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September 25, 2005

Nightmares & Night Terrors in Bipolar Disorder

Nightmares and night terrors are a commonly reported symptom of bipolar disorder. Those with bipolar disorder often have nightmares filled with death and injury themes, which can be especially frightening for children with bipolar disorder. Children seem to suffer more from nightmares as well as night terrors than their adult counterparts.

"Night terrors and such conditions as sleepwalking, restless leg syndrome, bruxism (teeth grinding) make up a group of arousal disorders called parasomnias. Night terrors do not occur during REM sleep and are not dreams, although they have nightmarish elements. They occur instead either during deep sleep or in a transitional state between deep and dreaming sleep and are a form of confusional arousal disorder....Night terrors are rare in adults, yet Papolos and Papolos cited a 1999 study by Dr. Maurice Ohayon which found that bipolar disorders and depression with anxiety were the most common factors associated with adults who reported night terrors" (

Children tend to have nightmares and night terrors in which they feel threatened on some level. Sometimes this is from a person in the night terror or maybe a fear of being abandoned by parents. Night terrors are strange because the person often will seem to be awake but will not recognize anyone and may feel extreme amounts of fear. They may scream, thrash about, or run. Night terrors are incredibly frightening and can lead a person to have an anxiety of sleeping and the terrors that come from it. Treating night terrors before they get out of hand is important for a persons mental and emotional health.

SOURCE: Nightmares and Night Terrors.

To learn more about night terrors, click here.

Read a case study of someone who was treated for bipolar disorder while suffering from nightmares and night terrors.

To learn more about the treatment of night terrors go to's Health Encyclopedia.

Posted by at 7:26 PM | Comments (5)

September 22, 2005

24-Hour Challenge For Charity

One man has decided to support both bipolar disorder and diabetes by running in a 24-hour race. This great show of support will help both disorders that affect this man's life.

Big Pete Mitchell, 31, of Christchurch will be entering the NZ 24-hour Track Running Champs at Sovereign Stadium, Auckland from 9am on 1st to 9am on 2nd October 2005.

Nearly 20 competitors from across the country will be taking part in this gruelling 24-hour race. Pete's not just going to make up the numbers and anticipates running an amazing 160-180 km within the time limit. While this is no mean feat in itself, Pete will be also be raising funds for both the Mental Health Foundation and Diabetes NZ (M.a.D Run Campaign).

Pete said, “I am really excited to be able to compete in this event as I have developed a real love of running over the last few years. I’m keen to support both of these charities as I have been diagnosed with Type 1 Diabetes and Bipolar Disorder. I know the awareness and money I raise will really make a difference. If local people or companies would like to support me, then it would be great to hear from them.”

Pete goes on to say, “I have been growing my beard since July 1st when I started ‘The M.a.D Run Campaign’ and am waiting until the day before the race to shave it off! There are a number of reasons I have chosen to do this, one being to make a comparison with Forrest Gump as most people associate Forrest’s running antics with his ever-growing beard. “

Bipolar affective disorder is another name for what was once known as manic depression. About one person in a hundred is affected by it. ‘Bipolar’ describes the mood fluctuations – from the extremely elated mood (mania) to the very low mood (depression) – that people with this condition may experience.

Diabetes is where the body does not create enough insulin and is unable to convert glucose into energy, and the level of glucose in the blood rises. Diabetes is a world epidemic and there are over 115,000 people in NZ currently diagnosed with diabetes with about 10% of these having Type 1. Type 1 Diabetics do not make any insulin (or very little) therefore they require insulin by injection plus healthy eating to stay alive and maintain good health.

Please support The M.a.D Run Campaign by making a donation at [or call into any Shoe Clinic Store].

M.a.D Run Campaign DVDs will be available for a minimum donation of $10 with all profits going to the charities.

SOURCE: Pete Mitchell
You can view the full article at Scoop Independent News
For information on Pete’s charities of choice visit:

If you are interested in how you can help support charities or causes for bipolar disorder, go to our Bipolar Advocacy page.

Posted by at 1:08 PM | Comments (2)

September 20, 2005

Relatives' Criticism Increases Bipolar Severity

Getting upset due to the criticism of relatives and close friends apparently increases the severity of the symptoms of bipolar disorder. High levels of expressed emotion from those close to the person with bipolar disorder can have adverse effects on their course of illness. Researchers used expressed emotion (EE) levels to predict the course of illness over 1 year.

360 individuals with bipolar disorder took a four-item Perceived Criticism Scale (PCS) for 1 or more of their close relatives or friends. They were then monitored over 1 year for symptoms of mania and depression, as well as the amount of time spent recovering. "Contrary to their expectations, the researchers found that the severity of perceived criticism was not associated with patients' scores on the Montgomery Åsberg Depression Rating Scale (MADRS) or the Beck Depression Inventory (BDI)-II over the study year.

However, the results did show that the degree to which patients reported feeling upset by criticisms from relatives strongly predicted their MADRS scores, even after including all covariates" (

Every 1 point of increase in their distress to criticism on the PCS, led to a 0.33 point increase on the Montgomery Åsberg Depression Rating Scale (MADRS), upon follow up. Those with higher PCS scores (distress from criticism) tended to have higher BDI-II scores on follow up. Researchers noted that those most greatly affected may be "stress sensitive" to their environment. They believe that it may be beneficial for clinicians treating bipolar disorder to include a measure of their perception of their family relationships.

SOURCE: Getting upset by relatives' criticism increases bipolar disorder severity. September 20, 2005.

This research article was published in Psych Res 2005; 136: 101–111.

Here is another study on the effects of expressed emotion in bipolar disorder.

Here is an article on the effects of sociocultural factors on bipolar disorder.

Check out this research article on Family Transactions and Relapse in Bipolar Disorder.

Our site has a coping area for friends and family of someone with bipolar disorder. It gives information on how to deal with your feelings and how to best react to the person with bipolar disorder. Click here to read.

Posted by at 11:39 AM | Comments (9)

CATIE Study Finds One Size Does Not Fit All

The CATIE study was a landmark research study on the clinical effectiveness, as well as side effects of 4 atypical antipsychotics and 1 typical antipsychotic. It was funded by NIMH instead of drug companies, making it a valid source of information. The study was aimed at those with schizophrenia, but it is still important for those with bipolar disorder since many take antipsychotics as well. Also, because it is the first head to head study of antipsychotics without any conflict of interest.

Today the American Psychiatric Association (APA) commented on the groundbreaking research on schizophrenia that will be published in the September 22, 2005, edition of the New England Journal of Medicine (NEJM). The study, known as "Clinical Antipsychotic Trials of Intervention Effectiveness" (CATIE), was sponsored by the National Institute of Mental Health (NIMH) and involved more than 1,400 patients with schizophrenia. It is the first head-to-head comparison of different antipsychotic medications and their effectiveness and safety.

"The American Psychiatric Association was an early supporter of CATIE and we continue to advocate for head-to-head comparisons of medications," said Darrel A. Regier, M.D., M.P.H., director of the APA's Division of Research. "CATIE shows that there's no one-size-fits-all treatment. None of these medications is without side effects and none is without substantial benefit. It is vital that we preserve access to a full range of medications and respect physicians' clinical judgments about which medication to use and when to change."

