November 29, 2009

Psychosurgery: New techniques sure to raise old questions

When Americans hear the term "Brain Surgery" their first thought may be of Jack Nicholson's character in the 1975 movie "One Flew over the Cuckoo's nest" and the crippling lobotomy performed on him. Indeed, "Psychosurgery" was popularized in the United States during the 1930's and 1940's when the American physician Walter Freeman advocated the use of lobotomies to treat patients with various mental illnesses. Thousands of Americans were subjected to these brutal "procedures" to devastating effect.

But, scientific inquiry and progress is a long and winding road; and, it should be no surprise that new, less invasive psychosurgeries are being explored and performed for specific mental illnesses. I came across an excellent article on this topic in last Friday's New York Times, the latest in a series of articles on "Brain Power." The article describes four new brain surgeries including Gamma knife surgery where an M.R.I. like device focuses small beams of radiation to destroy small areas of brain tissue thought to cause Depression and Obsessive-Compulsive Disorder (O.C.D.). The article tracks two patients who underwent Gamma knife surgery; one patient claims the surgery was transformative and "saved my life" whereas the other patient seems to have had no measureable effect from the surgery. And, there is the cautionary tale of one U.S. patient who suffered disabling brain damage from one of these new operations which resulted in a $7.5 million dollar judgment against the hospital that performed the surgery.

While these new surgical techniques are still exploratory (only 500 people have undergone one of them in the last decade) for use with patients who suffer from depression and O.C.D, it seems inevitable to this writer that at some future point we will see the advent of "brain surgeries" for patients with bipolar disorder. This prospect is at once frightening and intriguing. It's not hard to imagine future patients, who have exhausted all conventional methods to combat bipolar disorder, turning to brain surgery as a choice of last resort; alternatively, among those who are less risk adverse, brain surgery might be a choice of first resort.

The way people with mental illnesses are treated for their afflictions has undergone a sea change during the past 60 years and, as a result, millions of people with bipolar disorder or other illnesses are able to live normal, productive lives. I wonder how our current techniques and medicines will be viewed 60 years from now; and, I wonder if brain surgery will be as commonplace as popping a pill.

Posted by Michael Lane at 9:38 PM | Comments (5)

November 23, 2009

FDA Approves Geodon for Bipolar Disorder

The US Food and Drug Administration (FDA) has approved the atypical antipsychotic Geodon (ziprasidone) for maintenance treatment of bipolar I disorder as an adjunct to lithium or Depakote (valporate) in adults. In 2004, the FDA approved Geodon for treatment of acute manic or mixed episodes in Bipolar 1 Disorder. The additional approval for maintenance treatment, announced by Pfizer on Nov. 20, gives doctors and patients another long-term use drug to help stabilize moods. Geodon was initially FDA approved, in 2001, to treat schizophrenia.

Unlike other atypical antipsychotics, it appears that Geodon may not to be associated with weight gain. In a six-week, head-to-head study between Zyprexa (olanzapine) and Geodon, the Zyprexa patients' median weight gain over the six weeks was ten pounds, while Geodon patients gained less than one pound. In line with this finding, Zyprexa patients saw significant increases in cholesterol and other blood fats, while Geodon patients lipid profiles remained stable. These results suggest that not only is Geodon a healthier alternative, but patients may also be less inclined to stop taking it on their own due to weight gain.

Our readers may recall that Geodon was one of four drugs that Pfizer was found to have illegally promoted for uses which had not been FDA approved. As a result, Pfizer recently agreed to pay $2.3B in the largest healthcare fraud settlement in the history of the Department of Justice.

