September 16, 2008

New Medications Coming

Most new drugs that are used in treatment for schizophrenia have also been found to be helpful in bipolar disorder, and have been approved for use in treatment of bipolar disorder. Wired magazine writes about a series of new drugs that are in the research phase and may (if they prove effective) eventually be used in treatment for schizophrenia and bipolar disorder.

Read the story: Angel Dust Inspired a new Schizophrenia Drug

Posted by szadmin at 10:41 AM | Comments (6)

Interesting Interview with Brain Scientist Nancy Andreasen

There is a fascinating interview with Nancy Andreasen, a leading brain researcher, in today's New York Times. In the interview she discusses her research she's been doing for the past 18 years and which is not yet published. Much of her research is related to schizophrenia, but because schizophrenia is thought to have a lot of genetic overlap with bipolar disorder - her research may also be relevant to bipolar disorder.

In it she notes "The big finding is that people with schizophrenia are losing brain tissue at a more rapid rate than healthy people of comparable age. Some are losing as much as 1 percent per year. That’s an awful lot over an 18-year period."

In response to this interview - researchers have made the following comment:

Re “A Conversation With Nancy C. Andreasen” (Sept. 16): We have to express concern about Dr. Andreasen’s comments on the loss of brain tissue in individuals with schizophrenia.

She implies that such loss is caused by antipsychotic drugs despite the fact that it was clearly described before such drugs became available. The fact that “the more drugs you’ve been given, the more brain tissue you lose” may be explained by the fact that individuals with more severe schizophrenia are given more drugs.

We are particularly concerned that the studies that she cites have not been subject to the process of peer review. Your readers should be cautioned not to accept findings in complex disorders such as schizophrenia until they are subject to scientific scrutiny.

Robert Yolken, M.D.
Baltimore

E. Fuller Torrey, M.D.
Chevy Chase, Md.
Dr. Yolken is a professor of pediatrics at Johns Hopkins School of Medicine, and Dr. Torrey is executive director of the Stanley Medical Research Institute in Gaithersburg, Md.

Read the interview: Using Imaging to Look at Changes in the Brain

Posted by szadmin at 10:36 AM | Comments (7)

McCain and Obama Health-care Plans Analyzed

This morning the Wall Street Journal covers the recent analysis of the health-care proposals of the McCain and Obama campaigns. Health-care coverage is, of course, a huge issue for families where a child or spouse has bipolar disorder and all the associated high costs of in and out-patient treatment. Many people who have bipolar disorder have a difficult time maintaining consistent employment so may not have employer health insurance benefits on an ongoing basis. For this reason, we recommend you study the proposals of each of the candidates closely.

The WSJ notes:

"Republican presidential candidate John McCain's health-care plan would make only a small dent in the ranks of the uninsured, at best covering about five million more people, two new reports conclude.

Democratic nominee Barack Obama would cover more people -- eventually adding about 34 million, according to one of those reports, by the nonpartisan Tax Policy Center.

Sen. Obama's plan would be costly, the center concluded: $1.6 trillion over 10 years. Sen. McCain's would cost nearly as much: $1.3 trillion over the same span. The center doesn't give either campaign credit for initiatives to reduce the cost of health care."

Read the full story at the Wall Street Journal: Studies Detail Contrasts in Rivals' Health-Care Plans

Posted by szadmin at 8:30 AM | Comments (1)

September 15, 2008

NIMH study suggests that Newer Antipsychotics No Better Than Older Drug for Treating Child and Adolescents

A new study by the National Institute of Mental Health suggests that two newer atypical antipsychotic medications were no more effective than an older conventional antipsychotic in treating child and adolescent schizophrenia and may lead to more metabolic side effects. While this study focuses on the use of the medications in youth diagnosed with schizophrenia - frequently these same medications (Risperdal and Zyprexa) are also used in the treatment of adolescent bipolar disorder.

“Schizophrenia and schizophrenia-related disorders are rare in childhood. But when they do occur, those afflicted generally have more severe symptoms and a worse prognosis than those who develop the disorder in adulthood,” said NIMH Director Thomas R. Insel, M.D. “The newer atypical antipsychotics are often used to treat these children, but until now, it has been unclear how effective and safe they really are in children. The side effects of the newer medications should be factored into making treatment decisions.”

The six-year, multisite Treatment of Early Onset Schizophrenia Study (TEOSS) included 116 youth between 8 and 19 years old, diagnosed with early onset schizophrenia spectrum disorder (EOSS). The TEOSS team randomly assigned the children to eight weeks of either olanzapine (Zyprexa) or risperidone (Risperdal)—both new generation atypical antipsychotics—or to the older conventional antipsychotic molindone (Moban) plus benztropine, a medication often used to reduce side effects like uncontrolled shaking or tremor that can be associated with molindone. The children were monitored throughout the study by an NIMH oversight board to ensure their safety.

Response rates after eight weeks of treatment were comparable among the three medications—50 percent of the children taking molindone improved, 46 percent taking risperidone improved, and 34 percent taking olanzapine improved. Children taking olanzapine or risperidone improved within the first two weeks, while the children on molindone improved within three weeks.