CATIE found that only 18 to 26 percent of patients remained on the initial medication for 18 months in all treatment groups except olanzepine (36 percent), validating clinicians' belief that, in order to offer the greatest benefit and the least adverse side effects for the individual patient, it is often necessary to try two or more medications.

In February 2004 the APA published the second edition of its guideline for treating patients with schizophrenia.

"This study contributes to our body of knowledge," said Anthony F. Lehman, M.D., M.S.P.H., who chaired the APA's work group on schizophrenia treatments. "From a public policy perspective, it would be a mistake to conclude that restricting access to any of the currently available antipsychotic medications is in the interest of patient care. Since all medications have potentially serious side effects, individual patient risk factors need to be considered in choosing a medication. The more choices, the better. This is consistent with the APA's Guideline on Treatment of Schizophrenia."

In his NEJM editorial accompanying the study, Robert Freedman, M.D., observed that the introduction of antipsychotic medications has had a profound social impact: today the vast majority of patients with schizophrenia are able to live in their communities as opposed to institutional settings. Treatment of schizophrenia has come a long way, but schizophrenia remains a mental illness that often requires long-term management.

"We commend NIMH for undertaking this large-scale clinical trial and we await more information from future reports from CATIE," said Dr. Regier, noting that the Thursday edition of the NEJM carries only the first round of findings from CATIE. "Schizophrenia is a severe medical condition that requires medical training and the patient's involvement to consider the metabolic and neurological side effects as well as the substantial benefits these medications can bring."

SOURCE: American Psychiatric Association (APA)

Check out the CATIE website.

Learn more about the funders of this study: NIMH site

Zyprexa received positive and negative results from this study, learn more at

CATIE Questions & Answers at NIMH.

You can view the first phase of the trial in PDF format here.

The full results from the CATIE study will be published in The New England Journal of Medicine

Posted by at 11:06 AM | Comments (4)

September 19, 2005

Environmental Stressors Increase Suicide Risk

Environmental stressors increase the risk of suicide and attempted suicide in those suffering from bipolar disorder. Researchers looked at 648 outpatients who had either bipolar I or II disorder. They took a survey that looked at their background, their illness' background, and their past suicide attempts. Some were also followed up on their mood ratings, depressive symptoms, manic symptoms, and their ability to function.

"In all, 34% of the cohort had attempted suicide. After excluding less serious suicide attempts (ie, those that did not require medical attention) and adjusting for known risk factors, Leverich et al identified five factors that were significantly and independently associated with a serious suicide attempt" (PsychiatryMatters.MD).

The factors that increased risk of suicide were: sexual abuse, lack of confidence before they developed bipolar disorder, more hospitalizations due to depression, depression accompanied by suicidal thoughts, and cluster B personality disorder. Cluster B personality disorders are also referred to as the dramatic-emotional personality disorders. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder.

The researchers noted that this link between environmental adversity and suicide risk in those with bipolar disorder, can also be seen in those with unipolar depression. Bipolar disorder is already known for having a higher risk of suicide than the general population. Those with bipolar disorder dealing with environmental adversity may be especially prone to attempting suicide. Making sure to treat the depressive symptoms of bipolar disorder is as important as treating the manic symptoms.

SOURCE: Environmental stressors predict suicide in bipolar disorder. PsychiatryMatters.MD.

This research article was published in J Clin Psychiatry 2003; 64: 506-515

To learn more about the relationship between suicide and bipolar disorder check out our Bipolar Disorder & Suicide page.

If you are considering suicide or are having suicidal thoughts you should call the National Hopeline in the United States: 1- 800-784-2433, or contact a local emergency room or the police.

Also, if you are having suicidal thoughts, please check out this page on suicide titled, If you are thinking about suicide, Read This First.

Posted by at 4:58 PM | Comments (1)

Early Treatment Prevents Chronic Bipolar Disorder

Those who develop bipolar disorder at a younger age tend to have a more difficult form of the illness. But adolescents and young adults do not necessarily develop chronic bipolar disorder. Their risk of developing a chronic case lowers if they receive an early diagnosis and treatment. Researchers noted that it was significantly easier to treat those who had less than three episodes prior to beginning treatment. The more episodes that one has had before treatment, the more difficult it is to treat.

The participants in the study were 42 people with bipolar disorder who were taking part in the Systematic Treatment Enhancement Program for Bipolar Disorder. They all had developed bipolar disorder while adolescents (at an average age of 16), they were presently at an average age of just under 22.

"Following almost 2 years of treatment, the patients showed improvements in their overall psychological, social, and occupational functioning. Moreover, episodes of depression or mood elevation fell from 48% before therapy to 12% afterwards. The patients were taking, on average, 2.4 medications, which Ketter noted is fewer than the average four for adults with bipolar disorder"(PsychiatryMatters.MD).

Anxiety disorders and hospitalizations in the past were common. Substance abuse was also common: 43% history of heavy marijuana use, 37% abused alcohol, 26% attempted suicide. Researchers noted that the group was easy to treat and had a good prognosis. The only participants who did not were those with a first-degree relative with bipolar disorder (13 participants). The illness was more severe for the 13 who had a close relative with bipolar disorder.

SOURCE: PsychiatryMatters.MD. Early treatment helps prevent chronic bipolar disorder.

This research study was announced at the 15th annual meeting of the American Psychiatric Association: New York, USA; 1-6 May 2004

You can check out more about the early treatment of bipolar disorder at

You can look at other articles on the early treatment of bipolar disorder on our website, by clicking here.

Posted by at 4:03 PM | Comments (4)

September 16, 2005

Walk for Mental Health Stigma

The stigma associated with mental illness is well known and although it has lessened over the years, it is still a real problem. For those of us living in New York, there is going to be a walk for mental illness that is being held to reduce the stigma surrounding mental illness. Also, I don't believe you have to pay to participate. It seems like a great event to attend and for everyone to benefit from.

The fourth annual "LI Festival & Walk for Mental Health" [LI stands for Long Island] is scheduled for Sunday, September 25, 2005 at 1:00 p.m. It is the only event of its kind that is intended solely to raise awareness of mental illness and the consequences of its stigma instead of raising funds. Participants throughout the tri-state area represent many community members, mental health organizations, professional associations, parent groups, individuals and families.

Participants will gather at the Huntington Post Office on Gerard Street by 12:30. The Master of Ceremonies, Ed Lowe, is currently writing for the LI Press after many years as a Newsday columnist with a common-sense approach to life. He'll lead "Walkers" to Huntington's Heckscher Park, where several speakers will discuss the negative affects of the stigma of mental illness.

An art show, music, food and exhibits will be in the park throughout the day to encourage the walk's anti-stigma message.

"Although one in five people across our nation is affected by mental illness, far too often there is a stigma associated with it even today," noted M.J. Pulling, a "Walk" committee member. "Stigma continues to be a significant obstacle for individuals and their families and discourages them from getting help they need because of their fear of discrimination," added Ms. Pulling.

