My Support - December 2009

Greetings!

I do earnestly hope this e-newsletter finds you well.

I hope you like the new format of this issue of My Support, it matches our new web site. If per chance you haven't had the chance to check out the site, please do. It is filled with downloadable educational brochures, videos (5 so far) including ones starring Dr. Kay Jamison and actor Richard Dreyfuss, our support group schedule (listed to the right in the green box under Support Groups), and much, much more.

Although I'm sure you need no reminders, the holiday season is upon us. They can be stressful and disappointing for many. I encourage you to reach out to loved ones and friends for support and/or to attend one of our (free) caregiver support groups (group times can be found on our web site http://www.californiabipolarfoundation.org/support-groups-meetings ) Please pay particular attention to "10 Tips for Surviving the Holidays". And for those who'd like a stress-free way to shop, check out the article below about Sam's Cause. It's easy, there's no additional cost to you, and CBF benefits with a donation from the vendor.

Warmest wishes for a wonderful, stress-free, healthy holiday.

Sincerely,
Muffy Walker

P.S. Please contact me at anytime: muffwalk@aol.com

10 Tips for Surviving the Holidays

by Joy Austin About.com

The holiday season is usually a stressful time for most people; it is even worse for those with mental illnesses such as bipolar disorder. However, there are ways to alleviate some of the anxiety surrounding the many events associated with the holidays. Joy Austin, a longtime member of this community, has compiled ten suggestions for coping with the seasonal stress of Thanksgiving, Christmas, Hanukkah, Kwanzaa and New Year's Eve. Most of these tips are good year 'round, too!

1. The number one rule for surviving the holidays is remembering that you can always say "No" and you can always do things more simply, even if that isn't the way it's always been done in the past.
2. If you're worried about getting the perfect gift for that special someone, but the thought of battling through all the holiday traffic, spending hours finding a parking place, then walking miles through a crowded mall seems too overwhelming for you, then remember that sometimes the best gift is a simple one. You can buy almost anything online from the comfort of your own home. Gift cards are also an easy way to go, whether you want to spend a few dollars on a video rental gift card, or a lot on a gift card for a fancy restaurant.
3. If the thought of a party, family gathering, or other "mandatory" social event leaves you knotted up with anxiety, plan ahead for some "escape time" for yourself. No matter where you are, if you are suddenly feeling overwhelmed with anxiety, claustrophobia, or simply more emotion than you feel safe showing in public, seek out the nearest restroom and stay inside until you have mentally gathered yourself together. The bathroom is a simple solution that is always available. It gives you privacy to take a few deep breaths, try to calm down, and mentally reevaluate your situation enough to decide if you think you really can calm down, or if you really need to tell the host or leader of the party or social event that you are not feeling well and need to go home.
4. Do you ever find yourself thinking, "I need a vacation! Not days spent with those people!"? If the family or friends that you are spending the holidays with are going to or already are causing you more stress than you can handle, then reconsider whether spending time with them is really the best choice you could make right now. Most people are afraid to spend the holidays alone, but as opposed to being around people who invalidate you, with everything from guilt-tripping to actual abuse, you might want to consider which situation you would really prefer.
5. So how do you spend all that time by yourself without getting depressed? Well, here are a few tips. Stay busy. On any day that I am not working, even if it is just the weekend, I make a list of things that I need to do and cross them out as I go. Even on the holidays and during the summer, it helps me to have a list, even if the things on it are very short and simple, like "check mail" or "vacuum." Just being able to look at my list at the end of the day and feel like I have accomplished something helps me feel positive about myself, and actually DOING those things helps fill my day with activity, which doesn't give me as much time for sitting and thinking about loneliness and depression. And if you think there is nothing you need to do, take a closer look at your house. When was the last time you really scrubbed the floor? Everything in the bathroom? Cleaned out the refrigerator? Organized all those papers on your desk? If you look hard enough, it's pretty easy to come up with a list of things to do.
6. Tip number two for surviving the holidays alone, whatever your reason may be: forget those centuries-old traditions and create some new traditions of your own. This year I had a big pepperoni pizza for my Thanksgiving dinner and enjoyed it far more than I would have the traditional turkey and stuffing. Instead of staying up to the wee hours of the morning cooking and baking and cleaning, stay up late watching a favorite movie and sleep as late as you want to the next day.
7. Get plenty of sleep. Whether you are spending the holidays rushing around doing all of your usual things or planning ahead for what to do with your alone time, sleep is essential. Schedule in your sleep time first when you plan out your day. If you are too tired to think straight, you cannot get anything done efficiently and perhaps not even done at all.
8. Make sure you eat enough to keep yourself going, and eat as healthfully as you can. When you are under a lot of stress, it is easy to just keep going on manic energy alone. However, when you are running on manic energy, your body burns calories at a much higher rate than normal, so when your body tells you that it is hungry, listen to it and eat something as soon as possible. And to help keep off those infamous holiday pounds despite all the scrumptious goodies around you, buy some fruit or vegetables and eat them first before you eat anything else at mealtime or for snacks. Fresh fruit is especially good for you because it is filling and very nutritious, and the extra vitamin C will help you stay healthy too.
9. Schedule at least 30 minutes of leisure time a day. If that sounds practically impossible, then you are working too hard. Even when you are under a tremendous amount of stress at work and/or at home, you will be amazed at what just 30 minutes of pure leisure time can do to help you de-stress and more easily cope with the rest of your life. I usually read a book for my 30 minutes, and I love losing myself in someone else's world for a little while. Just not thinking about everything that I have been worrying about all day helps me lower my stress level.
10. Once again, it is ok to say "No" when you are too stressed, too overcommitted, or just too overwhelmed to take on one more thing. "No, I can't bake cookies for the party." "No, I can't make the office party because my child's class is having their party the next morning and I'm the room mother.." "No, I can't make it to church today; I'm just too tired and I need the sleep." It is ok to say no when you really can't do one more thing, and you don't even have to explain why if you don't want to. You are an adult and you can make your own decisions without having to justify them. Too often we let other people manipulate us into doing things that we really don't want to do, but we don't have to let things be that way. Your choices and your decisions are always your own.

