My Support - July 19, 2009

The Thinkers: She peers into the brain for cause of bipolar disorder

Monday, June 29, 2009mary phillips
By Mark Roth, Pittsburgh Post-Gazette
Lake Fong/Post-Gazette

Mary Phillips peers into the brains of people with bipolar disorder, and what she has found there gives a whole new meaning to the term "bipolar."

Dr. Phillips, a University of Pittsburgh psychiatrist, has discovered that each half of a bipolar patient's brain may be responsible for a different extreme of the illness.
Bipolar patients often cycle between periods of paralyzing depression and hyperactive mania.

Using a brain imaging technique that shows the connections between different parts of the brain, Dr. Phillips' group has shown that wiring problems in the left half of the brain may cause patients' manic phases, while a different kind of wiring problem on the right half may create the episodes of depression.

Her study focused on a bundle of fibers known as the uncinate fasciculus, which connects an emotion-processing area known as the amygdala, at the bottom of the brain, with a regulatory area known as the orbital prefrontal cortex, at the front of the brain.
Simply put, she said, the amygdala "allows us to perceive the emotional salience" of things we experience, while the orbital prefrontal cortex areas on either side of the brain "act like brakes on the amygdala."

Her study found that on the left side of the brain, which is associated with more positive feelings, the uncinate fasciculus was much thinner than normal, which could mean the front of the brain was less able to control those feelings in bipolar patients, sending them into hyperactive, sometimes grandiose episodes of mania.

On the right side, which is more linked to negative feelings, the wiring was thicker and had more cross-connections, which she said "can lead to sort of getting off the point and thinking too much, getting off into this reverberative, ruminative loop" of anxious, melancholy ideas.
In mentally healthy people, that right-side cabling is smoother and more unidirectional, she said, which may allow the front of the brain to short-circuit any excessive negative thoughts.
To measure patients' feelings while they were in the brain scanner, Dr. Phillips' team showed them images of happy and fearful faces. Previous research has shown that people with bipolar disorder react much more strongly to fearful faces than typical people do.
Finding out what is wrong in the brains of people with bipolar disorder is an important first step, Dr. Phillips said, but the more exciting potential is to use that information to improve diagnosis and treatment.

The studies hold out the potential that "we can use neuroimaging to choose the right medication and dose" for patients.

It may also help doctors differentiate those who have bipolar disease from those who just have depression, since they are separate disorders with distinct treatments.
And someday, it could help researchers predict who is likely to develop bipolar disease, which could be crucial to offering early treatment.

Dr. Barbara Sahakian, a neuropsychology professor at Cambridge University, said at an international bipolar conference held in Pittsburgh last week that "many of the neuropsychiatric disorders that exist become chronic, and the more episodes a person has, the more difficult it is to treat them effectively, so prevention or early detection is an extremely important issue."

Dr. Phillips' work could also help resolve a controversy that has sprung up over diagnosing bipolar disease in children.

While research at Pitt has shown that children can get bipolar disorder and often suffer the most severe form of the disease, there also have been reports that some psychiatrists have been diagnosing children as bipolar without strong evidence for it. Brain imaging "biomarkers" could help resolve those questions, she said.

Dr. Phillips, who grew up near Nottingham in Great Britain and has both an M.D. and Ph.D. from Cambridge University, spends a lot of time flying over the Atlantic.
While she lives most of the year in Pittsburgh, she flies to the United Kingdom every month to six weeks to fulfill parallel duties as a neuroscience professor at Cardiff University, and she conducts her research in both places.

She entered medical school at the age of 18 and soon knew what she wanted to focus on. "I was fascinated by psychiatric illnesses because they were so un-understandable at the time."
She also knew she wanted to work with the fast-growing field of brain imaging, which uses everything from X-rays to radioactive isotopes to magnetic fields to view what parts of the brain are active.

As a psychiatrist, she has always wanted to use the results of her imaging work to find new ways to help patients, and she believes there is the real potential of doing that with bipolar disorder, which affects an estimated 1 percent of the population, or more than 3 million people in the United States.

Her discoveries also have strengthened her belief that mental illness is centered in a dysfunctional brain. People may be born with their problems, or their illnesses may alter their brains, but either way, there are concrete changes in the structure and functioning of the brain that scientists will be able to unravel. "People suffering from these illnesses want to know what's going on in their brains. Just like with a broken leg, you want to know where the break is -- you want to know where the break is in your brain."

