August 26, 2007

Growing Up with a Mentally Ill Mother - "Daughters of Madness", a New Book

daughtersmadcover.jpg

Daughters of Madness is a new book on daughter's experiences of growing up with mentally ill mothers. The book is unique in that it includes an introduction on how children are affected by mentally ill parents and also covers the related research. The rest of the book is full of interviews, and personal stories of women who have experienced a mother suffering from mental illness. Although the book is about daughters and their mothers, anyone with a mentally ill parent or family member may find it beneficial.

Susan Nathiel, the author, is an accomplished psychotherapist who is also a "daughter of madness" - and wrote this book with a wide range of audiences in mind; from professionals, to students, adults, and teens. The book is divided into sections based on age relevance of the stories, and includes perspectives from many different mental illnesses; including schizophrenia and bipolar disorder.

We are fortunate to have had an opportunity to ask her some questions that may be helpful and hopeful to the reader. In the interview you will find information on how to deal with with mental illness in the family, and plenty of resource links.

Click Here for an extensive Q&A with Susan and more information on the book.

From Susan Nathiel, author of Daughters of Madness: Growing Up and Older with a Mentally Ill Mother, Praeger/Greenwood Press, 2007.

To Purchase the Book: go to Amazon.com at the following link:
Daughters of Madness: Growing Up and Older with a Mentally Ill Mother
Price Range $40-$50

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

August 23, 2007

Bipolar Disorder Relapse Rate Decreased 50% With New Program

Australian mental health researchers have succeeded in halving the number of relapses experienced by people with bipolar disorder.

With funding from the MBF Foundation and Beyond Blue, a team led by the Mental Health Research Institute of Victoria has developed an innovative structured group program to help people with bipolar disorder to better manage their condition.

The 12-session program, led by trained mental health clinicians, enables people battling the disorder to effectively monitor their mood, assess personal triggers and early warning signs of oncoming illness and take the necessary steps to stay well.

In a controlled randomized study of 84 people diagnosed with bipolar disorder, those on the special intervention program had half the number of relapses after 12 months as the control group which continued with normal treatment. Even with modern drug therapies that act as mood stabilizers, relapse rates for people with bipolar disorder are as high as 40 per cent in the first year and almost 75 per cent over five years. This new research suggests that the risk of relapse can be brought down to half that level, or 20% in the first year. This is an important development in the treatment of bipolar disorder.

MBF general manager health product, Michael Carafillis, said the new program provides a much-needed bridge between the mental health services that treat people when they are acutely ill and the GPs and private psychiatrists who provide ongoing care.

“Bipolar is a complicated disease involving periods of depression and mania and its sufferers don’t always take their medications when they should,” said Mr Carafillis.

“People with the condition straddle the divide between public and private systems resulting in poor continuity of care for many sufferers. They tend to gain access to the public system in the most severely disabling phase of their illness, typically mania, and are often too ill and the disorder too complex to be easily managed in primary care.”

Professor David Castle at the Mental Health Research Institute of Victoria said providing people with bipolar disorder with the right tools and strategies to better self-manage their disease in a supportive group environment can substantially reduce the burden on individuals, their families and the health system.

Buoyed by the exciting results, the research team is now training clinicians in metropolitan and regional Victoria. The development of an accompanying service delivery framework, already being implemented in parts of Victoria, South Australia and the ACT, will enable the program to be rolled out in other states.

Posted by szadmin at 8:27 AM | Comments (6)

August 22, 2007

Risperdal Approved by FDA for Treatment of Bipolar Disorder In Children and Teens

A few months ago we featured a news story that Risperdal was in the process of being approved by the FDA for use in children and adolescents for treatment of Bipolar Disorder. Many psychiatrists already prescribe the drug to children and teens, but now the FDA has approved its safety and use based on further research.

Now that its officially approved, the research that lead to the approval may have strengthened the efficacy and safety of Risperdal's use in children and teens. Until now, physicians have not had a lot of guidance in prescribing the drug to these younger populations.