Guest speakers include Tom O'Clair, responsible for convincing the NY Senate and Assembly to enact Timothy's Law. The bill was named for Timothy O'Clair, Tom's 12-year-old son who was afflicted by mental illnesses, which four years ago led to suicide. Because insurance companies routinely differentiate between individuals diagnosed with mental health disorders and those with physical disorders, Tom spent years trying to get treatment for his son but was unable to. Timothy's Law is intended to ensure that the state will provide coverage for mental health and chemical dependency that is on par with coverage for other physical issues.

The Honorable Sol Wachtler, former Chief Judge of the State of NY Court of Appeals, also will address participants. Judge Wachtler has had his own struggles with mental illness and knows very well the stigma associated with it. For information call (631) 434-9277, ext. 337.

SOURCE: LI Festival & Walk for Mental Health

You can check out other bipolar disorder events on our website by clicking here.

Posted by at 11:59 AM | Comments (3)

Bipolar Disorder Linked to 2 Chromosomes

There have been several publicized studies that have claimed to find the chromosomes that cause bipolar disorder to occur. Many of these studies have come out with different findings. This study is different in that it has taken the results of 11 studies and used the data involved to narrow the chromosomes down. Although no study is entirely definitive, this one seems to have taken both a large sample size and an incredible amount of data to come to their findings.

An international team of 53 researchers has offered the most convincing evidence so far linking bipolar disorder, also known as manic depression, to two chromosomal regions in the human genome. The finding gives scientists refined targets for further gene studies.

"Even though bipolar disorder affects millions of people around the world-sometimes throughout their lifetimes-what we understand to be biologically relevant at the genetic level is not terribly characterized," said Matthew McQueen, lead author and postdoctoral fellow in the Department of Epidemiology at the Harvard School of Public Health (HSPH). "This research can help focus the field to identify viable candidate genes."

The study will appear in the October issue of the American Journal of Human Genetics and is available now in the journal’s electronic edition online at

The exact cause of the illness remains unknown, but scientists suspect the involvement of several genes, coupled with environmental influences. A number of individual studies have suggested genomic regions linked to bipolar disorder, but their results have been inconsistent and difficult to replicate, leaving the field "standing at a crossroads, wondering in which direction to go next," said McQueen.

To establish more definitive research, McQueen and his colleagues did something unusual. They secured and then combined original genome scan data from 11 independent linkage studies, instead of relying on the more common approach of using summary data from such studies.

"The use of original data made a significant difference in our ability to control for variation in several factors among the different data sets and to make the overall analysis much more consistent and powerful," said Nan Laird, HSPH Professor of Biostatistics and senior author on the paper.

The resulting analysis involved 1,067 families and 5,179 individuals from North America, Italy, Germany, Portugal, the UK, Ireland, and Israel, who had provided blood samples and family medical histories. The research team combined the data into a single genome scan and found strong genetic signals on chromosomes 6 and 8. The team now hopes to narrow the search to find associations between specific genes and the mental illness.

The analysis was funded through the Study of Genetic Determinants of Bipolar Disorder Project at the National Institute of Mental Health. Other researchers on the analysis team represented Massachusetts General Hospital, The Broad Institute, and the University of Pittsburgh.

SOURCE: Harvard School of Public Health You can access the full article here.

This site goes over other the genetics of bipolar disorder: Manic-Depressive and Depressive Association of Boston.

Check out another one of our articles on the chromosomes linked to bipolar disorder here.

Posted by at 11:10 AM | Comments (2)

September 15, 2005

Disclosing Bipolar Disorder to an Employer

Determining whether to disclose your bipolar disorder to an employer can be a difficult decision to make. As Dr.Miklowitz states, those with bipolar disorder usually pick one of four options:

"-Tell everyone about the condition, including the boss and co-workers.

-Tell one or more trusted co-workers who don't hold positions of authority.

-Don't tell anyone, but admit to having a bipolar disorder on any work-sponsored health insurance claims, opening the possibility that the employer may find out.

-Don't tell anyone at work, and don't use your employer-provided health insurance to cover treatment costs."

Of course, under the Americans with Disabilities Act, one with a disability does not have to make it known unless they want a certain accomodation at work. The best thing about disclosure is that it means you can ask for those accomodations you might require and actually attain them. Maybe you need a well lit area to work in or a place that does not have as much noise and distraction. Your employer will be more understanding if you need these things and he/she knows that you have bipolar disorder rather than if he/she is unaware.

On the negative side, it is possible that you might be passed up for promotion because your boss does not believe that you could handle it. Actions you make could sometimes be seen as a result of your illness rather than just something "normal." Having bipolar disorder does not mean that you can't have a successful career. "A survey conducted by the Center for Psychiatric Rehabilitation at Boston University found that 73% of 500 professionals previously diagnosed with a psychiatric illness were able to maintain full-time employment in their chosen fields, including nurses, executives, lawyers, professors and newspaper reporters" (

You can always discuss the idea with your therapist to see his or her take on it. Make sure to "feel out" how your boss feels about mental conditions and how sensitive they are to them. It is oftentimes fairly obvious how sensitive they would be, although sometimes its difficult to tell. Ultimately, whether you decide to disclose your condition to an employer is your decision alone and comes with several potential advantages and disadvantages, just as everything does.

Original Source: Disclosing Bipolar Disorder. September 15, 2005. By Scott Reeves.

The original article has seven tips for discussing bipolar disorder with an employer. You can check them out by clicking on the link in the original article.

You can access a great booklet on how to retain a job when you are dealing with a psychiatric disability by clicking here (pdf format). It goes over all of the basics for disclosure as well.

Posted by at 12:19 PM | Comments (10)

The Battle for Mental Health Coverage

Mental health coverage is something that many individuals have to battle with insurance companies for. The battle for mental health coverage has made some headway over the years although it has not reached equal status (or equal coverage) with physical illnesses or physical wounds. Unfortunately one's ability to stay mentally healthy is limited by how much money one has in the bank. This article, written by Madeleine Baran of The New Standard (a non-profit/ anticommercial news organization), goes over the bill that could lead to full mental health coverage if congress decides to pass it.

Every year, thousands of people with mental illness must struggle to stay healthy despite insurance plans that limit the maximum number of psychiatric hospital stays, therapy visits, and other treatment. Unlike coverage for diseases like cancer or AIDS, coverage for mental illness is often capped at certain levels regardless of patients’ needs.

Now, a bipartisan group of lawmakers, advocates, doctors and people living with mental illness are calling for passage of a bill that would mandate comprehensive and equal mental health coverage on a national level.

Last February, Senator Edward Kennedy (D-MA) and Senator Pete Domenici (R-NM) introduced the Senator Paul Wellstone Mental Health Equitable Treatment Act, which would would require companies with more than 50 employees to provide health insurance plans with equal coverage for mental and physical illnesses. Under the bill, named after the late Minnesota senator, himself a long-time advocate for mental health coverage, health plans that covered physical illness would be required to cover mental illness as well.