Holiday Blues, With Some Shades of Grey

By Ronald Pies, M.D.
Meagan really wanted this Christmas to be "extra special" - not like last year, when the family dinner turned nasty and Uncle Fred left in a huff. But as Christmas approached, the shopping chores multiplied, and the savings account dwindled, Meagan became increasingly anxious and dejected. Paul, her husband, wasn't of much help - he was preoccupied with his job search, after having been laid off two months ago. Meagan was left to deal with three school-age kids and a part-time "temp" job as a secretary. And all this, at a time Meagan strongly associated with her late mother, who always used to help with the holiday cooking - and who had passed away at about this time last year.

In the past few days, Meagan had found it increasingly hard to fall asleep, and noticed that her appetite was poor. From time to time, she found herself weeping or sighing, but not knowing what to do. She wondered if "maybe having a few drinks" might do her some good.
Meagan (a composite character) has a number of risk factors for feeling down or depressed. First, women have rates of serious depression about twice those of men, and are also at higher risk for a particular type of major depression called Seasonal Affective Disorder (SAD). In addition, the combined stresses of holiday chores, child care, and financial woes put Megan at risk for what is popularly known as "the holiday blues." So does Meagan's "anniversary reaction" over the death of her mother. But what do we really know about the "holiday blues," beyond hundreds of anecdotes and Internet postings? How do the "blues" differ from SAD and other forms of major depression? And is the commonly-held notion that suicide rates soar during the Christmas and winter holiday season really valid? Some recent research sheds light on these questions, while also highlighting many "grey areas" in our knowledge.

Let's deal with the "Christmas suicide" story first. From all the data we have gathered in the U.S. and parts of Europe, we can say confidently that this is a myth. In fact, we have evidence going back to the 19th century that suicide rates generally decline in the late fall and winter months, and spike upward in late spring and summer. The precise reasons for this pattern are not known, but the finding is consistent across many studies. In fact, data from Zurich, Switzerland, show that suicide rates begin to fall as early as late November, and remain lower until just after New Year's Eve. That's the good news, and ought to allay fears that Christmas, Chanukkah, Kwanzaa or other winter celebrations are times of high suicide risk. The not-so-good news, however, is that suicide rates appear to spike upward after New Year's Eve - largely among men. Rates for women seem to return to baseline, without a major spike.

