September 21, 2009

Children of Bipolar Parents

Apropos of our recent post on September 17, we came across a University of Pittsburgh Study released earlier this year which offers additional information about children of bipolar parents. Children and teens of parents with bipolar disorder have an increased risk of early-onset bipolar disorder, mood disorders and anxiety disorders, according to a study by University of Pittsburgh School of Medicine researchers published in the March issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

An estimated one in 100 children and teens worldwide has bipolar disorder. Identifying the condition early may improve long-term outcomes, potentially preventing high psychosocial and medical costs. Researchers from the Pittsburgh Bipolar Offspring Study suggest that having family members with bipolar disorder is the best predictor of whether their children will go on to develop the condition.

"A bipolar diagnosis at a young age deprives children of the opportunity to experience normal emotional, cognitive and social development, and this is why there is an urgent need to identify, diagnose and treat these patients early on," said Boris Birmaher, M.D., director of the Child and Adolescent Anxiety Program and co-director of the Child and Adolescent Bipolar Services at Western Psychiatric Institute and Clinic of UPMC, endowed chair in Early Onset Bipolar Disease and professor of psychiatry at the University of Pittsburgh School of Medicine.

Compared with the offspring of control parents, children with bipolar parents had a 14-fold increased risk of having a bipolar spectrum disorder, as well as a two-to three-fold increase of having a mood or anxiety disorder. Children in families where both parents had bipolar disorders also were more likely to develop the condition than those in families containing one parent with bipolar disorder. However, their risk for other psychiatric disorders was the same as children who had one bipolar parent.

Bipolar disorder, commonly called manic-depression, often emerges in adolescence, and is characterized by intense swings between depression, mania and periods with mixed symptoms. Bipolar spectrum disorders consist of three sub-types. Bipolar I (BP-I) is characterized by episodes of full-blown mania and major depression; bipolar II (BP-II) involves episodes of less severe mania, called hypomania, and major depression; and the third sub-type is called Bipolar Not Otherwise Specified (BP-NOS), which involves symptoms consistent with elated or irritable moods that are disruptive to daily living, plus two to three other symptoms of bipolar disorder.

In this blind study, researchers compared 388 children and teens, ages 6 to 18, of 233 parents with BP-I and BP-II to 251 offspring of 143 demographically matched control parents. Parents were assessed for psychiatric disorders, family mental health history, family environment, exposure to negative life events, and also were interviewed about their children. Children were assessed directly for bipolar disorder and other psychiatric disorders by researchers who did not know their parents' diagnoses.

"Consistent with prior research, most parents with bipolar disorder recalled that their illness started before age 20 and about 20 percent had illness that started before age 13," said Dr. Birmaher. "In contrast, most of their children developed their first bipolar disorder episode before age 12, suggesting the possibility that parents were more perceptive of their children's symptoms early in life or perhaps that bipolar disorder appears earlier in new generations."

The researchers note that these findings have important clinical implications. "Clinicians who treat adults with bipolar disorder should question them about their children's psychopathology to offer prompt identification and early interventions for any psychiatric problems that may be affecting the children's functioning, particularly early-onset bipolar disorder," said Dr. Birmaher. "Further studies are needed to help determine the clinical, biological and genetic risk factors that may be modified to prevent the development of psychiatric disorders in the children of those with bipolar disorder."

For more information about this study, you can access the study abstract in the Archives of General Psychiatry at http://archpsyc.ama-assn.org/cgi/content/abstract/66/3/287

Posted by Michael Lane at 3:58 PM | Comments (0)

September 17, 2009

Genetic link between Adults and Children with bipolar disorder

Many bipolar patients must face the terrifying prospect that their illness may be passed along to their children!

A recent Q&A post from CNN Health.net caught our attention:

Question: "My boyfriend and I discussing getting engaged and having children one day. He said he's scared to have kids. His biological grandmother and his father both have been diagnosed with bipolar disorder. He has no symptoms of it, but some of his siblings do. He is terrified that his children could inherit this disorder! My family has no history of it at all. Since neither of us have it, should we be worried?"