Although the legislation has 69 Senate and 246 House co-sponsors and the support of over 300 health organizations, including the American Medical Association, it has languished in various committees. The Senate is expected to eventually bring it to a vote after some negotiations, but the bill is completely stalled in the House, where Speaker Dennis Hastert (R-IL) has refused to let it come to a vote. Even President Bush has expressed support, although some of the bill’s proponents complain that he has not done much work to see it passed.

Without pressure, many are skeptical that Hastert will change his handling of the bill. In 2003, according to an article in Washington HealthBeat, he joked to reporters: "They want to make the co-pays the same for a broken leg and a mental health condition. What mental health condition is at parity with a broken leg?" Hastert’s office has not returned calls for comment.

Mental health advocates say that the bill is urgently needed, and that any additional delays will only result in more tragedy. "Everyday that lawmakers wait to act on this is a day that folks are suffering needlessly," said Christopher Burley, spokesperson for the Judge David L. Bazelon Center for Mental Health, a legal advocacy group for people with mental disabilities. Mental health advocates say recent research bolsters their argument. Although for many years doctors, insurers and the general public believed physical and mental illness had little in common, that thinking has changed in the past several decades. New exploration into the biological origins of diseases like bipolar disorder and schizophrenia has led many to view mental illness like any other condition. The flood of memoirs written by people living with mental illness has also contributed to a change in public perception.

Source: Mental Illness Survivors Demand Parity in Medical Coverage (the full article can be viewed here). The New Standard. By Madeleine Baran.

Learn more about the Senator Paul Wellstone Mental Health Equitable Treatment Act and other mental health parity laws here:

The NASW (National Association of Social Workers) goes over what you can do to help make sure that this bill gets passed. Mental health parity is important for everyone:

Posted by at 11:38 AM | Comments (6)

September 14, 2005

Stimulant Use Predicts Poor Prognosis

Adolescents who were treated with stimulant may have a more severe case of bipolar disorder and therefore may have a poorer prognosis. Researchers in Ohio looked at the effects of antidepressant and stimulant treatment in those suffering from bipolar disorder. They looked at the severity of their bipolar disorder in 80 hospitalized adolescents that were suffering from manic or mixed bipolar disorder. Having a comorbid ADHD diagnosis was occurent in 49% of the adolescents. 35% of the group had been treated with stimulants and 44% had been treated with antidepressants.

"The researchers found that illness severity in hospital, as measured by length of stay, requirement for "as needed" medication, and the number of "seclusion and restrain" orders, was associated with a history of stimulant use. In contrast, there was no link with a history of ADHD diagnosis, antidepressant treatment, or mixed or manic BP type" (PsychiatryMatters.MD).

They noted that having a more "severe hospital course" for those taking stimulants may be due to their comorbid ADHD, since all of those who received stimulant treatment had ADHD. Although this is a complicating factor, it still lead the researchers in this study to believe that adolescents with bipolar disorder who had been exposed to stimulants had a poorer prognosis and a more severe form of bipolar disorder.

Original Source: Stimulant exposure predicts poor prognosis in bipolar adolescents. PsychiatryMatters.MD.

This research article was published in J Affect Disord 2002; 70: 323–327

Posted by at 12:25 PM | Comments (0)

Medicaid Preferred Drug List Expanding

The cuts to medicaid and the new and recent changes in its plan have been scary for many of those depending on a medication that was not going to be paid for by Medicaid. Medicaid has been developing a "preferred drug list" meaning that if your drug was not on the list, you would have to jump through several hoops to actually get it covered. Your clinician would have to show that they has attempted numerous other medications to help your ailment, but that only this one worked. This is especially difficult for those with a serious mental illness that has been stabilized by a specific medication. They would be forced to get off the medication that was working for them, try several others, and then if those did not work, their psychiatrist could send in proof that this was a necessary medication. A lengthy and potentially dangerous process for those in desperate need of their medication.

Luckily Medicaid is putting several important medications for mental illness back on the preferred drug list, as they announced Monday. There had been talk that ELi Lilly was refusing to lower drug prices and that officials in Florida were refusing to consider any alternatives to lowering drug prices. The stalemate meant that Zyprexa would not be able to be on the preferred drug list.

But now Zyprexa is back on the preferred drug list. "Lilly spokeswoman Carole Puls said they agreed to lower the prices in exchange for a continuity-of-care agreement, where the amount of patients that remain on Zyprexa helps determine the drug price. In other words, Puls said the more people who stay on Zyprexa, the lower the company will sell the drug to the state. 'We are not trying to tell doctors that they have to keep their patients on a certain drug,' Puls said. 'It just leaves the door open for that'" (Gomez, 2005).

Zyprexa is not the only drug that has been put back on the preferred drug list. When it comes to mental health medications Depakote ER, Keppra, Lamictal, Trileptal and Zonegran have been put back on the list. This is an important change in the Medicaid battle in Florida. Hopefully this will mean that many of those with a mental illness will be able to continue the medication that was already working for them. At the very least, it allows more options.

Original Source: Fla. Medicaid, drug firm reach agreement on antipsychotic drug. Palm Beach Post. September 14, 2005. By Alan Gomez

Posted by at 11:42 AM | Comments (0)

September 13, 2005

Childhood Mania is Chronic & Severe

Children with bipolar disorder tend to have chronic episodes of mania, and their episodes are usually for long periods of time. Researchers developed a 4-year longitudinal study that examined the history of mania in 86 children with bipolar disorder. The children were at an average age of 10.8 years and were checked up on at 6, 12, 18, 24, 36, and 48 months.

All of those in the study suffered from bipolar I disorder, with either manic or mixed episodes. To qualify for the study they also had to have one or more symptom of grandiosity and or elation; this was to ensure that they were not actually suffering from ADHD. Manic episodes usually lasted on average 79.2 weeks in a row.

Mild, major, or dysthymic depression happened during 47.1% of total weeks and their polarity switched at an average of 1.1 times a year. Children had a faster relapse after recovering from mania if they received little "maternal warmth." Having psychosis increased the amount of time that kids were ill with mania or hypomania.

Researchers noted that children seemed to suffer from highly chronic and severe episodes of mania, and therefore there is a need for better prevention and intervention when mania occurs. They also mentioned that how this affects children once they become adolescents and then adults should also be examined.

Original Source: Child mania 'chronic and severe'. PsychiatryMatters.MD.

This research article was published in Arch Gen Psychiatry 2004; 61: 459-467

Posted by at 1:43 PM | Comments (2)

Complicated Grief in Bipolar Patients

Those with bipolar disorder commonly suffer from complicated or traumatic grief which only puts more of a burden upon them. "Although complicated grief is not yet a formal psychiatric diagnosis, there is growing consensus about its core elements, which include unrelenting grief persisting for 6 months or more after loss, with symptoms of separation distress, traumatic distress, and difficulty adapting to the loss" (PsychiatryMatters.MD).

The participants in the study were 120 individuals with bipolar disorder that were taking part in the Systematic Treatment Enhancement for Bipolar Disorder study. They found that 103 of them (86%) reported having a lifetime history of significant loss. 24.3% of them had complicated grief, their average score on the Inventory of Complicated Grief was 33.7 points.

