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    Psychiatric Disorders: Bipolar Disorder

    Can a Cancer Drug Stabilize Bipolar Patients?

    Mental health professional have struggled to treat the mania of bipolar disorder. An article published in Medical News Today, March 5, 2008, examines this issue. The article reports on a study published in a issue of Archives of General Psychiatry. The researchers "...conducted a clinical trial. The study consisted of 66 patients between 18 and 60 years old. All patients were diagnosed with bipolar disorder and at the time were experiencing mania or a mixed state that included mania as one component. The researchers randomly assigned participants to take either a) tamoxifen (40 milligrams to 80 milligrams per day) or b) identical placebo tablets twice daily for up to three weeks. All patients received up to 5 milligrams per day of lorazepam, a sedative that helps control symptoms." The results of this study were interesting. "Of the 66 patients who began the study, 50 patients completed the 21-day trial - 29 from the tamoxifen group and 21 from the placebo group.....Tamoxifen takers scored significantly lower on tests measuring the severity of mania...Placebo takers had mania scores that slightly increased...48% of patients taking tamoxifen responded to the drug (a reduction of at least half in mania scores)...5% of patients taking placebo responded to the drug...28% of tamoxifen takers vs. zero placebo takers had mania scores low enough for it to be considered in remission...Tamoxifen patients used less lorazepam during the study (averaging 25.2 mg compared to 41.8 mg)" The implications of this study are significant. First,the results of this study confirm importance of abnormal activity on the protein kinase C family of enzymes and their impact in bipolar disorders. The researchers note "...People who have bipolar disorder and related dysfunctions - ability to be distracted, poor judgment-making abilities, and disorganized thoughts - have been associated with abnormal activity levels of these enzymes." Second, the study confirms that fact that tamoxifen may be become a significant part of the treatment protocol for bipolar patients. The researchers conclude "The findings [of this study] encourage further clarification of the role of protein kinase C in the pathophysiologic mechanism of bipolar 1 disorder and development of novel anti-protein kinase C agents as potential antimanic or mood-stabilizing agents."

    The Bottom Line: The results of this study strongly suggest that tamoxifen may be an effective treatment for bipolar disorder.

    Source: The Original Article

    Resources for Bipolar Disorder

    How to Understand Bipolar Disorder. View this top rated video from Youtube


    Suggested Reading:

    1. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    2. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz

    More Resources on Bipolar Disorder

    Overviews

    Latest News

    Diagnosis/Symptoms

    Treatment

    Nutrition

    Coping

    Disease Management

    Specific Conditions

    Related Issues

    Health Check Tools

    Clinical Trials

    Research

    Journal Articles

    References and abstracts from MEDLINE/PubMed (National Library of Medicine)

    Directories

    Organizations

    Law and Policy

    Statistics

    Children

    Teenagers

    Women

    You may also be interested in these MedlinePlus related pages:

    Resources:

    Great Informational Websites Created by Dr. Speller and Dr. Korkosz:

    Additional Resources:

    • For related articles on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to the Category LIst or type in the keywords into “Google Search” located in the sidebar.
    • For related articles from Psychology Today, click on the “Psychology Today” banner in the side bar and type in the keywords into the Psychology Today “Search”.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keywords into “Amazon Search” on the Amazon banner located in the side bar.

    Sources: National Institute of Health, See blogposts in Psychiatric Disorders: Bipolar Disorder, Youtube


    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com

    Posted by Dr. Jeff and Dr. Tanya on April 06, 2009 at 05:43 AM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    Can a Light Box Help Depressed Women?

    Mental health professional have long debated about what the benefits of bright light for depression. An article published in Medical News Today, January 5, 2008, examines this issue. The article reports on a study published in recently in the journal Bipolar Disorders. In this study "...women with bipolar depression were given light boxes and instructed on how to use them at home. The women used the light boxes daily for two-week stretches of 15, 30 and 45 minutes." The results of this study were quite interesting. "Some patients responded extremely well to the light therapy, and their symptoms of depression disappeared. The responders to light therapy stayed on the light therapy for an additional three or four months. Four patients received morning light, and five used their light boxes at midday. Participants also continued to take their prescribed medications throughout the study period...Of the nine women treated, six achieved some degree of response, with several reaching full recovery from depressive symptoms. While most attained their best recovery with midday light, a few responded more fully to a final adjustment to morning light.....44 percent of patients were full responders, and 22 percent were partial responders." The researchers concluded that "Light therapy..is an attractive and possibly effective augmentation strategy to improve the likelihood of full-treatment response."The implications of this study is quite significant. First, bipolar depressed women should give serious consideration to adding bright light to their treatment with the guidance of a qualified mental health professiona. As this study shows, even in bipolar depressed women who are already receiving medication for their disorder can still gain significant benefit from bright light. Second, mental health professionals who routinely prescribe medication for bipolar depressed women should encourage their patients to consider bright light treatment. Third, spouses of bipolar depressed women should definitely speak to their wives about this treatment option. And, fourth, public health professionals should increase public education and awareness efforts to educate bipolar parents about the benefits of bright light as a possible treatment for bipolar depression.

    Resources for Bipolar Disorder

    How to Understand Bipolar Disorder. View this top rated video from Youtube


    Suggested Reading:

    1. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    2. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz

    More Resources on Bipolar Disorder

    Overviews

    Latest News

    Diagnosis/Symptoms

    Treatment

    Nutrition

    Coping

    Disease Management

    Specific Conditions

    Related Issues

    Health Check Tools

    Clinical Trials

    Research

    Journal Articles

    References and abstracts from MEDLINE/PubMed (National Library of Medicine)

    Directories

    Organizations

    Law and Policy

    Statistics

    Children

    Teenagers

    Women

    You may also be interested in these MedlinePlus related pages:

    Resources:

    Great Informational Websites Created by Dr. Speller and Dr. Korkosz:

    Additional Resources:

    • For related articles on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to the Category LIst or type in the keywords into “Google Search” located in the sidebar.
    • For related articles from Psychology Today, click on the “Psychology Today” banner in the side bar and type in the keywords into the Psychology Today “Search”.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keywords into “Amazon Search” on the Amazon banner located in the side bar.

    Sources: Orginial article, National Institute of Health, See blogposts in Psychiatric Disorders: Bipolar Disorder, Youtube


    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com

    Posted by Dr. Jeff and Dr. Tanya on April 06, 2009 at 05:42 AM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    Do Children with Bipolar Parents Have Increased Risk Of Psychiatric Disorders?

    Mental health professionals have long debated about whether bipolar parents increase the risk of psychiatric illness in their children. Now an article published in Medical New Today on March 3, 2009 examines this issue. The article reports on a study published in the March issue of Archives of General Psychiatry. The researchers compared, "...388 offspring (ages 6 to 18) of 233 parents with bipolar disorder to 251 offspring of 143 demographically matched control parents. Parents were assessed for psychiatric disorders, family psychiatric history, family environment and other variables, and were also interviewed about their children. Children were assessed directly for bipolar disorder and other psychiatric disorders by researchers who did not know their parents' diagnoses." The results were disturbing. "Compared with the offspring of control parents, children of parents with bipolar disorder had an increased risk of having a bipolar spectrum disorder (41 or 10.6 percent vs. two or 0.8 percent) and having any mood or anxiety disorder. Children in families where both parents had bipolar disorders also were more likely than those in families containing one parent with bipolar disorder to develop the condition (four of 14 or 28.6 percent vs. 37 of 374 or 9.9 percent); however, their risk for other psychiatric disorders was the same as offspring of one parent with bipolar disorder." The public health implications of this study are significant. Health professionals who treat bipolar parents should educate and alert these individuals to the increase risk of their children developing bipolar disorder and take the appropriate measures.

    The Bottom Line: The results of this study strongly suggest that children of bipolar parents are at risk for developing bipolar spectrum disorders.

    Original Article: Arch Gen Psychiatry. 2009;66[3]:287-296.
    http://archpsyc.ama-assn.org/cgi/content/short/66/3/287

    Article URL: http://www.medicalnewstoday.com/articles/140929.php

    Resources for Bipolar Disorder

    How to Understand Bipolar Disorder. View this top rated video from Youtube


    Suggested Reading:

    1. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    2. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz

    More Resources on Bipolar Disorder

    Overviews

    Latest News

    Diagnosis/Symptoms

    Treatment

    Nutrition

    Coping

    Disease Management

    Specific Conditions

    Related Issues

    Health Check Tools

    Clinical Trials

    Research

    Journal Articles

    References and abstracts from MEDLINE/PubMed (National Library of Medicine)

    Directories

    Organizations

    Law and Policy

    Statistics

    Children

    Teenagers

    Women

    You may also be interested in these MedlinePlus related pages:


    Additional Resources:

    • For related articles on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to the Category LIst or type in the keywords into “Google Search” located in the sidebar.
    • For related articles from Psychology Today, click on the “Psychology Today” banner in the side bar and type in the keywords into the Psychology Today “Search”.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keywords into “Amazon Search” on the Amazon banner located in the side bar.

    Sources: National Institute of Health, See blogposts in Psychiatric Disorders: Bipolar Disorder, Youtube


    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com

    Posted by Dr. Jeff and Dr. Tanya on March 06, 2009 at 08:56 AM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    Do Bipolar Patients Have An Increased Risk of Premature Death?

