Bipolar 101

Trading your brain for your kidney and other medication conundrums

2011-11-18T16:13:00.001-08:00

This is a blog about cutting edge science and bipolar disorder.

And here's the problem with cutting edge science and bipolar disorder: we get the treatments that could kill us or make us feel awful in a different way.

Of all the things I hate about being mentally ill (and there are many), it is the trading off my brain function for liver function, or one kind of brain function for another. Tweak one med and it means more frequent blood tests to make sure that my sanity doesn't kill the rest of me.

If you're like most people with a mental illness, this is the major reason people do not take their medications: side effects. Sometimes it doesn't even make sense to read the list of likely side effects, never mind the unlikely ones, because not taking psych meds can result in other ugly things happening. So you trade one bad thing for one good thing and hope it all works out in the end.

Lucky for me, I have a combination that works. Very well. But there are times they need an upgrade because the brain is not static. And the pill count gets higher or more complicated and if you have something else wrong with you it eliminates most of the drugs that could help with that problem.

For example, taking lithium means that lots of hypertensive drugs are off the table. If you take olanzapine, you may end up with diabetes (hmmmmm...... sanity or diabetes??). Benzodiazepenes which are used for sleep could make you an addict.

The reason people with mental illness are so bad with their medication compliance is not just that we feel better from taking them (which in any illness this is true) but because the side effects can be so irritating and health threatening. Anyone who takes lithium knows how annoying dry mouth is and the volumes of liquid consumed means that there are many trips to the toilet. And every 3 months you hope the blood tests don't show signs of liver damage or kidney trouble or perhaps one day you wake up and your thyroid no longer works.

Well, there dont seem to be very good answers right now. Perhaps one day science will find a way to target the parts of our brain causing us trouble and zap.... we're done. Until then, science has brought us some compromises that require us to make tough choices about our lives. So we take them as instructed and keep track of our side effects and if they get too bad, we try something else until if we're lucky we find something that works.

What choice do we have???

Getting through exams when you have bipolar disorder

2011-11-15T18:04:00.001-08:00

It's that time of year again for the high school or college student.... midterms. And soon it will be finals. If you are a student with bipolar disorder, you must take extra care to make sure the stress does not cause you to have symptoms or a full-blown manic or depressive episode. So how do you stay healthy amid all the demands on your time? The short list of strategies (I don't want to add to your to-do list:).

1. Make a monthly assignment calendar on which you put all due dates. Place it on your refrigerator, your door or your mirror: some place where you will see it everyday. This prevents surprises.

2. Go see your professors for a check-in about how you are doing and what you can do better and on what areas you should focus. If you have not registered as a student with a disability then you may want to reconsider so that you can have extra time if you need it.

3. Go to student support workshops re:stress, exams, studying strategies etc offered by your university campus.Your tuition pays for all these great resources on campus; don't waste those dollars.

4. Go to a library orientation. This will probably be one of the best spent 30-60 minutes of your entire college career. Understanding databases, references & citations, where to find what, and how to access library help, is essential to getting an A on that paper.

5. Form a study group. Accountability to others is a great motivator for us to do what we often do not like to do. You will learn from each other and you will put some structure into your study life while adding a little bit of social to the solitary study routine.

6. Set a study schedule. Now that you know when things are due, when your study group(s) will meet, and what the professor wants you to do, and how you are going to maximize the library, it's time to set a specific time and place to do your studying. Sometimes you may want to be in the library and other times at home or in a coffee shop. Change up the routine to keep you focused but do what works for you. Tip: If you get your weekend studying out of the way on Saturday and Sunday morning then you are guilt-free to enjoy your weekend night.

7. Take care of yourself. All-nighters are a college staple; minimize them by taking the steps above. Below are some ways to make sure your body is ready for the studying and testing ahead.

Take your medications as prescribed. This is not the time to be playing around with your medications without the supervision of your doctor.
Exercise regularly - daily if possible; even if its a walk to run all your errands. Get your heart rate up and stress slowly melts away and sleep comes much easier at night.
Eat. Fresh fruits, vegetables and protein. Many people snack when they study so pop grapes or munch on carrots to stop that freshman 15 turning into a senior 30. Add in some Vitamin D and Omega 3 supplements and get at least half hour of sun everyday if you can. Best if you get it while going for a walk. Clears the head and calms the mood.
Sleep. Six to 8 hours of sleep maximizes memory function and brain function overall and keeps you alert in class. It may be best to skip that last hour of studying and go to bed so you can remember what you have already studied instead of forgetting everything. Maintain a sleep routine where you go to bed and wake up at the same time each night. See my post on sleep for more on how to keep your sleep and mood regular.