Having complicated grief was linked to higher levels of panic disorder as well as alcohol abuse, both of which was evident in 16% of those with complicated grief. Bipolar patients without complicated grief suffered from panic disorder and alcohol abuse at a rate of 3%. Panic symptoms and phobic avoidance were also linked to complicated grief.

Suicide attempts were more likely in those with complicated grief, 58.3% had attempted suicide at least once during their life. Of those without complicated grief 33.8% had made a suicide attempt in their lifetimes. Those with complicated grief also suffered from more functional impairment and less social support than those without complicated grief. The researchers in this study noted that clinicians should take extra care with those suffering from the loss someone close to them and the potential consequences.

Original Source: Complicated grief needs consideration in bipolar disorder patients. September 13, 2005.

This research article was published in J Clin Psychiatry 2005; 66: 1105–1110

Posted by at 12:49 PM | Comments (1)

September 12, 2005

Omega-3 oils (EPA) Promising

EPA Omega-3 fatty acids (fish oils) -- EPA is short for eicosapentaenoic acid -- have, in another study, been shown to have some promising effects in people who have bipolar disorder.

Omega-3 oils have been used as a complimentary treatment for the depressive phase of the disorder and it has been noted for not precipitating a manic episode, as some antidepressants can.

In this study 12 individuals with bipolar I disorder that were being treated as outpatients were given 1.5/2 g/day of omega-3 fatty acid EPA for around 6 months.

8 of the 10 who followed up for at least a month were able to get a 50% lessening in symptoms of depression. This was determined with the Hamilton Rating Scale for Depression. No one developed hypomania or mania and there were no extreme side effects.

This study has a number of limitations. The small sample size is a limitation as well as its open label design. Also there is the fact that these were all outpatients with bipolar disorder, so the most severely afflicted patients have not been determined to benefit from such treatment (inpatients). The results were extremely positive though, and should be replicated in larger studies that take into account other groups, such as inpatients with bipolar disorder.

More information on EPA Omega 3 fish oils as complementary treatment for bipolar disorder

Original Source: Eicosapentaenoic acid treatment shows promise for bipolar therapy. Managed Care Law Weekly via via and September 2005.

This research article was published in J Clin Psychiatry, 2005;66(6):726-9.

Posted by at 12:07 PM | Comments (0)

Sleep Deprivation Improves Antidepressant Response

Researchers in Turkey have been examining the effects of sertraline (Zoloft) monotherapy and sleep deprivation on patients quality of life, as well as their responsiveness to the medication. The participants were 24 individuals with major depressive disorder. Being that many people with bipolar disorder take SSRI's in addition to a mood stabilizer, this holds important meaning for them as well. Of course, a study done explicitly on those with bipolar disorder should be done before this can be concluded.

"In all, 13 of the patients received sertraline plus 6 nights of partial sleep deprivation. During these nights, which together with the following day were spent in the clinic, the patients were allowed to sleep from 11.00/12.00 pm to 3.00 am. Some special activities were provided and the patients were forbidden from napping the day after" (PsychiatryMatters.MD).

The average dose given was 61.53 mg/day for those getting sleep deprivation sleep therapy and 72.72 mg/day for those not additionally receiving such therapy. The Hamilton Rating Scale for Depression was used to ascertain patients response. After 4 weeks those who had only been receiving sertraline had their depression scores reduced by an average of 47.39%. Those who had also been receiving sleep deprivation therapy had their scores reduced by an average of 85.81%.

12 of those receiving sleep deprivation and sertraline, compared to only 5 in the sertraline only group were determined to be responders to the treatment, this was determined if their depression scores reduced by 50% or more. Quality of life was found to improve more quickly in those receiving adjunctive sleep deprivation therapy. The WHO's Quality of Life Assessment found that those in the sleep deprivation group greatly improved on 5 of the 6 domains (physical health, psychological, social relations, environment, spirituality/personal beliefs) after 1 month, whereas no one in the sertraline only group improved significantly on any of the domains.

Researchers concluded that sleep deprivation can be used to lessen depression more quickly, and therefore can be used during the time it takes for antidepressants to come fully into effect.

Original Source: Sleep deprivation enhances antidepressant response. PsychiatryMatters.MD. 2005

This research article was published in J Affect Disord 2005; 88: 75-78.

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September 11, 2005

Continued Antidepressant Use Reduces Relapse

Researchers have found that continuing one's antidepressants even after symptoms have lessened reduces the chance of having a depressive relapse. The current general practice is to have patients stop taking their antidepressants after or within 6 months of their symptoms waning. Researchers at UC Los Angeles found that following such a practice can increase one's chance of relapsing by almost doubling it. Continuing antidepressants did not increase one's chance of having a manic relapse.

"The team, led by Lori Altshuler, compared the risk of depressive relapse in 84 patients with bipolar disorder who had achieved remission with the addition of an antidepressant to ongoing mood stabilizer treatment. Of these, 43 individuals stopped taking antidepressants within 6 months of remission, while 41 continued taking the drugs beyond 1 year" (PsychiatryMatters.MD).

70% of the patients who stopped taking their antidepressants had a depressive relapse within 1 year. Only 36% of those who were continuing their antidepressant medication had a depressive relapse. Out of the whole group only 18% (15 patients) had a manic relapse, of which only 6 of the 15 were taking antidepressants at that time.

Researchers believe that discontinuing antidepressant medication can increase the chance of relapse in those with bipolar disorder. It might be better if they had maintenance treatment, like those with unipolar depression do. This is of course for those who respond to antidepressants.

Original Source: Continued antidepressant use lowers bipolar relapse risk. PsychiatryMatters.MD.

This research article was published in Am J Psychiatry 2003; 160: 1252-1262.

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Katrina Survivors at Risk for Mental Illness

Katrina Survivors At Higher Risk for Mental Illness-Hurricane Katrina affected all of our lives, even if we do not live directly in the path of destruction. Our country watched in horror as news agencies captured on camera the pain and suffering of tens of thousands of individuals as they waited for aid. The victims of Katrina not only have to worry about the physical items lost, but also need to care for their psychological needs as they try to cope with the complete upheaval of their life. They may experience depression, anxiety, or post traumatic stress syndrome.

H.M. Cooper, psychologist, educator, and experienced author, states, “There is meaning in madness, even though it appears chaotic, and political, social and personal realities influence the experience.” Mr. Cooper has written a novel titled Something Lyrical for the Night that examines the relationship between the mentally ill and the influence of their surroundings on their illness. Something Lyrical for the Night is an inspirational story that will bring joy and insight to the reader. They will come away with knowledge of the human mind and the way it copes with them. Something Lyrical for the Night is published by American Book Publishing and available at a discount online at the Publisher Direct Bookstore at

Although it will take many months and even years to deal with the physical aftermath of the destruction, officials must not overlook the more delicate mental aid that is necessary for all of the survivors, and possibly even others throughout the country. Just as people look different, the ways people deal emotionally with a traumatic event are different. Some people feel the effects of the stress immediately, while others may suppress their feelings for months and even years after the event.