Doctors have, in many cases, been using Risperdal and other antipsychotic medicines to treat bipolar disorder, but the drug agency’s stamp of approval will allow Johnson & Johnson to promote the drug for short-term treatment of bipolar episodes in ages 10 to 17.

"The pediatric studies of Risperdal provided an opportunity to assess the effectiveness, proper dose, and safety of using this product in the pediatric population," said Dianne Murphy, M.D., director of FDA’s Office of Pediatric Therapeutics. "These data have permitted the identification of the effective pediatric dose ranges and have provided an evidence-based approach for treating these disorders in pediatric patients."

However, The Wall Street Journal reported today that there are still many concerns about the long term impact of giving medications to children:

"Some doctors are concerned about the safety of treating children whose bodies are still growing with Risperdal and similar medications. They point out that the FDA's decision is based on short-term studies. Risperdal and competing drugs have previously been tied to serious side effects including increased blood sugar, a potential precursor to diabetes.

"We definitely need to have longer-term followup data to learn the full extent of the side-effect liabilities," said Jeffrey Lieberman, chairman of the psychiatry department at Columbia University in New York. His department gets research funding from drug companies."

There are still side effects and dangers associated with its use - as has been known with adult use. "Drowsiness, fatigue, increase in appetite, anxiety, nausea, dizziness, dry mouth, tremor, and rash were among the most common side effects reported."

To reduce the risk of side effects patients on Risperdal should have their diet and weight gain closely monitored and have their dosage or medication adjusted if needed.

Risperdal is manufactured by Janssen, L.P. of Titusville, N.J

Read Full FDA Press Release:
FDA Approves Risperdal for Two Psychiatric Conditions in Children and Adolescents

Posted by Michelle Roberts at 10:47 AM | Comments (9)

August 20, 2007

Antioxidants Being Studied as Treatment for Bipolar Disorder

Clinical Psychiatry News featured an article outlining the research of Dr. Michael Berk, which was presented at the Seventh International Conference on Bipolar Disorder. Dr. Berk focuses on possible treatment of bipolar disorder and schizophrenia with antioxidants. The article is heavy on brain chemistry terms and theory, but still a good read about an exciting possible new treatment.

This research is motivated by the studies that suggest oxidative stress plays a role in both of the disorders and they even show deficits of certain antioxidant enzymes. Glutathione, specifically, acts as a defense against oxidative damage and is connected to the effectiveness of lithium and valproate (depakote) - the two most commonly prescribed drugs for treatment of bipolar disorder. Dr. Berk has focused his research on its possible use for treating bipolar disorder.

N-acetylcysteine (NAC), is a precursor of glutathione - which means its a compound that participates in the chemical reaction to produce glutathione, and its presence is necessary for glutathione to be created in the body. It's currently approved for treatment of overdoses of acetaminophen (Tylenol).

The article outlines Berk's small study on NAC and bipolar disorder, where they found that those in the participants receiving NAC showed significant improvements in a variety of areas; depression, mania, and overall functioning.

Some downsides of NAC are it takes very long to feel an effect, and the research supporting its use for bipolar disorder is preliminary. The drug however is available and FDA approved for other uses, which can speed up the process for researching its potential in the psychiatric field. Dr. Berk says, "Nonetheless, we are encouraged by these data, and we hope it will be a fruitful foundation for further study".

Read Full Article:
Antioxidants Studied for Bipolar Disorder, Schizophrenia
Clinical Psychiatry News By: Miriam Tucker

Posted by Michelle Roberts at 12:46 PM | Comments (8)

Neuroimaging: A Tool for Diagnosis and Treatment of Bipolar Disorder

The Clinical Psychiatry News featured an article on "neuroimaging as tool for diagnosis, treatment in sight: identifying bipolar disorder is a priority". Dr. Mary Philips, a professor of psychiatry and director of the functional neuroimaging program, has recently supported that neuroimaging may soon be a diagnostic and treatment tool for mood disorders including bipolar disorder. She discussed this developing technology at the Seventh International Conference on Bipolar Disorder.

fMRI's (functional magnetic resonance imaging) have long been used in research of mental illness, but not as often in clinical or diagnostic situations because its still considered "experimental"--but this may change soon. fMRI's are similar to regular MRI's but they show movement, and activity. This is especially beneficial because they can pinpoint areas of the brain that are over active, under active, or just abnormal in their functioning. They can also measure brain activity during specific tasks, or mood states. Also, fMRIs are non invasive and possess little to no risk to the patient.