There are two main hypotheses to explain these patterns. The "broken promises" hypothesis holds that, during the holiday season, people have very high expectations. Like Meagan, many view the holidays as a time to put things right, experience the joy of family and friends, and perhaps to experience some kind of spiritual renewal. Unfortunately, many are disappointed when these hopes are dashed - and some who become very despondent may take their lives. In contrast, the "withdrawn support" hypothesis begins with the observation that the winter holidays are usually a time of increased contact with family and friends. Social contact and support are known to protect against the risk of suicide. But after New Year's Day, social supports usually diminish rapidly. This is what I call the "picking up the wrapping paper phase," and it may be the time some very vulnerable individuals decide to take their own lives. Why does the post-holiday increase in suicides affect men more than women, at least in Switzerland? It may be partly because women are better than men at maintaining post-holiday social support networks, but this remains speculative.
With all the annual hoopla over the "holiday blues," it is surprising that so little solid research has been done on it. There seems to be no specific definition of the term, and - so far as I can tell - there are no well-designed epidemiological studies of the phenomenon in the U.S. That said, Dr. Jennifer Wider reports that nearly two-thirds of women surveyed by the National Women's Health Research Center reported feeling depressed during the previous year's winter holidays. I'm not aware of comparable data for men. However, Dr. Wider observes that often, during the holidays, the burdens of family caretaking fall mainly on the shoulders of women. Increased alcohol use during the holidays, combined with family stressors, may set many women up for the holiday blues. Of course, men are hardly immune to this condition, and are at higher risk for completed suicide.

Psychologist Dr. Herbert Rappaport believes that those he calls "fixers" - individuals intent on "making everything right" during the holidays - are especially prone to grief reactions after Christmas and Chanukkah. Fortunately, the "holiday blues" are usually short-lived, lasting a few days or perhaps a week or two in most cases. This differs from SAD, which tends to last weeks or months, and reappears winter after winter, regardless of social stressors. SAD, which affects perhaps 10 percent of the population, may be related to decreased daylight in the winter months, which in turn may reduce mood-boosting brain chemicals like serotonin. SAD is often characterized by excessive daytime sleep, substantial weight gain, inability to function, and persistent thoughts of suicide. Unlike the "blues," SAD and other types of major depression require professional intervention.

Preventing the holiday blues involves four main strategies: keeping expectations realistic; delegating responsibilities; shoring up social supports; and avoiding excessive alcohol consumption. More detailed advice is found in several of the articles listed below. Finally, another good strategy, according to Dr. Hinda Dubin of the University of Maryland Medical Center, is to find ways of helping those less fortunate than oneself. Taking the focus off your own problems and aiding somebody truly in need may be the best gift you'll ever get during the holiday season!

Your Holiday Shopping Can Help CBF!

Did you know if you shop Sam's Cause you'll be helping CBF at the same time? Simply go to his web site and click on the store where you'd like to shop. (Amazon has everything!!). The vendor will donate a % back to Sam who in turn donates every penny to CBF.
www.SamsCause.com

Characteristics of Juvenile Bipolar Disorder: A New Phenotype

This is the second of a three-part series to inform you about JBRF sponsored research on juvenile bipolar disorder. We hope you will be encouraged by our progress and inspired to believe that the end of this journey is attainable. What do the following have in common?

• suffers horrendous nightmares
• antagonizes siblings
• excessively craves sweets and carbohydrates
• wets the bed
• sleeps hot
• takes excessive risks
• hoards food
• has many ideas at once
• interrupts or intrudes on others
• experiences periods of self-doubt and poor self-esteem
• deflects blame

Independently, each of these traits is a symptom of a myriad of different psychiatric disorders. Considered together, they are all symptoms of Pediatric Bipolar Disorder (PBD).
But wait a minute! Isn't bipolar disorder all about mania and depression? How can these unrelated symptoms be part of that same profile?

This more complete list of symptoms is reflective of the research progress JBRF has made by adopting the dimensional approach of defining psychiatric disorders: symptoms overlap between psychiatric conditions and one condition is differentiated from the other by how those clusters of overlapping symptoms come together.

Proceeding down this path, researchers have arrived at a novel perspective of the illness. While traits like mania and depression remain important, this analysis finds that they are not the central behavioral dimensions of PBD. Other dimensions such as aggression, anxiety, sensory sensitivity, sleep/wake disturbance, attention/executive function deficit, and oppositional behavior also figure prominently. Of paramount interest is a dimension that establishes a link between obsessive fears and aggressive behavior. JBRF investigators have termed this correlation "Fear-of-Harm" (FOH). This new characterization of PBD has been labeled the "Core phenotype".

The Core phenotype is a more complete and accurate description of what these children experience than what is offered by the Diagnostic and Statistical Manual for Mental Disorders (DSM). Investigators suggest that in the DSM, bits and pieces of this single disorder have been parceled out into numerous other diagnoses. It is likely that this fragmented perspective of the disorder has obscured a clear view of its actual presentation in children and stalled efforts to get at the underlying biology.