If you or your loved ones are experiencing this trauma, the American Psychological Association has a number of recommendations on how to deal with your feelings. First, talk openly with your loved ones and friends. Find support groups led by an experienced professional who can help you process your feelings. Try to eat a healthy diet, and get enough sleep. Resume activities that you did before the hurricane, such as eating meals on a schedule, participating in hobbies, exercising, etc.

company: American Book Publishing
contact person: media director
phone: 888-288-7413

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September 8, 2005

Bipolar I Disorder Mostly Depressive

Bipolar I disorder is characterized by full manic episodes and moderate to mild depression. But a new study shows that depression predominates in bipolar I disorder, in terms of the amount of time that one is in either phase. Researchers used information from 146 individuals with bipolar I disorder. They had all took part in the National Institute of Mental Health Collaborative Depression study between 1978 and 1981.

They followed up on patients for an average of 12.8 years, during which they were ill (dealing with symptoms of the disorder) nearly half of the time.

"Furthermore, the occurrence of depressive symptoms predominated in 31.9% of total follow-up weeks, followed by manic/hypomanic in 8.9 % of weeks, and cycling/mixed symptoms in 5.8% of weeks. Interestingly, subsyndromal, minor depressive, and hypomanic symptoms were almost three times more frequent than syndromal-level major depressive and manic symptoms, the team reports" (PsychiatryMatters.MD).

Only a little over half of those with bipolar I disorder wxperienced psychosis, and when they did it was usually due to a manic episode. The group as a whole changed symptom status an average of 6 times a year. Polarity changed more than 3 times a year. The researchers stated that their findings supported the fact that this a dimensional illness with "a full spectrum of affective symptom severity and polarity."

Original Source: Bipolar I disorders predominantly depressive. PsychiatryMatters.MD.

This research study was published in Arch Gen Psychiatry 2002; 59: 530–537.

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Epilepsy Patients Liable for Bipolar Disorder

Apparently those with epilepsy are at a higher risk of developing bipolar disorder than those with other chronic medical ailments. The participants in the study were 1,236 people with epilepsy, 8,994 with migraine, 7,951 with asthma, 7,342 with diabetes, and a healthy control group of 57,172 individuals.

Epilepsy patients had bipolar disorder at a rate of 12%. This was 2 times more common than in any of the other groups with bipolar disorder and 6 times more common than those in the healthy control group.

"'Our findings suggest that bipolar symptoms and perhaps formal bipolar disorder may be significantly underrecognized in patients with epilepsy and patients with other chronic disorders,' Ettinger said in an interview with Reuters Health" (Reuters Health, 2005). One of the reasons that bipolar disorder may go unrecognized in epilepsy patients is the fact that anticonvulsants are often used to fight epileptic symptoms. Anticonvulsants are sometimes prescribed to those with bipolar disorder to better regulate their moods. So coincidentally such patients may sometimes receive treatment for epilepsy and the bipolar disorder that they suffer from.

Sometimes those with epilepsy are said to have mood instability which could be explained by this recent finding.

Original Source: Epilepsy patients may be prone to bipolar disorder. Reuters Health. September 7, 2005.

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September 7, 2005

Agitated Depression in Bipolar I Disorder

A new study suggests that agitated depression afflicts one fifth of those with bipolar I disorder. "Mario Maj and colleagues from the University of Naples studied all patients with bipolar I disorder presenting to the psychiatric department who fulfilled Research Diagnostic Criteria for agitated depression. These 61 patients were compared with 61 bipolar I patients with non-agitated depression, and 61 bipolar I patients with an index episode of mania" (

Every 2 months the participants were tested on the Comprehensive Psychopathological Rating Scale (CPRS) and the Schedule for Affective Disorders and Schizophrenia. There were 22 men and 39 women with agitated depression. The average age of the group was 41.6 years. Those with agitated depression tended to be older when they first used any psychiatric services and had more psychiatric admissions before their "index episode" of mania.

There were several negative symptoms that seemed to accompany those with agitated depression, such as agitation, irritability, overly sexual, etc. Delusional guilt was experienced by 15 of them, and no one in the agitated depression group had delusions of grandeur or an "elated" mood.

Those with agitated depression scored higher on their CPRS and took longer to recover (12 weeks as opposed to 9 weeks). The researchers involved in this study believe that the effects of mood stabilizers on this group of patients should be studied, as they might have differing effects.

Original Source: Agitated depression common in bipolar I disorder. PsychiatryMatters.MD.

This research study was originally published in Am J Psychiatry 2003; 160: 2134-2140.

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Course of Bipolar Disorder Inherited

New research suggests that the course of bipolar disorder may be inherited in terms of whether it was remitting or unremitting. If one has developed bipolar disorder and has a parent (with bipolar disorder) who responded well to lithium treatment and was able to completely recover from the illness, than you are likely to have the same results.

"The team assessed affective disorders in 55 children aged 10 to 25 years using the Schedule for Affective Disorders and Schizophrenia for School-aged Children - Present and Lifetime Version. Of these, 34 had a parent with bipolar disorder who responded to lithium treatment, while 21 had a bipolar parent who did not respond to such treatment. In all cases, the second parent was free of any psychiatric disorder" (PsychiatryMatters.MD).

The kids of those who responded well to lithium treatment often were the same kids who did not have any problems early on and usually did well in school. A large number of the children of those who had not done well with lithium ended up having an early onset of bipolar disorder and this had a detrimental affect on their academic and social functioning.

"However, while the children of nonresponders to lithium experienced significant psychiatric symptoms prior to the onset of the mood disorder, those of responders showed no significant psychiatric symptoms" (PsychiatryMatters.MD). Apparently one does not only inherit bipolar disorder genetically, they also inherit the form and course that the illness takes. This information may be well used for bipolar parents who have children stucken by bipolar disorder. They can use their history of the illness to help determine early on what will help their childrens symptoms remit.

Original Source: Clinical course of bipolar disorder inherited. PsychiatryMatters.MD.

This research study was published in J Clin Psychiatry 2002; 63: 1171–1178.

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September 6, 2005

Interpersonal & Social Rhythm Therapy Effective

University of Pittsburgh Study Results Published in Archives of General Psychiatry

PITTSBURGH, Sept. 1 - A treatment program that stresses maintaining a regular schedule of daily activities and stability in personal relationships is an effective therapy for bipolar disorder, report University of Pittsburgh School of Medicine researchers in September's Archives of General Psychiatry. Interpersonal and Social Rhythm Therapy (IPSRT), a novel approach developed by the University of Pittsburgh researchers, was effective in preventing relapse over a two-year period, particularly in patients who don't have other chronic medical problems such as diabetes or heart disease.

IPSRT is based on the idea that disruptions in daily routines and problems in interpersonal relationships can cause recurrence of the manic and depressive episodes that characterize bipolar disorder. During the treatment, therapists help patients understand how changes in daily routines and the quality of their social relationships and their social roles, such as a parent, spouse or caregiver, for example, can affect their moods. After identifying situations that can trigger mania or depression, therapists teach the individuals how to better manage stressful events and better maintain positive relationships.

