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July 26, 2006

New UK Guidelines for Diagnosis and Treatment of Bipolar Disorder set by NICE

New guidelines in UK (England) set to raise awareness and improve identification, diagnosis and treatment of bipolar disorder in children and adults.

"The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Mental Health have today (26 July) launched a clinical guideline on the identification, treatment and management of bipolar disorder in children and adults.

Bipolar disorder (formerly known as manic depression) is a serious mental health condition characterized by the presence of episodes of mania and depression. During a manic episode, the person usually has feelings of elation, irritability, or both. They may also feel over-confident and be driven to take unnecessary risks. When a person has depression they feel low and lose pleasure in things they used to enjoy and may also have other symptoms such as feeling tired all the time, sleep problems, poor concentration, feelings of worthlessness and/or guilt and thoughts of suicide or harming oneself.

The guideline calls for more to be done to ensure that bipolar disorder is correctly identified and recognized by health professionals and sets out the criteria for when patients need to be referred on for specialist psychiatric assessment and treatment. It also sets out the drug treatment options for people with bipolar disorder and emphasizes the need to involve service users in treatment decisions. Other recommendations cover the need for annual physical health checks for people with bipolar disorder and the need for all healthcare professionals to monitor carefully the medication taken by patients."


Read full press release
PDF: 2006/035 New guidelines set to raise awareness and improve identification, diagnosis and treatment of bipolar disorder in children and adults26 July 2006

At a glance info on the new guidelines

Related Articles:

A Call for Mental Disorder Checks



Posted by Michelle Roberts at 11:04 AM | Comments (2)

July 24, 2006

Researching Drug Interventions in Bipolar Offspring: Current Ongoing Research

Here is a Blog about Stanford Medical Center and Lucile Packard Children's Hospitals recent research into treating children who exhibit symptoms, but do not meet the diagnostic criteria for Bipolar I or II with mood stabilizers (Davalproex). The study was headed by Dr. Kiki Chang, assistant professor of psychiatry and behavioral sciences at the School of Medicine and a psychiatrist at Packard Children's Hospital.

"Our goal is to identify these children early for treatment and perhaps prevention," Chang said. "If we can prevent bipolar disease in childhood, we can prevent later treatment resistance and future complications like substance abuse, poor work and school performance, and even suicide."

They found that "78 percent of study participants were either very much improved or much improved in their mood or behavioral disorders", yet no control group was used, so further research is definitely needed to rule out pacebo effect an othe variables. Dr. Chang states he will be conducting these much needed studies.

Dr. Chang and his colleagues are aware of the connectuion between unipolar depression and ADHD as being possible predictors for Bipolar disorder and plan to conduct further studies to examine their connections and possibly find other indicators. He is also concerned with the increase in treating children with drugs for ADHD, standard medications for other mood and behavior disorders, as well as anxiety disorders. He believes that children predisposed to bipolar disorder will not do well with these treatments, and they could cause greater severity in bipolar symptoms in the future.

"We want to raise awareness about these kids and the idea that perhaps they will be better treated with mood stabilizers," said Chang’s colleagues at Stanford.

Read Blog:

Researching Drug Interventions in Bipolar Offspring: Current Ongoing Research Brain Blogger (www.brainblogger.com)July 23rd, 2006

More Info:

Stanford, Packard Research Finds Better Drug Therapy For Children Predisposed To Bipolar Disorder

Posted by Michelle Roberts at 11:03 AM | Comments (5)

July 18, 2006

Delving Into Bipolar Disorder

St. Joseph Hospital psychiatrist Himasiri De Silva held a lecture on Thursday night (7/13/06) in Orange County on Bipolar Disorder. More than 200 people attended the lecture, which consisted of overview of the illness, and of course a question and answer section.

Many of the people attending brought pictures of loved ones with the disorder, shared personal stories, and asked for advice. Most importantly stigma was discussed; and the significance of realizing that actions of people with bipolar are out of their control until they receive treatment.

"If you have a broken leg and are limping, everyone will come to your help," De Silva said. "Not with mental illness."

Because of the overwhelming turnout, this was a great opportunity to educate and hopefully eliminate some stigma in society. The recent account of Orange County journalist, Valerie Godines, and her struggle with bipolar disorder is speculated to have had a significant impact on the amount of people attending.