Recently, research is suggesting that fMRIs may be able to identify "specific neural biomarkers that may help distinguish patients with bipolar disorder from those with unipolar disorder." They also hope that fMRIs can help guide physicians in picking correct medications to treat different "chemical imbalances", or even predict which "healthy" people are at high risk for developing bipolar disorder.

"I think neuroimaging is a really interesting, promising technique for the future. We've moved beyond blue sky high-level science for its own sake. We're now using neuroimaging to ask and answer real-lifeclinical problems," she said at a press briefing held during the conference.

Bipolar disorder is one of the mental illnesses that is often misdiagnosed for years before the patient is given proper treatment. Prolonging the time before the patient receives proper treatment can make their illness outcome less successful. Meaning the longer one goes un treated, the less likely they are to be responsive to treatments.

"If we can do anything to speed up the process of diagnosis, it would be a good thing," she remarked.

The article contains information about research results that may hold clues to bipolar disorder. Many of the biological markers of bipolar disorder are being researched in hopes that we can diagnose and treat individuals earlier. Although fMRI for clinical psychiatry use is still fairly new, Dr. Philips sees in the near future that brain imaging may be used the same way xrays have been--as a diagnostic tool.

"It's not going to be the only tool we have, but it will be part of a battery of tests, along with blood tests and paper-and-pencil cognitive tests," Dr. Phillips said.

For details on the studies Dr. Philips has been working on, and some of the great information we already have on neuroimaging and bipolar disorder, read the full article. Here is some information on related research that has helped to identify novel pathways and markers for diagnosis and treatment of the disease.

Source:
Neuroimaging as Tool for Diagnosis, Treatment in Sight:Identifying bipolar disorder is a priority. Clinical Psychiatry News. By: Miriam Tucker

Posted by Michelle Roberts at 12:46 PM | Comments (2)

August 9, 2007

Dark Therapy: A Possible Treatment For Bipolar Disorder

Insight Journal, which is an online resource maintained by the National Center for Health and Wellness, provided a short article on a possible new complementary treatment for bipolar disorder - dark therapy.

It's fairly well known that "light therapy" is sometimes used to help those suffering from depression, especially seasonal affective disorder. This type of mood disorder occurs when people are sensitive to the changes in natural light through the seasons. They are exposed to bright lights for certain amount of time each day, and research has shown that bright light can activate the production of serotonin. A depletion of serotonin is often considered the main neurotransmitter cause of depression.

It's clear that sleep/wake cycles are effected by bipolar disorder, and that disruptions in those cycles can exacerbate the disorder. Bipolar disorder does cause problems with the persons sleeping and waking cycles-but its more complicated than depression, you have a manic symptom as well. Also, research and many people’s personal experiences have found that lack of sleep can increase symptoms.

"Dark therapy" is much the opposite of light therapy. It focuses on exposing people to complete darkness – blocking blue spectrum lights (florescent, incandescent and LED). The theory is that spending this time in complete darkness with help reset the circadian rhythm (the body's natural sleep/wake rhythm) to a more normal level.

There isn't a lot of research for this complementary therapy yet. Recently "researchers at the Corvallis Psychiatric Clinic in Corvallis, Oregon studied what they called "virtual darkness," or artificial darkness created by amber lenses."

Dr. Jim Phelps of PsychEducation.org, and the Corvallis Psychiatric Clinic believes that dark therapy is beneficial in treating rapid cycling, and other symptoms of bipolar disorder. He believes that its one of the easiest things, with the least amount of side effects that someone with bipolar disorder can do to decrease the need for medications. Though he does not say to stop medications, but it may be good to augment medications with dark therapy.

They found that the 14 hours (6pm-8am) necessary for an effect was very inconvenient for the participants. Not only is that a long time, but its also difficult to maintain an environment of complete darkness for that long. They decided that instead of created full darkness they would used an amber lens to block the blue spectrum lights.