“Our study shows that this form of psychotherapy is helpful to many people with bipolar disorder,” said Ellen Frank, Ph.D., professor of psychiatry at the University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic, and principal investigator of the study. “Second, it shows that the type of psychotherapy we choose for a patient should depend on the individual’s circumstances. Treatment for bipolar is not ‘one-size-fits-all.’ We have shown that IPSRT is a powerful tool in the prevention of illness recurrence.”

More than 4 percent of adults in the United States suffer from a bipolar disorder or “sub-threshold” bipolar disorder. Bipolar disorder, commonly referred to as manic-depressive illness, is characterized by cycles of mania, depression or mixed states that often disrupt work, school, family and social life.

Conventional treatment approaches for the disorder include lithium and other mood stabilizers, which work well in the short-term but often have limited long-term success. Historically, psychotherapy has not been given much credence as a treatment option for the condition because of the disorder’s strong biological basis. Only recently have researchers begun to investigate the effectiveness of psychotherapy for people with bipolar disorder, and studies like this one have shown that psychotherapy can have promising long-term benefits.

The University of Pittsburgh study involved 175 acutely ill individuals with bipolar I disorder, the more serious form of the illness involving full-blown episodes of mania and major depression, who were enrolled in the Maintenance Therapies in Bipolar Disorder trial. They were randomized to one of four treatment groups. One group received IPSRT during both the acute phase of their bipolar disorder, defined by a severe episode of mania, depression or mixed symptoms, and for two years after the episode, referred to as the maintenance phase. The second group received Intensive Clinical Management therapy (ICM), a form of psychotherapy that addresses the general causes, symptoms and treatments of bipolar disorder, during both the acute and maintenance phases. The remaining two groups received either IPSRT during the acute phase and ICM during the maintenance phase or ICM during the acute phase and IPSRT during the maintenance phase. Patients in all groups received standard medication therapy throughout the study.

After controlling for the effects of marital status, medical burden and anxiety, the researchers found that patients who received IPSRT during the acute treatment were more likely to remain well during the two-year maintenance phase. Furthermore, the strength of the effect was directly related to the extent to which patients increased the regularity of their social routines. Those who responded well to IPSRT were more likely to be those in somewhat better physical health.

Patients who had multiple medical problems in addition to bipolar disorder and those with anxiety responded better to the ICM therapy, possibly because of that therapy’s focus on physical symptoms. Study authors hypothesized that these patients had a greater need to manage and cope with their medical symptoms and were less able to focus on controlling their social rhythms and relationships. Individuals with bipolar disorder are at an increased risk for a number of serious medical illnesses, including cardiovascular disease, diabetes and pulmonary problems.

Co-authors of the study include: David J. Kupfer, M.D., Michael E. Thase, M.D., Alan G. Mallinger, M.D., Holly A. Schwartz, M.D., Andrea M. Fagiolini, M.D., Victoria Grochocinski, Ph.D., Patricia Houck, M.S.H., John Scott, A.M., Wesley Thompson, Ph.D., and Timothy Monk, Ph.D., all of the University of Pittsburgh School of Medicine’s department of psychiatry and the Western Psychiatric Institute and Clinic.

Source: University of Pittsburgh Medical Center News Bureau

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Attention & Memory in Bipolar Disorder

A report published in the September issue of Psychotherapy and Psychosomatics by a group of investigators of the University of Barcelona suggests that cognitive deficits may occur in bipolar disorder.

In clinical practice, bipolar patients complain of cognitive deficits such as attentional or memory disturbances. The main aim of this study was to determine whether subjective cognitive complaints were associated with objective neuropsychological impairments.

Sixty euthymic bipolar patients were assessed through a neuropsychological battery. A structured clinical interview was used to determine subjective cognitive complaints in patients. Thirty healthy controls were also included in the study in order to compare the neuropsychological performance among groups. Bipolar patients with a higher number of episodes, especially the number of mixed episodes, longer duration of the illness and the onset of the illness at an earlier age showed more subjective complaints.

Furthermore, bipolar patients with subjective complaints showed lower scores in several cognitive measures related to attention, memory and executive function compared with the control group. Nevertheless, patients without complaints also performed less well than controls in some neuropsychological measures.

Bipolar patients who were aware of cognitive deficits were more chronic, had presented more previous episodes, especially mixed type, and their illness had started at an earlier age compared with patients who did not complain about cognitive problems. Moreover, patients with good cognitive insight also had a poorer social and occupational functioning as well as a poorer neuropsychological performance.

However, the bipolar group without complaints also obtained lower scores in several tests compared with healthy controls. Cognitive status of bipolar patients should be routinely assessed, regardless of the patients awareness about their cognitive deficits.

Reference URL


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September 5, 2005

FDA-Approved Office Lithium Test

The FDA has approved a lithium test that can be easily administered in a psychiatrists office within a matter of minutes. This quick and easy method will make it easier for clinicians to monitor levels of lithium in the blood of patients taking it for bipolar disorder. Lithium levels must be monitored due to the fact that the amount needed to be effective is just below toxicity level. Their therapeutic range is between 0.4 mEq/L and 1.4 mEq/L. The testing system is said to be similar to the glucose level tests used for diabetic patients.

The office test has been found to be just as accurate as testing done in commercial laboratories. Some psychiatrists find prescribing lithium troublesome because of the fact that it needs to be consistently monitored. This may be one of the reasons that lithium is not prescribed as often as it used to be for bipolar disorder. Clinicians in the US prescribe it much less often than those in other parts of the world, in which it is commonplace.

"There are specific times, Goodwin said, when he might want to know more about his patients' lithium levels and have the levels monitored frequently. For example, if a patient experiences breakthrough depression, one of the strategies that works well is to increase the lithium levels temporarily. If a patient has started a vigorous exercise program, such as training for the Boston Marathon, Goodwin said he would want to know the effects of sweating on the patient's lithium levels" (Psychiatric Times).

The office test is also a great way to ensure compliance with medication which is the number#1 reason why medications are found not to work. Lithium has also been found to reduce the level of suicide in patients with bipolar disorder. Some studies find it to be the best medication for preventing suicide in patients with bipolar disorder.

Original Source: FDA-Approved Office Lithium Test Expected To Enhance Clinical Care. Psychiatric Times. August 2005. By Arline Kaplan.

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September 4, 2005

NAMI Creates Fund for Mentally Ill in Hurricane Disaster

More Than A Half Million Persons in Alabama, Louisiana and Mississippi Live With Mental Illnesses
ARLINGTON, Va., Sept. 2 /PRNewswire/ -- The National Alliance on Mental Illness (NAMI) has established a special dedicated fund to help provide relief to individuals and families affected by serious mental illnesses in the Gulf region left devastated by Hurricane Katrina.

Donations to the NAMI Katrina Hurricane Relief Fund can be made on-line at or at any Wachovia bank nationwide (Account 200024603407).

NAMI has made initial contact with state departments of mental health in Alabama, Louisiana, Mississippi and Texas and will be working to coordinate and supplement local relief efforts through cash assistance and NAMI's national network of affiliates and volunteers.

"People living with mental illnesses often are among the most vulnerable in our society," said NAMI Executive Director Michael J. Fitzpatrick. "Unfortunately, they also are often among the most marginalized."