Concentrated exploration of the FOH trait has lead investigators to define a clinically homogeneous subgroup of children who are the most severely impacted by this disorder. This subgroup is called the "FOH phenotype". These children are characterized by extreme anxiety and the hyper-perception of threat which causes them to respond in a defensively retaliatory manner. They are often hospitalized and face great challenges socially and academically.

Not only have JBRF investigators been able to describe the symptom profile of the FOHphenotype, but under this new paradigm, they have also pieced together the likely underlying biology involved in the disorder. Certain brain areas, activities and development that had not previously been considered became obvious foci for their attention. The specific neural pathway that ties these activities together in a manner consistent with the profile has been identified. Investigation of this complex system is ongoing. The more the details fall into place, the greater its explanatory value grows.

The definition of the FOH phenotype moves us further in our quest to uncover the genetic variations associated with PBD. The high heritability of the FOH trait, refinement of the dimensionally derived symptoms that associate with it, and the fact that the CBQ can identify with 96% accuracy children whose profiles fit the phenotype make us optimistic that we are on the right path for a meaningful genetic analysis.
JBRF is actively collecting DNA from children whose CBQ scores indicate that they fit the FOH Phenotype.

This novel understanding of the dimensions of bipolar disorder in childhood puts us on much firmer footing as we move towards the identification of biological markers. The identification of new biological markers opens the door for new treatments.
Click here to read more about JBRF research progress.. http://www.jbrf.org/juv_bipolar/approachanddefinition.html

A randomized, double-blind, placebo-controlled study of maintenance treatment with adjunctive risperidone long-acting therapy in patients with bipolar I disorder who relapse frequently.

Bipolar Disorders
Volume 11 Issue 8, Pages 827 - 839
Macfadden, W. et al

ABSTRACT
Objective: No large controlled trials have evaluated adjunctive maintenance treatment with long-acting injectable antipsychotics in patients with bipolar disorder. This study assessed whether adjunctive maintenance treatment with risperidone long-acting therapy (RLAT), added to treatment-as-usual (TAU) medications for bipolar disorder, delays relapse in patients with bipolar disorder type I.

Methods: This study included patients with bipolar disorder type I with ≥ four mood episodes in the 12 months prior to study entry. Following a 16-week, open-label stabilization phase with RLAT plus TAU, remitted patients entered a 52-week, double-blind, placebo-controlled, relapse-prevention phase. Randomized patients continued treatment with adjunctive RLAT (25-50 mg every two weeks) plus TAU (n = 65) or switched to adjunctive placebo injection plus TAU (n = 59). The primary outcome measure was time to relapse to any mood episode.

Results: Of 240 enrolled patients, 124 entered double-blind treatment. Time to relapse was longer in patients receiving adjunctive RLAT (p = 0.010). Relapse rates were 23.1% (n = 15) with adjunctive RLAT versus 45.8% (n = 27) with adjunctive placebo; relative relapse risk was 2.3-fold higher with adjunctive placebo (p = 0.011). Completion rates were: adjunctive RLAT, 60.0% (n = 39) and adjunctive placebo, 42.4% (n = 25; p = 0.050). Adverse event (AE)-related discontinuations were 4.6% (n = 3) and 1.7% (n = 1), respectively. Common AEs (adjunctive RLAT versus adjunctive placebo) were: tremor (24.6% versus 10.2%), insomnia (20.0% versus 18.6%), muscle rigidity (12.3% versus 5.1%), weight increased (6.2% versus 1.7%), and hypokinesia (7.7% versus 0.0%).

Conclusions: Adjunctive RLAT significantly delayed time to relapse in patients with bipolar disorder type I who relapse frequently. Safety and tolerability of RLAT were generally consistent with that previously observed.