    Mental health professionals have long debated whether bipolar disorder increases the risk of premature death. An article published February 12, 2009, in Medscape Medical News examines this issue. The article reported on a study published in the February issue of Psychiatric Services. The researchers reviewed "...17 studies involving more than 331,000 patients with bipolar disorder, affective psychosis, affective disorder requiring inpatient psychiatric care or treatment with lithium, or schizoaffective disorder." The results were disturbing. "Compared with age- and sex-matched control samples without mental illness from the general population, mortality ratios for death from natural causes and from specific general medical conditions such as heart disease, stroke, diabetes, and chronic obstructive pulmonary disease were significantly higher...The investigators point out this finding was particularly striking in larger studies of more than 2500 patients with bipolar disorder."
    The findings of this study make it clear that mental health professionals who treat these patient should have these patients be screened regularly by their primary care provider for the development of significant physical disorders. It is unclear exactly what the link is between bipolar disorder and premature death but the researches speculate that "Having a major mental illness such as bipolar disorder increases the likelihood of developing physical illness through a variety of factors, including poor diet, smoking, lack of exercise, substance abuse, social deprivation, and a lack of medical care, among others...In addition, the chronic stress inherent in having a major medical illness can affect the hypothalamic-pituitary-adrenal axis, increasing cortisol levels and leading to heightened activity of the sympathetic nervous system, possibly leading to earlier development of medical illness."

    The Bottom Line: The results of this study strongly suggest that patients with bipolar disorder are at risk form premature death due to medical illness.

    Resources for Bipolar Disorder

    How to Understand Bipolar Disorder. View this top rated video from Youtube


    Suggested Reading:

    1. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    2. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz

    More Resources on Bipolar Disorder

    Overviews

    Latest News

    Diagnosis/Symptoms

    Treatment

    Nutrition

    Coping

    Disease Management

    Specific Conditions

    Related Issues

    Health Check Tools

    Clinical Trials

    Research

    Journal Articles

    References and abstracts from MEDLINE/PubMed (National Library of Medicine)

    Directories

    Organizations

    Law and Policy

    Statistics

    Children

    Teenagers

    Women

    You may also be interested in these MedlinePlus related pages:


    Additional Resources:

    • For related articles on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to the Category LIst or type in the keywords into “Google Search” located in the sidebar.
    • For related articles from Psychology Today, click on the “Psychology Today” banner in the side bar and type in the keywords into the Psychology Today “Search”.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keywords into “Amazon Search” on the Amazon banner located in the side bar.

    Sources: National Institute of Health, See blogposts in Psychiatric Disorders: Bipolar Disorder, Youtube


    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com

    Posted by Dr. Jeff and Dr. Tanya on March 06, 2009 at 08:52 AM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    How to Understand Bipolar Disorder: View A Top Rated Video from Youtube

    Additional Resources:

    • For related articles on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: General” or type in the keywords into “Google Search” located in the sidebar.
    • For related articles from Psychology Today, click on the “Psychology Today” banner in the side bar and type in the keywords into the Psychology Today “Search”.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keywords into “Amazon Search” on the Amazon banner located in the side bar.

    Sources: National Institute of Mental Health, See also blogposts in: Addictions: General and Psychiatric Disorders: General and Psychiatric Disorders: Bipolar, Youtube

    Suggested Reading:

    1. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    2. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz

    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com

    Posted by Dr. Jeff and Dr. Tanya on February 27, 2009 at 08:51 AM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    Best Resource Guide on Bipolar Disorder


    Bipolar disorder is a serious mental illness. People who have it experience dramatic mood swings. They may go from overly energetic, "high" and/or irritable, to sad and hopeless, and then back again. They often have normal moods in between. The up feeling is called mania. The down feeling is depression.

    Bipolar disorder can run in families. It usually starts in late adolescence or early adulthood. If you think you may have it, tell your health care provider. A medical checkup can rule out other illnesses that might cause your mood changes.

    Untreated, bipolar disorder can result in damaged relationships, poor job or school performance, and even suicide. However, there are effective treatments: medicines and "talk therapy". A combination usually works best.

    National Institute of Mental Health

    Start Here Overviews Latest News Diagnosis/Symptoms Treatment Nutrition Coping Disease Management Specific Conditions Related Issues Health Check Tools Clinical Trials Research Journal Articles
    References and abstracts from MEDLINE/PubMed (National Library of Medicine)
    Directories Organizations Law and Policy Statistics Children Teenagers Women You may also be interested in these MedlinePlus related pages:

    Additional Resources:

    • For related articles on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to the Category LIst or type in the keywords into “Google Search” located in the sidebar.
    • For related articles from Psychology Today, click on the “Psychology Today” banner in the side bar and type in the keywords into the Psychology Today “Search”.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keywords into “Amazon Search” on the Amazon banner located in the side bar.

    Sources: National Institute of Health, See blogposts in Psychiatric Disorders: Bipolar Disorder


    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com

    Posted by Dr. Jeff and Dr. Tanya on February 09, 2009 at 11:43 AM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    Is Adjunctive Psychotherapy Useful in the Treatment of Bipolar Disorder?

    Mental health professionals have long debated whether psychotherapy is useful in the treatment of bipolar disorder. A recent article published in American Journal of Psychiatry examines this issue. The researchers studied “eighteen trials of individual and group psychoeducation, systematic care, family therapy, interpersonal therapy, and cognitive-behavioral therapy…Relevant outcome variables include time to recovery, recurrence, duration of episodes, symptom severity, and psychosocial functioning.” The results were interesting. “The effects of the treatment modalities varied according to the clinical condition of patients at the time of random assignment and the polarity of symptoms at follow-up. Family therapy, interpersonal therapy, and systematic care appeared to be most effective in preventing recurrences when initiated after an acute episode, whereas cognitive-behavioral therapy and group psychoeducation appeared to be most effective when initiated during a period of recovery. Individual psychoeducational and systematic care programs were more effective for manic than depressive symptoms, whereas family therapy and cognitive-behavioral therapy were more effective for depressive than manic symptoms.” The results of this study suggest that different modalities of psychotherapy are useful in treating different aspects of bipolar disorder.

    The Bottom Line: The results of this study suggest that different modalities of psychotherapy are useful in treating different aspects of bipolar disorder.

    Reference: Article

    Sources: See blogposts in: Addictions: General and Psychiatric Disorders: General and Psychiatric Disorders: Bipolar 

    Suggested Reading:

    1. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    2. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz

    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com


    Email this • Sphere: Related Content • Technorati Links • View CC license • Subscribe to this feed • Save to del.icio.us • Share on Facebook • Stumble It! • Add to Mixx! • Discuss on Newsvine • Digg This! • outside.in: geotag this story

    Posted by Dr. Jeff and Dr. Tanya on January 29, 2009 at 10:47 AM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    Are there Gene Abnormalities in Bipolar Disorder?

    Links Sodium, Calcium Imbalances to Manic Depressive Episodes

    gene chip
    Gene Chip

    The largest genetic analysis of its kind to date for bipolar disorder has implicated machinery involved in the balance of sodium and calcium in brain cells. Researchers supported in part by the National Institute of Mental Health, part of the National Institutes of Health, found an association between the disorder and variation in two genes that make components of channels that manage the flow of the elements into and out of cells, including neurons.

    "A neuron's excitability - whether it will fire - hinges on this delicate equilibrium," explained Pamela Sklar, M.D., Ph.D., of Massachusetts General Hospital (MGH) and the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard, who led the research. "Finding statistically robust associations linked to two proteins that may be involved in regulating such ion channels - and that are also thought to be targets of drugs used to clinically to treat bipolar disorder - is astonishing."

    Although it's not yet known if or how the suspect genetic variation might affect the balance machinery, the results point to the possibility that bipolar disorder might stem, at least in part, from malfunction of ion channels.

    Sklar, Shaun Purcell, Ph.D., also of MGH and the Stanley Center, and Nick Craddock, M.D., Ph.D., of Cardiff University and the Wellcome Trust Case Control Consortiuum in the United Kingdom and a large group of international collaborators report on their findings online Aug. 17, 2008 in Nature Genetics.

    "Faced with little agreement among previous studies searching for the genomic hot spots in bipolar disorder, these researchers pooled their data for maximal statistical power and unearthed surprising results," said NIMH Director Thomas R. Insel, M.D. "Improved understanding of these abnormalities could lead to new hope for the millions of Americans affected by bipolar disorder."

    In the first such genome-wide association study for bipolar disorder, NIMH researchers last fall reported the strongest signal associated with the illness in a gene that makes an enzyme involved the action of the anti-manic medication lithium. However, other chromosomal locations were most strongly associated with the disorder in two subsequent studies.

    Since bipolar disorder is thought to involve many different gene variants, each exerting relatively small effects, researchers need large samples to detect relatively weak signals of illness association.

    To boost their odds, Sklar and colleagues pooled data from the latter two previously published and one new study of their own. They also added additional samples from the STEP-BD study and Scottish and Irish families, and controls from the NIMH Genetics Repository. After examining about 1.8 million sites of genetic variation in 10,596 people - including 4,387 with bipolar disorder - the researchers found the two genes showing the strongest association among 14 disorder-associated chromosomal regions.

    Variation in a gene called Ankyrin 3 (ANK3) showed the strongest association with bipolar disorder. The ANK3 protein is strategically located in the first part of neuronal extensions called axons and is part of the cellular machinery that decides whether a neuron will fire. Co-authors of the paper had shown last year in mouse brain that lithium, the most common medication for preventing bipolar disorder episodes, reduces expression of ANK3.

    Variation in a calcium channel gene found in the brain showed the second strongest association with bipolar disorder. This CACNA1C protein similarly regulates the influx and outflow of calcium and is the site of interaction for a hypertension medication that has also been used in the treatment of bipolar disorder.

