families often have a tough time recognizing that this is a disease, and often times kids are misdiagnosed," Miklowitz said. While the disease itself only afflicts the child, the fallout affects the entire family unit.

"You often see significant family conflict associated with mood episodes making it so stressful that something like having a meal together is almost impossible," Miklowitz said. "Left untreated, severe episodes can even lead to suicide attempts."

During a one-year uncontrolled study, 20 bipolar adolescents were treated with mood-stabilizing medications and attended 21 family-counseling sessions over nine months. During that period, their depression and mania symptoms and behavioral problems improved, he said.

Results from an ongoing randomized controlled study will clarify whether adolescents suffering from bipolar disorder improved under the combined treatment method over a two-year period, compared to those who received only medication and a brief education about the disorder.

In earlier studies Miklowitz and colleagues showed that adult patients who received medication and a family-focused treatment program had fewer episodes of the disease, and longer delays before relapses, than those receiving medication and standard treatment.

Miklowitz described the treatment program in the 1997 book "Bipolar Disorder: A Family Focused Treatment Approach." He was recently honored at the International Conference on Bipolar Disorder with the Mogens Schou Award for Research. The award recognized Miklowitz's work to develop effective approaches to educate families on how to cope with bipolar disorder and the many factors contributing to control of the disease and relapse.

Posted by at 12:02 PM | Comments (1)

August 17, 2005

Cerebellar Abnormalities in BP Disorder

A recent MRI (magnetic resonance imaging) analysis has found that those with multiple-episode bipolar disorder are at higher risk for "abnormalities in the posterior-inferior cerebellar". This area of one's brain has recently been found to have an effect on mood regulation. These neurons extend to several areas of the brain that in turn modulate one's mood.

Researchers therefore decided to examine patients with bipolar disorder using an MRI to look at the cerebellar vermal's part in this illness. There were 18 participants with a first-episode of bipolar disorder and 21 had multiple episoder bipolar disorder. There were 32 mentally healthy controls to compare the results with. "The results, published in the American Journal of Psychiatry, showed that vermal subregion V2 volume was significantly smaller in patients with multiple-episode bipolar disorder than in first-episode patients and mentally healthy individuals, at an average of 1048 cm³ versus 1241 cm³ and 1203 cm³, respectively.

The multiple-episode bipolar patients also showed abnormalities in vermal subregion V3, showing significantly smaller volumes than the mentally healthy individuals, at an average of 1407 cm³ versus 1505 cm³; however, there was a nonsignificant overall difference among the groups" (PsychiatrySource.com, 2005).

The number of episodes of mania and depression did not seem to have an effect on V3 volume. Antidepressant usage did have an effect on V3 volume though. The potential effect on mood that the vermal region has should be examined further so that it is fully understood.

Original Source: Cerebellar vermal abnormalities linked to bipolar disorder. PsychiatrySource.com. August 16, 2005.

This study was published in: Am J Psychiatry 2005; 162: 1530–1533

Posted by at 12:46 PM | Comments (0)

Patty Duke Launches Online Mental Wellness Center

Encourages Individuals and Families Battling Bipolar Disorder to Share Stories

COEUR D'ALENE, Idaho, Aug. 17 /PRNewswire/ -- In a continuing effort to provide help, information, and resources to people struggling with mental illness, Patty Duke today announced the rollout of her Online Center for Mental Wellness at www.PattyDuke.net.

The center will be a "virtual" gathering place for individuals and families looking for information on Bipolar Disorder specifically and mental illness generally. Also, Duke is asking people to share their experiences and success stories regarding mental illness with her and the online community to help others understand that they are not alone. This can be done on her blog site (http://pattyduke.blogspot.com ) or on the "Ask Patty Duke" page on Duke's web site.

"I have been blessed with a long and fulfilling career on the stage, on television, and in the movies," said Patty Duke. "But I've come to realize that one of my most important roles in life is to assist people who struggle with mental illness get the help they need to live productive, happy lives."