Increased Prevalence of Obesity and Glucose Intolerance in Youth Treated With Second Generation Antipsychotic Medications

Canadian Journal of Psychiatry, 11/23/09

Panagiotopoulos C et al. - Youth treated with SGAs have significantly higher rates of obesity and glucose intolerance than SGA-naive youth. These data emphasize the need for consistent metabolic monitoring of youth with psychiatric disorders who are prescribed SGAs. read more: http://publications.cpa-apc.org/media.php?mid=872&xwm=true

Pfizer Receives FDA Approval For Geodon(R) (Ziprasidone HCI) Capsules For The Adjunctive Maintenance Treatment Of Bipolar Disorder In Adults

Pfizer announced that the U.S. Food and Drug Administration (FDA) has approved Geodon® (ziprasidone HCI) Capsules for maintenance treatment of bipolar I disorder as an adjunct to lithium or valproate in adults. http://www.medicalnewstoday.com/articles/171865.php

Forward

Incorporating BI-POLAR NEWS
A WORK IN PROGRESS Written by manic depressives for manic depressives
Issue Number 42 Weekend edition 28th - 29th November 2009

Dear Reader,
You may be one of the 241 people who now subscribe to FORWARD and look forward to receiving your own copy by email each week.

You might also be one of the 482 readers we estimate receive a copy of FORWARD from one of those 241 subscribers. Well, this is an invitation for you to receive your own copy in future directly from the publisher - with good reason. The valiant team of volunteers who put FORWARD together each week want to turn the venture into a social enterprise which will enable us to seek charitable funding to deploy more volunteers in FORWARD's production and reach even more readers, including those without email facilities.

To do this we really need a minimum of 500 subscribers, so our request is simple enough. If you are willing to become a subscriber instead of just a reader, send your email address to ashby300@hotmail.com with the word SUBSCRIBE in the Subject: box. Your willingness to do this would be most gratefully appreciated.

Thanks and best wishes,
Jonathan Ashby
Editor, FORWARD

Methodology in the I.E.P.

Dear Friend & Advocate
School officials often refuse to write educational methodologies into the IEP. They argue that teachers should be free to use an "eclectic approach" to educating children with disabilities, and should not be forced to use any specific methodology.

Congress rejected this practice when they reauthorized IDEA 2004 - a win, win situation for all - especially for children who will benefit when they receive effective instruction from teachers who are trained in research-based instructional methods.

In this issue of the Special Ed Advocate, learn how parents, as participants in developing their child's IEP, benefit by having input into the instructional methods used to teach their children. http://www.wrightslaw.com/nltr/09/nl.1124.htm

Help for Parents

For parents, like us, that are putting so much love and effort for our children with disabilites. We also want to nourish our relationship. Relationship Research Foundation is non-profit organization funded by the federal government under the Fatherhood grant. A place for programs designed to enrich relationships for all couples in all stages of life and whether they are troubled or just need enrichment. RRF is located in Newport Beach, www.USrelationships.org, 949-752-2888. These programs are for couples, singles, singles again, new parents, expecitng parents, and stepfamilies. They are low-cost and we offer scholarships. Our personal website is www.lovelandrelationship.com. Class dates for "Ready for Love", for singles and singles again is Dec.5th at 1400 Bristol North Suite 100, Newport Beach. "Mastering the Mysteries of Love" is on Jan.30th, with 4 follow-up Tuesdays. "Bringing Baby Home" designed by Gottman, is Feb.5 & 6, and includes supper. For more information call 949-752- 2888. To receive classes in your region out of Orange County, if you are in San Diego or Long Beach for example, please contact us directly at alfredlucinda@lovelandrelationship.com.

Lucinda & Alfred Loveland
Marriage Educators

Scientists identify gene linked to mental illnesses

Scientists have identified a gene which could be responsible for depression, bipolar disorders and schizophrenia.
Identifying genes that predispose people to psychiatric illness is considered the most important step in developing new ways to tackle the condition
An international team of researchers, led by the University of Edinburgh, compared genes of 2,000 psychiatric patients to 2,000 healthy people to pinpoint the 'ABCA13' gene.
They discovered it is partially inactive in patients suffering severe illnesses such as schizophrenia, bipolar disorder and depression.
The results suggest the gene plays a crucial role in maintaining brain health as scientists found it was faulty more frequently in patients with mental illness than the control group.
Identifying the genes that predispose people to psychiatric illness is considered the most important step in developing new ways to tackle the condition.
Lead researcher Douglas Blackwood, professor of Psychiatric Genetics at the University of Edinburgh, said the discovery would help the development of new drugs to treat mental illness.
He said: ''This is an exciting step forward in our understanding of the underlying causes of some common mental illnesses.
''These risk genes could signpost new directions for treatments.''
Dr Ben Pickard, of the University of Strathclyde, said the team believed ABCA13 influences the way fat molecules are used in the brain.
They are now focused on finding out exactly how that occurs.
Dr Pickard said: ''This study is the first to identify multiple points of DNA damage within a single gene that are linked with psychiatric illness.
''It strongly suggests that this gene may regulate an important part of brain function that fails in individuals diagnosed with these devastating disorders.''
The research results are published in the American Journal of Human Genetics.

