Bipolar Disorder Daily News Blog

New Database to Help Specify Genes Linked to Bipolar Disorder

Johns Hopkins University, Department of Psychiatry and the National Institute of Mental Health have teamed together to create a new, innovative and free database, which researchers are saying is going to increase their ability to pinpoint genes linked to bipolar disorder. The database, called The Bipolar Disorder Phenome Database, is revolutionary in its ability to offer "...detailed descriptions of symptoms and course of disease on more than 5,000 people with bipolar (disorder)..."

Because DNA samples are available for this group, the database will let researchers correlate specific symptoms with sequences of genetic material. The new database...is meant to complement the massive bodies of genetic data generated already by the Human Genome Project, the International HapMap Consortium and the Genetic Analysis Information Network.

"This database describes the clinical picture of bipolar disorder in the fullest detail possible," said James Potash, who led the Johns Hopkins portion of efforts to assemble the site. "It also lets us pick out meaningful clusters of symptoms that will ultimately help identify genes."

These clusters of symptoms enable scientists to notice DNA and genes that stand out. For example, if they group together patients who developed bipolar disorder early or patients who experience panic attacks, then they're more likely to notice DNA that stands out in those groups. Apparently, scientists have used this same clustering to find genes that are now known to be associated with conditions such as breast cancer and Alzheimer's disease.

Another advantage The Bipolar Disorder Phenome Database has is that it cuts down the costs of collecting data from patients. The database already stores data collected from two large national studies conducted over a twenty-year period. Thus researchers are able to tap into this data when using the database without the cost of collecting new data.

Full Story: New Databases Put Wings on Search for Bipolar Risk Genes (The JHU Gazette)
More Information: Mood Disorders at Johns Hopkins Psychiatry

New Study on Children With Bipolar Disorder & Their Response to Facial Expressions

As we've covered in the past, children with bipolar disorder often misread facial expressions. Now new research further supports this finding:

Children with bipolar disorder respond differently to facial expressions than children without psychiatric disorders, according to a new study led by a Bradley Hospital researcher. These findings provide additional insight into the neurobiology of pediatric bipolar disorder.

"Although we know a great deal clinically about bipolar disorder in kids, our understanding of its neurobiology is quite limited, making it difficult to design targeted treatments," said lead author Daniel P. Dickstein, M.D., director of the pediatric mood, imaging and neurodevelopment program at Bradley Hospital. "We used neuroimaging technology to study the brain-behavior interactions of children with bipolar disorder in hopes of shedding some light on this relatively unknown area."

The study included 23 children with bipolar disorder and 22 typically developing children without psychiatric disorders between the ages of 7 and 17. Dickstein and his team used functional magnetic resonance imaging (MRI), a non-invasive technique that localizes regions of the brain activated during cognition and experience, to scan the children while they "encoded" different facial expressions.

During the MRI scan, the children viewed photos of 32 different actors -- eight actors each displaying one of four emotions (angry, fearful, happy and neutral) -- from standard gray-scale photograph sets of facial expressions. After seeing the photos four times, they rated each face by answering questions such as "How afraid are you?" "How hostile is the face?" and "How wide is the nose?"

Thirty minutes after the MRI scan, children were given a surprise out-of-scanner memory task, during which they viewed 48 actors (half of which were seen previously during the MRI and half that were not previously viewed). They were then asked whether they recalled seeing the face during the earlier test.

During the encoding of "happy" faces, researchers observed increased activity in the region of the brain (striatum) associated with rewards in the children with bipolar disorder. Increased activity was also found in the part of the brain (orbitofrontal cortex) linked to irritability when the same children encoded "angry" faces. Brain activity in both instances was significantly greater than in children without bipolar disorder.

Based on the number of correct identifications during the memory task, Dickstein and colleagues also found that children with bipolar disorder demonstrated reduced memory for emotional faces as compared to children without bipolar disorder -- particularly with "fearful" faces.

"This study suggests a neural basis for mania in children, which typically involves unusually irritable or excessively happy moods, and raises questions about whether treatments, therapy or medication could address these brain changes," Dickstein said.

The authors say further research is required to determine the impact of mood state, medication and the presence of an additional illness, such as attention deficit hyperactivity disorder, on these findings.

Full Story: Facial Expressions Have Greater Impact On Kids With Bipolar Disorder (ScienceDaily)

An Increased Risk for Suicide: Bipolar Disorder and a Family History of Suicide

A new study out of the UK shows that people who suffer from bipolar disorder and who also have a family history of suicide, may be at a higher risk for committing suicide themselves. Specifically, bipolar patients with a family history of suicide are three times more likely to attempt suicide than is the rest of the population.

Yet this increased risk of suicide isn't concentrated around just bipolar patients. As Dr. Eduard Vieta, one of the study's authors states, a family history of suicide also increases the risk of suicide for people who suffer from other mental illnesses. He's careful to point out though, that this genetic risk for suicide doesn't make the act inevitable. Rather, knowledge of your family history should lead to engaging in preventative behavior and education about suicide.