No drugs. Avoid all non-prescribed mood-altering drugs such as alcohol and caffeine. They impair your sleep and have a negative impact on the regulation of your moods. DO NOT TAKE ANY UNPRESCRIBED MEDICATIONS especially medications that are prescribed to your friends. These could have dangerous interactions with the medications you may be taking for bipolar disorder.

Relax. However it is you do that: yoga, meditation etc. If your mind is clear you will find that there is more room for all the knowledge you're paying for.
See your doctor if you are not feeling well or think you may need some support to get through this stressful time. Prevention is much better than cure.

No more points for you to learn here. You may do all this and not be able to prevent having symptoms or a full-blown episode but you will reduce the risk and improve your ability to cope.

This professor is wishing you happy studying and great grades. Now for me to come up with tips on how professors can get through the grading without pulling their hair out.

Seasons, climate and bipolar disorder. Revisited.

2011-11-12T14:08:00.001-08:00

I don't know much about blog protocol but I do know that in the traditional world of publishing, there are times when popular articles get republished. So as we head into the dark days of winter I thought I would re-post an entry from September 2010 with the addition of a study from Finland which came out in 2010.

This study tested people diagnosed with bipolar disorder and their first-degree (immediate family) relatives and found that variations in mood and behavior tended to run in families and influenced performance on a neuropsychological tests that tested working memory, verbal fluency, executive functioning, auditory attention among others.
Rajajarvi et al (2010). The effects of seasons and seasonal variation on neuropsychological test performance in patients with bipolar 1 disorder and their first-degree relatives. Journal of Affective Disorders, 127(1-3), 58-65.

The original post is below.

As fall approaches many people living with bipolar disorder find that the changes in light/dark influence their mood. So I reviewed the literature for a sample of studies on the topic. Not much has been written lately on the topic but there seems to be inconclusive evidence about the influence of seasons and climate on the moods of people living with bipolar disorder. For a small sample of the research in this area, see below:

Using observations were provided by patients from different geographic locations in North and South America, Europe and Australia a recent study conducted by numerous researchers around the world found no relationship between moods in people living with bipolar disorder and seasons, latitude or climate.
Bauer et al (2009). Relationship among latitude, climate, season and self-reported mood in bipolar disorder. Journal of Affective Disorders, Vol 116(1-2), pp. 152-157.

In a large study of lithium serum levels measured between January 1995 and July 2004 in 3 large teaching hospitals in the Netherlands, there was a significant difference found in average lithium serum levels across seasons, with summer being the highest and winter being the lowest. However, these differences were too small to impact the therapeutic impact of lithium. Temperature variations followed the same pattern.
Wilting et al. (2007). The impact of environmental temperature on lithium serum levels. Bipolar Disorders, Vol 9(6), pp. 603-608.

As part of the ongoing STEP-BD (Systematic Treatment Enhancement Program for Bipolar Disorder), there was a study of seasonal and regional effects on people living with Bipolar Disorder I and II. Results showed that study participants who lived in northern areas were more likely to be depressed. Bipolar II patients were more ill year-round than were patients with Bipolar I and had greater monthly fluctuations in illness rates that patients with Bipolar I.
Friedman et al. (2006). Seasonal changes in clinical status in bipolar disorder: A prospective study in 1000 STEP-BD patients. Acta Psychiatrica Scandinavica, Vol 113(6), pp. 510-517.

Sleep: the secret to even moods

2011-11-12T11:48:00.001-08:00

According to the National Institutes of Health, chronic sleep loss or sleep disorders may impact up to 70 million Americans and cost up to $16billion in healthcare costs and $60billion in lost productivity. So sleep is a big deal, not only to people living with bipolar disorder, who often have sleep disorders related to the illness

but also to people in general.

GOOD SLEEP is as essential for health as is good nutrition and physical activity. Getting good sleep means going to bed when you are tired, falling asleep within 15-30 minutes, staying asleep for 6-8 hours, and waking up feeling rested.