In the near future, the Online Center will offer CDs, tapes, books, and seminars, as well as sponsoring events that bring medical professionals and mental health experts together on topics of importance to people struggling with mental illness and their families.

Duke, who won the 1962 Best Supporting Actress Academy Award for her role as Helen Keller in "The Miracle Worker," has written two bestselling books chronicling her life in show business and her struggles with Bipolar Disorder. She has been an advocate for more than 20 years on the topic of mental illness and has worked to reduce the stigma of the diagnosis.

Patty Duke has been asked to testify in Congress in September on the topic of mental illness by Representative Sue Myrick (R-NC), which will be her third time testifying.

For more information or to arrange an interview directly with Patty, contact: Bradley Dugdale at 208-661-2588.

The original source of this press release is Patty Duke.

Posted by at 12:37 PM | Comments (16)

August 16, 2005

Oregon Mental Health Coverage

On Monday, Oregon's governor Ted Kulongoski did a big service to those suffering from mental illness in Oregon. He signed a bill that will force insurance companies to cover mental-health treatment just like they cover physical health treatments. Now insurance companies will not be allowed to put restrictions on treatment or financial requirements that are not asked for when covering physical conditions.

Oregon is now the 35th state to ensure that insurance companies cover mental health the same way they cover physical health. The signing of this bill is seen as a reduction in the discrimination imposed upon those with mental health disorders. Those who opposed the bill cited that it would make health care cost much larger, something that is not true in other states who have adopted such legislation. In states that have adopted a similar bill the "premiums" have either not raised or raised by 1-2 percent. This is a negligible amount when thinking of all of the people that this will benefit.

One example of someone who has suffered from the lack of mental health coverage is Kathleen Ris, "In the five years since their son was diagnosed with bipolar disorder, Kathleen Ris and her husband have spent $100,000 and wiped out their personal savings to get mental health treatment for him. Her son, now 15, is "doing better every day," Ris says, but the improvement has come after years of fighting with the family's health insurance company" (Cain, 2005).

Governor Ted Kulongoski stated this bill will be a step closer to ending the stigma surrounding mental illness as well as substance abuse disorders. Hopefully all of the states in the US will someday follow suit.

Original Source: Mental health coverage bill a law. Worldlink.com. By Brad Cain. August 16, 2005.

Posted by at 2:24 PM | Comments (3)

New President of NAMI

HARRISBURG, Pa., Aug. 10 /PRNewswire/ -- Suzanne Vogel-Scibilia, M.D., of Beaver, PA, was elected president of national NAMI, the National Alliance on Mental Illness, at the recent national convention in Austin, Texas. Vogel-Scibilia is a long-time board member of NAMI-PA, as well as the national NAMI board.

"NAMI has tirelessly advanced the cause of persons with mental illness, their families and friends for over 26 years," Vogel-Scibilia said. "We look forward to more successes in the coming years involving our goals of advocacy, support, education, and research."

A clinical psychiatrist, Vogel-Scibilia operates an independent mental health clinic in Beaver County. She has had bipolar disorder since the age of fifteen.

Vogel-Scibilia is also a Clinical Assistant Professor at Western Psychiatric Institute and serves on the faculty of two community hospitals. She stays very active leading local peer education and support groups and acts in an advisory capacity for national organizations.

"Since I am a consumer, a family member and a provider," Vogel-Scibilia said, "I reflect the broad perspective that NAMI brings to our important advocacy movement."

"The entire organization is extremely proud that Suzanne Vogel-Scibilia, M.D., has been elected national president," said Jim Jordan, executive director of NAMI-PA, "and that Carol Caruso, our state president, was elected to the national NAMI board."

Vogel-Scibilia and Caruso are co-chairs of NAMIWalks, the Pennsylvania statewide walk-a-thon and fundraiser scheduled for Saturday, September 24, 2005, with 9 A.M. registration behind the Capitol in Harrisburg.

For information on NAMI-PA call 1-800-223-0500, or visit the website at http://namipa.nami.org.