"This produced the effects of total darkness while allowing the patients to see and carry on evening activities. The key to dark therapy isn't necessarily to sleep for a full 14 hours. Instead, the bipolar patient would sleep for 8 of those hours and maintain light activity in virtual darkness for the other 6 hours. Using an amber lens to block the blue light allows for this light activity."

Further research is needed, and there is no evidence yet that this therapy will replace medications, but it is interesting to note that researchers are finding that non drug treatment can have significant effects.

Article:
Keeping bipolar disorder in the dark may just do the trick Insight Journal.

More Resources:

Bipolar Disorder and Sleep

Wake and Light Therapy for Bipolar Disorder Depression

Dark therapy for mania: a pilot study.

Bipolar Disorder, Light, and Darkness: Treatment Implications

Posted by Michelle Roberts at 10:43 AM | Comments (4)

August 7, 2007

Sleep Disorder Medication Studied as Treatment for Bipolar Disorder

A new study conducted by the Mayo Clinic, and in the August issue of the American Journal of Psychiatry is looking at the possible success of a sleep disorder medication to treat bipolar disorder. This study is only preliminary with 85 participants, but they have already found that it might be successful in controlling the depressive symptoms of bipolar disorder.

Mark Frye, author of the study, states that this is groundbreaking because currently there aren't many options for treating the depressive symptoms associated with bipolar disorder.

"Mood stabilizers in general are better at treating mania than depression, but the depressive phase of the illness is far more common. We really need continued research in this area."

The study looked at Modafinil, commonly called the "wake-up pill", because it's used to treat chronic sleepiness or excessive sleepiness like narcolepsy. Researchers put this drug together with bipolar disorder because the depressive symptoms are similar to the disorders it treats; excessive sleepiness and fatigue. Modafinil has been prescribed "off label" for other disorders, including ADHD, MS, and is even said to be a "smart drug" or a cognitive enhancer.

"This is a placebo-controlled study with real world community impact," Dr. Frye says. Half of the patients in the study were given modafinil, 100-200 milligrams daily, and the other half were given a placebo over a six-week period."

"While the trial was small, the 44 percent response rate was greater than that of the placebo group. Forty-four percent said they felt better, while 39 percent said their symptoms were in remission after six weeks. This compares to 23 percent and 18 percent in the control group. Modafinil was not associated with any greater risk of the manic and depressive mood swings associated with bipolar disorder."

Although there was this 44% response rate of decreased depressive symptoms in the group given Modafinil, the researchers are not sure what affect the drug had to alleviate these symptoms. They do not know how it works, but only that it is showing promising preliminary results. However, they do believe it's entirely different than psycho stimulants.

Though these results are promising, and the drug is deemed safe for other uses, it will be a while before we see psychiatrists prescribing it for bipolar disorder. More research is needed.

Press Release:
Mayo Clinic in Rochester: "Wake-Up Pill" Under Study to Treat Patients with Bipolar Disorder: Preliminary study shows drug's potential in treating the depressive phase of bipolar disorder

Research Article:
A Placebo-Controlled Evaluation of Adjunctive Modafinil in the Treatment of Bipolar (2007). Am J Psychiatry 164:1242-1249.

Corresponding Editorial:
Modafinil Add-On in the Treatment of Bipolar Depression

Posted by Michelle Roberts at 12:10 PM | Comments (2)

August 6, 2007

Dialectical Behavior Therapy for Adolescents With Bipolar Disorder

Here is a summary of an initial study on the benefits of Dialectical Behavior Therapy (DBT) used in the treatment of adolescents with Bipolar Disorder. This is a newer therapy with less than 20 years exposure to the mental health community that has been proven effective for other disorders. The results of the study, although preliminary, show that DBT may be an effective psychotherapy for bipolar disorder. We have also included numerous resources for further reading on DBT.

Who did the study?

Tina Goldstein PhD and colleagues from the Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center conducted this study. It was supported by the American Foundation for Suicide Prevention (AFSP), grants from University of Pittsburg and NIMH. It was released in the July issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

What did they study?