    In addition to NIMH, the research was also funded by NARSAD (National Alliance for Research on Schizophrenia and Depression), the Wellcome Trust, Johnson & Johnson Pharmaceutical Research & Development, the Johnson & Johnson Foundation, the Sylvan C. Herman Foundation, the Stanley Medical Research Institute, the Dauten Family, the Merck Genome Research Institute, and the National Health and Medical Research Council of Australia.

    Additional Resources:

    • For related articles on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: General” or type in the keywords into “Google Search” located in the sidebar.
    • For related articles from Psychology Today, click on the “Psychology Today” banner in the side bar and type in the keywords into the Psychology Today “Search”.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keywords into “Amazon Search” on the Amazon banner located in the side bar.

    Sources: National Institute of Mental Health, See also blogposts in: Addictions: General and Psychiatric Disorders: General and Psychiatric Disorders: Bipolar 

    Suggested Reading:

    1. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    2. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz

    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com


    Email this • Sphere: Related Content • Technorati Links • View CC license • Subscribe to this feed • Save to del.icio.us • Share on Facebook • Stumble It! • Add to Mixx! • Discuss on Newsvine • Digg This! • outside.in: geotag this story

    Posted by Dr. Jeff and Dr. Tanya on November 19, 2008 at 11:56 AM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    Can Mood Disorders Predict Later Substance Abuse Problems?

    Mania symptoms and bipolar disorder II more likely to lead to substance abuse than depression

    People with manic symptoms and bipolar disorder type II are at significant risk of later developing an alcohol abuse or dependence problem, a long-term study conducted in Switzerland confirms. The study was published in the January 2008 issue of the Archives of General Psychiatry.

    Extensive research using retrospective reports has demonstrated a clear association between mood disorders and substance abuse. But few prospective long-term studies have been able to show evidence of this.

    Kathleen Merikangas, Ph.D., of the NIMH Mood and Anxiety Disorders Program, collaborated with colleagues to follow 591 people (292 men and 299 women) over two decades, beginning in 1978 when the participants were 19 or 20 years old. The participants were interviewed six times between 1979 and 1999.

    By 1993, almost 10 percent met criteria for major depression. Although bipolar disorder type I was very rare, 4 percent met criteria for bipolar disorder II—a milder form of the disorder. In addition, 24 percent had symptoms of mania but did not meet specific criteria for bipolar disorder.

    By 1999, when participants were about 40 years old, 18 percent met criteria for alcohol abuse or dependence problems, while 8 percent met criteria for cannabis (marijuana) abuse and 3 percent met criteria for benzodiazepine abuse.

    Merikangas and colleagues found that people who showed symptoms of mania, but who did not meet criteria for bipolar disorder, were at significantly greater risk for later developing an alcohol abuse or dependence problem. Those with bipolar disorder II were even more at risk of developing an alcohol problem or benzodiazepine abuse problem. Major depression was associated only with developing a benzodiazepine abuse problem among this population.

    “The findings confirm the link between mood disorders and substance abuse or dependence problems,” said Dr. Merikangas. “They also suggest that earlier detection of bipolar symptoms could help to prevent consequent substance abuse problems.”

    The study was known as the Zurich Cohort Study.

    Reference

    Merikangas, KR, Herrell R, Swendsen J, Rossler W, Ajdacic-Gross V, Angst J. Specificity of bipolar spectrum conditions in the comorbidity of mood and substance abuse disorders. Archives of General Psychiatry. 2008;65(1): 47-52.

    Additional Resources:

    • For related articles on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: General” or type in the keywords into “Google Search” located in the sidebar.
    • For related articles from Psychology Today, click on the “Psychology Today” banner in the side bar and type in the keywords into the Psychology Today “Search”.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keywords into “Amazon Search” on the Amazon banner located in the side bar.

    Sources: National Institute of Mental Health, See also blogposts in: Addictions: General and Psychiatric Disorders: General and Psychiatric Disorders: Bipolar 

    Suggested Reading:

    1. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    2. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz

    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com


    Email this • Sphere: Related Content • Technorati Links • View CC license • Subscribe to this feed • Save to del.icio.us • Share on Facebook • Stumble It! • Add to Mixx! • Discuss on Newsvine • Digg This! • outside.in: geotag this story

    Posted by Dr. Jeff and Dr. Tanya on November 19, 2008 at 11:21 AM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    The best patient guide to the fourteen common signs and symptoms of bipolar disorder, manic phase

    1. Increased energy, activity, and restlessness
    2. Excessively “high,” overly good, euphoric mood
    3. Extreme irritability
    4. Racing thoughts and talking very fast, jumping from one idea to another
    5. Distractibility, can’t concentrate well
    6. Little sleep needed
    7. Unrealistic beliefs in one’s abilities and powers
    8. Poor judgment
    9. Spending sprees
    10. A lasting period of behavior that is different from usual
    11. Increased sexual drive
    12. Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
    13. Provocative, intrusive, or aggressive behavior
    14. Denial that anything is wrong

    A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.

    Thirteen Great Books on Bipolar Disorder:

    1. The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers by Wes Burgess (Paperback - Jun 8, 2006)
    2. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    5. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    6. A Story of Bipolar Disorder (Manic-depressive Illness): Does This Sound Like You? (Paperback - 2007)
    7. Coping With Bipolar Disorder and Manic-Depressive Illness (Coping) by Joann Jovinelly (Library Binding - Aug 2001)
    8. Everything You Need to Know About Bipolar Disorder and Manic Depressive Illness (Need to Know Library) by Michael A. Sommers (Library Binding - Aug 2002)
    9. High, Flat, Down And Back Up Again!: A Guide To Manic-Depressive Illness by Alain Amzallag (Paperback - Feb 21, 2005)
    10. Brilliant Madness: Living with Manic Depressive Illness by Patty Duke and Gloria Hochman (Mass Market Paperback - Feb 4, 1997)
    11. Understanding Bi-Polar Disorder (DVD - Jul 27, 2006)
    12. Touched with Fire: Manic-Depressive Illness and the Artistic Temperament by Kay Redfield Jamison (Paperback - Oct 18, 1996)
    13. An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison (Paperback - Jan 14, 1997)

    Ten Resource and Support Groups for Bipolar Disorder

    1. Depression and Bipolar Support Alliance
    2. Bipolarconnect.com
    3. The Bipolar Support Group
    4. MDjunction.com 
    5. The Bipolar Advantage  
    6. Bipolar Disorder Today
    7. Bipolar Dream 
    8. Bipolar Freedom
    9. Bipolar Hope
    10. Bipolar Support Friends

    Additional Resources:

    • For related articles on bipolar disorder disorders on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog  posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: Bipolar Disorder” or type in the keyword “bipolar disorder” into “Google Search” located in the sidebar.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keyword, “bipolar disorder” into “Amazon Search” on the Amazon banner located in the side bar.
    Sources: National Institute of Mental Health, See Blogposts: 8/4/08, 9/07/08 (9:19AM), 9/7/08(9:28AM), See Blogposts in: Psychiatric Disorders: Bipolar 

    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com


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    Posted by Dr. Jeff and Dr. Tanya on November 14, 2008 at 08:00 AM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    The best patient guide to the eleven common signs and symptoms of bipolar depression

    1. Lasting sad, anxious, or empty mood
    2. Feelings of hopelessness or pessimism
    3. Feelings of guilt, worthlessness, or helplessness
    4. Loss of interest or pleasure in activities once enjoyed, including sex
    5. Decreased energy, a feeling of fatigue or of being “slowed down”
    6. Difficulty concentrating, remembering, making decisions
    7. Restlessness or irritability
    8. Sleeping too much, or can’t sleep
    9. Change in appetite and/or unintended weight loss or gain
    10. Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
    11. Thoughts of death or suicide, or suicide attempts

    A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

    Thirteen Great Books on Bipolar Disorder:

    1. The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers by Wes Burgess (Paperback - Jun 8, 2006)
    2. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    5. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    6. A Story of Bipolar Disorder (Manic-depressive Illness): Does This Sound Like You? (Paperback - 2007)
    7. Coping With Bipolar Disorder and Manic-Depressive Illness (Coping) by Joann Jovinelly (Library Binding - Aug 2001)
    8. Everything You Need to Know About Bipolar Disorder and Manic Depressive Illness (Need to Know Library) by Michael A. Sommers (Library Binding - Aug 2002)
    9. High, Flat, Down And Back Up Again!: A Guide To Manic-Depressive Illness by Alain Amzallag (Paperback - Feb 21, 2005)
    10. Brilliant Madness: Living with Manic Depressive Illness by Patty Duke and Gloria Hochman (Mass Market Paperback - Feb 4, 1997)
    11. Understanding Bi-Polar Disorder (DVD - Jul 27, 2006)
    12. Touched with Fire: Manic-Depressive Illness and the Artistic Temperament by Kay Redfield Jamison (Paperback - Oct 18, 1996)
    13. An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison (Paperback - Jan 14, 1997)

    Ten Resource and Support Groups for Bipolar Disorder

    1. Depression and Bipolar Support Alliance
    2. Bipolarconnect.com
    3. The Bipolar Support Group
    4. MDjunction.com 
    5. The Bipolar Advantage  
    6. Bipolar Disorder Today
    7. Bipolar Dream 
    8. Bipolar Freedom
    9. Bipolar Hope
    10. Bipolar Support Friends

    Additional Resources:

    • For related articles on bipolar disorder disorders on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog  posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: Bipolar Disorder” or type in the keyword “bipolar disorder” into “Google Search” located in the sidebar.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keyword, “bipolar disorder” into “Amazon Search” on the Amazon banner located in the side bar.
    Sources: National Institute of Mental Health, See Blogposts: 8/4/08, 9/07/08 (9:19AM), 9/7/08(9:28AM), See Blogposts in: Psychiatric Disorders: Bipolar 

    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com


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    Posted by Dr. Jeff and Dr. Tanya on November 14, 2008 at 08:00 AM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    Can the Manic Phase of Bipolar Disorder Benefit from a Breast Cancer Medication?