"In the face of a profound catastrophe that has destroyed communities in the Gulf states, we must make sure they are not forgotten. The NAMI family and our network of friends want to help."

An estimated 220,000 persons in Louisiana, 220,000 in Alabama and 140,000 in Mississippi live with serious mental illnesses, which include major depression, bipolar disorder, anxiety disorders and schizophrenia. The number may be closer to a million by less conservative estimates.

Pre-existing conditions can be worsened by trauma or dislocation. Traumatic or stressful events also may trigger the onset of mental illnesses.

NAMI's national Web site offers psychiatric resources in the states affected by the disaster, including Texas, along with special electronic message boards for those seeking to locate missing persons with mental illnesses in the region or messages from those seeking to contact family and friends.

Source: NAMI

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Accurate Screening of Bipolar Disorder

The British Journal of General Practice (BJGP) has published an editorial paper highlighting the vital role GPs play in distinguishing between unipolar and bipolar disorder and treating it accordingly.

Authors from the University of Melbourne, say there is increasing evidence that treating bipolar patients with unipolar therapy may be harmful to patients.

According to the authors, new research suggests that up to 30 per cent of patients presenting with depression in primary care are diagnosed with bipolar disorder. GPs are often the first clinicians to screen for bipolar disorder and manage its initial treatment. However, they say patients presenting with bipolar may be diagnosed with unipolar depression and as a result treated inaccurately, thereby potentially exacerbating the illness.

The authors conclude that GPs play a pivotal role in detecting, managing and, where necessary, appropriately referring patients with bipolar disorder. This role, they believe, is essential to the management of this highly prevalent and disabling, yet treatable, condition.

Dr Michael Berk, lead author and Professor of Psychiatry at the Department of Clinical and Biomedical Sciences, University of Melbourne, said: “It is essential to accurately differentiate bipolar from unipolar depression as treatments are very different. Optimal outcomes are dependent on appropriate therapy. The key is to screen both for a past history of mania or hypomania and for the clinical signature of bipolar depression.”


Berk M, Dodd S, Berk L, Opie J. “Diagnosis and management of patients with bipolar disorder in primary care” BJGP September 2005; 55: 662-663.

The BJGP is published monthly and distributed to over 22,000 RCGP members, associates, and subscribers in more than 40 countries worldwide. Its primary purpose is to publish first-rate, peer reviewed research papers on topics relevant to primary care.

The Royal College of General Practitioners (RCGP) is the largest membership organisation in the United Kingdom solely for GPs. It aims to encourage and maintain the highest standards of general medical practice and to act as the “voice” of GPs on issues concerned with education, training, research, and clinical standards. Founded in 1952, the RCGP has over 22,500 members who are committed to improving patient care, developing their own skills and promoting general practice as a discipline.

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Bipolar Disorders and African Americans

University of Cincinnati (UC) researchers want to determine why African Americans seeking help for mood disorders, such as depression or bipolar disorder, are often misdiagnosed with schizophrenia - putting them at risk of receiving incorrect treatment.

UC will lead a 4-year, multicenter, national study to determine why these misdiagnoses occur, whether they lead to excessive use of antipsychotic drugs among African Americans and whether misdiagnoses are happening in the Latino population as well.

"Research has already shown that African American patients are being improperly diagnosed," said Stephen Strakowski, MD, professor in UC's department of psychiatry and lead investigator for the study, "but we need to find out why."

Treatment for mood disorders is different from that typically used for schizophrenia, Strakowski pointed out.

"Patients suffering from depression or bipolar disorder who only receive medications for schizophrenia will continue to experience their original symptoms," he said, "and they will be at risk for very poor outcomes.

"Untreated mood disorders result in functional impairment both at work and in the home. These patients are also at an increased risk for suicide."

Previous studies suggest that misdiagnosis occurs when clinicians overemphasize certain symptoms often associated with schizophrenia, and overlook or stop short of checking for symptoms of mood disorders.

"If we can determine that these misdiagnoses are in fact happening because symptoms are not being recognized properly," said Strakowski, "we can find ways to correct the problem through new education techniques and new tools for assessing patients.

"Ultimately, we hope that our findings provide a starting point for improving the way clinicians arrive at a final diagnosis and treatment plan."

Funded by nearly $10 million from the National Institute of Mental Health (NIMH), the UC-led study will also include Howard University in Washington, DC, the University of California, Los Angeles, the University of Medicine and Dentistry of New Jersey, the University of Michigan and the University of Texas, San Antonio.

Source: University of Cincinnati

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September 1, 2005

Brain Abnormalities in Pediatric Bipolar Disorder

In a study called "Cingulate Cortex Anatomical Abnormalities in Children and Adolescents With Bipolar Disorder," researchers looked at the anatomical abnormalities in the brains of children and adolescents with bipolar disorder. The study used magnetic resonance imaging to the cingulate cortex in those with pediatric bipolar disorder in comparison to mentally healthy individuals.

16 people with with pediatric bipolar disorder at an average age of 15.5 years were examined in comparison to 21 people were were mentally healthy and at an average age of 16.9 years. Three dimensional echo imaging was used and cingulate volumes were assessed.

Those with pediatric bipolar disorder had smaller average volumes in the left anterior cingulate, left posterior cingulate, and right posterior cingulate. "No significant between-group difference was found for the right anterior cingulate" (Kaur, 2005). The results of this study exemplify that those with pediatric bipolar disorder have "smaller cingulate volumes" meaning that this abnormality is present early on in the course of bipolar disorder.

Original Source: Cingulate Cortex Anatomical Abnormalities in Children and Adolescents With Bipolar Disorder. The American Journal of Psychiatry. September 2005.

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MRI Brain Activation in Euthymic Bipolar Disorder

This study was titled "Abnormal fMRI Brain Activation in Euthymic Bipolar Disorder Patients During a Counting Stroop Interference Task," and was published in the American Journal of Psychiatry. The studies participants were 16 people with euthymic bipolar disorder and 16 mentally healthy individuals. They all had a fMRI (functional magnetic resonance imaging) done upon them while they were doing a counting Stroop interference task.

Those with bipolar disorder had a more difficult time with the task that they were asked to perform. The areas of the brain that were activated were very different for those with bipolar disorder in comparison to the control group.

"Healthy subjects exhibited relatively increased activation in temporal cortical regions, middle frontal gyrus, putamen, and midline cerebellum. Bipolar subjects exhibited relatively greater activation in the medial occipital cortex. The groups demonstrated different associations between task performance and fMRI activation in these brain regions" (Strakowski et al., 2005).

There was no difference in the areas of activation for the patients with bipolar disorder who were receiving medication compared to those who were not. Although the level of activation was greater in the anterior cingulate and dorsolateral prefrontal cortex for those who were taking medication. The researchers suggested that the impaired performance in those with euthymic bipolar disorder may be due to the inability to activate the brain regions linked to performance on "an interference task."

Original Source: Abnormal fMRI Brain Activation in Euthymic Bipolar Disorder Patients During a Counting Stroop Interference Task. The American Journal of Psychiatry. September 2005.

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