Expert (Dr Charles Raison) answer:The answer -- as best as we know from many studies over the years -- is that you should be worried but not terrified. Although we have very little definitive knowledge about which genes cause bipolar disorder (i.e., manic depression) or how they might do it, there is no doubt that the disease runs in families. Moreover, a person's risk of coming down with bipolar disorder is directly proportional to how many relatives have it and how close they are genetically to the individual.

Consider the situation with twins. If you are an identical twin and your twin has bipolar disorder you have a 50 percent chance of having or getting it yourself. If you are a non-identical twin the risk falls to around 10 percent in most studies. If both your parents have bipolar disorder you have a 50 percent chance of getting it say some studies. If only one parent has it, your odds fall to around 10 percent. What I find really amazing is that if you have a parent or a sibling with bipolar disorder you are about twice as likely to have regular old depression as you are to come down with bipolar disorder.

This last piece of data points to something important. The genes that set a person up for getting bipolar disorder are only somewhat specific for bipolar disorder per se. What really runs in families is a tendency toward mood disorders in general, as well as a number of other conditions, such as anxiety and risk of substance abuse.

But there is a piece of good news. A number of studies suggest that family members without the full disease tend to be more creative and/or intelligent than average, run-of-the-mill folks, which may be part of the reason why the genes for bipolar disorder are still with us. Some of the greatest poets of the past 200 years have had bipolar disorder, as have many artists, scientists and political leaders. If you are interested in this check out a great book called "Touched with Fire: Manic-Depressive Illness and the Artistic Temperament" by Kay Redfield Jamison, Ph.D.

So what is the take-home message for your situation? The fact that neither you nor your potential fiancé have bipolar disorder does indeed offer promise that your children would be at less risk for developing the condition. It is also good that you have no affected individuals in your family. In terms of your husband, his age is also very relevant to what his risk might be of developing the disease. Most people first show definitive symptoms in their 20s and often have a history of mood swings, irritability and depression dating back to childhood. If your boyfriend is a little older and/or has been steady as a rock thus far, his risks of developing the illness (and therefore having a stronger genetic loading that might get passed down to children) is pretty low.

If your boyfriend is a good man and you love him, I wouldn't let what you've described to me stand in the way of marrying or having children. But I would keep half an eye on any future children and intervene early if they show signs of psychiatric abnormality.

We would like to open a dialouge on this issue. Please feel free to share any information you may have (research, scientific data, ancedotal experience) to address this important issue that many bipolar folks face.

Dr Charles Raison Background: http://www.cnn.com/HEALTH/expert.q.a/mentalhealth/archive/

Posted by Michael Lane at 10:21 AM | Comments (5)

September 15, 2009

Yale study increases understanding of bipolar disorder

Damage to the brain caused by chronic stress or lead poisoning can be repaired by blocking a key molecular pathway, Yale University researchers report in the September 7-11 edition of the Proceedings of the National Academy of Sciences.

Rats subjected to chronic stress develop damage to the prefrontal cortex, an area of the brain crucial to working memory, impulse control and the ability to stay focused on tasks. Long-term stress triggers excessive activity of a family of enzymes called protein kinase C, which in turn damages the cytoskeleton of neurons and hinders their ability transmit information. This loss of the brain's grey matter due to stress has been linked to poor impulse control, a decline in working memory and inability to focus on tasks.

These findings have direct relevance to our understanding of bipolar disorder, where genetic insults increase protein kinase C signaling which may be associated with a loss of prefrontal grey matter and behavioral control.

The Yale team led by senior author Amy Arnsten, professor of neurobiology at Yale and her graduate student, Avis Brennan Hains, succeeded in protecting against the effects of stress by blocking the action of protein kinase C in rats. The researchers found that dendritic spines of neurons stayed intact and that the rats' ability to perform a task requiring working memory and impulse control was improved.

"When you inhibit protein kinase C, cells can talk to each other again and you rescue cognition," Arnsten said.