With the progress being made in neuroscience, "we will be able to say, 'This is where the problem is, it's not all in your mind,' and that's going to destigmatize psychiatric illnesses more than anything."

Mark Roth can be reached at mroth@post-gazette.com or 412-263-1130.
First published on June 29, 2009 at 12:00 am

Read more: http://www.post-gazette.com/pg/09180/980596-53.stm#ixzz0KgWDD2SB&C

Connections; Support Group

Connections is geared towards parents of children who are either in an out
of home placement or at risk of being placed into one. The majority of
attendees are adoptive parents with children who are either already in
Residential Treatment, or on the way into it.

If the parents you know are interested in hearing from other parents our
thoughts on some of the local residential treatment centers, then I'd
recommend they come. Most of us who are there have lots of experience with
the local mental health hospitals for kids as well as several of the RTC's
here in town, and some out of town. So if that sounds like information they
could benefit from, go ahead and send them.

Connections, a Support Group for families with children either in or at risk for out-of-home pacements ie. hospitalizations, residential treatment centers, foster or group care.
If you are looking for support, information or referrals feel free to join
us . Please note the new location!!!

Contact Cheryl for date & location cheryllynn65@cox.net
Rancho San Diego Branch
11555 Via Rancho San Diego
El Cajon, CA 92019
(619) 660-5370

Books in the Barn

Great Event for Kids in Thousand Oaks!

Kiwanis Club of Conejo Valley and Ride On to host free
"Books in the Barn" children's event

The Kiwanis Club of Conejo Valley and Ride On Therapeutic Horsemanship will team up to present "Books in the Barn" on Saturday, July 25, 2009 at Ride On, 401 Ronel Court in Newbury Park . This free children's event will be held from 10 a.m. to 2 p.m.

Targeting children ages two to eight, "Books in the Barn" includes storytelling in the barn, making "horsey" crafts that children can bring home, petting a pony and refreshments. The theme for the event is "Christmas in July" and Santa will be reading stories! Children's books and other items will be available for sale with a portion of all proceeds being donated to Ride On to help provide more therapeutic horseback riding opportunities for kids and adults with disabilities.

"This is a wonderful family event and an opportunity to entertain children with two favorite activities, the love of horses and reading," said Jenni Moore, club president. Special guests at this unique event will be Heather McNamara, co-author of several Chicken Soup for the Soul books including Chicken Soup for the Special Need Parents Soul and Chicken Soup for the Horse Lovers Soul and Rocky Stayart, author of Magic Manners at Mealtime. The event will also provide awareness of the beneficial services Ride On Therapeutic Horsemanship offers to members of our community."

Books in the Barn is open to the public, but has limited space availability. For more information and to reserve your seat, contact Sara Jones at (805) 375- 9078 or sara@rideon.org.

Best wishes,
Jenni Moore
Educational Supervisor, Usborne Books
www.BuildingBrightMinds.com
513-325-2222

Building bright minds one book at a time! I can help you get free books for your family, school, or the organization of your choice...Contact me today for more information.

Zeitgebers! I Need a Good Night's Sleep

About.com Thursday July 9, 2009
Not just a clever expletive, a Zeitgeber is an environmental cue that resets a person's circadian rhythm, the internal clock of all living things. Bora Zivkovic, also known as the blogger Coturnix, is a scientist who specifically studies the circadian clocks of birds, but also all animals in general including humans. He has written a number of articles on Lithium, Circadian Clocks and Bipolar Disorder. Coturnix notes that our internal clocks, unlike a lot of animals, are sensitive to environmental and social cues. "Whenever you start a new relationship, get a new job, buy a new pet, or have a baby, your schedule is disrupted." And people with bipolar disorder are extremely sensitive to these changes. Marcia notes in Mood Disorders and Sleep that "studies have found that 25 to 65 percent of those with bipolar disorder who had a manic episode experienced a social rhythm disruption prior to the episode." Have you found this to be true? Do changes in your schedule or surroundings throw you off? Have you found anything to be really triggering? What helps when this does happen? ~Kimberly

Question: What is Tardive Dyskinesia?