Read Full Article:

Delving Into Bipolar Disorder OC Register (www.ocregister.com)

Posted by Michelle Roberts at 12:28 PM | Comments (0)

Risk and Resilience Markers in Bipolar Disorder: Brain Responses to Emotional Challenge in Bipolar Patients and Their Healthy Siblings

By: Stephanie Kruger, M.D., Martin Alda, M.D., F.R.C.P.C., L. Trevor Young, M.D., Ph.D., F.R.C.P.C., Kim Goldapple, B.S., Saghar Parikh, M.D., F.R.C.P.C., and Helen S. Mayberg, M.D.
Published: American Journal of Psychiatry, 163:257-564, February 2006.

Purpose of the Study

Studies indicate that there is a high level of genetic influence in the development of bipolar disorder, but that it is not the only factor; many people who are genetically predisposed never become bipolar. Yet some scientists believe that although the full blown disorder is never developed, these individuals "manifest traits associated with the illness, namely pathological reactivity to emotional stress." This means that they have similar vulnerability to stress that can be seen in bipolar disorder.

This study aims to look for these bipolar traits at the brain level. They have hypothesized that exposure to mood related stress (in this case sadness) would reveal similar brain activity in those predisposed but who did not have the disorder (the hypothesized regions are; medial frontal cortex, dorsal anterior cingulated, dorsolateral prefrontal cortex, and anterior insula). They also hypothesized that there would be regions of resilience in these participants. These regions of resilience would be the protecting factors for not developing the disorder.

Method

This study utilized nine bipolar disorder type I subjects, and their "healthy" siblings (these siblings acted as the group that was predisposed, but didn't have bipolar disorder. This was extensively evaluated prior to the study with DSM-IV criteria). The bipolar subjects were considered euthymic (not depressed or manic), stable for at least 3 years and were responding well to their lithium treatment

The study also included comparative analyses between a previous group of participants (from an earlier study of the same thing) who were taking valproate, had been euthymic for at least 6 months, and the current lithium bipolar participants.

They measured regional cerebral blood flow (rCBF) changes with positron emission tomography (PET) after asking participants to write a short autobiographical script of a sad life event. This was their "induction of transient intense sadness" which has been used and validated in other research. They performed the PET scan 1 min after the participants had reviewed what they wrote and reached peak emotion. Peak emotion of sadness was assessed using a likert scale, (0 not sad to 7 very sad). They performed 2 “rest” scans and two sadness scans.

Results

8 lithium participants and 2 siblings showed tears during the inducted sadness portion of the experiment. The siblings had a slightly higher anxiety rating from the induced sadness, but were similar to their bipolar siblings in terms of emotion provoking time, and stability after the study (though the siblings felt less "overwhelmed" by sadness than the bipolar participants).

The bipolar participants and their siblings showed increased rCBF in the premotor cortex, dorsal and rostral anterior cingulated, anterior insula, and cerebellumn. They showed decreases of rCBF in the orbitofrontal cortex, and the inferior temporal cortex. The difference between these groups was the changes in medial frontal cortex rCBF. The "healthy" siblings showed an increase in rCBF, in the medial frontal cortex, while the bipolar participants treated with lithium showed a decrease.

When comparing the lithium bipolar participants to the valproate bipolar participants, differences in the rostral anterior cingulate and the dorsolateral prefrontal cortex were found. The lithium treated participants showed an increase in rCBF of the rostral anterior cingulated, while the valproate treated participants showed a decrease. The valproate group also showed a decrease in dorsolateral prefrontal cortex rCBF, while no changes were present in this region in the lithium group.

Conclusions

Although the siblings didn't meet the criteria to be diagnosed with a psychiatric disorder, the brain imaging in this study suggested that provoking emotions in these "healthy" siblings showed similar brain activity as their bipolar siblings. The increase in rCBF of the ventral medial frontal cortex in the non bipolar siblings is hypothesized to be a resilience factor preventing bipolar symptoms. Research shows that this region is associated with processing of emotional tasks; which includes reassessment of feelings, and increased self awareness. This is further supported with the reports of the non bipolar siblings not feeling overwhelmed emotionally.