This article features a small study that looks at a therapeutic method not previously researched on adolescents with bipolar disorder. This therapy is called Dialectical Behavior Therapy (DBT), and is considered a “3rd wave” therapy, meaning it is of the newer generation in psychotherapy approaches (created in 1993). The study is very preliminary and does not include a control group -- therefore it has many limitations, and it’s hard to determine how this type of therapy measures up to other types, like cognitive behavioral therapy (CBT). But it is one of the first studies truly examining new and innovative therapeutic approaches on this growing population. Hopefully the results of the study, as well as its limitations, will only encourage more research into psychosocial treatments for people with bipolar disorder.

DBT was created by Marsha Linehan in 1993, and was the first therapy shown through control trails to be effective with Borderline Personality Disorder (BPD) clients, and it has been empirically validated with other populations. There are very significant similarities between BPD and bipolar disorder. Both exhibit mood swings, emotional dysregulation, chaotic relationships, instability, and behavioral disturbances to name just a few. These disorders are even similar enough that people are mistakenly diagnosed with one, when later it’s revealed they experience the other. There are some cases though, where people have co-occurring BPD and bipolar disorder. Because BPD can’t be diagnosed in teens, this study did not include any patients with known BPD.

DBT is a psychosocial cognitive-behavior therapy (though differing in some ways from CBT). DBT focuses on the larger context of behaviors, similar to a systems approach. This means that behaviors are understood in the context they occur; as in when, with whom, and where they occur. DBT also focuses on skill building in 4 areas, mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation. DBT utilizes “homework” and monitoring similar to CBT – clients are asked to keep a diary. Clients record in the diary their moods, stability of their mood, their behaviors, and application of skills learned in DBT. Traditionally DBT incorporates both individual and group therapy.

But one main difference of DBT – that is not usually a part of CBT -- is its integration of Buddhist and Zen philosophies, which are common in other “3rd wave” therapy approaches. DBT encourages clients to be mindful of the current moment. This concept of mindfulness is the intentional awareness of thoughts, feelings, experiences, and reactions. It also encourages clients to accept reality without judgment. Being mindful is highly beneficial because it allows people to take a step back and react with full intent. This means that a person can work to avoid reacting “irrationally”, over emotionally, or out of rage. This would be of great benefit for any adolescent, since impulse control can be difficult during that developmental period.

Why did they do it?

Bipolar Disorder in children and adolescents is an increasing issue. More children are being diagnosed earlier, and the course of the disorder is different than it is in adults. It currently affects about 1% of adolescents. Bipolar disorder is a particularly important issue when working with adolescents because its onset is associated with suicide, substance abuse, unprotected sex, and other risky behaviors. Bipolar disorder takes this already difficult developmental period, the teenage years, and makes it even more complex and hard to navigate through. Adolescents with bipolar disorder have a higher rate of psychosis, co morbidity, and hospitalization. Early intervention is very crucial; otherwise these teens with bipolar disorder can experience a “deteriorating course into adulthood, with poor outcomes including chronic functional impairment and treatment resistance.”


“To date, there are no empirically validated – supported by a wealth of research - psychosocial treatments for bipolar disorder adolescents.”

But there is some support for certain therapies, and promising results from initial trails. CBT, family-focused therapy, and psychoeducation have shown the most promise.

These researchers choose to look at DBT, and whether it can be beneficial for adolescents with bipolar disorder because of its emphasis on issues that plague bipolar disorder . The similarity of BPD and bipolar disorder clued these researchers in to the possibility of DBT working effectively for these adolescents.

How did they do it?

Because working with adolescents is different than working with adults, and suicide is an increased risk for those suffering with bipolar disorder, the researchers implemented DBT adapted for suicidal adolescents (Miller et al 1996). This incorporated “age-appropriate language, decreasing treatment length, and involving family members in skills training groups.”

Tina Goldstein PhD, the author of the paper, administered all the therapy; she received education on the DBT model, as well as training and supervision before and during the study. In the therapeutic community, being competent in a discipline is usually defined as having education, training, and supervision – all of which were met here.