NAMI-PA is the largest family- and consumer-based organization in Pennsylvania dedicated to improving the lives of individuals impacted by mental illness, providing education, training, support and advocacy throughout Pennsylvania to improve the lives of the estimated 1 in 5 Pennsylvanians affected by serious mental illness. NAMI-PA has 60 affiliates across the state, with 9000 members.

This press release's original source is NAMI Pennsylvania.

Posted by at 2:13 PM | Comments (6)

August 15, 2005

Antipsychotics & The Risk of Insulin Resistance and Dyslipidemia

Second generation antipsychotics (SGA's) have been studied thoroughly in regard to many health risks. The metabolic effects of SGA's which are also known as atypical antipsychotics, were looked at in this study which was found in the Psychiatric Times. The researchers had three treatment conditions "antipsychotic-naive, pretreated but currently drug free and switchers", and six different atypical antipsychotics. The six medications used were: Abilify, Clozaril, Zyprexa, Seroquel, Risperdal, and Geodon. The study was not randomized, but it has the benefit of being the largest study done on "naive individuals taking novel antipsychotics". This study also looked at the effects that these medications had on children's metabolic effect.

Several factors were measured, including factors such as their weight, fat mass, fasting glucose, and insulin levels. There were several other factors that were measured; these were all looked at in the beginning of the study, after 4 weeks, and after 12 weeks. The study found that "When individual SGAs were considered, increases in glucose reached significance only for risperidone, while changes in insulin and HOMA-IR [HOMA-IR=insulin umol x glucose mmol/22.5] were only significant for olanzapine. Glucose increase was correlated with low baseline glucose levels and male gender (R2=0.48, p<0.0001), while an increase in HOMA-IR was correlated with weight gain and a diagnosis of disruptive behavior disorders (R2=0.21, p<0.0001)" (Kaplan, 2005).

The researchers found that insulin resistance was more common in the young population taking olanzapine (Zyprexa), risperidone (Risperdal) or quetiapine (Seroquel) after 3 months of taking the medications. Weight and glucose level should be routinely monitored by those taking these medications.

Risk of developing dyslipidemia was also looked at; dyslipidemia is a "a condition marked by abnormal concentrations of lipids or lipoproteins in the blood" (Medline Plus Medical Dictionary) (lipids are essentially fats, and lipoproteins are a complex of lipids and proteins). Researchers found that "individual lipid parameters increased significantly from baseline to end point, but 19.2% of youths developed new-onset dyslipidemia, without statistical differences between the medication groups" (Kaplan, 2005).

These findings hold important meaning to those who take atypical antipsychotics, especially children. One's insulin resistance and dyslipidemia should be consistently looked at to insure that one does not develop either of these conditions and so that one does not develop diabetes.

Original Source: Second-Generation Antipsychotics and the Risk of Insulin Resistance, Dyslipidemia in Children. Psychiatric Times Vol.XXII Issue 8. By Arline Kaplan. July 2005.

Posted by at 1:06 PM | Comments (0)

Psychiatric Disorders Delay Cancer Diagnosis

Patients with psychiatric disorders are diagnosed with esophageal cancer much later and at a more advanced stage than patients with no psychiatric diagnosis, according to a study conducted by researchers in the Oregon Health & Science University Digestive Health Center. The finding is significant, according to the study's principal investigator, Blair Jobe, M.D., because life and death for cancer patients is all about early detection and intervention.

This study was prompted by observations made in Jobe's clinical practice. He and colleagues wished to determine whether psychiatric illness represented an independent risk factor for delay in diagnosis and advanced disease at the time the patient first displayed symptoms.

"Research has shown that initial diagnosis and management of a disease process is more difficult in patients with a psychiatric disorder," explained Jobe, an assistant professor of surgery in the OHSU School of Medicine, Portland Veterans Affairs Medical Center (PVAMC). "Although a delay in diagnosis of esophageal cancer did not appear to result in a reduction of overall survival -- a reflection of the lethality of esophageal cancer -- the relationship between psychiatric disorders and esophageal cancer is very important to heed, especially as we improve in our ability to make the diagnosis in the early, more curable stages."

