July 30, 2007

A Move To A More Holistic Approach In Bipolar Disorder

Pharmiweb.com, a UK based news and resource site relating to pharmacology issues, included a piece on the changing outlook of bipolar disorder in the psychiatric community. In this article they discuss how more professionals and patients are realizing that a holistic approach - an approach that deals with more than just the primary symptoms of the disorder and treats the "whole" person - is of greater benefit and may "revolutionize patients' prospects". The article includes references for the information listed.

The article points out that a holistic approach makes sense because bipolar disorder affects so many areas of one's life. Often time's work and relationships are impaired, medication side effects can cause sexual issues, or other physical problems, suicide risk is increased, substance and alcohol abuse is common, and other physical health symptoms or psychological health symptoms appear.

"On average, an uncontrolled (meaning untreated or stabilized) sufferer (of BD) will die nine years earlier than the rest of the population and experience 12 fewer years of healthy life."

The article also states that current compliance with psychiatric medications isn't very high. The drugs prescribed may be prescribed in excess, or the side effects of the drug may be very uncomfortable. Its much harder to maintain treatments when someone is required to take up to 4 different types of pills that cause side effects.

Many patients have been expected to take up to four types of drugs daily, including several associated with adverse effects including weight gain, somnolence, sexual dysfunction and involuntary movements.

In the past psychiatrists were only focused on maintaining mood, and decreasing depressive and manic symptoms; which are the hallmarks of bipolar disorder. But noticing how wide a range the effects of the disorder are, and the lack of success in treating many patients, the focus has changed to a more holistic approach. This approach focusing on not only maintaining symptoms, but also dealing with the physical, cognitive, social, emotional, behavioral, and even spiritual aspects of a person.

Only when every domain of bipolar illness is addressed, do patients have the best chance of fully recovering ability to participate in normal life.

The article argues that the fewer drugs a person needs to take, the higher likelihood they will continue their treatment, meaning compliance rates go up. They also argue that other therapies, besides increasing medications, may be more beneficial to supplement with.

Talking therapies are also key, they believe, as is psycho-education. Teaching patients to understand the nature of bipolar disorder and the importance of seeking help early is recognised as a necessary part of management for every patient. Psycho-education programmes explain when and why medicines must be taken regularly, and teach coping strategies. By avoiding destabilising triggers such as stress, overwork, and too little sleep, patients can help prevent acute episodes of mania and depression.

Read Full Article:
BIPOLAR DISORDER: a new holistic approach. Pharmiweb.com
30 Jul 07

Posted by Michelle Roberts at 11:26 AM | Comments (2)

July 23, 2007

New Lithium Study in Pediatric Bipolar Disorder - Chicago

Researchers at the University of Illinois at Chicago are participating in a national study to evaluate lithium for the treatment of bipolar disorder in children and adolescents.

"Lithium is the prototype mood stabilizer for treating adult bipolar disorder, but it is not FDA-approved for use in kids younger than 13," said Mani Pavuluri, director of the Pediatric Mood Disorders Clinic at UIC's Institute for Juvenile Research. "We do not have a perfect drug that cures all aspects of bipolar disorder, but knowing more about lithium -- and how it affects children -- may bring us closer to managing this devastating disorder."

Results from the Collaborative Lithium Trials will provide the first comprehensive analysis of lithium treatment for pediatric bipolar disorder, according to Pavuluri.

UIC researchers are recruiting patients between 7 and 17 with bipolar disorder. The study will evaluate medication dosage strategies, drug efficacy, and short- and long-term safety and tolerability.

Pediatric bipolar disorder, also known as manic depressive disorder, is characterized by extreme and unusual changes in mood, ranging from mania to depression. Symptoms of mania can include extreme or persistent euphoria or irritability, inflated self-esteem, increased energy and a decreased need for sleep. Depressive symptoms may include physical complaints such as headaches, tiredness, lack of interest in activities, or social isolation.