    The medication tamoxifen, best known as a treatment for breast cancer, dramatically reduces symptoms of the manic phase of bipolar disorder more quickly than many standard medications for the mental illness, a new study shows. Researchers at the National Institutes of Health's National Institute of Mental Health (NIMH) who conducted the study also explained how: Tamoxifen blocks an enzyme called protein kinase C (PKC) that regulates activities in brain cells. The enzyme is thought to be over-active during the manic phase of bipolar disorder.

    By pointing to PKC as a target for new medications, the study raises the possibility of developing faster-acting treatments for the manic phase of the illness. Current medications for the manic phase generally take more than a week to begin working, and not everyone responds to them. Tamoxifen itself might not become a treatment of choice, though, because it also blocks estrogen — the property that makes it useful as a treatment for breast cancer — and because it may cause endometrial cancer if taken over long periods of time. Currently, tamoxifen is approved by the Food and Drug Administration for treatment of some kinds of cancer and infertility, for example. It was used experimentally in this study because it both blocks PKC and is able to enter the brain.

    Results of the study were published online in the September issue of Bipolar Disorders by Husseini K. Manji, MD, Carlos A. Zarate Jr., MD, and colleagues.

    Almost 6 million American adults have bipolar disorder, whose symptoms can be disabling. They include profound mood swings, from depression to vastly overblown excitement, energy, and elation, often accompanied by severe irritability. Children also can develop the illness.

    During the manic phase of bipolar disorder, patients are in "overdrive" and may throw themselves intensely into harmful behaviors they might not otherwise engage in. They might indulge in risky pleasure-seeking behaviors with potentially serious health consequences, for example, or lavish spending sprees they can't afford. The symptoms sometimes are severe enough to require hospitalization.

    "People think of the depressive phase of this brain disorder as the time of risk, but the manic phase has its own dangers," said NIMH Director Thomas R. Insel, MD. "Being able to treat the manic phase more quickly would be a great asset to patients, not just for restoring balance in mood, but also because it could help stop harmful behaviors before they start or get out of control."

    The three-week study included eight patients who were given tamoxifen and eight who were given a placebo (a sugar pill); all were adults and all were having a manic episode at the time of the study. Neither the patients nor the researchers knew which of the substances the patients were getting.

    By the end of the study, 63 percent of the patients taking tamoxifen had reduced manic symptoms, compared with only 13 percent of those taking a placebo. Patients taking tamoxifen responded by the fifth day — which corresponds with the amount of time needed to build up enough tamoxifen in the brain to dampen PKC activity.

    The researchers decided to test tamoxifen's effects on the manic phase of bipolar disorder because standard medications used to treat this phase, specifically, are known to lower PKC activity — but they do it through a roundabout biochemical route that takes time. Tamoxifen is known instead to block PKC directly. As the researchers suspected would happen, tamoxifen's direct actions on PKC resulted in much faster relief of manic symptoms, compared with some of the standard medications available today.

    "We now have proof of principle. Our results show that targeting PKC directly, rather than through the trickle-down mechanisms of current medications, is a feasible strategy for developing faster-acting medications for mania," said Manji. "This is a major step toward developing new kinds of medications."

    Findings from another recent NIMH study strengthen the results. This previous study showed that the risk of developing bipolar disorder is influenced by a variation in a gene called DGKH. The gene makes a PKC-regulating protein known to be active in the biochemical pathway through which standard medications for bipolar disorder exert their effects - another sign that PKC is a promising direct target at which to aim new medications for the illness.

    "Mania isn't just your average mood swing, where any of us might feel upbeat in response to something that happens. It's part of a brain disorder whose behavioral manifestations can severely undermine people's jobs, relationships, and health," said Zarate. "The sooner we can help patients get back on an even keel, the more we can help them avoid major disruptions to their lives and the lives of people around them."

    Reference

    Zarate Jr. CA, Singh JB, Carlson PJ, Quiroz J, Jolkovsky L, Luckenbaugh DA, Manji HK. Efficiency of a Protein Kinase C Inhibitor (Tamoxifen) in the Treatment of Acute Mania: A Pilot Study. Bipolar Disorders, online ahead of print, September 2007.

    Thirteen Great Books on Bipolar Disorder:

    1. The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers by Wes Burgess (Paperback - Jun 8, 2006)
    2. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    5. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    6. A Story of Bipolar Disorder (Manic-depressive Illness): Does This Sound Like You? (Paperback - 2007)
    7. Coping With Bipolar Disorder and Manic-Depressive Illness (Coping) by Joann Jovinelly (Library Binding - Aug 2001)
    8. Everything You Need to Know About Bipolar Disorder and Manic Depressive Illness (Need to Know Library) by Michael A. Sommers (Library Binding - Aug 2002)
    9. High, Flat, Down And Back Up Again!: A Guide To Manic-Depressive Illness by Alain Amzallag (Paperback - Feb 21, 2005)
    10. Brilliant Madness: Living with Manic Depressive Illness by Patty Duke and Gloria Hochman (Mass Market Paperback - Feb 4, 1997)
    11. Understanding Bi-Polar Disorder (DVD - Jul 27, 2006)
    12. Touched with Fire: Manic-Depressive Illness and the Artistic Temperament by Kay Redfield Jamison (Paperback - Oct 18, 1996)
    13. An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison (Paperback - Jan 14, 1997)

    Ten Resource and Support Groups for Bipolar Disorder

    1. Depression and Bipolar Support Alliance
    2. Bipolarconnect.com
    3. The Bipolar Support Group
    4. MDjunction.com 
    5. The Bipolar Advantage  
    6. Bipolar Disorder Today
    7. Bipolar Dream 
    8. Bipolar Freedom
    9. Bipolar Hope
    10. Bipolar Support Friends

    Additional Resources:

    • For related articles on bipolar disorder disorders on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog  posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: Bipolar Disorder” or type in the keyword “bipolar disorder” into “Google Search” located in the sidebar.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keyword, “bipolar disorder” into “Amazon Search” on the Amazon banner located in the side bar.
    Sources: National Institute of Mental Health, See Blogposts: 8/4/08, 9/07/08 (9:19AM), 9/7/08(9:28AM), See Blogposts in: Psychiatric Disorders: Bipolar 

    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com


    Email this • Sphere: Related Content • Technorati Links • View CC license • Subscribe to this feed • Save to del.icio.us • Share on Facebook • Stumble It! • Add to Mixx! • Discuss on Newsvine • Digg This! • outside.in: geotag this story

    Posted by Dr. Jeff and Dr. Tanya on October 29, 2008 at 01:43 PM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    Are Rates of Bipolar Diagnosis in Youth Rising?

    The number of visits to a doctor's office that resulted in a diagnosis of bipolar disorder in children and adolescents has increased by 40 times over the last decade, reported researchers funded in part by the National Institutes of Health (NIH). Over the same time period, the number of visits by adults resulting in a bipolar disorder diagnosis almost doubled. The cause of these increases is unclear. Medication prescription patterns for the two groups were similar. The study was published in the September 2007 issue of the Archives of General Psychiatry.

    Mark Olfson, M.D., M.P.H., of New York State Psychiatric Institute of Columbia University, along with National Institute of Mental Health (NIMH) researcher Gonzalo Laje, M.D., and their colleagues examined 10 years of data from the National Ambulatory Medical Care Survey (NAMCS), an annual, nationwide survey of visits to doctors' offices over a one-week period, conducted by the National Center for Health Statistics. The researchers estimated that in the United States from 1994-1995, the number of office visits resulting in a diagnosis of bipolar disorder for youths ages 19 and younger was 25 out of every 100,000 people. By 2002-2003, the number had jumped to 1,003 office visits resulting in bipolar diagnoses per 100,000 people. In contrast, for adults ages 20 and older, 905 office visits per 100,000 people resulted in a bipolar disorder diagnosis in 1994-1995; a decade later the number had risen to 1,679 per 100,000 people.

    While the increase in bipolar diagnoses in youth far outpaces the increase in diagnosis among adults, the researchers are cautious about interpreting these data as an actual rise in the number of people who have the illness (prevalence) or the number of new cases each year (incidence).

    "It is likely that this impressive increase reflects a recent tendency to over-diagnose bipolar disorder in young people, a correction of historical under recognition, or a combination of these trends. Clearly, we need to learn more about what criteria physicians in the community are actually using to diagnose bipolar disorder in children and adolescents and how physicians are arriving at decisions concerning clinical management," said Dr. Olfson.

    The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) provides general guidelines that can help doctors identify bipolar disorder in young patients. However, some studies show that youths with symptoms of mania (over-excited, elated mood)—one of the classic signs of bipolar disorder—often do not meet the full criteria for a diagnosis of bipolar disorder. Other disorders, such as attention-deficit hyperactivity disorder (ADHD), may have symptoms that overlap, so some of these conditions may be mistaken for bipolar disorder as well. For example, in a study conducted in 2001, nearly one-half of bipolar diagnoses in adolescent inpatients made by community clinicians were later re-classified as other mental disorders.