Asenapine for schizophrenia and bipolar I disorder

Current Psychiatry, 12/03/09
Lincoln J et al. - Asenapine (Saphris) is the first psychotropic to obtain simultaneous FDA approval for schizophrenia and bipolar disorder. The drug's unique receptor binding profile shows promise in treatment of positive and negative symptoms of schizophrenia with a low risk of extrapyramidal and anticholinergic side effects.

Most Read Articles: Bipolar Disorder

Popular Bipolar Disorder articles most read by fellow clinicians

Bipolar Disorder and Dopamine Dysfunction: An Indirect Approach Focusing on Tardive Movement Syndromes in a Naturalistic Setting
Results of a 2-year observational study on the outcomes of pharmacologic treatment for acute mania.
BMC Psychiatry http://www.medscape.com/viewarticle/706274?src=nl_crb

Olanzapine may be an Effective Long-term Treatment for Bipolar Disorder
Dr. Peter Yellowlees reviews a study examining the efficacy and safety of olanzapine in the long-term treatment of patients with bipolar disorder.
Medscape Psychiatry & Mental Health http://www.medscape.com/viewarticle/709316?src=nl_crb

FDA Panel Gives the Nod to New Antipsychotic Drug
A FDA committee gave a near unanimous 'thumbs up' to a novel antipsychotic drug for the acute treatment of adults with schizophrenia and mania/mixed episodes of bipolar 1 disorder.
Medscape Medical News http://www.medscape.com/viewarticle/706933?src=nl_crb

The Emergence of the Bipolar Spectrum: Validation Along Clinical-Epidemiologic and Familial-Genetic Lines
What is the new paradigm of the bipolar spectrum and how is it shaping research literature and clinical practice?
Psychopharmacology Bulletin http://www.medscape.com/viewarticle/569751?src=nl_crb

Update on Bipolar Disorder: Epidemiology, Etiology, Diagnosis, and Prognosis
Bipolar disorder, or manic-depressive illness, continues to be a diagnostic challenge, even for experienced clinicians.
Medscape Psychiatry & Mental Health http://www.medscape.com/viewarticle/431115?src=nl_crb

Metabolic Issues with Antipsychotic Meds

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on December 2, 2009

Although experts believe antipsychotic medications are generally effective and well tolerated, the medications do convey a risk for side effects.
These side effects can heighten the chance of developing diabetes, hypertension and cardiovascular disorders.
According to researchers, treatment with a number of antipsychotic medications is accompanied with weight gain, and for some, hyperglycemia and hyperlipidemia.
In the current issue of Biological Psychiatry, researchers discuss this cluster of metabolic side effects and how it may contribute to the risk for diabetes, hypertension, and other medical disorders associated with heart disease.
The topic is of particular concern because there is a higher cardiovascular mortality among the severely mentally ill compared to the general population.
Researchers already know that differences exist between antipsychotics in their effect on clinical measures associated with cardiovascular risk, namely weight, lipids and glucose.
Systemic inflammation has recently emerged as an important marker of cardiovascular risk, but the effects of antipsychotics on inflammatory markers in the blood have not been extensively studied until now.
Using data from the multi-center CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) study, funded by the National Institute of Mental Health, Jonathan Meyer and colleagues examined the impact of multiple antipsychotic therapies on changes in systemic inflammation.
Their findings provide evidence that antipsychotic medications, particularly olanzapine (Zyprexa®, Eli Lilly and Co.) and quetiapine (Seroquel®, AstraZeneca), increase the levels of inflammation markers.
The markers implicated include C-reactive protein, E-selectin, and intercellular adhesion molecular-1 (ICAM-1).
Increased levels of C-reactive protein in particular are associated with increased risk for the development or progression of many illnesses including heart disease, and stroke.
"This analysis provides the most compelling evidence to date that differences in antipsychotic metabolic liability are also seen with markers of systemic inflammation," explained Dr. Meyer. "It also provides an impetus for monitoring cardiovascular risk markers in antipsychotic treated patients."
Dr. John Krystal, the Editor of Biological Psychiatry, which is publishing this report, commented, "Doctors always try to balance the benefits and the risks associated with medications when making the decision to prescribe a particular medication to a particular patient. The more information that we have regarding the medical consequences of prescribing particular medications, the better the prescribing decisions can be."
Although this report does not provide any direct evidence linking the antipsychotic medications to these disorders, he added that "it is helpful to know that antipsychotic medications may contribute to inflammatory processes in the body and that these medications differ somewhat in producing this effect."
Source: Elsevier