Blocking protein kinase C has potential for treating bipolar disorder and post-traumatic stress disorder, Arnsten said. Medications such as lithium can inhibit protein kinase C and have been shown to restore normal levels of grey matter in patients with bipolar disorder. She also noted such a therapy might help reverse the effects of lead poisoning, which causes learning disabilities and behavioral problems in tens of thousands of children. Lead, like stress, can also increase protein kinase C activity and erode grey matter in the prefrontal cortex. These findings suggest that medications that inhibit protein kinase C may help restore prefrontal brain function in children with residual problems from lead poisoning.

The study was funded by the National Institutes of Health and the Yale Stress Center.

We will analyze this research and post our findings on this blog.

Posted by Michael Lane at 11:56 AM | Comments (2)

Review of Mood Tracking Software: bStable

bStableTM (McGraw Systems LLC)

Our findings are drawn from conversations with the McGraw Systems CEO (Ben McGraw) and current users of bStable, and our independent review of bStable. We plan to use this software and provide a subsequent report on how it performs over time. We use pseudonyms to ensure bStable users' privacy.

What is bStable?

bStable is a comprehensive "Life Management System" software tool which enables patients diagnosed with affective disorders such as Bipolar Disorder or Depression, their loved ones, psychiatrists, and psychologists to manage the patient's disease state. Patients input and track numerous relevant areas that affect their well being. These include inputting personal data such as family members, friends, medicines, medical insurance, exercise schedule as well as providing journal entry, cognitive behavior and "crisis planner" modules which can be used when a patient is in a depressed or manic state.

bStable was officially launched last September (2008) and was presented at the International Review on Bipolar Disorder (IRBD) conference in Lisbon (May/09) and the annual NAMI conference in San Francisco (July/09).

What do users say about it?

We spoke with several users about their experience using bStable. Stephanie, a nurse who suffers from bipolar disorder, praised the software as an excellent tool that she uses daily. She keeps track of her medicines, daily moods, sleep hours etc. and "finds it satisfying to track the various issues that affect her well being." She uses it to monitor key areas that could trigger a new depressed or manic episode and shares the information with her doctor prior to her appointments. "When you provide all this data to your doctor it gives him a snapshot of your current status and helps to build a better, more informed Doctor/Patient relationship." Our takeaway from this conversation is that Stephanie, who is fully committed to managing her illness so that it doesn't wreak havoc on her personal and professional life, views bStable as essential in her daily effort to manage her bipolar condition.

We also spoke with James whose wife Laurie has recently purchased bStable.
Laurie has recently been diagnosed with a Mood Disorder NOS but both James and Laurie believe Laurie is likely to be bipolar. James said that "Laurie has looked at a lot of mood tracking systems and she feels that bStable offers a robust life management tool which enables her to capture the myriad details of daily life that need to be looked at for managing Laurie's Mood Disorder. While Laurie will input data into bStable, James will observe her input into bStable to see if it matches his own perception of Laurie's moods and progress. They are clearly using bStable as a tool that allows them to work together as well as providing Laurie's doctor with current information (Laurie will be emailing information to her Doctor prior to their meetings).

Software tool versus web-based system.

Ben McGraw indicated that he gave a lot of thought to the decision to build downloadable software versus building a web-based tracking tool. After conducting his own extensive research, he decided that a downloadable software product was the best way to ensure the privacy of users who are tracking personal sensitive information. We should note that other Mood Tracking System vendors (which we are researching and will be posted on this blog) came to the opposite conclusion and offer their systems as a web-based tracking tool.

What does bStable cost?

bStable costs $99 which includes a one-time license fee and unlimited product support. Once you have purchased bStable (via www.mcgrawsystems.com ), McGraw Systems sends you a link to download the software and provides a comprehensive user guide (PDF format). They also send a PDF plug-in so you can generate various report modules including a Crisis Plan Report.

Conclusions

bStable appears to be the only "life management" software tool currently available on the market which caters specifically to bipolar and unipolar patients. The robust software enables patients to capture numerous data points which help in managing their conditions. It does require some time to download and set up the software on your computer, but bStable seems to be very responsive in helping its customers with initial set up instructions and ongoing support. We intend to track bStable's progress and will check in with the bStable users to gauge their ongoing experience with the software.

Additional information:

bStable_Product_Datasheet.pdf

Click here to access the McGraw Systems website.

Posted by Michael Lane at 11:44 AM | Comments (5)