Sleep has been the bane of my existence ever since I was a child and I have spent a lot of my life trying to sleep when my body has other ideas so I have spent a lot of time researching sleep and trying strategies that work and spent a chapter in my book, Bipolar 101, discussing sleep. Sleep behaviors are on the list of symptoms for both depressive and manic episodes. Lack of sleep triggers bipolar symptoms and makes existing symptoms worse so getting enough sleep is very important to the mental health of someone living with bipolar disorder.

For manic episodes sleep goes bye bye and the rush of being able to just go-go-go eventually puts us in the hospital if we don't get back on track. During a bout of depression many people would prefer not to get out of bed. Treatment for bipolar disord

er usually gets people back on track with their sleep but if sleeplessness continues then they are often treated with medications that induce sleep.

Sleep deprivation (sleep deficit) is also the leading cause of accidents (of all kinds) in the USA because the brain does not function well on lack of sleep. Too little sleep also weakens our immune system so that we are more susceptible to illness. So what I am saying in this post can apply to anyone, not just people living with mental illness.

The latest research suggests that a sleep routine that keeps our circadian rhythms (internal clock) on a regular schedule, also keeps the mind on an even keel.

How do we do this? By developing a sleep routine; and at a minimum your sleep routine should include the following:

Going to bed at the same time each night and getting up at the same time each morning. Everyday. No changes on weekends. This sets your internal time clock and helps keep your moods on an even keel.
Give yourself 30 - 60 minutes to prepare for bed and find a way of developing a habit in terms of the sequencing of your preparation. The point is to slow down the body so it is ready to go to bed. For example, you could start by taking your medications (in particular, medications that make you drowsy) so they have some time to take effect before getting into bed? Or if they are quick acting you may want to take them last. Make sure you have set your alarm or put a glass of water by the bed (this is especially for people suffering from the dry mouth side effects of many bipolar medications). Some people find a bath calming. Others find a shower either calming or stimulating so find the activities that work best for you.
A calming down activity such as meditation or yoga or reading (a calm book:). Drinking a cup of warm milk (which has naturally occurring ingredients that make people sleepy) or chamomile tea is also helpful.

Research has also shown that we sleep better in cool temperatures so make sure to turn off/down the heating in your room. A dark room also encourages sleep and if you cannot create a really dark room then sleep with a blindfold on. TVs should be banned from the bedroom. So should laptop computers and your cellphone, if you are having a hard time with distractions.

One of the best ways to get better sleep is to be physically active on a regular basis. For those who have trouble sleeping it is better if you exercise in the morning, because the body takes some time to calm down when you exercise so if you do it too close to your bedtime, your body may be to revved up to fall asleep.

If you want to know more about sleep and mental well-being and find evidence-based strategies for improving sleep, then check out a new publication by the Mental Health Foundation in the UK, which has published a free downloadable book on sleep called, 'Sleep Matters: The Impact of Sleep on Health and Well-Being', click here.

The National Institutes of Health also publishes a sleep guide called, 'Your Guide to Healthy Sleep' is available free if you click here.

War and the mind

2011-11-11T21:23:00.000-08:00

Today is Veteran's Day. And in honor of all those who have served I explore the impact of war on mental health on my Psychology Today blog with a post titled: Mental Health and the Culture of War.

Imagine what it would be like to have bipolar disorder and deal with the challenges of war and there seems to be no clear evidence that war can trigger bipolar disorder but who knows. If you know someone who is a veteran who may have mental health problems, please refer them to the Department of Veteran's Affairs (VA)

Can racism make us mentally ill?

2011-10-24T00:32:00.001-07:00

I am writing a blog on the Psychology Today website called Culture in Mind, which explores issues related to culture and mental health. I have a new entry that relates directly to this blog so I'm posting the link here: http://www.psychologytoday.com/blog/culture-in-mind

Grief and bipolar disorder

2011-03-30T17:51:00.001-07:00

I lost a very close friend on December 20 and last spoke to him on his birthday on December 17. I got the email telling me of his death an hour after my child arrived for Christmas.

So I've not been much up to blogging. And even searches of research for how grief plays out in bipolar disorder were quite dissatisfying because basically whatever happens to everyone else happens to us but just more intensely.

What I know is that if it were not for friends I would not have lived through the last 3 months without hospitalization. I made it through teaching and being an economics student and just keeping my head above water. Daily emails from close friends got me out of bed in the morning and made me commit to my well-being. I avoided the psychiatrist and therapist because really I knew i needed more drugs and/or out of my house.