To further analyze the differences in predisposed individuals, non predisposed, and diagnosed patients, brain scans using the same method of this study were examined in healthy, non predisposed participants. Similarities of the siblings were found again; the healthy subjects had no change in medial frontal cortex, and had increased rCBF in the subgenual cingulate (which neither sibling groups showed). This supports the hypothesis that similar brain regions are affected in those predisposed and those diagnosed, that are not present in individuals with no predisposition, and no psychiatric illness.

When examining the results of the litium group versus the valproate group, no consistant conclusions could be drawn. The valproate patients had less of a favorable outcome in their treatment, but this study cannot prove whether the lithium "stabilizes pathways responsible for emotional and behavioral reactions to stressful events or that the course of illness in these highly selected bipolar patients may leave cortical circuits at least partially intact."

Limitations

Although this study aimed to find a link between those genetically predisposed and those with the disorder, one could argue that many of the siblings lacked the actual genetic exposure (siblings only share about 50% of their genes). Without genetic mapping, theres no way to be sure these siblings had the genetic predisposition.

Another theory may be that these similarities were not a result of genetics, but rather a result of developing cognitive skills in the same environment. Growing up with the same parents, possibly attending similar schools may cause these siblings to form similar neurocognitive connections.

Also, more research is needed to determine the cognitive mechanisms of the apparent cortical resilience found in the “predisposed” siblings, as well as analyzing early brain scans of those who develop bipolar disorder, and whether these resilience factors are present or absent.

Read Full Article:

Risk and Resilience Markers in Bipolar Disorder: Brain Responses to Emotional Challenge in Bipolar Patients and Their healthy Siblings American Jounral of Psychiatry (http://ajp.psychiatryonline.org/). Feb 2006.

Posted by Michelle Roberts at 11:21 AM | Comments (3)

July 13, 2006

Overview of Genetics and Bipolar Disorder

Overview of Genetics and Bipolar Disorders

The Foundation for Genetic Education and Counseling highlights the genetics of bipolar disorder, and will soon offer downloadable brochures and information packets for families, physician, and patients.

View Website:

The Foundation for Genetic Education and Counseling: Bipolar Disorder (www.fgec.org)

More on this:

Genetic Counseling for Bipolar Disorder

Related Stories and More on Genetics of Bipolar:

The Genetics of Bipolar Disorder

Hunting for Bipolar Disorder Genes

Bipolar Disorder Causes

Posted by Michelle Roberts at 10:21 AM | Comments (0)

July 11, 2006

Speaking Her Mind: Personal Recount of Bipolar Disorder, A 5 Part Series

Orange County reporter and 2005 Pulitzer Prize finalist, Valerie Godines, creates a 5 part series about her experiences with Bipolar Disorder. She goes through her psychotic experiences, her desire to get help, and the treatments she endured.

Valerie Godines briefly discusses her struggle in this video.

Part 1: On Dec. 5, 2004, I killed my Daughter
Part 2: Treatment briefly clears the storm clouds
Part 3: Will extremem measures work where normal ones haven't?
Part 4: The illness is manifesting itself in ugly ways
Part 5: Can someone who has lost their mind reclaim her life?

The series includes video, stories, facts about her treatments, and discussion forums.

Part 1, 2, and 3 are already available. Part 4 will be up on Wednesday, and Part 5 on Thursday.

To view the series:

Speaking Her Mind Orange County Register (http://ocregister.com)

Click to participate in the discussion forums, and speak with Valerie

Posted by Michelle Roberts at 10:07 AM | Comments (5)

July 10, 2006

Redefining Bipolar Disorder: Toward DSM-V

By: Mary L. Pillips, M.D., and Ellen Frank, Ph.D.

Here is a short editorial by Dr. Mary Phillips and Ellen Frank, Ph.D. discussing possible redefining Bipolar Disorder for the upcoming DSM-V.

They ask that Bipolar Disorder DSM-V criteria reflect the multiple dimensions that are commonly affected (anxiety, eating, and substance abuse disorder, medical illness, sleep disruption, and dysfunctional social relations).