    Doctors also face tough questions when deciding on proper treatment for young people. Guidelines for treating adults with bipolar disorder are well-documented by research, but few studies have looked at the safety and effectiveness of psychiatric medications for treating children and adolescents with the disorder. Despite this limited evidence, the researchers found similar treatment patterns for both age groups in terms of use of psychotherapy and prescription medications.

    Of the medications studied, mood stabilizers, including lithium—which was the only medication approved at the time of the study by the U.S. Food and Drug Administration for treating bipolar disorder in children—were prescribed in two-thirds of the visits by youth and adults. Anticonvulsant medications, such as valproate (Depakote) and carbamazepine (Tegretol), were the most frequently prescribed type of mood stabilizers in both groups.

    Doctors prescribed antidepressant medications in slightly over one-third of visits by youth and adults. Antidepressant medications include the older classes of antidepressant medications, such as tricyclics, tetracyclics, and monoamine oxidase inhibitors (MAOIs); selective serontonin reuptake inhibitors, such as fluoxetine (Prozac) and paroxetine (Paxil); and also newer types of antidepressants, including venlafaxine (Effexor). In both age groups, about one-third of the visits where antidepressant medications were prescribed did not include prescription of a mood stabilizer. This trend raises concerns, considering an earlier NIMH-funded study (Thase & Sachs, 2000) which reported that treating adults who have bipolar disorder with an antidepressant in the absence of a mood stabilizer may put them at risk of switching to mania. Also, a recent NIMH study showed that for depressed adults with bipolar disorder who are taking a mood stabilizer, adding an antidepressant medication was no more effective in managing bipolar symptoms than a placebo (sugar pill).

    Roughly the same percentage of youth and adult bipolar visits included a prescription for an antipsychotic medication, although young patients were more likely to be prescribed one of the newer, atypical antipsychotic medications, such as aripiprazole (Abilify) or olanzapine (Zyprexa), than other types of antipsychotics. This finding suggests that doctors may be basing their treatment choices for bipolar youth on prescribing practices for adults with the disorder.

    However, one main difference between youth and adult treatment was that children and teens were more likely than adults to be prescribed a stimulant medication—usually prescribed for treating ADHD—and adults were more likely than youth to be prescribed benzodiazepines, a type of medication used to treat anxiety disorders. More than half of all diagnosed youths and adults were prescribed a combination of medications. Given the relative lack of studies on appropriate treatments for youth with bipolar disorder, the researchers noted the urgent need for more research on the safety and effectiveness of medication treatments that are commonly prescribed to this age group.

    The study had several important limitations. For example, the survey relied on the judgment of the treating physicians, rather than an independent assessment. As a result, the researchers' findings reveal more about patterns in diagnosis among office-based doctors than about definitive numbers of people affected by the illness. Another limitation is that the survey recorded the number of office visits instead of the number of individual patients, so some people may have been counted more than once.

    "A forty-fold increase in the diagnosis of bipolar disorder in children and adolescents is worrisome," said NIMH Director Thomas R. Insel, M.D. "We do not know how much of this increase reflects earlier under-diagnosis, current over-diagnosis, possibly a true increase in prevalence of this illness, or some combination of these factors. However, these new results confirm what we are hearing increasingly from families who tell us about disabling, sometimes dangerous psychiatric symptoms in their children. This report reminds us of the need for research that validates the diagnosis of bipolar disorder and other disorders in children and the importance of developing treatments that are safe, effective, and feasible for use in primary care."

    "This research, performed at a National Center on Minority Health and Health Disparities Center of Excellence, underscores the need to fully engage the community with their health care providers to better understand the actual prevalence of bipolar disease in children and adolescents," said John Ruffin, Ph.D., Director of NCMHD.

    Additional study authors were Carmen Moreno, M.D., and Carlos Blanco, M.D., Ph.D., of New York State Psychiatric Institute/College of Physicians and Surgeons of Columbia University; Andrew B. Schmidt, C.S.W., of New York State Psychiatric Institute; and Huiping Jiang, Ph.D., of Columbia University.

    The study was funded by the NIMH Intramural Research Program, National Institute on Drug Abuse (NIDA), NCMHD, the Agency for Healthcare Research and Quality (AHRQ), the Alicia Koplowitz Foundation, and the New York State Psychiatric Institute.

    Reference

    Moreno C, Laje G, Blanco C, Jiang H, Schmidt AB, Olfson M. National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Arch Gen Psychiatry. 2007 Sep;64(9).

    Thirteen Great Books on Bipolar Disorder:

    1. The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers by Wes Burgess (Paperback - Jun 8, 2006)
    2. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    5. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    6. A Story of Bipolar Disorder (Manic-depressive Illness): Does This Sound Like You? (Paperback - 2007)
    7. Coping With Bipolar Disorder and Manic-Depressive Illness (Coping) by Joann Jovinelly (Library Binding - Aug 2001)
    8. Everything You Need to Know About Bipolar Disorder and Manic Depressive Illness (Need to Know Library) by Michael A. Sommers (Library Binding - Aug 2002)
    9. High, Flat, Down And Back Up Again!: A Guide To Manic-Depressive Illness by Alain Amzallag (Paperback - Feb 21, 2005)
    10. Brilliant Madness: Living with Manic Depressive Illness by Patty Duke and Gloria Hochman (Mass Market Paperback - Feb 4, 1997)
    11. Understanding Bi-Polar Disorder (DVD - Jul 27, 2006)
    12. Touched with Fire: Manic-Depressive Illness and the Artistic Temperament by Kay Redfield Jamison (Paperback - Oct 18, 1996)
    13. An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison (Paperback - Jan 14, 1997)

    Ten Resource and Support Groups for Bipolar Disorder

    1. Depression and Bipolar Support Alliance
    2. Bipolarconnect.com
    3. The Bipolar Support Group
    4. MDjunction.com 
    5. The Bipolar Advantage  
    6. Bipolar Disorder Today
    7. Bipolar Dream 
    8. Bipolar Freedom
    9. Bipolar Hope
    10. Bipolar Support Friends

    Additional Resources:

    • For related articles on bipolar disorder disorders on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog  posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: Bipolar Disorder” or type in the keyword “bipolar disorder” into “Google Search” located in the sidebar.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keyword, “bipolar disorder” into “Amazon Search” on the Amazon banner located in the side bar.
    Sources: National Institute of Mental Health, See Blogposts: 8/4/08, 9/07/08 (9:19AM), 9/7/08(9:28AM), See Blogposts in: Psychiatric Disorders: Bipolar 

    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com


    Email this • Sphere: Related Content • Technorati Links • View CC license • Subscribe to this feed • Save to del.icio.us • Share on Facebook • Stumble It! • Add to Mixx! • Discuss on Newsvine • Digg This! • outside.in: geotag this story

    Posted by Dr. Jeff and Dr. Tanya on October 29, 2008 at 01:42 PM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    Do Bipolar Youth Show a Distinct Pattern of Brain Development?

    The first picturess of the brain changing before-and-after the onset of pediatric bipolar disorder reveal a distinct pattern of development, when compared to that seen in healthy youth or in childhood onset schizophrenia. Repeated magnetic resonance imaging (MRI) brain scans of youth, ages 7-22, followed prospectively as they developed symptoms of mania and depression, showed asymmetrical gains and losses of the brain's working tissue, or gray matter, report scientists at the National Institute of Mental Health (NIMH) and the University of California at Los Angeles (UCLA).

    Nitin Gogtay, M.D., Judith Rapoport, M.D., NIMH Child Psychiatry Branch, and colleagues, report on their discovery in the September, 2007 issue of the Journal of Child Psychology and Psychiatry.

    "Our findings should help put to rest speculation that pediatric bipolar disorder and childhood onset schizophrenia might stem from the same underlying illness process, despite overlapping symptoms and genetics," said Gogtay.

    Thirteen Great Books on Bipolar Disorder:

    1. The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers by Wes Burgess (Paperback - Jun 8, 2006)
    2. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    5. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    6. A Story of Bipolar Disorder (Manic-depressive Illness): Does This Sound Like You? (Paperback - 2007)
    7. Coping With Bipolar Disorder and Manic-Depressive Illness (Coping) by Joann Jovinelly (Library Binding - Aug 2001)
    8. Everything You Need to Know About Bipolar Disorder and Manic Depressive Illness (Need to Know Library) by Michael A. Sommers (Library Binding - Aug 2002)
    9. High, Flat, Down And Back Up Again!: A Guide To Manic-Depressive Illness by Alain Amzallag (Paperback - Feb 21, 2005)
    10. Brilliant Madness: Living with Manic Depressive Illness by Patty Duke and Gloria Hochman (Mass Market Paperback - Feb 4, 1997)
    11. Understanding Bi-Polar Disorder (DVD - Jul 27, 2006)
    12. Touched with Fire: Manic-Depressive Illness and the Artistic Temperament by Kay Redfield Jamison (Paperback - Oct 18, 1996)
    13. An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison (Paperback - Jan 14, 1997)

    Ten Resource and Support Groups for Bipolar Disorder

    1. Depression and Bipolar Support Alliance
    2. Bipolarconnect.com
    3. The Bipolar Support Group
    4. MDjunction.com 
    5. The Bipolar Advantage  
    6. Bipolar Disorder Today
    7. Bipolar Dream 
    8. Bipolar Freedom
    9. Bipolar Hope
    10. Bipolar Support Friends

    Additional Resources:

    • For related articles on bipolar disorder disorders on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog  posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: Bipolar Disorder” or type in the keyword “bipolar disorder” into “Google Search” located in the sidebar.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keyword, “bipolar disorder” into “Amazon Search” on the Amazon banner located in the side bar.
    Sources: National Institute of Mental Health, See Blogposts: 8/4/08, 9/07/08 (9:19AM), 9/7/08(9:28AM), See Blogposts in: Psychiatric Disorders: Bipolar 

    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com


    Email this • Sphere: Related Content • Technorati Links • View CC license • Subscribe to this feed • Save to del.icio.us • Share on Facebook • Stumble It! • Add to Mixx! • Discuss on Newsvine • Digg This! • outside.in: geotag this story

    Posted by Dr. Jeff and Dr. Tanya on October 29, 2008 at 01:41 PM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    Is Bipolar Spectrum Disorder Underrecognized?