But I made it. I'm out of the tunnel and into a bit of a bright light but better hypomania than the darkness of depression.

This is a science blog and yet i'm not quoting science this post. What I am saying with resounding support from the literature is that having good friends is worth the effort. There is no pill for that. No therapy for that.

Brain flip-flop to pharma trip-hop

2011-01-25T14:40:00.000-08:00

Ahhhh the sanity/pharma dilemma.

Do I beat back depression with Zyprexa and suffer nightmares and gain weight I don't want?

Do I suffer the desertification of my mouth from Lithium to keep my moods in check?

Do I beat resist being the living dead (i.e. insomniac from hell) with the zombiefication of Ambien?

Stay tuned for my next post later this week on the side effects game and what can be done about it.

In the meantime it's load up on the Omega-3, Vit Bs and Vit Ds.

If anyone can send me feedback on Biotene I'm really interested to hear what your experience has been.

SO WHAT IF I’M CRAZY?

2010-09-11T23:50:00.001-07:00

I am a strong African American woman: The kind that aced two challenging concurrent grad school programs while pregnant, spent years of duty as a single, professional mother thousands of miles from family, backpacked alone through Central America in my 40’s, soloed up 6000+ft mountains, worked as a social worker with challenging populations in Canada, the USA and the UK, rode the rapids of the White Nile in a tiny kayak and on a big rubber raft, got tenure, and started a highly successful maternal and child health project in Africa. I’ve earned a cape and a big ‘S’ on my chest.

I am an African American woman with a brain disorder – aka mental illness (specifically manic depression, also known as bipolar disorder). I have spent time in a mental health treatment facility, will probably need medication for a lifetime, and have spent many hours in a therapist’s office. I’ve got a whole professional team that works with me to keep me sane.

I used to be ashamed and secretive of the reality described in the previous paragraph but proud of the life described in the first. Now it’s an integrated whole. I know that taking off the cape and stripping my chest of the ‘S’ doesn’t make me any less of a strong African American woman. Superhero status is not required. I cannot save the world and sometimes I’m the one that needs saving.

Like many people I once felt that having a mental illness was a sign of personal weakness. As a mental health professional I spent lots of time convincing people otherwise, but when it was my turn I felt that going to the psychiatrist was a sign of failure. I tried running, acupuncture, yoga, Chinese herbs, meditation – anything but get ‘mainstream’ medical attention. I did not want to go to a psychiatrist because,“ Nothing is wrong with me. I’m not crazy!”.

I had no issue with going to the dentist, gynecologist, or orthopedist. Like many African Americans I stigmatized mental illness in a way we do not stigmatize obesity, diabetes, hypertension and so many other chronic and life-threatening illnesses. We will take pills to lose weight or lower our blood pressure but not to get or stay mentally well.

According to the mythology that surrounds the strength of African Americans, ‘falling apart’ is just not something we do. We survived the Middle Passage, slavery, racial oppression and economic deprivation. We know how to “handle our business”, “be a man”, or “be a woman”. We see therapy as the domain of ‘weak’, neurotic people who don’t know what ‘real problems’ are. Instead, to deal with our psychic pain we eat our way into life-threatening obesity, excessively use alcohol and drugs, and act-out violently through word and deed, but we do not go crazy.

Because being ‘crazy’ means you can’t handle life and in our story of who we are, we are survivors who can handle anything,; which means we do what we have to do to survive. But this does not usually include a trip to the mental health professional of our choice. It is time to add this to our survival toolkit.

Is it really better to be a drug addict, obese with high blood pressure and diabetes, or be verbally/physically/emotionally violent to those around us, instead of seeking help for that which troubles us so deeply that we choose to self-destruct - though perhaps not in the stereotypical idea of what suicide looks like to us? I don’t think so.

At some point we must stop worrying what other people are going to think and get about the business of getting well and moving forward with our lives.

So how do African Americans begin to eliminate the stigma of mental illness so that we can get the help we need sooner rather than later, and support those who need it?