The treatment groups did differ in side effects. The children taking olanzapine gained about 13 pounds (6 kilograms) during the trial on average, while children taking risperidone gained about 8 pounds (3.6 kilograms), and those taking molindone did not gain weight. The olanzapine group also showed increases in cholesterol levels and other metabolic disruptions that may have become dangerous. The outcome prompted the safety review board to end the olanzapine arm of the study in 2006.

“Atypical antipsychotics are commonly used to treat kids with EOSS, but these results question the wisdom of that approach,” said lead author Linmarie Sikich, M.D., of the University of North Carolina at Chapel Hill. “They also remind us that we need to develop safer, more effective medications to treat these children, given the limited effectiveness of both the atypical and the conventional medications.”

Study coauthor Jeffery Lieberman, M.D., of Columbia University Medical Center, noted that TEOSS is the first documented evidence of how newer antipsychotics compare to older ones when treating children and adolescents with schizophrenia. “Doctors need to educate families about the potentially serious side effects these drugs can have so that strategies can be put into place to address them,” he reiterated. The TEOSS results are similar to those found in the NIMH-funded Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), for which Lieberman was the principal investigator. CATIE found that the newer antipsychotics were no more effective than an older antipsychotic in treating adults with schizophrenia.

TEOSS was conducted at the University of North Carolina at Chapel Hill, Harvard University, Seattle Children’s Hospital, and Case Western Reserve University.
Reference

Sikich L, Frazier JA, McClellan J, Findling RL, Vitiello B, Ritz L, Ambler D, Puglia M, Maloney AE, Hunt-Harrison T, Jackson JA, De Jong S, Slifka K, Noyes N, Michael E, Hlastala S, Pierson L, McNamara NK, Delporto-Bedoya D, Anderson R, Hamer RM, Lieberman JA. Comparative efficacy of antipsychotics in early onset schizophrenia. American Journal of Psychiatry

Posted by szadmin at 2:17 PM | Comments (1)

Childhood Bipolar Disorder Covered in NY Times

There is a good story that starts with one family's experience with childhood bipolar disorder in this week's New York Times magazine. The story chronicles the early life of "James" as he develops the disorder and eventually gets treatment.

Using that personal story as a background, the author then digs into the current controversies around the disorder and other families stories. Describing the issue that is around the exact frequency of bipolar disorder in children, the author notes:


"A study last fall measured a fortyfold increase in the number of doctor visits between 1994 and 2003 by children and adolescents said to have bipolar disorder, and the number has likely risen further. Most doctors I spoke with found the “fortyfold increase” misleading, since the number of bipolar kids at the beginning of the study was virtually zero and by the end of the study amounted to fewer than 7 percent of all mental-health disorders identified in children. Many also said that because bipolar children are often severely ill, they can proportionately account for more doctors’ visits than children with other psychiatric complaints, like A.D.H.D. or Anxiety Disorder. Still, nearly every clinician I spoke to said that bipolar illness is being overdiagnosed in kids. In Leibenluft’s studies at the National Institute of Mental Health, only 20 percent of children identified with bipolar disorder are found to meet the strict criteria for the disease.

Read the full story: The Bipolar Puzzle (New York Times)

Furious Seasons blog issued a rebuttal to the article here

Posted by szadmin at 1:22 PM | Comments (3)

September 3, 2008

Children of Older Fathers at Higher Risk for Bipolar Disorder

Research over the past decade has clearly shown that children of older fathers have a higher risk for schizophrenia because their sperm is more likely to have damaged DNA in them due to the ravages of time. Now new research has identified the same risk for bipolar disorder - a disorder that is believed to be genetically and environmentally close to schizophrenia.

A new study by researchers at the Swedish medical university Karolinska Institute suggested that older age among fathers is associated with an increased risk for bipolar disorder in their offspring,.

Bipolar disorder is a common, severe mood disorder involving episodes of mania and depression. Other than a family history of psychotic disorders, few risk factors for the condition have been identified. Older paternal age has previously been associated with a higher risk of complex neurodevelopmental disorders, including schizophrenia and autism.

Postgraduate student Emma Frans and colleagues at the Department of Medical Epidemiology and Biostatics identified 13,428 patients in Swedish registers with a diagnosis of bipolar disorder. For each one, they randomly selected from the registers five controls who were the same sex and born the same year but did not have bipolar disorder.

When comparing the two groups, the older an individuals father, the more likely he or she was to have bipolar disorder. After adjusting for the age of the mother, participants with fathers older than 29 years had an increased risk. The offspring of men 55 years and older were 1.37 times more likely to be diagnosed as having bipolar disorder than the offspring of men aged 20 to 24 years.

The offspring of older mothers also had an increased risk, but it was less pronounced than the paternal effect, the authors note. For early-onset bipolar disorder (diagnosed before age 20), the effect of the father's age was much stronger and there was no association with the mother's age.

As men age, successive germ cell replications occur and new mutations accumulate monotonously as a result of DNA copy errors. Women are born with their full supply of eggs that have gone through only 23 replications, a number that does not change as they age. Therefore, DNA copy errors should not increase in number with maternal age.

Consistent with this notion, we found smaller effects of increased maternal age on the risk of bipolar disorder in the offspring, says Emma Frans.

Source: Advancing Paternal Age and Bipolar Disorder, Archives of General Psychiatry, 1 september 2008; 65[9]:1034-1040.

Posted by szadmin at 12:25 PM | Comments (2)