In this study, Jobe and colleagues reviewed the medical records of 160 veterans with esophageal cancer seen at the PVAMC during a 13-year period. Fifty-two of the veterans had been diagnosed with a psychiatric disorder prior to their cancer diagnosis; the remaining 108 patients had no psychiatric disorder prior to diagnosis. Psychiatric disorders reported include depression, dementia, anxiety, schizophrenia, personality disorder and post-traumatic stress disorder.

The researchers found that no single risk factor contributed to a delay in diagnosis. Rather, they suggest that one or more variables may play a role, including provider bias or lack of awareness, patients' inability to articulate symptoms, patients' socio-economic status or their lack of access to care. Research to determine exactly which of these variables play a role and how to best rectify them is ongoing at OHSU.

"From here it will be important to understand why patients with psychiatric illness have a delay and eliminate it," said Jobe, also a member of the OHSU Cancer Institute. "In the meantime, our findings emphasize the importance of prompt evaluation of symptoms in all patient populations."


ABOUT ESOPHAGEAL CANCER
The National Cancer Institute estimates 13,200 Americans will be diagnosed with esophageal cancer this year and 12,500 will die of the malignancy. Of the new cases, 9,200 will occur in men and 3,100 will occur in women.

An estimated 25 million Americans have some form of esophageal disease, the most common of which is gastroesophageal reflux disease (GERD). Patients with severe GERD have a 40 times greater risk of developing esophageal cancer than those without GERD symptoms, similar to the risk of developing lung cancer for a cigarette smoker. However, for any one particular individual with GERD, the risk of esophageal cancers is quite low.

For more about diseases of the esophagus and esophageal cancer, visit the OHSU Digestive Health Center Web site http://ohsuhealth.com/htaz/digest/esophageal_cancer.cfm

ABOUT PSYCHIATRIC DISORDERS
Approximately 44 million Americans have a psychiatric disorder, according to the National Institute of Mental Illness of the National Institutes of Health. Mental health disorders account for four of the top 10 causes of disability in established market economies, such as the US, worldwide, and include: major depression (also called clinical depression), manic depression (also called bipolar disorder), schizophrenia, and obsessive-compulsive disorder.

Approximately 18.8 million American adults will suffer from a depressive illness (major depression, bipolar disorder, or dysthymia) each year. Many of them will be unnecessarily incapacitated for weeks or months because their illness is left untreated.

For more information about psychiatric disorders, visit www.ohsuhealth.com/htaz/mental/

For more information about lymphoma, visit www.lymphomainfo.net

Posted by at 12:44 PM | Comments (8)

August 11, 2005

Talk Therapy For Suicide Prevention

A new study in the Journal of American Medicine shows that short-term cognitive-behavioral therapy intervention can significantly reduce suicide risk and depression severity in a population of high-risk subjects who have previous histories of attempted suicides.

People with bipolar disorder have a significantly increased risk of suicide as compared to the general population - meta-analysis studies estimate that about 1/3 of all people with bipolar disorder will attempt suicide at least once, and 10-15% will succeed in taking their own life (Source: TAC Briefing Paper on Suicide). People with Bipolar II have been reported to have higher risk of suicide attempts than bipolar I, perhaps because of the higher burden of depression that is often associated with that subtype.

Given this increased risk, the findings of this study offer hope that we can reduce suicide attempts among people with bipolar disorder with short-term, relatively easy psychosocial interventions.

The study included 120 subjects who had been medically or psychiatrically evaluated following a suicide attempt. 77% had a major depressive disorder and 68% had a substance use disorder. These types of subjects represented a particularly high-risk and treatment-resistant population, and are often excluded from studies of suicide prevention techniques because they tend to confound results.

"These are the kinds of people who wouldn't qualify for 90 percent of the treatment trials out there" said Dr. Steven Hollon, a psychology professor at Vanderbilt University (not associated with the study). "But if you don't ever include them, you don't know what works for them. No guts, no glory." (Source: NY Times Article, Aug 9 2005).