1. Talk about it. Don’t whisper or gossip about it. Talk about it at the BBQ. From the pulpit. On TV. On the radio. With our doctors. With our loved ones. If we can talk about our ‘sugar’ and our ‘pressure’, then we should be willing to talk about our depression.
2. Support each other in getting help. We send friends to the doctor for the nagging back pain so send them to get relief from their mental and emotional pain too. And don’t forget to ask them how they are doing as time passes; they need friends more than you know.
3. Let us not stigmatize the brain. It is attached to the body so mental illness IS a physical illness, especially as chemical imbalances are at the root of their expression. Furthermore, the biochemical impacts of a brain disorder are felt throughout the whole body, not just in the brain.
4. Say, “This person HAS a mental illness”, NOT “This person IS mentally ill”. We do not say, “That person IS cancerous”. Words have power.
5. Acknowledge that those who survive a brain disorder are as much survivors as family and friends who survive life-threatening diseases. Understand that we work just as hard to stay sane as the addict does to stay sober. As cancer or addiction go into remission so too do brain disorders.
6. Support people who share their stories of brain disorders. It is time to show that the faces and lives of African Americans with a mental illness are not just the faces and lives of the homeless person talking to the unseen. It is my face and my life; and the faces and lives of so many other men and women like me.
7. Advocate for accessible and affordable, culturally appropriate mental health services.

“Coming out” requires courage. Like any other consciousness-raising process, a range of role models that represent a variety of experiences with mental illness will change perceptions. As a community we have lists of accomplished African Americans to inspire us in our various endeavors. We need a list of African Americans with mental illness who have survived and thrived.

No doubt due to the stigma, it was difficult to find names of well-known African Americans with a “‘confirmed“‘ history of mental illness – and this is no place for innuendo or rumor-mongering. So I will start this list with me: My name is Ruth White and I have manic depression. I am a mother, poet, researcher, writer, kayaker, hiker, traveler, professor, swimmer, and as sane and happy a person as you would ever want to meet. My brain disorder does not define who I am.

Seasons, Climate and Bipolar Disorder

2010-09-09T19:32:00.000-07:00

As fall approaches many people living with bipolar disorder find that the changes in light/dark influence their mood. So I reviewed the literature for a sample of studies on the topic. Not much has been written lately on the topic but there seems to be inconclusive evidence about the influence of seasons and climate on the moods of people living with bipolar disorder. For a small sample of the research in this area, see below:

Using observations were provided by patients from different geographic locations in North and South America, Europe and Australia a recent study conducted by numerous researchers around the world found no relationship between moods in people living with bipolar disorder and seasons, latitude or climate.

Bauer et al (2009). Relationship among latitude, climate, season and self-reported mood in bipolar disorder. Journal of Affective Disorders, Vol 116(1-2), pp. 152-157.

In a large study of lithium serum levels measured between January 1995 and July 2004 in 3 large teaching hospitals in the Netherlands, there was a significant difference found in average lithium serum levels across seasons, with summer being the highest and winter being the lowest. However, these differences were too small to impact the therapeutic impact of lithium. Temperature variations followed the same pattern.

Wilting et al. (2007). The impact of environmental temperature on lithium serum levels. Bipolar Disorders, Vol 9(6), pp. 603-608.

As part of the ongoing STEP-BD (Systematic Treatment Enhancement Program for Bipolar Disorder), there was a study of seasonal and regional effects on people living with Bipolar Disorder I and II. Results showed that study participants who lived in northern areas were more likely to be depressed. Bipolar II patients were more ill year-round than were patients with Bipolar I and had greater monthly fluctuations in illness rates that patients with Bipolar I.

Friedman et al. (2006). Seasonal changes in clinical status in bipolar disorder: A prospective study in 1000 STEP-BD patients. Acta Psychiatrica Scandinavica, Vol 113(6), pp. 510-517.

Bipolar Tweets

2010-08-25T15:15:00.000-07:00

Follow along with me on Twitter for information, strategies, science and random bipolar stuff:

bipolar101tweet

What Works...

2010-08-17T23:06:00.000-07:00

I have not updated this blog for more than a year because I wanted to take some time off from thinking about bipolar disorder after completing my book, Bipolar 101. Sometimes talking about bipolar disorder gets to be tedious and tiring but I know that the point of this blog is to take the 'relevant' science of bipolar disorder and make it accessible to a broad readership. I am thus back and ready to keep you current on information from science that you can use in your own life. Or at least, find it interesting.

This first entry of 2010 starts with a nice summary of what works in managing bipolar disorder. I have found all these strategies quite useful for myself and all of these are given full treatment in my book, Bipolar 101. Nice to know that taking these individual strategies which have been found useful are also useful in the aggregate.