BIMR wins a GO grant from the National Institute of Mental Health

Thanks to a $50,000 grant from the California Bipolar Foundation (CBF) to post-doctoral research fellow Dr. Illyas Singec at the Burnham Institute for Medical Research (BIMR), a research team headed by Dr. Evan Snyder (along with co-investigators Drs. Dieter Wolfe and Lawrence Brill), was able to accumulate sufficient preliminary data to win an extremely competitive Grand Opportunities (GO) grant from the National Institute of Mental Health to explore the molecular basis of Bipolar Disorder (BPD).
BPD is a severe and prominent societal malady with poorly understood etiology. This neuropsychiatric condition is defined by a lifetime of relapsing and remitting manic and depressive episodes and has been shown to have strong genetic linkage with familial predisposition.
The recently funded project represents the convergence of a series of cutting-edge technologies and approaches to better understand the molecular basis of this condition and hopefully identify better and more rational treatments.
Authentic laboratory models -- including animal models -- that reliably represent aspects of BPD (or most human neuropsychiatric diseases) have been difficult to establish. Recent advances in stem cell biology have allowed the conversion of skin cells taken from actual patients into "stem-like cells" called "human induced pluripotent stem cells (hIPSCs)". These skin cells can be "reprogrammed" to the point that they can be induced to yield almost every mature cell type of the body following various differentiation protocols, including brain cells. Such hIPSC-derived brain cells will bear the "molecular fingerprint" of the patient from which the skin cells were taken. Therefore, the first cutting-edge technique to be employed by the team will be to develop a representative, predictive model system to explore function and regulation in brain cells that faithfully recapitulate the underlying defects of actual human patients with BPD.
The team will generate hIPSCs from small samples of skin cells from a range of actual patients with BPD, turn those cells into brain cells, and then subject those cells to phosphoproteomic analysis in order to understand how the cell controls various important functions. To make the study as revealing and specific as possible, the hIPSCs from BPD patients - both responsive to lithium and non-responsive to lithium - will be compared to hIPSCs generated from unaffected patients, from patients with schizophrenia but not BPD, from patients with non-neurologic diseases, and from patients with neurogenetic disorders lacking a psychiatric component.
Importantly, this valuable dataset will be made available to the broader research community so that complementary parallel studies may be launched on the basis of these proteomic and phosphoproteomic results by other investigators in the field in order to accelerate progress in BPD and other neuropsychiatric disorders. Furthermore, the insights and databases generated by this project may be applicable to many cell types, organ systems, and other diseases.
Learning to make hIPSCs, how to turn them into brain cells at various stages of development, and performing pilot phosphoproteomic analysis on immature stem cells was aided by seed money from CBF.
The team will now be looking for volunteers from the CBF community who might donate a tiny piece of skin from which these stem-like cells can be made and can be used for the study. There is no restriction on age of donor.