Posted by Michael Lane at 8:35 PM | Comments (10)

November 18, 2009

Frontline Video explores Bipolar Disorder in children

Frontline recently aired a program that explores the rapid increase in diagnoses of bipolar disorder in children during the past 7-8 years; the program is an update from earlier Frontline pieces which aired in 2001 and 2008. This program offers an overview of the current environment and attitude in the US vis-à-vis diagnosing young children with bipolar disorder and prescribing psychiatric medicines (many of which are "off label" for kids and adolescents). The video asserts that the rapid increase in diagnosis of bipolar disorder for kids is primarily a US phenomenon and conveys the heart wrenching uncertainty for families who wrestle with the counter-intuitive notion of giving young children psychiatric medicines. It also provides updates on kids who were first interviewed in 2001 and 2008 to see how they are progressing and how their bipolar diagnosis affects their lives. It's worthwhile to watch this program as it aptly raises critical issues for families and young kids faced with a bipolar disorder diagnosis (see my Nov. 10, Oct 28 & Oct 13 blogs for additional background on bipolar disorder and children).

Posted by Michael Lane at 10:23 AM | Comments (7)

November 17, 2009

Managing Bipolar Disorder: "Mood Mapping"

I've recently blogged about using Mood Tracking Solutions as a tool for those with bipolar disorder to help manage their lives (see Oct. 27 and Sept. 15 posts). I came across an interesting article which supports this notion. A UK based psychologist and bipolar patient, Dr. Liz Miller, has written a book: "Mood Mapping" which offers a method for bipolar patients to closely monitor their moods as a way to help manage their condition.

Dr. Miller was a successful neurosurgeon when she was diagnosed with biopolar disorder at age 28; a series of personal setbacks associated with the bipolar condition ended her career as a neurosurgeon. Like many people who are diagnosed with bipolar disorder, Dr. Miller sought as much information as possible about the illness and how to best treat it. Over time, she began to track her moods and daily habits. Eventually, she wrote a book which focuses on five main areas of life which affect a person's mood that can be changed: one's surroundings, physical health, relationships, strategies for life, and being yourself.

Thoughts: Dr. Miller's story is reminiscent of Dr. Kay Redford Jamieson's reliance on her own experience with bipolar disorder to create her compelling account in "The Unquiet Mind." That said, I have not yet read this book and I welcome any comments or critiques. Dr. Miller, now 52 years old, has not taken any medication to treat her bipolar disorder for 8 years. This approach flies in the face of a commonly accepted precept about how to manage bipolar disorder over the long term: i.e. taking a mix of meds to stablize mood and protect against depression is generally thought of as a crucial part of of treating bipolar disorder.

Posted by Michael Lane at 10:28 AM | Comments (5)

November 12, 2009

Personal Stories about bipolar disorder

I came across an intersting set of Short Stories on the online BBC Health "Secret Life" section. These short clips feature eight people with bipolar disorder who were asked questions about how they first felt when they were diagnosed; their experiences of mania, depression and getting treatment; and whether they'd push a magic button and get rid of the condition if they could. Interestingly, when asked if they could "eliminate their bipolar condition with the magic touch of a button," at least half of them said they wouldn't push that button. Their answers are illuminating and no doubt our readers understand the rationale behind either choice. You need to use RealPlayer to access these stories.

Posted by Michael Lane at 3:10 PM | Comments (5)

November 10, 2009

House passes Health Care Reform bill - All eyes on the Senate

Last Saturday (Nov. 7) the House of Represenatives passed the Health Care Reform bill (H.R. 3962) by a narrow margin of 220-215. The Health Care reform debate has moved over to the Senate side where a similar bill may be brought to the Senate Floor as early as next week. We'll keep you posted on the Senate side developments and monitor the key provisions that impact people with bipolar disorder and other mental illnesses.

Posted by Michael Lane at 1:08 PM | Comments (2)

Large Increase in Pediatric Bipolar Disorder?

The Issue

The steady drum beat of diagnosing kids and adolescents across the U.S. with mental illnesses seems to have quickened during the past few years. Increasingly, parents come out of meetings with school counselors, psychologists, psychiatrists et. al. with a diagnosis of pediatric bipolar disorder, early onset bipolar disorder and/or ADHD and a prescription for psychiatric medicines. These diagnoses can both calm and alarm parents.

Several recent posts from Kimberly Read, a regular contributor to About.com regarding bipolar disorder, caught my eye. She sites a whopping 4,000 percent increase in pediatric bipolar disorder; I was intrigued by this statistic and sought out its source.