Redefining Bipolar Disorder: Toward DSM-V. The American Journal of Psychiatry (http://ajp.psychiatryonline.org/) July 2006.

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

New Bipolar Novel, Written to Educate the Public, Dispel Myths

"The Province of Hope", by Mark Lee Kirchmeier, is a partly autobiographical novel about struggling with Bipolar Disorder. Kirchmeier felt that portrayal of Bipolar disorder in pop culture (television, films) was highly inaccurate and negative, which motivated him to write the book once he was able to manage his own illness with medication.

"It's about some of the pitfalls people with this illness seem to get into, particularly his obsession with his first love, even though he's not treated particularly well," Kirchmeier said. "And there's not a reciprocality that there would be in a healthy relationship."

Kirchmeier is an openly gay author, and the main character is a gay male. This is one of the few books dealing with Bipolar Disorder in the homosexual community.

Click here for Amazon review and purchase information

Gay Dallas author’s book explores bipolar disorder Dallas Voice (www.dallasvoice.com) July 10, 2006.

Posted by Michelle Roberts at 2:45 PM | Comments (6)

July 6, 2006

Study Says Obesity, Mood Disorders Linked

A new study reports that Dr. Gregory E. Simon and his colleagues, from the Group Health Cooperative in Seattle, surveyed 9,125 adults across the US from 2001 to 2003 in a national study on mental disorders. They found there is a 25% increased risk in developing mood and anxiety disorders, and a 25% decreased risk for substance abuse in those suffering from obesity.

They were questioned about demographics, physical attruibutes like height and weight, as well as psychological/psychiatric disoders (which included substance abuse).

2,330 of the participants matched the criteria for obesity (a Body Mass Index >30), and showed an increase in mood and anxiety disorders and a decrease in substance abuse compared to those who did not meet the obesity criteria.

But these are only correlations (relationships), and do not denote cause and effect. Therefore it is uncertain whether one causes the other, or a completely different third factor is the cause.

Read Full Story:

Study Says Obesity, Depression Linked Seattle times (www.seattletimes.com) July 4, 2006.

Link to Abstract:

Association Between Obesity and Psychiatric Disorders in the US Adult Population. Archives of General Psychiatry (http://archpsyc.ama-assn.org/) July 2006.

Related Stories

Weight Management Has Link To Bipolar Disorder

Obesity Linked to Depression, or Vice Versa


Posted by Michelle Roberts at 4:29 PM | Comments (17)

July 3, 2006

Memory impairment in bipolar disorder

Sources of declarative memory impairment in bipolar disorder: Mnemonic processes and clinical features

What are declarative memories?

Declarative memories are our conscious memories, also called explicit memories. They can be episodic, a memory of a specific event, or semantic, a memory of facts and information. But they all require three distinct abilities, encoding, storing, and retrieving. Encoding is the ability to form a neurological pathway out of the information/event perceived. Storing is simply maintaining that neurological pathway for future retrieval, which is the ability to recover and utilize that information, the memory. The brain regions associated with these three abilities are the medial temporal lobe, and the prefrontal cortex.

Importance of this study:

There is some evidence that provides a connection between bipolar disorder and declarative memory impairments (specifically verbal declarative memories). Studies even concluded brain region abnormalities found in bipolar patients correlated to the regions utilized in the declarative memory process.

The article outlines very inconsistent findings for declarative memory impairments and the suspected source in bipolar patients. Some studies found it to be state specific (manic versus depressed) and correlating to unipolar depression. This would mean the impairments on declarative memories are greater in depressive states. Other research found no evidence for state specific impairments, and instead found severity of illness, relating to number of manic and depressive states, age of onset, and length of hospitalizations to be correlating factor. One study even found a higher cognitive dysfunction in males versus females. Needless to say, the results didn't paint a clear picture on the subject at hand.

These findings only prove the need for further more extensive research in this area. Many previous experiments made little effort in distinguishing manic/depressive states, and symptomatic versus euthymic (normal, not manic or depressed) at the time of study. These distinctions can have a very great impact on results and interpretations.

Purpose:

“This study seeks to: (i) better characterize the nature of declarative memory impairment in bipolar disorder, and (ii) determine the relationship between clinical variables and memory function in bipolar disorder.”