    A new study supports earlier estimates of the prevalence of bipolar disorder in the U.S. population, and suggests the illness may be more accurately characterized as a spectrum disorder. It also finds that many people with the illness are not receiving appropriate treatment. The study, published in the May 2007 issue of Archives of General Psychiatry, analyzed data from the National Comorbidity Survey Replication (NCS-R), a nationwide survey of mental disorders among 9,282 Americans ages 18 and older. The NCS-R was funded by the National Institutes of Health’s National Institute of Mental Health (NIMH).

    NIMH researcher Kathleen Merikangas, Ph.D. and colleagues identified prevalence rates of three subtypes of bipolar spectrum disorder among adults. Bipolar I is considered the classic form of the illness, in which a person experiences recurrent episodes of mania and depression. People with bipolar II experience a milder form of mania called hypomania that alternates with depressive episodes. People with bipolar disorder not otherwise specified (BD-NOS), sometimes called subthreshold bipolar disorder, have manic and depressive symptoms as well, but they do not meet strict criteria for any specific type of bipolar disorder noted in the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV), the reference manual for psychiatric disorders. Nonetheless, BD-NOS still can significantly impair those who have it.

    The results indicate that bipolar I and bipolar II each occur in about 1 percent of the population; BD-NOS occurs in about 2.4 percent of the population. The findings support international studies suggesting that, given its multi-dimensional nature, bipolar disorder may be better characterized as a spectrum disorder.

    “Bipolar disorder can manifest itself in several different ways. But regardless of type, the illness takes a huge toll,” said NIMH Director Thomas R. Insel, M.D. “The survey’s findings reiterate the need for a more refined understanding of bipolar symptoms, so we can better target treatment.”

    Most respondents with bipolar disorder reported receiving treatment. Nearly everyone who had bipolar I or II (89 to 95 percent) received some type of treatment, while 69 percent of those with BD-NOS were getting treatment. Those with bipolar I or II were more commonly treated by psychiatric specialists, while those with BD-NOS were more commonly treated by general medical professionals.

    However, not everyone received treatment considered optimal for bipolar disorder. Up to 97 percent of those who had some type of bipolar illness said they had coexisting psychiatric conditions, such as anxiety, depression or substance abuse disorders, and many were in treatment for those conditions rather than bipolar disorder. The researchers found that many were receiving medication treatment considered “inappropriate” for bipolar disorder, e.g., they were taking an antidepressant or other psychotropic medication in the absence of a mood stabilizing medication such as lithium, valproate, or carbamazepine. Only about 40 percent were receiving appropriate medication, considered a mood stabilizer, anticonvulsant or antipsychotic medication.

    “Such a high rate of inappropriate medication use among people with bipolar spectrum disorder is a concern,” said Dr. Merikangas. “It is potentially dangerous because use of an antidepressant without the benefit of a mood stabilizer may actually worsen the condition.”

    Merikangas and colleagues speculate that as people seek treatment for anxiety, depression or substance abuse disorders, their doctors, especially if they are not mental health specialists, may not be detecting an underlying bipolar condition in their patients.

    “Because bipolar spectrum disorder commonly coexists with other illnesses, it is likely underrecognized, and therefore, undertreated. We need better screening tools and procedures for identifying bipolar spectrum disorder, and work with clinicians to help them better spot these bipolar symptoms,” concluded Dr. Merikangas.

    Reference

    Merikangas KR, et al. Lifetime and 12-Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey Replication. Archives of General Psychiatry. May 2007; 64.

    Thirteen Great Books on Bipolar Disorder:

    1. The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers by Wes Burgess (Paperback - Jun 8, 2006)
    2. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    5. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    6. A Story of Bipolar Disorder (Manic-depressive Illness): Does This Sound Like You? (Paperback - 2007)
    7. Coping With Bipolar Disorder and Manic-Depressive Illness (Coping) by Joann Jovinelly (Library Binding - Aug 2001)
    8. Everything You Need to Know About Bipolar Disorder and Manic Depressive Illness (Need to Know Library) by Michael A. Sommers (Library Binding - Aug 2002)
    9. High, Flat, Down And Back Up Again!: A Guide To Manic-Depressive Illness by Alain Amzallag (Paperback - Feb 21, 2005)
    10. Brilliant Madness: Living with Manic Depressive Illness by Patty Duke and Gloria Hochman (Mass Market Paperback - Feb 4, 1997)
    11. Understanding Bi-Polar Disorder (DVD - Jul 27, 2006)
    12. Touched with Fire: Manic-Depressive Illness and the Artistic Temperament by Kay Redfield Jamison (Paperback - Oct 18, 1996)
    13. An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison (Paperback - Jan 14, 1997)

    Ten Resource and Support Groups for Bipolar Disorder

    1. Depression and Bipolar Support Alliance
    2. Bipolarconnect.com
    3. The Bipolar Support Group
    4. MDjunction.com 
    5. The Bipolar Advantage  
    6. Bipolar Disorder Today
    7. Bipolar Dream 
    8. Bipolar Freedom
    9. Bipolar Hope
    10. Bipolar Support Friends

    Additional Resources:

    • For related articles on bipolar disorder disorders on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog  posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: Bipolar Disorder” or type in the keyword “bipolar disorder” into “Google Search” located in the sidebar.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keyword, “bipolar disorder” into “Amazon Search” on the Amazon banner located in the side bar.
    Sources: National Institute of Mental Health, See Blogposts: 8/4/08, 9/07/08 (9:19AM), 9/7/08(9:28AM), See Blogposts in: Psychiatric Disorders: Bipolar 

    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com


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    Posted by Dr. Jeff and Dr. Tanya on October 29, 2008 at 01:00 PM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    Is Intensive Psychotherapy More Effective Than Brief Therapy for Treating Bipolar Depression?

    Patients taking medications to treat bipolar disorder are more likely to get well faster and stay well if they receive intensive psychotherapy, according to results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), funded by the National Institutes of Health’s (NIH) National Institute of Mental Health (NIMH). The results are published in the April 2007 issue of the Archives of General Psychiatry.

    Bipolar disorder is a debilitating illness marked by severe mood swings between depression and mania that affects 2.6 percent of Americans in any given year. “We know that medication is an important component in the treatment of bipolar illness. These new results suggest that adding specific, targeted psychotherapy to medication may help give patients a better shot at lasting recovery,” said NIH Director Dr. Elias A. Zerhouni.

    “STEP-BD is helping us identify the best tools—both medications and psychosocial treatments—that patients and their clinicians can use to battle the symptoms of this illness,” said NIMH Director Thomas R. Insel, M.D.

    Psychotherapy is routinely employed as a means to treat bipolar illness in conjunction with medication, but the extent to which psychotherapy is effective has been unclear. In addition, most psychotherapeutic studies have been limited to a single site and compared only one type of treatment to routine care. Thus, in addition to examining the role of medication, STEP-BD set out to compare several types of psychotherapy and pinpoint the most effective treatments and treatment combinations.

    With 293 participants, David Miklowitz, Ph.D., of the University of Colorado and colleagues set out to test the effectiveness of three types of standardized, intensive, nine-month-long psychotherapy compared to a control group that received a three-session, psychoeducational program called collaborative care. The intensive therapies were

    • family-focused therapy, which required the participation and input of patients’ family members and focused on enhancing family coping, communication and problem-solving;
    • cognitive behavioral therapy, which focused on helping the patient understand distortions in thinking and activity, and learn new ways of coping with the illness; and
    • interpersonal and social rhythm therapy, which focused on helping the patient stabilize his or her daily routines and sleep/wake cycles, and solve key relationship problems.

    All participants were already taking medication for their bipolar disorder, and most were also enrolled in a STEP-BD medication study reported in the New England Journal of Medicine on March 28, 2007. The researchers compared patients’ time to recovery and their stability over one year.

    Over the course of the year, 64 percent of those in the intensive psychotherapy groups had become well, compared with 52 percent of those in collaborative care therapy. Patients in intensive psychotherapy also became well an average of 110 days faster than those in collaborative care. In addition, patients who received intensive psychotherapy were one and a half times more likely to be clinically well during any month out of the study year than those who received collaborative care. Discontinuation rates among the groups were similar—36 percent of those in the intensive programs discontinued and 31 percent of those in collaborative care discontinued. None of the three intensive psychotherapies appeared to be significantly more effective than the others, although rates of recovery were higher among those in family-focused therapy compared to the other groups.

    “Intensive psychotherapy, when used as an adjunctive treatment to medication, can significantly enhance a person’s chances for recovering from depression and staying healthy over the long term,” said Dr. Miklowitz. “It should be considered a vital part of the effort to treat bipolar illness.”

    Reference

    Miklowitz D. et al. Psychosocial Treatments for Bipolar Depression. Archives of General Psychiatry. Apr 2007; 164.