Please read. Comment. And if you've read my book, please place a review online at Amazon.com or BN.com. Thank you.

A study of 32 high-functioning individuals diagnosed with bipolar disorder I and II found that the following self-management strategies were most effective in managing symptoms:
1. management of sleep, rest, exercise and diet;
2. ongoing monitoring;
3. enacting a plan;
4. reflective and meditative practices
5. understanding bipolar disorder and educating others;
6. connecting with others.
What works for people with bipolar disorder? Tips from the experts by Suto, M; Murray, G; Hale, S; Amari, E; & Michalak EE. (2010). Journal of Affective Disorders, Vol 124(1-2), pp. 76-84.

A review of the new diagnosis of Pediatric Bipolar Disorder suggests that the childhood characteristics of people who were diagnosed with classic Bipolar 1 symptoms are different than the characteristics of children now being diagnosed with Pediatric Bipolar Disorder. This suggests that perhaps many of the children now being given this diagnosis may grow out of their behaviors and may not meet the Bipolar diagnosis when they become adults.
Pediatric Bipolar Disorder: Part I-Is it related to classical bipolar disorder? by Littrell, J & Lyons, P (2010). Children and Youth Services Review, Vol 32(7), pp. 945-964.

ADHD in adults have different characteristics than ADHD in children and adolescents with less externalizing symptoms and more co-existing mental health disorders. People who simultaneously have ADHD and bipolar disorder have a more severe disease course, more severe mood disorder symptoms and lower scores on tests of functioning when compared to people who have only one of these disorders occurring at a time. ADHD symptoms are often diagnosed as part of bipolar disorder symptomatology and therefore people who have both disorders at the same time tend to be underdiagnosed and undertreated.
Adult ADHD and its comorbodities, with a focus on bipolar disorder by Klassen, LJ, Katzman, MA, & Chokka, P. (2010) Journal of Affective Disorders, Vol124(1-2), pp.1-8.

Bipolar Research Update April 9, 2009

2009-04-09T21:27:00.000-07:00

In a Swedish study of more than 9 million individuals, it was found that first degree relatives of people with bipolar disorder and schizophrenia were more likely to get these illnesses. Relatives of people with bipolar disorder were also more at risk of schizophrenia, including children adopted by a parent with bipolar disorder. Heritability for schizophrenia and bipolar disorder was 64% and 59% respectively.
Lichtenstein et al (2009). Common genetic determinants of schizophrenia and bipolar disorder among Swedish families: A population-based study. Lancet, 373(9659): 234-239.

In a family study there was no relationship between mood disorder in parents and personality traits in their children. Furthermore, parent's personality traits were not associated with risk of depression in their children.
Rothen et al. (2009). Personality traits in children of parents with unipolar and bipolar mood disorders. Journal of Affective Disorders, 113(1-2), 133-141

In a retrospective cohort study of more than 75,000 inmates in the largest prison system in the USA, it was found that inmates with serious mental illnesses, such as schizophrenia, bipolar disorder and major depressive disorder among others, were more likely to have had previous incarcerations. The greatest increase in risk of prior incarcerations were inmates with bipolar disorder who were 3.3 times as likely as inmates with no mental illness to have had 4 or more previous incarcerations in the 6 years prior to the study.
Baillargeon et al (2009). Psychiatric disorders and repeat incarcerations: The revolving prison door. American Journal of Psychiatry, 166(1), 103-109

Bipolar Research Update February 26, 2009

2009-02-26T23:03:00.000-08:00

The goal of this randomized, double-blind study was to measure the safety and effectiveness of aripiprazole (sold as Abilify) as monotherapy for acute biolar mania. Aripiprazole casued significantl more improvement than placebo and the same was shown for lithium. Most common side effects with aripiprazole were headache, nausea, sedation, constipation and akathisia, which is a feeling of inner restlessness that causes people to have an inability to stay still. Within 2 days, aripiprazole provided relief of symptoms of acute mania within 2 days, which continued over 3 weeks and sustained over 3 months. At twelve weeks both medications had similar outcomes.
Keck, P.E., et al (2009). Aripiprazole monotherapy in the treatment of acute bipolar I mania: A randomized, double-blind, placebo and lithium-controlled study. Journal of Affective Disorders, 112(1-3), 36-49