The structure of the therapy included skills training, which was with done with the family unit in hopes of teaching new skills, and individual therapy, which was to help the adolescent apply these new skills in their lives.

“During the acute treatment period (months 1-6) participants received 24 weekly 60-minute sessions, alternating between the two modalities: 12 family skills training and 12 individual therapy sessions. The continuation phase of treatment (months 7-12) consisted of 12 total sessions (six family skills training, six individual therapy) during which the aim was to consolidate gains and review skills application.”

Family Skills Training
Sessions 1-2: Psychoeducation on bipolar disorder and emotional vulnerability, and emotional dysregulation

Emotional Vulnerability (experienced by adolescents with bipolar disorder)
1) Sensitivity to emotions: Things bother you that may not bother other people. Your emotional reactions are easily triggered.
2) Intensity of emotions: When something bothers you, your emotional reaction is more intense or extreme than it might be for other people. You feel things very strongly.
3) Duration of emotions: When you have an emotional reaction, it lasts longer for you than it might for other people. Your emotions take longer to come back down to baseline.

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Emotional Vulnerability + Difficulty Regulating Emotions = Emotional Dysregulation

*The 4 DBT modules*
Sessions 3-4: Mindfulness
Sessions 5-7: Distress Tolerance
Sessions 8-10: Emotional Regulation
Sessions 11-12: Interpersonal Effectiveness

Individual Therapy Sessions: Theses sessions were tailored to the individuals needs. Priority was given to issues such as suicide and medication nonadherence. Problems solving skills were taught, as well as behavioral management.

Skills Coaching by Telephone: Part of DBT is the openness and availability of the therapist. In this study the therapist was available by pager to provide telephone coaching as needed. The appropriateness of when to call was discussed, and over using this privileged - or under using it - was considered “therapy-interfering” behavior, and openly discussed in sessions.

Diary Cards: Participants completed diary cards daily, as part of their “homework” and progress. The diary cards assessed mood, sleep, suicidality, and medication adherence. The cards also asked which DBT skills were used, as well as logging individual goals of each client. Monitoring alone has been shown to be highly effective in changing behaviors – bringing awareness of behaviors to someone influences how they act - this diary technique not only monitors behaviors, but it also helps the client and therapist stay on the same page with regards to how the client did at home away from the therapy session.

Dialectical.Behavior.Therapy.BP%204.jpg

Medication Management: Because bipolar disorder is marked by difficult mood swings that may prove dangerous or inhibit other treatment, all clients were on medication to stabilize their moods and reduce bipolar disorder symptoms. The DBT therapist collaborated with the psychiatrist and medication management sessions were given weekly to bi-weekly till stabilization. After stabilization, clients saw the psychiatrist as needed and for routine check-ins.

Who were the participants?

The study included 10 participants and at least 1 family member, though only 9 completed the study – one relocated to another state and was unable to continue. Because this is an open trail and a very long (1 year) study, as well as one that requires a lot of activity/commitment on the part of the adolescent and the family, the small sample is not surprising.

The participants were between 12 and 18 years old, with 16 being the average age – all with a diagnosis of Bipolar Disorder, I, II, or NOS (not otherwise specified). All participants had either a depressive, manic, or mixed (both manic and depressive) episode in the 3-months prior to the study. They were all on medications, and some even had co morbid diagnoses; such as, anxiety, substance abuse, and suicide attempts. All participants had at least 1 family member willing and able to participate in the study and skills training, and none of them were currently participating in any psychosocial therapy.

These participants, when compared to the norm of adolescents with bipolar disorder, were considered highly symptomatic and more severely affected by bipolar disorder. The authors speculated this may be because more severely affected patients and families were more motivated to participate. This shows that DBT had benefit to those with severe symptoms, and may be more successful for those with milder bipolar disorder.

What were the results?

Feasibility: Because only 1 client withdrew, and not for reasons due to the structure of DBT, and each participant attended 90% of the session, DBT for the treatment of adolescents with bipolar disorder seems feasible and easy to administer.