    Thirteen Great Books on Bipolar Disorder:

    1. The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers by Wes Burgess (Paperback - Jun 8, 2006)
    2. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    5. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    6. A Story of Bipolar Disorder (Manic-depressive Illness): Does This Sound Like You? (Paperback - 2007)
    7. Coping With Bipolar Disorder and Manic-Depressive Illness (Coping) by Joann Jovinelly (Library Binding - Aug 2001)
    8. Everything You Need to Know About Bipolar Disorder and Manic Depressive Illness (Need to Know Library) by Michael A. Sommers (Library Binding - Aug 2002)
    9. High, Flat, Down And Back Up Again!: A Guide To Manic-Depressive Illness by Alain Amzallag (Paperback - Feb 21, 2005)
    10. Brilliant Madness: Living with Manic Depressive Illness by Patty Duke and Gloria Hochman (Mass Market Paperback - Feb 4, 1997)
    11. Understanding Bi-Polar Disorder (DVD - Jul 27, 2006)
    12. Touched with Fire: Manic-Depressive Illness and the Artistic Temperament by Kay Redfield Jamison (Paperback - Oct 18, 1996)
    13. An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison (Paperback - Jan 14, 1997)

    Ten Resource and Support Groups for Bipolar Disorder

    1. Depression and Bipolar Support Alliance
    2. Bipolarconnect.com
    3. The Bipolar Support Group
    4. MDjunction.com 
    5. The Bipolar Advantage  
    6. Bipolar Disorder Today
    7. Bipolar Dream 
    8. Bipolar Freedom
    9. Bipolar Hope
    10. Bipolar Support Friends

    Additional Resources:

    • For related articles on bipolar disorder disorders on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog  posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: Bipolar Disorder” or type in the keyword “bipolar disorder” into “Google Search” located in the sidebar.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keyword, “bipolar disorder” into “Amazon Search” on the Amazon banner located in the side bar.
    Sources: National Institute of Mental Health, See Blogposts: 8/4/08, 9/07/08 (9:19AM), 9/7/08(9:28AM), See Blogposts in: Psychiatric Disorders: Bipolar 

    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com


    Email this • Sphere: Related Content • Technorati Links • View CC license • Subscribe to this feed • Save to del.icio.us • Share on Facebook • Stumble It! • Add to Mixx! • Discuss on Newsvine • Digg This! • outside.in: geotag this story

    Posted by Dr. Jeff and Dr. Tanya on October 29, 2008 at 12:59 PM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    Extreme Irritability: Is It Childhood Bipolar Disorder?

    Brain’s Electrical Signals Provide Clues

    Results of a new study may help improve the diagnosis and treatment of two debilitating childhood mental disorders — pediatric bipolar disorder (BD) and a syndrome called severe mood dysregulation (SMD). When the brain's electrical signals were measured during mildly frustrating situations, researchers from the National Institute of Mental Health (NIMH), of the National Institutes of Health, found a very different pattern in children with SMD, compared with children who had BD. The results indicate that different brain mechanisms may lead to irritability in children with SMD, suggesting that they may have an illness other than BD and may require different treatments.

    "These aren't children with the occasional bad moods you see in most kids. They're typically very ill, with symptoms that interfere with their lives in major ways. Establishing clear diagnostic criteria is an essential step toward making sure they get the help they need," said NIMH Director Thomas R. Insel, M.D.

    Children have a comparatively low rate of BD, but the rate increases with age, to approximately 1 percent among adolescents. About 3 percent of pre-adolescent and adolescent youth are estimated to have SMD. Mood-stabilizing and antipsychotic medications are used to treat children with BD, although the data on their effectiveness are limited and several studies are underway. Since SMD was only recently defined, there are no systematic studies on its treatment, and children with SMD are often treated as if they have BD.

    Defining pediatric BD is a major issue in child psychiatry, because the disorder tends to be severe in this age group and the rate of diagnosed cases is rising. Until recent years, most studies of BD were conducted in adults. Some researchers maintain that pediatric BD should be defined more broadly to include children with SMD, an assertion countered by the new finding. Results of the study were published in the February 2007 issue of the American Journal of Psychiatry.

    The classic definition of BD includes extreme, sustained mood swings that range from over-excited, elated moods and irritability — the manic phase of the disorder — to depression. In contrast, children with SMD are extremely irritable and hyperactive, but do not have clear-cut manic episodes.

    One component of irritability is the tendency to get acutely frustrated when a goal is not met. Thus, through electroencephalograms (EEGs), the researchers could observe the brain's electrical signals that occurred during frustration while children with either disorder performed simple tasks.

    The new study shows that clinicians some day could use biological measurements, such as EEGs, to help make psychiatric diagnoses, in combination with clinical symptoms. Currently, clinicians diagnose mental illnesses based on symptoms alone. The difficulty of diagnosing BD in children is compounded by the frequent co-occurrence of one or more other mental disorders.

    "We're approaching the day when we'll be able to use neuroscience techniques to improve psychiatric diagnoses. Pediatric BD has some of the most pressing needs in this regard, because of its severity and because of questions about how to best make the diagnosis," said senior author Ellen Leibenluft, M.D., Chief of the Unit on Bipolar Spectrum Disorders in the Emotion and Development Branch of the NIMH Mood and Anxiety Disorders Research Program.

    In this study, scientists obtained EEGs of 35 children with classic BD, 21 children with SMD, and 26 healthy children (average age 12 to 13) while they performed a task repeatedly; each time they did the task, they won or lost 10 cents. The task was frustrating because the children often lost money.

    The researchers found that while both the children with BD and those with SMD became more frustrated than did healthy children performing the same task, the brain mechanisms associated with their frustration differed. Children with BD had an abnormality in the brain's P3 electrical signals, which measure ability to purposefully direct attention, but children with SMD had abnormalities in N1 signals, which occur when a stimulus grabs someone's attention. Both abnormalities suggest deficits in the brain's attention-related activity, but in different phases of that activity.

    "If future research indicates that BD and SMD are two separate disorders, this could guide parents and physicians toward the right treatments," said first author Brendan Rich, Ph.D., of the NIMH Unit on Bipolar Spectrum Disorders. "A good example is that medication prescribed for symptoms seen in SMD, such as stimulant medication, might be inappropriate for a child with classically defined bipolar disorder," he said.

    NIMH scientists Mariana Schmajuk, B.S., and Daniel Pine, M.D., also contributed to the research, as did University of Maryland scientists Koraly E. Perez-Edgar, Ph.D., (currently at George Mason University) and Nathan A. Fox, Ph.D.

    Thirteen Great Books on Bipolar Disorder:

    1. The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers by Wes Burgess (Paperback - Jun 8, 2006)
    2. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    5. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    6. A Story of Bipolar Disorder (Manic-depressive Illness): Does This Sound Like You? (Paperback - 2007)
    7. Coping With Bipolar Disorder and Manic-Depressive Illness (Coping) by Joann Jovinelly (Library Binding - Aug 2001)
    8. Everything You Need to Know About Bipolar Disorder and Manic Depressive Illness (Need to Know Library) by Michael A. Sommers (Library Binding - Aug 2002)
    9. High, Flat, Down And Back Up Again!: A Guide To Manic-Depressive Illness by Alain Amzallag (Paperback - Feb 21, 2005)
    10. Brilliant Madness: Living with Manic Depressive Illness by Patty Duke and Gloria Hochman (Mass Market Paperback - Feb 4, 1997)
    11. Understanding Bi-Polar Disorder (DVD - Jul 27, 2006)
    12. Touched with Fire: Manic-Depressive Illness and the Artistic Temperament by Kay Redfield Jamison (Paperback - Oct 18, 1996)
    13. An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison (Paperback - Jan 14, 1997)

    Ten Resource and Support Groups for Bipolar Disorder

    1. Depression and Bipolar Support Alliance
    2. Bipolarconnect.com
    3. The Bipolar Support Group
    4. MDjunction.com 
    5. The Bipolar Advantage  
    6. Bipolar Disorder Today
    7. Bipolar Dream 
    8. Bipolar Freedom
    9. Bipolar Hope
    10. Bipolar Support Friends

    Additional Resources:

    • For related articles on bipolar disorder disorders on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog  posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: Bipolar Disorder” or type in the keyword “bipolar disorder” into “Google Search” located in the sidebar.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keyword, “bipolar disorder” into “Amazon Search” on the Amazon banner located in the side bar.
    Sources: National Institute of Mental Health, See Blogposts: 8/4/08, 9/07/08 (9:19AM), 9/7/08(9:28AM), See Blogposts in: Psychiatric Disorders: Bipolar 

    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com


    Email this • Sphere: Related Content • Technorati Links • View CC license • Subscribe to this feed • Save to del.icio.us • Share on Facebook • Stumble It! • Add to Mixx! • Discuss on Newsvine • Digg This! • outside.in: geotag this story

    Posted by Dr. Jeff and Dr. Tanya on October 29, 2008 at 12:55 PM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    Suicidial thinking and bipolar disorder

    Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.

    Signs and symptoms that may accompany suicidal feelings include:

    • talking about feeling suicidal or wanting to die
    • feeling hopeless, that nothing will ever change or get better
    • feeling helpless, that nothing one does makes any difference
    • feeling like a burden to family and friends
    • abusing alcohol or drugs
    • putting affairs in order (e.g., organizing finances or giving away possessions to prepare for one’s death)
    • writing a suicide note
    • putting oneself in harm’s way, or in situations where there is a danger of being killed

    If you are feeling suicidal or know someone who is:

    • call a doctor, emergency room, or 911 right away to get immediate help
    • make sure you, or the suicidal person, are not left alone
    • make sure that access is prevented to large amounts of medication, weapons, or other items that could be used for self-harm

    While some suicide attempts are carefully planned over time, others are impulsive acts that have not been well thought out; thus, the final point in the box above may be a valuable long-term strategy for people with bipolar disorder. Either way, it is important to understand that suicidal feelings and actions are symptoms of an illness that can be treated. With proper treatment, suicidal feelings can be overcome.