In children, the disorder interferes with normal, healthy functioning and is associated with suicide, school failure, and risk-taking behaviors such as sexual promiscuity and substance abuse.

The prevalence and incidence of pediatric bipolar disorder is unknown.

"Lithium has proven to be effective in preventing future episodes of bipolar disorder and reducing suicidal thoughts in adults," said Pavuluri, who leads the UIC trial. "This study will help us to determine if lithium may have a similar protective effect in pediatric patients and help us to develop future treatment protocols."

To Learn more about this study, or to get information about having a child of yours participate - contact the University of Illinois at Chicago Pediatric Mood Disorders Clinic

Additional information on this study is available at www.clinicaltrials.gov - or at the following link: Lithium for the Treatment of Pediatric Mania (though this link may not be the same trial - we searched on the clinicaltrials.gov web site and this was the closest trial that seemed similar)

Source: a news release issued by University of Illinois at Chicago.

Posted by szadmin at 8:25 AM | Comments (2)

July 20, 2007

New Study Links Bipolar Disorder With Brain Tissue Loss

People with bipolar disorder, also called manic depression, suffer from an accelerated shrinking of their brain, researchers at the University of Edinburgh have found.

The study shows for the first time that bipolar disorder, a condition characterized by periods of depression and periods of mania, is associated with a reduction in brain tissue and proves that the changes get progressively worse with each relapse.

This discovery has implications not only for the way we research the disease, but may also impact the way this condition is treated.

The findings, published in the Journal of Biological Psychiatry, show that the loss of grey matter tissue is concentrated in areas of the brain which control memory, face recognition and co-ordination, namely the hippocampus, fusiform and cerebellum respectively.

Dr. Andrew McIntosh, senior lecturer in psychiatry and lead researcher, said: "For the first time, we have shown that as people with bipolar disorder get older, a small amount of tissue is lost in parts of the brain that are associated with memory and the coordination of thoughts and actions. The amount of brain tissue that's lost is greater in people with multiple episodes of illness and is associated with a decline in some areas of mental ability.

"Although we do no yet know the cause of this brain shrinkage, it may be that repeated episodes of illness harm the brain and lead to the decline. Another possibility is that the brain changes are caused by stress or genetic factors, which tend to lead both to more frequent illness episodes and to greater brain loss. Further research will be required."

Bipolar disorder, in its severe form, is a serious mental illness which affects around half a million people in the UK alone. When people have mania they are typically elated, overactive and need less sleep. They may also suffer from delusions or hallucinations, and are at significant risk of suicide. Once someone has an episode of bipolar disorder, the condition tends to be life long.

This work is funded by the Sackler Foundation, Health Foundation and by the UK Medical Research Council. Source: The University of Edinburgh

More Information: Bipolar disorder 'shrinks brain' (BBC)

Posted by szadmin at 8:19 AM | Comments (10)

July 17, 2007

Family-Focused Therapy For Bipolar Disorder

Many family therapy pioneers began their work with patient's suffering from psychotic disorders and severe mental illness. Murray Bowen, possibly one of the most well known frontiers of family therapy began his work with schizophrenic patients. During his time, he actually began hospitalizing entire families so that the "system" could be treated. This was highly innovative therapy, yet much too extreme. Those drastic measures of the Bowen days have paved the way for a newer approach to family therapy with severe mental illness, which some refer to as family-focused therapy. The Wall Street Journal included an interesting piece on how this approach is being used with a wide range of disorders, and the potential benefits, and possible risks. This new approach is becoming a go to treatment for those with bipolar disorder.

This new trend in family therapy focuses on treated the identified patient, the one suffering form the severe mental illness (commonly schizophrenia, bipolar disorder, anorexia, or other disorders where insight may be impaired). But it's different from individual therapy because it incorporates family members. Its similar to family pscyhoeducation, in that it helps family members understand and cope with caretaking, but its also allows the family members to help treat the identified patient.