Satisfaction: The study measured how satisfied the patients were by administering post treatment satisfaction questionnaires. Both adolescents and family members reported that the frequency of visits and the length of treatment were acceptable. Satisfaction ratings showed that they were also highly satisfied with the DBT approach, as well as the progress the patients made during the 1-year treatment.

“In fact, following the 12-month program, many parents expressed a desire for continued DBT.”

Suicide and Self-injurious Behaviors: Although 80% of the participants were suicidal at the start of the study, as well as some had attempted suicide in the past, there were not suicide attempts reported during the study. There was no significant change in non-suicidal self-injurious behavior – such as “cutting”, but non of these acts were reported in the last assessment of the study. This may mean that an improvement in these behaviors will occur if treatment continues longer.

Emotional Dysregulation: They measured emotional dysreulgation (which is often the difficulty in regulating ones emotions, and displaying extreme emotional responses) with the Children’s Affective Liability Scale (CALS), which has been validated in other studies as an effective measuring tool. They found that initially, participants had scores similar to those of psychiatric inpatients. At the completion of the DBT treatment, the participants had scores below that of outpatient samples. This means that patients were better at regulating their emotions.

Mood Symptoms: The participants showed significant improvement in depressive symptoms. There were no differences reported on manic symptoms, but the authors note that manic ratings were fairly mild even before starting treatment.

Interpersonal Functioning: There were no significant improvements with interpersonal functioning reported.

Limitations:

Because this study has a small sample size, its not the most reliable study for all adolescents suffering from bipolar disorder. The study also lacks a control group, or a comparison to other therapeutic methods, such as CBT, psychoeducation, and family-focused therapy – all of which are promising treatments for this population.

The authors encourage future studies, with more participants, and controlled trails. They also plan to further examine post treatment DBT skill acquisition, meaning how much of the DBT skills did the clients learn, and therefore how much was the skill learned related to their improvement.

Take Home message:

DBT is a unique approach that combines emotional regulation learning, and mindfulness with behavioral approaches. It’s a possible new therapeutic method for treatment of adolescents with bipolar disorder. Because its intent is for a disorder marked by similar symptoms and deficits, it’s an appropriate method of treatment. DBT is empirically valid for other populations and further study may reveal its full potential for treating bipolar disorder. DBT is currently used in many treatment centers, even those dealing with substance abuse, psychotic disorders, and dual diagnosis. The results here are preliminary, but promising, and should encourage further research into DBT’s benefits on bipolar disorder.

Full Article:
Dialectical Behavior Therapy for Adolescents With Bipolar Disorder: A 1-Year Open Trial.

DBT Resources:

DBT Therapist Directory

DBT Self Help Website: Created by individuals who have gone through DBT, not by professionals.

Behavioral Tech, LLC: Marsha Linihans DBT resource site.

Some Books on DBT:
Dialectical Behavior Therapy Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, & Distress Tolerance (good for both clients and clinicians)
Don't Let Your Emotions Run Your Life: How Dialectical Behavior Therapy Can Put You in Control
The High Conflict Couple: A Dialectical Behavior Therapy Guide to Finding Peace, Intimacy, & Validation

Some Centers Offering DBT Programs
Youth Care: a therapeutic boarding school and residential treatment center for youth
Le Salva Group for Mental Health, Palo Alto Ca.
Lakeview Center for Psychotherapy, Chicago: site offers basic FAQs about DBT.
DBT Center of Michigan
Walden House, San Francisco Based: Substance Abuse and Dual Diagnosis Program
San Francisco DBT Center: Offers everything DBT, therapy, resources, and training.


Posted by Michelle Roberts at 1:40 AM | Comments (9)

August 2, 2007

Los Angeles Bipolar Disorder Genetics Study for Latino Community - Opportunity to Participate

We recently received the following letter about a bipolar disorder genetics research study taking place that the University of California Los Angeles - and we encourage you to read about it and participate if you can. The information is repeated at the bottom of the page in Spanish for people who prefer that language.

