Bipolar Disorder Daily News Blog

Suicide Among Youth - Treatment Responses

Suicide among youth - Which mental disorders are responsible?

Diagnosis and treatment should address all disorders and not just focus on depression

Mental health professionals need to be watchful of mental health problems beyond depression in order to prevent youth suicide, according to new research from the World Health Organization (WHO). WHO researchers examine which mental disorders or combinations of disorders may be most responsible for youth suicide in a new study being released in the October issue of the American Journal of Orthopsychiatry, published by the American Psychological Association (APA).

Researchers from the WHO in Geneva, Switzerland and from the Christchurch School of Medicine in New Zealand reviewed the English language research from 1982 to 2001 to re-examine the occurrence and distribution of mental disorders in 894 cases of completed suicides among young people worldwide. The majority of the cases (89 percent) had at least one diagnosis of a mental disorder. Mood disorders were the most frequently diagnosed (42 percent) followed by substance-related disorders (40 percent) and then disruptive disorders (20 percent).

Mood disorders include major and minor depressive disorder, dysthymia, mania, hypomania, bipolar disorder and non-specific mood disorders. Substance-related disorders include drug abuse and alcohol dependency/abuse. Disruptive disorders include conduct disorder, attention deficit disorder, oppositional disorder and identity disorder.

The cases included subjects who were under 20 years of age – 72 percent. Twelve percent were between the ages of 20 - 29 and 15.5 percent were 15-29 years old. Studies that met the criteria for this review originated mostly from Europe and North America. Hence, caution is necessary in application of findings from that region to program development in Asian, African, South American or developing countries.

From the limited information available, lead author Alexandra Fleischmann, Ph.D., and co-authors suggest that comprehensive suicide prevention strategies for young people target mental disorders as a whole rather than just look for depression. Even though mood disorders were tied to suicide the most, these disorders were lower than expected, according to the study.

The authors add that beyond diagnosable mental disorders, other components, such as a person's predisposition, social and environmental conditions, psychosocial risk factors, and culture should be considered to prevent suicide among youth from escalating.

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Article: "Completed Suicide and Psychiatric Diagnoses in Young People: A Critical Examination of the Evidence," Alexandra Fleischmann, PhD, Jose Manoel Bertolote, MD, and Myron Belfar, MD, World Health Organization; Annette Beautrais, PhD, Christchurch School of Medicine, New Zealand; American Journal of Orthopsychiatry, Vol. 75, No. 4.

Full text of the article is available from the APA Public Affairs Office or at www.apa.org/journals/releases/ort754676.pdf.

Emotional impairment linked to cognitive deficits in bipolar children

Researchers at the University of Illinois at Chicago used functional brain imaging to establish a link between emotional impairment and poor cognition in children with bipolar disorder.

"This study is very exciting because it shows that negative emotions affect cognition differently than positive emotions in these kids," said Dr. Mani Pavuluri, associate professor of psychiatry at UIC's Institute for Juvenile Research and the Center for Cognitive Medicine, and lead author of the study.

Using functional magnetic resonance imaging, Pavuluri and her colleagues examined the brain activity of teens while they were performing certain mental tasks. The researchers scanned the brains of 10 unmedicated bipolar patients with normal mood and compared them with 10 healthy subjects of the same age and gender.

The children, aged 12 to 18, were asked to match positive or negative words with colors to determine how stimuli impact different areas of the brain responsible for emotion and cognition.

When shown negative words, compared to neutral words, the bipolar patients showed increased activation in the part of the brain that regulates emotions. When shown positive words, they showed activation in the reward centers of the brain which are often associated with pleasure and addiction.

In healthy subjects, positive and negative words activated the regions of the brain associated with cognitive behavior such as thinking, reasoning and learning.

"We found that the amygdala, the part of the brain that is supposed to react to emotional stimuli, is over-reactive to negative stimuli in children with bipolar disorder," said Pavuluri. "And the part of the brain that controls cognitive behavior is under-reactive."

Results of the study will be presented Oct. 20 at 2 p.m. at a joint meeting of the American Academy of Child and Adolescent Psychiatry and the Canadian Academy of Child and Adolescent Psychiatry in Toronto.

Pavuluri says the findings have direct clinical implications for present and future medication trials and cognitive behavioral therapy used to treat children with bipolar disorder.

Pediatric bipolar disorder, also known as manic depression, is associated with sexual promiscuity, failure in school, addiction and suicide. The disorder is characterized by extreme changes in mood and is often misdiagnosed. Patients may alternate between depression and euphoria, or mania.

Other UIC researchers in the study were Subhash Aryal, Megan O'Connor, Erin Harral, Ellen Herbener, and senior collaborator John Sweeney.

Source: University of Illinois at Chicago

Bipolar Disorder Information and Treatment Presentations

As we covered back in August this past summer, there was an excellent public education seminar held at Stanford University (California) that we reported on.

Today we are making available on the Internet the presentations on bipolar disorder that were made that day.