Family-based counselors meet regularly with the patient and family members. Certain loved ones, most often a spouse or parents, but sometimes siblings, as well, are designated as caregivers. Each member of the family, including the patient, agrees to the open nature of the treatment -- sometimes signing a waiver outlining what information the therapist can share with relatives. This can include details about symptoms and medication.

Family members are free to talk to the therapist about their loved one's behavior, symptoms and progress (as per agreed upon in the informed consent). They also talk about how their relative's illness affects them. The aim is to give each family member support and a role in the treatment.

Critics of family-based therapy say that the lack of boundaries can be dangerous. Patients may be leery of sharing intimate information with a therapist because they know there is a lower bar on confidentiality. And family members may resist talking about their problems.

But these issues with boundaries are lessened when working with a therapist who is open to restructuring some parts of the therapy process, in order to meet the needs and desires of the particular family. Informed Consent, which is very important in every kind of therapy but tenfold in family-based interventions, is the document that outlines the therapy, the risks, the rights of all clients, as well as the legality of therapy. When more than one person is the client, as is the case with a family, information about disclosure, and confidentiality need to be made very clear. Family members need to be aware and agree upon the terms so that there are no surprises or "secrets". Informed consent is treated as a contract, and is often signed by all members of the therapy process (therapist and clients).

Family-Based approaches also are similar to CBT, in that they are time limited, focus on the "here and now", as well as symptoms relief and symptom management.

Rather than going on indefinitely, the therapy is prescribed for a limited time, typically nine months to a year, with the idea that families will gain skills to continue on their own.

"What has happened in the past is mental-health professionals and the public would blame families and criticize them," says Susan Gingerich, a social worker in Philadelphia who uses family-based therapy to treat people with schizophrenia and has written many books on treating schizophrenia. "In fact, they can be an important source of treatment."

This type of therapy is especially useful with patients who may lack insight into their own illness (schizophrenia and bipolar disorder), or not be able to coherently relay their recent behaviors. Family members hold a huge wealth of information about the client's behaviors, their moods, and the stability of these things. When it's a psychotic illness, perception of reality is impaired, so family members who often live with or near the client can help piece together what's been going on.

Family interventions have been shown to decrease relapse rates and reduce the need for hospitalization. These approaches also help with medication management, and help build trust with family, providing for a safe support network. Most psychotherapists would agree that apart from drug treatment and CBT, family-focused interventions are the most beneficial form of therapy for individuals with bipolar disorder. Younger adults or children with Bipolar Disorder who may still live with parents might benefit the most from family-focused approaches, but for all age groups, whenever possible, family-focused therapy can be helpful.

In September, Beth Israel Medical Center in New York will open the Bipolar Family Treatment Center, an outgrowth of the hospital's Zirinsky Mood Disorders Center. The center's director, psychiatrist Igor Galynker, created an approach he calls "family-inclusive treatment."

At the bipolar center, therapists explain to patients how their families can be an early warning system for crises and how the patient and family can work together to improve behavior. The patient receives medication and psychotherapy, and both the patient and caregivers are evaluated on a quarterly basis. In addition, children of the patient are evaluated by a therapist.

Patients and family members sign consent forms that acknowledge that the doctor can share information with the family. "But we don't disclose private issues that were discussed in therapy, such as dreams or fantasies," says Dr. Galynker, who gives his cellphone number to all patients and their families.

Dr. Galynker says his approach is similar to the work of David Miklowitz, a psychologist and professor at the University of Colorado who pioneered a family-focused approach for bipolar patients.

In 2000 and 2003, Dr. Miklowitz published the results of his first randomized trials. "What those studies showed is that if you combine family-focused treatment with medications, then you get a better outcome over two years than if you just give medication or medication and equally intensive individual therapy," says Dr. Miklowitz, who has written a manual for clinicians detailing his approach, as well as a guide for families.