    Thirteen Great Books on Bipolar Disorder:

    1. The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers by Wes Burgess (Paperback - Jun 8, 2006)
    2. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    5. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    6. A Story of Bipolar Disorder (Manic-depressive Illness): Does This Sound Like You? (Paperback - 2007)
    7. Coping With Bipolar Disorder and Manic-Depressive Illness (Coping) by Joann Jovinelly (Library Binding - Aug 2001)
    8. Everything You Need to Know About Bipolar Disorder and Manic Depressive Illness (Need to Know Library) by Michael A. Sommers (Library Binding - Aug 2002)
    9. High, Flat, Down And Back Up Again!: A Guide To Manic-Depressive Illness by Alain Amzallag (Paperback - Feb 21, 2005)
    10. Brilliant Madness: Living with Manic Depressive Illness by Patty Duke and Gloria Hochman (Mass Market Paperback - Feb 4, 1997)
    11. Understanding Bi-Polar Disorder (DVD - Jul 27, 2006)
    12. Touched with Fire: Manic-Depressive Illness and the Artistic Temperament by Kay Redfield Jamison (Paperback - Oct 18, 1996)
    13. An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison (Paperback - Jan 14, 1997)

    Ten Resource and Support Groups for Bipolar Disorder

    1. Depression and Bipolar Support Alliance
    2. Bipolarconnect.com
    3. The Bipolar Support Group
    4. MDjunction.com 
    5. The Bipolar Advantage  
    6. Bipolar Disorder Today
    7. Bipolar Dream 
    8. Bipolar Freedom
    9. Bipolar Hope
    10. Bipolar Support Friends

    Additional Resources:

    • For related articles on bipolar disorder disorders on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog  posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: Bipolar Disorder” or type in the keyword “bipolar disorder” into “Google Search” located in the sidebar.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keyword, “bipolar disorder” into “Amazon Search” on the Amazon banner located in the side bar.
    Sources: National Institute of Mental Health, See Blogposts: 8/4/08, 9/07/08 (9:19AM), 9/7/08(9:28AM), See Blogposts in: Psychiatric Disorders: Bipolar 

    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com


    Posted by Dr. Jeff and Dr. Tanya on October 08, 2008 at 07:06 AM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    The best patient guide to the clinical course of bipolar disorder

    Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.3

    The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.

    People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated (see “How Is Bipolar Disorder Treated?”). Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared.4 But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.

    Thirteen Great Books on Bipolar Disorder:

    1. The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers by Wes Burgess (Paperback - Jun 8, 2006)
    2. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    5. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    6. A Story of Bipolar Disorder (Manic-depressive Illness): Does This Sound Like You? (Paperback - 2007)
    7. Coping With Bipolar Disorder and Manic-Depressive Illness (Coping) by Joann Jovinelly (Library Binding - Aug 2001)
    8. Everything You Need to Know About Bipolar Disorder and Manic Depressive Illness (Need to Know Library) by Michael A. Sommers (Library Binding - Aug 2002)
    9. High, Flat, Down And Back Up Again!: A Guide To Manic-Depressive Illness by Alain Amzallag (Paperback - Feb 21, 2005)
    10. Brilliant Madness: Living with Manic Depressive Illness by Patty Duke and Gloria Hochman (Mass Market Paperback - Feb 4, 1997)
    11. Understanding Bi-Polar Disorder (DVD - Jul 27, 2006)
    12. Touched with Fire: Manic-Depressive Illness and the Artistic Temperament by Kay Redfield Jamison (Paperback - Oct 18, 1996)
    13. An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison (Paperback - Jan 14, 1997)

    Ten Resource and Support Groups for Bipolar Disorder

    1. Depression and Bipolar Support Alliance
    2. Bipolarconnect.com
    3. The Bipolar Support Group
    4. MDjunction.com 
    5. The Bipolar Advantage  
    6. Bipolar Disorder Today
    7. Bipolar Dream 
    8. Bipolar Freedom
    9. Bipolar Hope
    10. Bipolar Support Friends

    Additional Resources:

    • For related articles on bipolar disorder disorders on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog  posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: Bipolar Disorder” or type in the keyword “bipolar disorder” into “Google Search” located in the sidebar.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keyword, “bipolar disorder” into “Amazon Search” on the Amazon banner located in the side bar.
    Sources: National Institute of Mental Health, See Blogposts: 8/4/08, 9/07/08 (9:19AM), 9/7/08(9:28AM), See Blogposts in: Psychiatric Disorders: Bipolar 

    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com


    Posted by Dr. Jeff and Dr. Tanya on October 08, 2008 at 07:06 AM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

    The best patient guide to the causes of bipolar disorder

    Scientists are learning about the possible causes of bipolar disorder through several kinds of studies. Most scientists now agree that there is no single cause for bipolar disorder—rather, many factors act together to produce the illness.

    Because bipolar disorder tends to run in families, researchers have been searching for specific genes—the microscopic “building blocks” of DNA inside all cells that influence how the body and mind work and grow—passed down through generations that may increase a person’s chance of developing the illness. But genes are not the whole story. Studies of identical twins, who share all the same genes, indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop the illness, and research has shown that this is not the case. But if one twin has bipolar disorder, the other twin is more likely to develop the illness than is another sibling.6

    In addition, findings from gene research suggest that bipolar disorder, like other mental illnesses, does not occur because of a single gene.7 It appears likely that many different genes act together, and in combination with other factors of the person or the person’s environment, to cause bipolar disorder. Finding these genes, each of which contributes only a small amount toward the vulnerability to bipolar disorder, has been extremely difficult. But scientists expect that the advanced research tools now being used will lead to these discoveries and to new and better treatments for bipolar disorder.

    Brain-imaging studies are helping scientists learn what goes wrong in the brain to produce bipolar disorder and other mental illnesses.8,9 New brain-imaging techniques allow researchers to take pictures of the living brain at work, to examine its structure and activity, without the need for surgery or other invasive procedures. These techniques include magnetic resonance imaging (MRI), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). There is evidence from imaging studies that the brains of people with bipolar disorder may differ from the brains of healthy individuals. As the differences are more clearly identified and defined through research, scientists will gain a better understanding of the underlying causes of the illness, and eventually may be able to predict which types of treatment will work most effectively.

    Thirteen Great Books on Bipolar Disorder:

    1. The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers by Wes Burgess (Paperback - Jun 8, 2006)
    2. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz
    3. The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder—Third Edition by Demitri Papolos and Janice Papolos
    4. Intense Minds: Through the Eyes of Young People with Bipolar Disorder by Tracy Anglada
    5. The Childhood Bipolar Disorder Answer Book: Practical Answers to the Top 275 Questions Parents Ask (Answers Book) by Tracy Anglada
    6. A Story of Bipolar Disorder (Manic-depressive Illness): Does This Sound Like You? (Paperback - 2007)
    7. Coping With Bipolar Disorder and Manic-Depressive Illness (Coping) by Joann Jovinelly (Library Binding - Aug 2001)
    8. Everything You Need to Know About Bipolar Disorder and Manic Depressive Illness (Need to Know Library) by Michael A. Sommers (Library Binding - Aug 2002)
    9. High, Flat, Down And Back Up Again!: A Guide To Manic-Depressive Illness by Alain Amzallag (Paperback - Feb 21, 2005)
    10. Brilliant Madness: Living with Manic Depressive Illness by Patty Duke and Gloria Hochman (Mass Market Paperback - Feb 4, 1997)
    11. Understanding Bi-Polar Disorder (DVD - Jul 27, 2006)
    12. Touched with Fire: Manic-Depressive Illness and the Artistic Temperament by Kay Redfield Jamison (Paperback - Oct 18, 1996)
    13. An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison (Paperback - Jan 14, 1997)

    Ten Resource and Support Groups for Bipolar Disorder

    1. Depression and Bipolar Support Alliance
    2. Bipolarconnect.com
    3. The Bipolar Support Group
    4. MDjunction.com 
    5. The Bipolar Advantage  
    6. Bipolar Disorder Today
    7. Bipolar Dream 
    8. Bipolar Freedom
    9. Bipolar Hope
    10. Bipolar Support Friends

    Additional Resources:

    • For related articles on bipolar disorder disorders on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
    • For related books or blog  posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: Bipolar Disorder” or type in the keyword “bipolar disorder” into “Google Search” located in the sidebar.
    • For more books with related content, click any hyperlinked keyword in the blog or type in the keyword, “bipolar disorder” into “Amazon Search” on the Amazon banner located in the side bar.
    Sources: National Institute of Mental Health, See Blogposts: 8/4/08, 9/07/08 (9:19AM), 9/7/08(9:28AM), See Blogposts in: Psychiatric Disorders: Bipolar 

    Dr. Jeffrey Speller

    Dr. Tanya Korkosz

    Psychopharmacology Associates of New England

    www.psychopharmassociates.com


    Posted by Dr. Jeff and Dr. Tanya on October 08, 2008 at 07:05 AM in Psychiatric Disorders: Bipolar Disorder | | Comments (0)

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