There were two presentations. Click on the links to get directly to the presentation:

Differential Diagnosis of Bipolar Disorder and Schizophrenia -

This presentation talks about how in the older traditional mode of thinking psychiatrists used to describe these brain disorders as fixed categories. The thinking now is that the "boarders" to these disease classifications are now much more flexible and fuzzy than they once were. Instead of thinking of these as fixed categories we should really be looking at them as a continuum, or spectrum, of different symptoms.

The Cutting Edge - Bipolar Treatment Options

This is an excellent presentation that covers the newest treatment options for bipolar disorder.

Bipolar Disorder Consumers Feeling Budget Cuts

Budget cuts and program cuts for mentally ill leaving some out in the cold

Rocky mountain news, in Denver, Colorado reports that in that state the people with brain disorders are seeing serious cuts to their programs. As is usually the case - this is extremly short sighted - the people they prematurely take out of support programs may end up costing the State much more in jailing costs or other areas.

"Last summer a therapist at Boulder Community Mental Health Center gave Octavia Tryon a surprising message.

"They told me I was one of the people in better shape who comes in here," recalls Tryon, who has bipolar disorder. "Someone had to get the ax."

Tryon is among the hundreds of severely mentally ill patients who got kicked out of Colorado's community mental health centers in recent years. Some, like Tryon, found other therapy. Hundreds more are unaccounted for. They could be in jail, homeless, dead or in other states.

And that, mental health advocates say, is a symptom of a cash-strapped system in shambles after years of budget cuts. It's also a system, critics say, that lacks accountability or much motivation to admit its failures.

During the past four years, the state has cut per-patient spending on mental health treatment for indigent people through Medicaid by one-third, even as the caseload went up by two-thirds. The average payments fell from $569 to $378 per Medicaid recipient per year.

State mental health funds for the working poor declined a net $5.1 million, or 25 percent, according to the Legislative Council.

At the same time, Colorado has participated in a national trend toward moving people out of mental hospitals. The average daily patient count at Fort Logan and Pueblo Mental Health Institutes has dropped 24 percent since 2000, from 708 to 539."

The paper lists some other ways in which mental health programs have been cut in recent years:

Mental health budget cuts

These are some of the ways the state has saved money on mental health services in the past four years:

* Waiting lists: Grew from 143 people seeking access to community mental health clinics in 2000-01 to 400 in 2004-05.

* Indigent patients: Hundreds were denied services because they were deemed too "healthy" for care.

* Medicaid caps: Outpatient visits were set at 35 a year, and hospitalization at 45 days.

* Tighter rules: The average daily occupancy of state mental health institutes declined 24 percent after changes made.

* Limited admittance: Mental health centers now try to treat patients in groups, not individually. They turn away clients who aren't "in crisis" - suicidal, having lost their jobs, arrested or homeless.

* More incarcerations: The number of mentally ill people in prisons has risen from 3 percent to 18 percent in the past 14 years.

Depression Conference in Pennsylvania

The National Alliance on Mental Illness, Pennsylvania (NAMI-PA), announced the theme of the statewide conference, "Depression: Its Impact on the Workplace, Home and Community," to be held on Friday, October 28, 2005, through Sunday, October 30, 2005, at the Radisson Penn Harris Hotel in Harrisburg, cosponsored by the Western Psychiatric Institute and Clinic.

NAMI-PA will offer a Criminal Justice Symposium on Thursday, October 27, for district justices, sheriffs, police officers, attorneys, and others involved in the criminal justice system.

CONFERENCE HIGHLIGHTS

RICHARD J. CODEY, ACTING GOVERNOR OF NEW JERSEY, is the keynote
speaker at the conference luncheon on FRIDAY, OCTOBER 28TH. Governor
Codey is a well-known and fervent Mental Health Advocate, and we are
honored to have him as our keynote speaker.

PAMELA SPIRO WAGNER and CAROLYN S. SPIRO, M.D., authors of Divided
Minds, will speak at the luncheon on SATURDAY, OCTOBER 29. Told in
the alternating voices of the twin sisters, Divided Minds is a
heartbreaking account of mental illness in one identical twin, while
her sister goes on to become a psychiatrist. The book explores the
depths of ambivalence and love between twins.

THE HONORABLE SANDRA SCHULTZ NEWMAN, Pennsylvania Supreme Court
Justice, is the keynote speaker for the Criminal Justice Symposium,
"Systems Integration - Coming Together," on THURSDAY, OCTOBER 27th.
Justice Newman is the first woman to be elected to Pennsylvania's
highest court.

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

National and state experts will provide information regarding causes, treatment and prevention strategies to address depression.

NAMI, the National Alliance on Mental Illness, with more than 220,000 members, is the nation's leading grassroots advocacy organization solely dedicated to improving the lives of persons with severe mental illness, including schizophrenia, bipolar disorder (manic-depressive illness), major depression, obsessive-compulsive disorder, and severe anxiety disorders.

NAMI Pennsylvania is a grassroots self-help, support, education and advocacy organization, with 60 affiliate chapters across the state, with more than 9000 members, including consumers, their families, advocates, and mental health professionals.

CONTACT: Bonnie Squires for NAMI Pennsylvania, +1-610-649-0998, or
Cellular: +1-610-329-6826

Web site: http://namipa.nami.org/