Answer: Tardive dyskinesia is a movement disorder caused by long-term use of certain medications called neuroleptic drugs, along with some other drugs that increase the brain's sensitivity to the neurotransmitter dopamine. It is characterized by uncontrolled facial movements such as protruding tongue, chewing or sucking motions and making faces. Tardive dyskinesia is a very serious side effect of antipsychotic medications in particular, and patients taking such drugs should know what to watch for. Drugs that can cause tardive dyskinesia are mainly antipsychotic medications and include:

• Thorazine (Chlorpromazine)
• Clozaril (Clozapine) (may also treat the condition)
• Haldol (Haloperidol)
• Seroquel (Quetiapine)
• Loxitane / Loxapac (Loxapine)
• Mellaril (Thioridazine)
• Navane (Thiothixine)
• Prolixin / Modecate (Fluphenazine)
• Piportil (Pipotiazine)
• Trilafon (Perphenazine)
• Orap (Pimozide)
• Stelazine (Trifluoperazine)
• Risperdal (Risperidone)
• Serentil (Mesoridazine)
• Zyprexa (Olanzapine)
• Some of the non-neuroleptic drugs that may also cause tardive dyskinesia are:
• Prozac (Fluoxetine)
• Zoloft (Sertraline)
• Nardil (Phenelzine)
• Elavil (Amitriptyline)
• Asendin (Amoxapine)
• Sinequan (Doxepine)
• Tofranil (Imipramine)
• Lithium
• Cocaine and other street drugs

Ironically, the neuroleptic drugs are dopamine antagonists, meaning they block dopamine receptors on nerve cells. However, over time this can cause the brain to compensate by creating more dopamine receptors and making them more sensitive, leading to serious side effects.

Symptoms of Tardive Dyskinesia
Tardive dyskinesia is characterized by repetitive, involuntary, purposeless movements such as:

• Fine, worm-like movements of the tongue
• Lip smacking
• Chewing or sucking movements
• Grimacing (making faces)
• Puckering or pursing the lips
• Tongue protrusion
• Rapid eye blinking

There may also be uncontrolled movements of the arms, legs and body. According to an article at Wikipedia, "Impaired movements of the fingers may appear as though the patient is playing an invisible guitar or piano."

Prevention, Treatment and Outlook
Prescribing physicians should attempt prevention by prescribing the lowest effective dose of these medications for the shortest possible time. After a diagnosis of tardive dyskinesia, decreasing dosage or discontinuing the problem drug(s) may solve the problem, or it may cause symptoms to worsen. If they do get worse, they may eventually go away, or they may continue indefinitely. Thus, it is important to get an early diagnosis if you suspect you or a loved one is exhibiting symptoms of this disorder. A number of medications have been used to try to control the symptoms of tardive dyskinesia, including Clozaril (clozapine), Botox (botulinum toxin), benzodiazepines such as Klonopin (clonazepam), and several others. Treatment is not always successful.

Helping Your Doctor Diagnose Tardive Dyskinesia
Always keep detailed records of the medications you are taking - when you start them, what the dosage is initially, when the dosage changes. If you begin to experience any of the symptoms listed above, take along your medication history when you visit the doctor. While your prescribing doctor should have your medication history, he or she may not have it in a compact form, or you may not be able to visit that particular doctor when you need assistance in a hurry.

Disclaimer: This is not intended to be all-inclusive or to replace information provided by your doctor or with prescriptions from drug manufacturers. by Marcia Purse About.com

Bipolar Disorder and Schizophrenia the Same Disorder with the Same Cause?

Monday July 6, 2009
I've been trying to think of a great line to grab everyone's interest in this ground-breaking research study ... or to be more precise a series of meta-analyses (comparing the results of several similar studies). But I know! Blah blah research. Boring. What does this have to do with me? This one has two things to do with you. No, really.