Briefly, the purpose of this study is to find genes that make people more likely to suffer from bipolar disorder.
Inclusion criteria:
-Patient with previous hospitalization or clinical diagnosis of bipolar disorder and/or schizoaffective, bipolar type.
-Onset before age 50
-Has a sibling with same diagnosis who is willing to participate
-Male or female 15-85 years of age
-Has at least 2 grandparents of Mexican or Central American descent

Exclusion Criteria:
-Severe substance abuse or medical illness which obscures diagnosis of bipolar disorder
-No sibling with psychiatric disorder
-Unable or unwilling to contribute a blood sample and interview

The study consists of the following procedures at one or more visits for each family member who participates:
-Diagnostic Interview regarding history of mental health problems of the patient and their family ($50)
-Tests to measure cognitive abilities ($25)
-Medical record review on past and current psychiatric treatment
-Blood samples will be drawn for genetic testing ($25)

The study consists of a diagnostic interview and blood sample for genetics tests.

For more information, please contact:

Ricardo Mendoza, M.D. - Telephone Number: 310.222.1800
Deborah Flores, M.D. - Telephone Number: 310.222.3133
Lorraine Garcia-Teague, Ph.D. - Telephone Number: 310.222.5260

Los Angeles BioMedical Research Institute
1124 WEST CARSON STREET * TORRANCE CA 90502
IRB NUMBER: 11260-01R2
IRB APPROVAL DATE: 2/10/2006

Background Information

"Our project received funding on August 12, 2005 to investigate the "Genetics of Bipolar Disorder in Latino Populations".

The Principal investigator is Ricardo Mendoza, MD. Co-investigators: Deborah Flores, MD; Alex Kopelowics, MD; and Lynn Marcinko, PhD. The proposed research is a five-year grant funded by the National Institute of Mental Health (NIMH).

An international consortium of psychiatric investigators from Costa Rica; San Antonio, Texas; Los Angels, CA; San Diego, CA; and Mexico City, has been assembled to accomplish this task of uncovering the susceptibility gene(s) for bipolar disorder. The intent is to map bipolar predisposition genes that are prominent in the Latin American population, with a special focus on the Latin Americans of Mexican and Central American descent because this population is now the largest single ethnic group in the United States.

Additionally, this population has been largely untapped in previous genetic studies of Bipolar disorder and has more individuals per family than other ethnic groups and has genetic isolates which may aid in the fine-mapping of susceptibility loci identified from initial genome screens. And since we are recruiting families (affected siblings and non-affected siblings) to draw blood from and interview, this is important.

The methodological design of the protocol is fairly straightforward and except for the final year of the study, the research is largely a recruitment study. The methodology does not include a form of treatment, therefore, risks associated with the research are minimal. Further, interference with on-going and current treatment should not be affected.

Latino families will be identified that are characterized by having at least two children that are afflicted with bipolar disorder. The diagnosis will be carefully assessed utilizing the Diagnostic Interview for Genetic Studies (DIGS), a rigorous structured clinical interview. Also, utilizing another structured clinical interview, an additional, non-affected family member will be asked a series of questions aimed at corroborating the history obtained from those suffering with the illness along with medical record abstraction. A database will be constructed without the use of patient identifiers for confidentiality. The blood of several family members, including both individuals affected with bipolar disorder along with those non-affected, will be drawn and shipped to a national repository at the NIMH.

The purpose of this research is to find the genes implicated in bipolar disorder. Adult men and women who have been diagnosed with bipolar disorder and have a sibling with the same diagnosis are needed. The immediate family will be asked to take part.

El objectivo del estudio es la identificación de los genes implicados en el trastorno bipolar.
Necesitamos mujeres y hombres diagnosticado con el trastorno bipolar que tengan un(a)
hermano(a) con el mismo diagnostico. La participación de la familia inmediata será
necesario.

El estudio consiste de una entrevista diagnostica y una muestra de sangre por examen genético.

LOS PARTICIPANTES RECIBIRÁN COMPENSACIÓN
MONETARIA

Para solicitor mas información, favor de llamar a:

Ricardo Mendoza, M.D. 31Ricardo - Tele: 310-222-1800
Deborah Flores, M.D. - Tele: 310-222-3133
Lorraine Garcia-Teague, Ph.D - Tele: 310-222-5260

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