Prior to this study, two other studies also found an increased risk of suicide in bipolar sufferers with a family history of suicide. However, the data collected for these studies were from hospital records. To ensure more reliability, Dr. Vieta and his colleagues performed their study by "evaluat(ing) 374 men and women, ranging in age from 19 to 88 years, who met standard criteria for a diagnosis of bipolar illness. Forty-eight of these patients had a family member who had committed suicide." They found that "(p)eople with a family history of suicide were more likely to have anxiety-related personality traits than those who did not. More than 52 percent of the family-history patients reported a suicide attempt compared with 26 percent of patients with no family history of suicide."

The researchers stress that the main thing to take away from these findings is the importance of preventative efforts, i.e., they think the focus should be on first identifying patients who suffer from mental illness and who have an increased risk for suicide and then to educate these patients on the prevention of suicide. Dr. Vieta provides the following analogy to better understand suicide in the context of mental illness: "Suicide should be thought of as a complication of mental illness, just as death from a heart attack is seen as a risk for people with cardiovascular disease..."

Dr. Vieta also emphasizes the importance of choice and prevention, highlighted in the following quote:

There is a lot of room for prevention if clinicians are aware and people are aware that some people are at higher risk of suicide than others," Vieta said. Even though genes may largely be responsible for the inheritability of suicidal tendencies, he added, "we still have some free will. Genetics doesn't mean that you are impelled to do what your genes tell you to do.

Full Story: Some bipolar patients have higher suicide risk (Reuters)

Abstract: Relevance of Family History of Suicide in the Long-Term Outcome of Bipolar Disorders
(Journal of Clinical Psychiatry, 2007)

Some Past Stories on Suicide:
1. New National Suicide Prevention Hotline
2. Suicide Among Youth - Treatment Responses
3. Environmental Stressors Increase Suicide Risk

Discussion: Research Findings on the Psychological Causes and Treatments of Bipolar Disorder

We've covered past research that demonstrates how high levels of certain kinds of expressed emotion have negative effects on the mental health of children. Recently, researchers at the University of Colorado discussed current research supporting this past research on bipolar disorder. A new story highlights their findings:

Bipolar disorder is "a highly recurrent and debilitating illness." Research has demonstrated that certain types of expressed-emotion affect the development of bipolar disorder. Basically, certain negative attitudes in the home or from peers (such as critical ones, i.e., criticism) can increase not only the risk of developing bipolar disorder, but also the risk of relapsing after development. [Read More About the Effects of Expressed Emotion Here.]

Symptoms of bipolar disorder are primarily treated by medication but can also benefit from simultaneous therapy. Past research has demonstrated that a combination of family-focused therapy and medications can "...delay...relapses and reduce... symptom severity among patients followed over the course of 1 to 2 years..." [Read More About Family-Focused Therapy Here.]

The researchers further stated that the effectiveness of family-focused therapy on delaying the development and relapse of bipolar disorder, specifically in the case of adolescents and children at high risk for the illness, are currently being investigated.

This discussion of up-to-date research findings brings up the important psychological factors at play in the development of mental illness in children and adolescents. Knowledge about these factors is essential to preventing the possible development or relapse of bipolar disorder.

Related Reading: CU professor to pioneer new bipolar disorder study

Listen to this Podcast (audio recording): Click on the following link and then scroll down to the podcast named: BIPOLAR DISORDER; Scientists at University of Colorado discuss research in bipolar disorder.

New Bipolar Disorder Studies at Stanford University - participants needed

Researchers at the Stanford University School of Medicine (in Palo Alto, California) are seeking volunteers for several research studies on bipolar disorder, which affects more than 10 million American adults.

The illness typically requires lifelong treatment, and researchers have been studying which medications are the most effective. "We're aiming to enhance the treatment of bipolar disorder by exploring agents with greater efficacy for mood symptoms and/or greater physical tolerability," said Terence Ketter, MD, professor of psychiatry and behavioral sciences and chief of the Bipolar Disorders Clinic, who is leading the studies.

Participants in each study must be ages 18 to 65 and have a diagnosis of bipolar disorder, an illness that is marked by episodes of mania and depression that can last from days to months.

Study 1: This study is examining the effectiveness of armodafinil as an add-on therapy for bipolar patients experiencing major depression.

Who is eligible: Volunteers for this study must be suffering from depression and currently taking divalproex sodium, lithium and/or olanzapine.

What is required: Participants will be carefully evaluated and assigned by random to receive either armodafinil or a placebo for a period of eight weeks. They will be monitored by a psychiatrist and be compensated for time and travel expenses.

For additional information, please contact Shelley Hill at (650) 498-4801 or shill@stanford.edu.

Study 2: This study focuses on the use of quetiapine to treat bipolar patients with both hypomania and depression.