The subjects were randomly assigned to one of two treatment groups. The "usual care" group received clinician care, case-manager follow-up, and referrals to community treatment facilities. The cognitive therapy intervention group received usual care plus 10 sessions of cognitive-behavioral therapy. The sessions were designed specifically for suicide prevention.

"The central feature of this psychotherapy was the identification of proximal thoughts, images, and core beliefs that were activated prior to the suicide attempt. Cognitive and behavioral strategies were applied to address the identified thoughts and beliefs and participants were helped to develop adaptive ways of coping with stressors. Specific vulnerability factors that were addressed included hopelessness, poor problem solving, impaired impulse control, treatment noncompliance, and social isolation. A relapse prevention task was conducted near the end of therapy." (Source: JAMA, Volume 294(5), 3 Aug 2005).

The results from the cognitive-behavioral group were encouraging: 13 out of 60 subjects in that treatment group (24%) tried another suicide attempt during the intervention and follow-up period, as compared to 23 subjects (41.6%) in the "usual care" group. Using statistical calculations, the authors estimated that the probability of staying re-attempt free for the cognitive-therapy group during an 18 month period was about .76, as compared to a calculated probability of .56 for the other group over the same time period.

Moreover, the cognitive-therapy group had significantly reduced depression and hopelessness severity as compared to the usual-care group.

The authors concluded: "The results of this randomized controlled trial indicated that a relatively brief cognitive therapy intervention was effective in preventing suicide attempts for adults who recently attempted suicide. Specifically, participants in the cognitive therapy group were approximately 50% less likely to attempt suicide during the follow-up period than participants in the usual care group."

It might be interesting for future studies to examine whether such psychosocial interventions, when used as adjunct therapy to lithium treatment, can even further reduce the risk of suicide. Both lithium and clozapine (an atypical antipsychotic sometimes used to treat acute mania) have been shown in studies to reduce risk of suicide. Further studies might also show whether this type of cognitive-behavioral therapy is as effective in a population of bipolar subjects with high-risk of suicide. The present study did not include anyone diagnosed with bipolar disorder, although 77% of the subjects had major depression.

However, we can surmise from the results of the current study that, especially for people who are lithium- or otherwise treatment-resistant, short-term psychosocial intervention may be an imporant treatment to control depressive tendencies and suicide attempts.

See more resources for preventing suicide in people with bipolar disorder

Study Abstract: Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial.
JAMA. 2005 Aug 3;294(5):563-70.

Original Source Article: Talk Therapy Succeeds in Reducing Suicide Risk. New York Times (http://www.nytimes.com), Aug 9 2005.

Posted by julia.d at 9:07 AM | Comments (5)

New Book on Bipolar Disorder

Judy Eron, a Texas native and trained clinical social worker has recently written a book called, "What Goes Up: Surviving the Manic Episode of a Loved One." According to Eron, the book is based on her experiences with her husband, a man who at one time was a "kind and sincere psychologist," but after abruptly stopping his medication developed an inflated ego. Eron's husband who suffered from bipolar disorder had managed his disorder for nine years with the help of medication. When he stopped his medication, he experienced mania followed by depression. Eron says that there isn't enough of a focus on the mania of bipolar disorder. Instead, she says that the depression aspect of the disorder receives the most attention.

Though Eron's husband's life ended tragically by suicide, she says there's hope for other sufferers and their loved ones. She states that, "there are ways people can try to help loved ones steer around some of the impulsive behavior that often characterizes manic behavior, such as spending recklessly and engaging in risky relationships."

Eron recommends:
(1) that sufferers of bipolar disorder should consult the aid of a counselor in addition to a psychiatrist;
(2) that "medication should never be stopped the way her husband did — all at once and without a physician’s care;"
and lastly,
(3) that people who reside with sufferers of bipolar disorder should "understand that a day may come when the (disorder) makes that person unrecognizable. Making an agreement in advance about what will happen (such as whether a couple will separate) if that day comes makes things easier for everyone should it occur."