New scientific evidence show that the long-term course of bipolar disorder (BD) is lnked with high rates of other psychiatric conditions and increased mortality rates due to medicl disease. This leads to chronic BD, involvement in many health and social welfare sysmptoms. Add this to the disturbances in circadian rhythms, unstable moods and cognitive difficulties lead to a high rate of medical burden. Therefore the authors propose a multidimensional approach that addresses all these symptom domains.
Sorcella, I., E. Frank, and D.J. Kupfer (2009). The phenomenology of bipolar disorder: What drives the high rate of medical burden and determines long-term prognosis? Depressiona and Anxiety, 26(1), 73-82.

The objective of this study was to observe more than 3,000 people with bipolar disorder I (BDI) with a focus on those with rapid cycling (RC) in a large, prospective, observational study that followed people over many years in 14 European countries. Findings imiply that in non-clinical settings, people with mania and RC have different socio-demographics, treatment prescriptions and clinical outcome, with worse work outcomes and more co-existing conditions. It was also indicated that people with RC BPI have a severe form of BD over time with diagnostic and therapeutic tools that do not have rigorous evidence to support their usefulness.
Cruz, N, et al. (2008). Rapid-cycling bipolar I disorder: Course and treatment outcome of a large sample across Europe. Journal of Psychiatric Research 42(13), 1068-1075.

The research question in this study was to find out if advanced paternal age was associated with higher incidence of BD in offspring since advanced paternal age is known to increase risk for neurodevelopmental disorders. Starting with a database of 7,328,100 individuals and their biological parents, the sample was more than 13,00 people with a BD diagnosis. Taking account number of prior births, maternal age, socioeconomoic status and family history of psychotic disorders, the children of men who were 55 years and older were at a one-third increase in risk of having BD than the children of men who were aged 20-24 years.
Frans, E. M. et al. (2008) Advancing paternal age and bipolar disorder. Archives of General Psychiatry 65(9), 1034-1040.

2009-02-15T17:14:00.000-08:00

Most (97%) of people in this study with co-occurring diagnoses of both bipolar disorder I and alcohol or drug abuse disorders had attempted suicide.
Sublette et al, (2009). Substance use disorder and suicide attempts in bipolar subtypes
Journal of Psychiatric Research Vol 43 #3, p. 230-238

A comparison of 39 bipolar I disorder clients with 53 healthy controls found that regardless of suicidal history, people with bipolar I scored lower on neuropsychological tests of memory, executive function, attention and decision-making. Those who had attempted suicide had lower performance on decision-making tests compared to those who had not. Caution: the small sample may detract from the validity of these findings.
Malloy-Diniz, L.F. et al (2009). Suicide behavior and neuropsychological assessment of Type I bipolar patients. Journal of Affective Disorders, Vol 112 #1-3, p. 231-236.

Electroconvulsive therapy (ECT) was found to have more effectiveness in subjective & objective measures of mood in people diagnosed with unipolar depression than in people with bipolar depression, where there was no improvement in subjective (client) measures of mood. In the latter only clinician-rated measures were found to have improvement. In people with unipolar depression, improvement was shown on both clinician (objective) and client (subjective) measures of improvement. The study suggests that ECT may be more useful for people with unipolar depression than those with bipolar depression.
Hallam, K.T., Smith, D. I., & Berk, M. (2009). Differences between subjective and objective assessments of the utility of electroconvulsive therapy in patients with bipolar and unipolar depression. Journal of Affective Disorders, Vol 112 #1-3, p. 212-218

Although no causal relationship can be determined from this cross-sectional study, children and adolescents with a history of physical abuse were more likely to have longer duration of bipolar disorder, non-intact family, PTSD, psychosis and first degree family history of mood disorder than those without a history of physical abuse.
Romero, S. et al (2009). Prevalence and correlates of physical and sexual abuse in children and adolescents with bipolar disorder. Journal of Affective Disorders, Vol 112 #1-3, p. 144-150

A small study (results to be taken with caution) explored the effectiveness of psychoeducation as compared to an unstructured support group for people diagnosed with bipolar II. Results showed that after 5 years people who were in the psychoeducation group had fewer and shorter bipolar episodes and fewer manic and depressive episodes with higher levels of functioning.
Colom, F. et al (2009). Psychoeducation for bipolar II disorder: an exploratory, 5-year outcome sub-analysis. Journal of Affective Disorders, Vol 112 #1-3, p. 30-35