Read Full Article:
Letting Your Family In on Your Therapy Approach Enlists Loved Ones To Participate in Treatments; Overcoming the Privacy Issue. Wall Street Journal Online.

Bipolar Family Treatment Center (great informtaion on family focused therapy, research articles, resources for families and patients, as well as a running blog.)

Family-Focused Therapy Program for Bipolar Disorder

Family Focused Therapy and Interpersonal and Social Rhythm Therapy (good article that begins with the basics of family focused therapy)

Posted by Michelle Roberts at 12:34 PM | Comments (8)

July 13, 2007

Documentary on Childhood Bipolar Disorder in the Works

Beyond Nuclear: Bipolar Children and Their Families is a new documentary looking at the rising issue of bipolar disorder in children, and the effects on the family. The documentary is in the process of being completed; they are continuing to gather expert interviews and personal stories. It is expected to be available later this year.

This an educational documentary which investigates a disorder that is hard diagnose and difficult to treat. It is a thoughtful and in-depth exploration of the real life situations faced by children and their families, told in their own voice. It includes interviews with children, parents, educators, doctors and medical researchers.

Click on the window below To View The Film Trailer (introduction)

The filmmaker decided to take on this project because of his extensive personal experience with bipolar disorder, and his more recent experience with it developing in children. Childhood bipolar disorder was once noted as rare, but is now sometimes referred to as an epidemic, possibly over-diagnosed.

Living with bipolar is deeply personal issue for me. Not only do I have a son, a brother, a sister and grandmother all diagnosed with bipolar, I have also managed my own illness for 25 years. Eight years ago, when my son was diagnosed at age six, we were told that bipolar disorder was exceedingly rare in children. I was later shocked to find out when my son participated in a research study that 45 other children from our area were being recruited for the study. It appeared it wasn't that rare at all. - Dave Barker (Filmmaker)

David Barker attempts to wins more money to complete the documentary in a NY commercial contest: Raising Awareness About Bipolar Disorde

July 9, 2007

Early Stage of New Bipolar Drug Production Shows Promise

Bipolar Disorder is currently treated with mood stabilizing drugs such as Lithium or Valproic Acid (Depakote). Some people have reported side effects with these medications, and when bipolar patients are prescribed an antipsychotic, side effects may be added. The development of a new drug that works as well as the current ones, but without the debilitating or uncomfortable side effects, may revolutionize quality of life for those living with bipolar disorder.

Current mood stabilizers act by blocking an enzyme, glycogen synthase kinase-3 (GSK-3). Alan Kozikowski of the University of Illinois in Chicago and his co-workers decided to attempt a new drug that used compounds that blocked an enzyme similar to GSK-3. They hypothesized that if the compound could block a similar enzyme, it may have an effect on GSK-3.

After much testing, they found that the compound did in fact block GSK-3, similar to current mood stabilizers. After refining the compounds ability to block the GSK-3 and get into the brain with ease, they studied its effects on mice with "mania". The Journal of the American Chemical Society featured the mouse study and showed that,

In a mouse model of 'mania', hyperactive mice were calmed and moved around much less when given the new candidate drug.

It may be years before these research results become useful to patients.

The new compound looks promising, but a lot of work remains to be done before it will be ready for human trials. The next step is to make molecules that bind as selectively to GSK-3 as possible, he adds, so that they don't interfere with the action of other, similar enzymes.

New candidate drug for bipolar disorder: A designed alternative to lithium shows early promise. News@Nature.com

Read Full Article:
Structure-Based Design Leads to the Identification of Lithium Mimetics That Block Mania-like Effects in Rodents. Possible New GSK-3 Therapies for Bipolar Disorders. Alan P. Kozikowski, Irina N. Gaisina, Hongbin Yuan, Pavel A. Petukhov, Sylvie Y. Blond, Allison Fedolak, Barbara Caldarone, and Paul McGonigle. The Journal of the American Chemical Society

Posted by Michelle Roberts at 12:17 PM | Comments (6)