Unfortunately, Eron and her husband had no such agreement. Thus, when he stopped his medication, she wasn't sure what to do.

To learn more about Judy Eron: http://www.judyeron.com/

Title: Author to speak on bipolar disorder
Author: Bill Kettler
Date: August 9. 2005.
Source: http://www.mailtribune.com

Posted by at 12:14 AM | Comments (1)

August 4, 2005

Bipolar Disorder in Women

A major review article in the Australian and New Zealand Journal of Psychiatry discusses special considerations for women who have bipolar disorder. There are several gender differences that differentiate diagnosis and treatment of bipolar disorder for men vs. women.

The authors of the review included relevant literature from the Medline, Psychinfo, and Pubmed databases. They examined studies from 1966 to the present day, and included over 100 references in their published article.

Among their findings were the following points:

Concerning prevalence, diagnosis, and presentation of bipolar disorder in women:

--Although bipolar I is equally prevalent among men and women, bipolar II (characterized by milder, 'hypomanic' episodes, but a greater burden of depression) is more commonly reported in women

--Women with bipolar disorder tend to report more episodes of depression than men. Women also experience more 'mixed' episodes (an episode which has simultaneous features of both mania and depression

--Women are almost three times more likely than men to have a comorbid diagnosis. Two of the most common comorbid disorders for women with bipolar were alcoholism and anxiety disorder.

--Women are more likely to be rapid-cyclers (experience for or more episodes per year) than men. Proposed explanations for this include: effects of gonadal steroids (estrogen or testosterone), hypothyroidism (more common in women), and greater use of antidepressant medication in women, which has been reported to cause episodes of mania in people with bipolar disorder.

Concerning the effects of female hormones (menstrual cycle) on bipolar disorder:

--Menstrual cycle hormones (fluctuations in estrogen and progesterone, which can act on the activity of neurotransmitters serotonin, noradrenaline, and GABA) may exacerbate bipolar symptoms in women. Two studies reported that a65% of women with bipolar disorder report worse mood symptoms during their menstrual cycle. Other studies did not support this finding, however.

Concerning pregnancy in women with bipolar disorder:

--Pregnancy represents a period of increased risk for women with bipolar disorder. Two studies found that about half of women with bipolar disorder reported a worsening of their symptoms during pregnancy. The post-partum period is also recognized in literature as a time of highly increased risk for an affective and/or psychotic episode. Relapse rates for women with bipolar disorder within 3-6 months of childbirth are reported to be as high as 67-82%. Moreover, the risk of psychosis increases from 10-20% in women with bipolar disorder during the post-partum period.

Dr. Terence Ketter, who recently spoke about bipolar disorder at the Stanford University Schizophrenia and Bipolar Education Day, also acknowledged that bipolar women in the post-partum period are at highly increased risk for experiencing an episode. He also mentioned, "although the books won't tell you things...in my clinical experience, women say it is the worst episode they have ever had." (See Dr. Ketter's full lecture from the Stanford Education Day.)

The authors found from their literature review that "use of lithium reduces the risk of relapse fivefold if re-instituted shortly before delivery (at about week 36), or within 48 hours of delivery and is continued into the post-partum period." However, they also cautioned: "as neonatal toxicity can occur, careful monitoring of maternal lithium levels needs to occur during and immediately after delivery."

--Other interventions mentioned by the authors to decrease the risk of the post-partum period included planning for extra support, especially at night, to ensure that the mother is allowed adequate periods of uninterrupted sleep. Irregular sleep patterns have been shown to have serious effects on mood in people with bipolar disorder.

As far as treatments for women during the post-partum period, the authors suggested that ECT may be the treatment of choice. Antidepressants (the risk for inducing mania notwithstanding) may also be considered; breast-feeding mothers can minimize exposure of their infant to medication by taking their pills immediately after breast-feeding, and then waiting 7-11 hours before breast-feeding again (using formula as needed). Small studies of the effects of antipsychotics on breast-feeding infants are inconclusive; the authors suggest that "if antipsychotics need to be used in a mother committed to breast-feeding, the infant should be closely monitored for side-effects such as somnolence, tremor, and rigidity).