Method:

In an effort to surmount the previous limitations of the research, this study utilized the California verbal learning test, which allows for analysis of memory processes. They utilized 5 trails of word lists, which could be semantically organized for easier memory formation. These lists were administered and recalled either with short/long delay, and free or cued recall.

The participants used were 49 adult bipolar patients and 38 control subjects. In order to control for other variables, these bipolar participants were well documented on mood state, co-morbidities, medication usage, family history, cognitive functioning, and motor processing speed, at time of the study. The control subjects were demographically matched to the bipolar participants. Results were obtained using statistical analyses to analyze the differences in memory performance and general cognitive performance.

Results:

Because no significant differences in processing speed were found, any differences could be attributed to higher-level cognitive processing versus general impairments or motor slowing. Education was also found to not be a significant factor in the results.

On results of memory task performances, the bipolar group remembered significantly fewer words when compared with the control. These results were more profound in the later trails, which may signify a lesser repeated exposure effect. The significantly fewer words recalled for bipolar participants was found in all recall measures, independent of length of delay, and type of recall (cued or free). But they did not differ in their rate of forgetting; number of words retained from the original words recalled for both short and long delayed recall. They did however find no significant differences in organizational strategies, which included semantic clustering and serial positioning. But the bipolar group made more errors by recalling more words not actually on the original list.

The bipolar participant’s medications ranged from no medications, mood stabilizers or antidepressants, and 2 or more psychotropic drugs. After analyzing the effects of medication on their performances, no memory differences were found.

Correlations were found in those bipolar participants with mood disorder family history, and female gender. A positive family history and female gender were associated with higher total learning scores. No correlation was found for severity of symptoms at time of study.

Conclusions:

This study found that bipolar patients show declarative memory impairments, which are are present in both acute and remitted patients, and independent of their current state (manic versus depressive). These impairments were not a result of slowed motor or processing functions, and were not a result of inability to utilize strategic and organizational memory skills (such as clustering).

Opposing the researcher’s predictions, there were no significant differences found based on the duration of participant’s bipolar illness. But certain demographics not often examined in previous research on the subject, such as female gender and family history of mood disorders, were correlated with better performances. Although this study did not find a significantly higher score for females in the control group, some gender studies associate higher verbal acuity with “normal” (those lacking diagnosis of mental illness) females versus males. Few studies are in agreement with the results that a positive family history of mood disorders correlate with better intellectual functioning for those suffering with bipolar, and the underlying mechanisms for this outcome require further research.

Because there was no difference in rate of forgetting between groups, the authors concluded the area of impairment for bipolar patients was in the encoding process. Once the memory was formed, it was not forgotten at a higher rate, but there was a lower rate of initial memory formation/encoding. The bipolar group did have an increased number of error words recalled (words not in the list), which may be a result of a deficit in source monitoring, associated with the prefrontal cortex (an area of abnormality in bipolar patients).

Accompanied with its rigorous attempt at eliminating much of the constraints in previous research on this subject, this study has many of its own limitations. The overall sample size is fairly small, and may not properly reflect the population as a whole. This may have particularly affected analyses of subgroups and decreased statistical power for determining differences among those subgroups. The sample also included very few bipolar participants in a euthymic (normal, not manic or depressive) state. Further research accounting for these sample size limitations would be helpful.

Take home message:

This study found that declarative memory impairments may be attributed to a “trait abnormality of bipolar disorder”, and not to current mood state, type of medication, comorbidity of other psychiatric disorders. Further research is still necessary to support this data, as well as provide longitudinal evidence for possible differences in state and trait deficits within subjects.

Full Article available at:

Sources of declarative memory impairment in bipolar disorder: Mnemonic processes and clinical features. Science Direct (www.sciencedirect.com). Journal of Psychiatric Research. Volume 40, Issue 1 , February 2006, Pages 47-58.

By: Carrie Bearden, David Glahn, E. Serap Monkul, Jennifer Barrett, Pablo Najt, Simerjiti Kaur, Marsal Sanches, Veronica Villareal, Charlies Bowden, Jair Soars.

Posted by Michelle Roberts at 1:36 PM | Comments (1)