Who is eligible: Volunteers for this study must be experiencing both hypomania -- a distinct period of elevated mood, lasting for at least four days -- and depressive symptoms.

What is required: Participants will be carefully evaluated and assigned by random to receive either quetiapine or a placebo for a period of eight weeks. They will be monitored by a psychiatrist and be compensated for time and travel expenses.

For additional information, please contact Kristine Keller at (650) 498-4968 or klkeller@stanford.edu.

Study 3: During this study, researchers are looking at the use of olanzapine to treat patients experiencing increases in symptoms of bipolar disorder.

Who is eligible: Volunteers for this study must be experiencing an obvious increase of bipolar symptoms, including hypomania and depression. They must have been on medication for at least two weeks.

What is required: Participants will be carefully evaluated and assigned by random to add olanzapine or a placebo to their other medications for one week. At the end of this period, all participants will receive olanzapine for one week while being monitored by a psychiatrist. Volunteers will be compensated for time and travel expenses.

For additional information, please contact Kristine Keller at (650) 498-4968 or klkeller@stanford.edu.

The researchers are also continuing to recruit volunteers for an ongoing study on the use of ziprasidone to treat bipolar patients experiencing weight gain, a common side effect of some medications. Over a 12-week period, participants will be carefully evaluated and treated with ziprasidone, and efforts will be made to decrease or discontinue medications implicated in weight gain. For additional information, please contact Kristine Keller at (650) 498-4968 or klkeller@stanford.edu.

Bipolar Disorder and Attitudes Toward Having Children

A new study out of Australia which will appear in the journal Psychological Medicine has found that over a third of relatives of people with bipolar disorder are afraid to have children. The reason for their fear seems mainly to be stigma associated with the disorder.

Despite a lower risk as compared to other genetic disorders, bipolar disorder aroused a more negative attitude from the 200 people who participated in the study, which was conducted at University of New South Wales. Even more surprising is that over half of the participants suffer from bipolar disorder themselves. Researchers state that studies on other hereditary diseases such as cancer do not demonstrate any significant difference of attitudes toward having children even though the genetic risks are much higher than for bipolar disorder. They state the importance of education for people suffering from and/or with a family history of bipolar disorder. One researcher states that "(p)roviding families with genetic risk information is important, but this study suggests that society as a whole needs to be better educated about mental health disorders, and in particular the effective treatments available for these."

Full Story:The Sydney Morning Herald, Too scared to have children

Related Research Article:Attitudes towards childbearing, causal attributions for bipolar disorder and psychological distress: a study of families with multiple cases of bipolar disorder, MEISER B et al(2007). Psychological Medicine, 37: 1601-1611.

Signs of Bipolar Disorder in Teens and Young Adults

Recently, we've covered stories on bipolar disorder in youth. With the rise in the number of teens diagnosed, it's important to know what signs to look for. But as the story which recently appeared in The San Diego Union-Tribune points out, knowing the signs may not be enough. The problem is that many parents notice abnormal behavior in their children but chalk it up to an "adolescent or teenage phase" that will pass. And though this may be the case for most teens, for the best possible prognosis, those suffering from mental illness should be diagnosed and treated as soon as possible. The story gives the examples of two teens who were diagnosed only after one became suicidal and the other was hospitalized because of a psychiatric breakdown. The second teen wished she had been diagnosed sooner, stating, "...parents should really try to get to know their child. Ask how they feel about themsel(ves) and the world. Ask them about their hopes and dreams...Nobody asked me, but if they would have, I'd have told them I wanted to live on the planet Pluto with nobody around me."

"Although some children have vague symptoms at age 10 to 12, the signs of bipolar disorder, severe depression and schizophrenia usually draw attention and peak at 17 to 22, according to the National Institute of Mental Health. Mental health experts believe that this unfortunate timing is triggered by changes in the brain. However, it also may be exacerbated by stress."

Some signs to watch out for: (If you notice any of these for extended periods of time, ask your child about them.)

"Increased isolation and social withdrawal. Children may lock themselves in their rooms and not spend as much time as they used to with friends and family."

"Severe overreaction to a situation, such as sobbing over one bad grade or screaming at someone who took a desired seat."

"Extreme indifference and lack of motivation."

"Severe anxiety or fearfulness."

"Deteriorating grades or job performance. This change will be noticeable, because the majority of children who have mental disorders are very bright and good students."

"Sleeping too little or too much."

"Excessive drinking or drug use." This is often something that parents notice but don't correlate with mental illness. It's important to stress that though not all children abusing drugs are suffering from mental illness, drug abuse is a risk factor and sometimes the result of suffering from mental illness. As mentioned in the story, drugs are often a method of self-medication for the mentally ill.

More Signs and the Full Story: The San Diego Union-Tribune, Knowing warning signs of adolescent mental health problems can lead to an essential early diagnosis and medical care
To Learn More About Symptoms and Diagnosis