--The article reiterated the risks of taking mood stabilizers or antipsychotics during pregnancy, due to their increased birth defect rates. The first trimester is a particularly risky period, when an infant's major organs are forming. Of the medications specifically mentioned in the review (lithium, sodium valproate, carbamazepine, and lamotrigine), lamotrigine showed the lowest risk of birth defects. However, the sample sizes used to study this drug were small, and therefore the findings need to be replicated. Women should always discuss their options with their doctors before planning a pregnancy.


Concerning medication considerations for women:

--Hormone flucuations during the menstrual cycle can effect a woman's metabolic rate, which subsequently can effect her blood levels of medication. This may result in periods of exacerbated symptoms and/or worse side-effect burden during certain periods of the menstrual cycle. The authors suggested that women may need a lower dose of lithium from men.

--the bipolar medication carbamazepine may reduce the effectiveness of oral contraceptives. It is important that young women who may depend on the protection of oral contraceptives be informed of this risk. Options include taking a higher dose of the oral contraceptive, or using barrier or other alternate methods.

Source: "Considerations in the management of bipolar disorder in women" Aust N Z J Psychiatry. 2005 Aug;39(8):662-73.

Posted by julia.d at 4:40 PM | Comments (11)

August 2, 2005

Highlights from SZ/BP Education Day

On Saturday morning, Drs. Ira Glick, Terence Ketter, and Po Wong gave enlightening talks on schizophrenia and bipolar disorder to a packed Fairchild Auditorium on the Stanford University campus. Dr. Glick expressed surprise and gratitude that so many of the community had a clear interest in these disorders. He seemed pleased with the success of the first annual schizophrenia and bipolar education day, which has been in the works for about a year.

The day began with a continental breakfast and a welcome address from Dr. Glick, who said that the objective of this event was to "increase public awareness [of these disorders], and awareness of the resources that can help."

The statistics on psychiatric disorders that he cited from a recent National Comorbidity Survey (published in the archives of general psychiatry)underscored why this day was so important:

--mental disorders begin early, and are lifelong
--mental disorders are severe: 25% are defined as serious, and 40% are defined as moderate (of all the diagnoses currently in the United states)
--mental disorders are not being treated: the comorbidity survey estimated that 60% of serious/moderate psychiatric disorders are recieving no treatment at all.

With national statistics such as these, we can hope that more major universities will be moved to sponser mental illness educaction days in their own communities, to raise awareness of the risk factors, the emergent symptoms, the importance of early diagnosis and treatment, and the prospects of recovery.

The rest of the agenda, which lasted until noon, proceeded thusly:

--Dr. Ketter lectured on the differential diagnosis of schizophrenia and bipolar disorder, speaking about the challenges of approaching severe psychiatric disorders as separate entities (categorically) or as overlapping syndromes (dimensionally). He presented both the commonalities and the differences between schizophrenia and bipolar disorder, as well some clues that can help distinguish between the two. To read a summary of Dr. Ketter's lecture, please click here.

--Dr. Wong presented new treatments in bipolar disorder; he suggested that bipolar treatment is heading away from treating the acute symptoms of manic and depressive episodes, and towards a more comprehensive mood stabilization strategy. He cited several ongoing research studies that are looking into new directions for bipolar treatment. To read a summary of Dr. Wong's lecture, please click here.

--At this point, the conference attendees split up into three breakout sessions. This author attended the question and answer session on bipolar disorder, hosted by Dr. Ketter. He fielded a variety of questions, dealing with everything from lithium toxicity to substance abuse to sleep and sleep deprivation. There were so many questions that the session ran thirty minutes over its allotted time, and there were still several hands in the air when Dr. Ketter finally had to end the discussion. To read a summary of the Bipolar Q and A session, please click here.

We hope to have audio .mp3 files of the lectures available on our site soon, as well as images of some of the data slides used in the doctors' presentations.

Posted by julia.d at 3:54 PM | Comments (1)