Hanbleceya

reprinted with permission from Kerry Paulsen, anaging partner

I'd like for you to be able to understand the clinical rationale behind a recommendation that we often make at the outset of treatment, as this may be helpful to you and others having to deal with these types of questions in the future. Also, it may be generally helpful for parents having to consider setting firm limits with their mentally ill loved one. First of all, one of the main factors involved in the proliferation of mental illness is the enabling, rescuing and shielding behavior that almost always permeates throughout the larger family system.. We have found in our experience that the continuance of these well-intentioned, but severely unhealthy coping patterns that exist within the family system are the single biggest reason behind unsuccessful treatment at Hanbleceya (and presumably other settings) - no question about it! This finding encompasses over 30 years of clinical experience in treating chronic disorders like schizophrenia and bipolar disorder and dual diagnoses.
As a result, we put a tremendous amount of emphasis on concurrent treatment of families. In fact, treatment with the larger family system often begins before the loved one has even joined the program, but minimally, it certainly starts at the same time. Families often come to us desperate, out of options, fearful and at a point where they recognize that something big needs to change. We agree - something needs to change, and that change needs to begin within the family system. Therefore, the family needs support immediately to begin the process of learning how to interact differently with their loved one, so as to create the space for a different outcome.
In order to start the process of helping families "restructure" their old roles and rules into more healthy and effective ones, we have found that having some separation is helpful. It is very difficult to interact differently with your loved one when you haven't yet been given the tools to do so and time to practice those new approaches. We have consistently found that a brief time of separation - which gives the loved one an opportunity to settle into treatment and the family an opportunity to get some much needed education and practice - has been essential and is highly correlated with success and positive treatment outcomes for our clients and their families. We like to think about it as taking some much needed breathing room from the usual day-to-day crises in order to "regroup" and come up with a more effective strategy. It's hard to do this sort of thoughtful, thorough, detailed planning, and have time to practice the "new plan" when a family is knee-deep in crisis.
We have also found another consistency, this one with the families who do not wish to or do not abide by this treatment recommendation of a "temporary separation." These families generally stay stuck in the old behavioral patterns that have not worked in the past. Once the initial crisis has passed, the system falls back into old, familiar patterns and it is just a matter of time before the illness shows up again. Loved ones sadly learn that parents don't really mean what they say, and what gets reinforced is the idea that "my family will always rescue me, no matter what." This generally leads to low motivation for change and keeps the entire family system stuck and in essence "held hostage" by the mental illness.
Further, once a family system has set a limit, for example, "you cannot live at home any more", then allows the loved one to come back home, then the family's word has lost credibility and the loved one gets the message that "I don't really have to do what is expected of me.....my family will always let me back." The same thing goes for contact. Once a family has said, "you need to get treatment, or we will not be speaking to you," it is ESSENTIAL that this message is carried out. If instead this limit is set, but then the family resumes contact because the loved one has refused to abide by the limit, then all that is learned here is, "I don't have to do what is expected of me....I can just refuse, and my family will eventually come get me" - which is an open invitation for the illness to take center stage and the client to not have to learn how to be an independent, functioning person - why would they? The family will always rescue.
Sorry this is such a long description of our philosophy on this issue - but as I mentioned, families continuing the same old, familiar patterns of rescuing, enabling and shielding is the SINGLE MOST contributing factor for lack of successful treatment, in our experience. Families must learn new ways of interacting with their loved ones, which includes learning how to set limits (and keep them!), if the loved one stands a chance at being able to get better. As a family member at one of our recent Family Support Groups said, "I've learned that my child has gotten better only to the degree that I've gotten better...I had to learn how to do things differently so my child could learn how to do things differently too." We couldn't agree more.
It's amazing how much money families will spend for our expertise then at a most crucial juncture in the treatment process revert to old behaviors because they're experiencing a flood of anxiety and in essence throw away all that has been achieved to that point. This is why Al-Anon, NAMI and groups like your are so incredibly important. Thanks for all that you do!
Hope this sheds some light for you and/or your foundation members.

Hanbleceya is an organization dedicated to helping individuals with a range of needs -- from those who need support with life transitions and personal growth, to those suffering from serious mental illnesses like Schizophrenia, Bipolar Disorder, Depression & Anxiety. Hanbleceya exists to support people in learning to function more effectively in the world, creating quality lives, experiencing hope and recognizing that
Kerry Paulson
www.hanbleceya.com

Mental Health Social Network Launched

The online environment allows people with mental health problems, as well as their caregivers, connect in a safe and anonymous environment.
By Mitch Wagner InformationWeek December 2, 2009 03:26 PM
Mental Health Social launched a new social network designed to let people with mental health conditions or those interested in those conditions to connect in a comfortable online environment. MentalHealthSocial..com is designed to allow people to share experiences anonymously, reach out to others with similar problems, and connect caregivers assisting loved ones facing mental health problems, the Naples, Fla., company said.
Colin Spencer Wood, the company president and CEO, was diagnosed with bipolar disorder in 1999. "When people suffer from mental health conditions, they can sometimes feel isolated," Wood said in a statement. "There might not be anyone else in a patient's life that has experienced their condition, which can make it difficult for family and friends to relate or understand what they're going through. MentalHealthSocial.com eliminates those feelings of isolation by bringing people with similar experiences together. Sometimes people just need someone to talk to who really understands whatever mental health condition they're dealing with." The service has the same major features as Facebook and other social networks. Users can share information about themselves, post videos, upload audio or photos, and offer help. It supports e-mail style messaging, instant messaging, chat, blogging, status updates, commenting, and forums, as well as free classifieds and events. Users can create private areas for peers with similar conditions. The service will also work to raise money for mental health related nonprofit organizations. http://mentalhealthsocial.com/