Source & Conclusion

Source: A 2007 study published in the Archives of General Psychiatry measured national trends in outpatient visits that resulted in a diagnosis of bipolar disorder, and then compared those trends between two age cohorts: a child/adolescent group (1-19) and an adult group (20 or older). The study compared office visits in the 1994-95 period to office visits in 2002-2003. The increase in office visits between these two periods for the child/adolescent group was 4,000%!

For those of you with young boys, there is additional grist for the mill: the study also showed a disproportionate number of boys (67.6%) coming in for visits and being diagnosed with bipolar disorder.

Conclusion: The study concluded that "there has been a rapid increase in the diagnosis of youth bipolar disorder in office-based medical settings." Why this might be the case is the subject for other studies.

What does it all mean?

While there is a massive increase in the diagnosis of bipolar disorder and other mental illnesses among kids and adolescents, we don't really know why that is the case. It may be that these illnesses were under diagnosed in the mid-90s or over diagnosed in the later period. It seems that terms such as bipolar disorder, ADHD etc. have come into the mainstream lexicon. Books such as The Bipolar Child (first published in 2000) helped increase the general public awareness about pediatric bipolar and probably gave encouragement to tens of thousands of families to seek out professional help for their children.

We will be on the look out for future studies that shed new light on the dramatic increase of diagnoses of bipolar disorder among kids and adolescents, and offer explanations that help families cope with this illness. As always, please feel free to offer your comments or observations on this post.

Posted by Michael Lane at 12:36 PM | Comments (2)

November 6, 2009

Health Care Reform bill with provisions for bipolar patients moving toward a House vote

In yesterday's blog, I indicated that the Health Care Reform Bill is moving toward a vote in the House of Representatives. The expected vote is now being considered for Sunday (Nov 8) or perhaps later. President Obama is planning to go to Capitol Hill on Saturday to lobby key swing vote Representatives who could make the difference in passing the Health Care Reform Bill. There are several important provisions for bipolar patients and people with other mental illnesses (see yesterday's blog for these points). Today and tomorrow are great days to call your Representative's Washington D.C. office and indicate your support for this legislation (H.R. 3962). You can call the U.S. Capital Switchboard at (202) 224-3121 and asked to be transferred to your Representative.

Here is a fantastic article with a great twist I recommend.
Psychic Universe

Posted by Michael Lane at 11:27 AM | Comments (2)

November 5, 2009

Health Care Bill has key provisions for bipolar disorder patients

Last week, the House of Representatives created a new bill, H.R. 3962, which combines previous legislation passed by three House committees. This newly created legislation represents the House version of Health Care reform which is scheduled for a House vote this Saturday (Nov 7). During the past two days, two large lobbying groups, the American Association of Retired Persons (AARP) and the American Medical Association (AMA), have thrown their support behind H.R. 3962. A Senate version which combines earlier legislation that passed through two Committees is being drafted and is expected to be introduced in the near term.

H.R. 3962 addresses several key issues for people who suffer from bipolar disorder or other mental illnesses. These provisions include:

1. Medicaid expansion for childless adults who make up to 150% of the federal poverty income level, including people living with serious mental illness who currently do not qualify for Medicaid coverage in their state.

2. Expanded coverage for the uninsured through a newly created health insurance "exchange" which would be required to have mental health benefits.

3. Insurance reforms that would ensure that people with mental illness could not be denied health insurance benefits on the basis of a preexisting condition or could not be dropped from existing coverage due to their medical condition.

These are important provisions and, if you agree with them, we encourage you to call your Representative or send an email between now and Saturday. Representatives' offices do keep track off emails and calls. If you're unsure of how to reach your Representative, you can call the U.S. Capital Switchboard at (202) 224-3121 and ask to be transferred to your Representative. For those of you with a lot of time on their hands, you can go to Health Care Reform Bill and read the actual bill which is nearly 2000 pages long!


Posted by Michael Lane at 2:54 PM | Comments (2)