Interview with Dr. Ruth C. White, author Bipolar 101

2009-02-15T16:40:00.000-08:00

http://psychjourney.libsyn.com/

2009-01-08T22:43:00.000-08:00

BIPOLAR RESEARCH UPDATE

The genes that influence our circadian rhythms and sleep cycles also influence the clinical features and age of onset of bipolar disorder.
Benedetti, F., Dallaspezia, S., Colombo, C., et al., (2008). A length polymorphism in the circadian clock gene Per3 influences age at onset of bipolar disorder. Neuroscience Letters, 14, 445(2), 184-187.

Cannabis abuse causes bipolar-related psychosis to start an average of three years earlier than for people who did not abuse cannabis.
Ongur, D., Lin, L., & BM Cohen (2009). Clinical characteristics influencing age at onset in psychotic disorders. Comprehensive psychiatry, 50(1), 13-19.

Treating even minor depressive symptoms after a first manic episode is integral to recovery after depression following a first manic episode because only depression was found to be related to functional outcomes at 6 months post a manic episode.
Kauer-Sant’anna, M, Bond, DJ, Lam, RW, Yatham, LN (2009). Functional outcomes in first-episode patients with bipolar disorder: a prospective study from the Systematic Treatment Optimization Program for Early Mania project. Comprehensive Psychiatry, 50(1), 1-8.

A 16-week trial found that aripiprazole seems to show promise as an adjunctive treatment or monotherapy in people with bipolar disorder who are unresponsive to mood stabilizers. Akathisia (inner restlessness) and slight weight gain were the main side effects. However, double-blind, placebo-controlled studies are necessary to measure the drug’s efficacy, tolerability and safety for bipolar patients.
Mazza, M, Squillacioti, MR, Pecora, JD, et al (2008). Beneficial acute antidepressant effects of aripiprazole as an adjunctive treatment or monotherapy in bipolar patients unresponsive to mood stabilizers: results from a 16-week open-label trial. Expert opinion on pharmacotherapy, 9(18), 3145-9.

A study of the effectiveness of acute treatment with interpersonal and social rhythm therapy on occupational functioning found that despite the lack of statistical significance, there was more improved occupational functioning than with a pscyhoeducational and supportive approach with no emphasis on functional capacity.
Frank, E, Soreca, I, Swartz, HA et al. (2008). The role of interpersonal and social rhythm therapy in improving occupational functioning in patients with bipolar I disorder. American Journal of Psychiatry, 165(12), 1559-65.

Bipolar 101- The Book

2008-12-21T15:53:00.000-08:00

Bipolar 101 : A Practical Guide to Identifying Triggers, Managing Medications, Coping with Symptoms, and More by Ruth C. White, John Preston

The best primer ever written on the topic of bipolar disorder.
-Stephen Hinshaw, editor of Psychological Bulletin and chair of the department of psychology at the University of California, Berkeley

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Today my sister called me to tell me that my book, Bipolar 101, was now listed on Barnes and Noble and Amazon. My book comes out in February and I had been slow at getting my marketing going but now here it was. and my website was not up. and it was a cool moment to realize that i had published my first book and i had joined the literary hordes writing about bipolar disorder. but i also had the stamp of approval from the head of psychology at UC Berkeley who as the editor of Psychological Bulletin pulls some weight in the psychology community and that feels awesome.

i thought i was going to be modest but instead i emailed all my close friends and family and let them know that my first book was listed online.

in the meantime i tried to figure out what the focus of my blog was going to be. For many good reasons I decided that the travails of my challenges and joys of living with bipolar disorder was not a topic for public consumption.

however, as a scholar I could continue to keep current on the breaking scientific news on the illness and share that with my readers in lay language with the practical applications that could be discerned from the findings.

i won't retell the story of my past up until today because it's been told in another forum. in particular, 3 years of my life are told in another book entitled

Breaking the Silence : Mental Health Professionals Disclose Their Personal and Family Experiences of Mental Illness

I encourage people to post questions or other scientific news as my goal for this blog is to be a repository of the 'best' information that science has to offer about bipolar disorder. My book brings us up to 2008 and the blog will continue this further. I have a vested interest in knowing what more there is to know about the illness that in many ways controls my life and i will read the journals and share what i learn with you.