Bipolar disorder and schizophrenia may be the same disorder;

Both are caused by the cumulative effects of thousands of tiny genetic mutations.
The scientists involved found a "highly polygenic model [which] suggests that genetically influenced individual differences across domains of brain development and function may form a diathesis for major psychiatric illness" (Nature). What? Ever play the game Jenga - that game where you try to be the last person to pull a block out of a stack of blocks without knocking them over? While the blocks are essentially the same size, there are little differences that make them not stack perfectly. As the game is played, various factors -- who stacked the blocks, the table surface, how well turns are completed, etc. -- contribute to the balance of the blocks. The more rounds of people poking and pulling out blocks, the closer the tower comes to falling over and it eventually collapses. Consider each of us as the stack of wooden blocks in the game. The variations in the blocks are genetic mutations and the players turns are life events. The two combine to eventually cause the onset of the disorder. So essentially the more mutations the higher the risk for developing the disorder and the more risk factors experienced in life, the higher the risk. This is the diathesis-stress model that I detailed in What Causes Bipolar Disorder. In Unlocked: The Secrets of Schizophrenia, Steve Connor with quotes Thomas Insel, director of the US National Institute for Mental Health, "If some of the same genetic risks underlie schizophrenia and bipolar disorder, perhaps these disorders originate from some common vulnerability in brain development. Of course the big question then is how some people develop schizophrenia and others develop bipolar disorder." Research marches on! ~Kimberly About.Com

Bipolar vs The Boogey Man

Check out this short video lip: http://bipolarlight.com/bipolar/bipolar_02_11_24_08.swf

Boy Interrupted

HBO beginning August 3rd
BOY INTERRUPTED is a wrenching profile of a family torn apart. Dana and Hart Perry share the intensely personal story of every parent's worst nightmare: the death of a child by suicide. As professional filmmakers, they were accustomed to making extensive personal films and videos of the family, but never suspected that their footage of son Evan - taken from the moment of his birth throughout childhood and adolescence - would end up becoming the primary source material for this moving account. Casual and innocuous before his death, the home movies provide a visual record of Evan's life, and help create an intimate portrait of this vibrant, troubled young man, supplemented by interviews with family, friends, doctors and teachers.

Evan Perry's life was marked by intense mood swings that alarmed both his parents, who were determined not to allow him to follow in the footsteps of his uncle Scott, who had committed suicide in 1971. Despite his family's vigilance, along with a new school, new friends and numerous therapy sessions and medication, Evan's obsession with ending his life proved overwhelming. His 2005 suicide sent his reeling parents looking for answers from experts, friends and family members, as well as from the reams of video they'd taken of Evan through the years. BOY INTERRUPTED is a touching documentary showing that even the best defenses - love, vigilance and treatment - cannot always protect those most vulnerable from themselves.

Dana Perry is a noted documentary filmmaker who most recently executive produced the four-part documentary series "Sex: The Revolution." With husband and partner Hart Perry, she previously produced and directed "The Drug Years" (2006), a four-hour documentary exploration of illicit drugs and popular culture. Nominated for two IDA Awards and a Prism Award, "The Drug Years" received a Cine Golden Eagle, Telly Award and High Times "Stony" Award, and was exhibited at the Full Frame Documentary Film Festival and the Big Sky Documentary Film Festival.

BOY INTERRUPTED was produced and directed by Dana Perry; director of photography, Hart Perry; edited by Geof Bartz, A.C.E.; music composed by Michael Bacon. For HBO: senior producer, Nancy Abraham; executive producer, Sheila Nevins. Watch the trailer: http://www.hbo.com/scripts/video/vidplayer.html?movie=/av/documentaries/...

An Unquiet Mind by Kay Redfield Jamison

Everyone who experiences mania and depression will benefit from reading this book. Every doctor, judge, police officer and criminal or family attorney should be required to read it. And every family member and friend of someone diagnosed with manic depression, especially bipolar I and II disorders, or of someone exhibiting the symptoms, will gain from reading Kay Redfield Jamison's courageous autobiography.

Guide Review - "An Unquiet Mind" by Kay Redfield Jamison
An Unquiet Mind is a powerful, uncompromising and illuminating story of severe manic-depressive illness from the informed perspective of a psychologist, psychotherapist and researcher who has lived with the illness for more than 30 years. Kay Redfield Jamison's work clearly illustrates the complex nature of the most deadly form of the illness - bipolar I disorder, severe, with psychotic features. Manic depression (the author dislikes the term "bipolar disorder") is revealed as a creature of many moods: the seductively effortless well-being, confidence and energy of hypomania; the on- or over-the-edge frenzies of mania; the long, narrow gray prison of depression. Readers will feel the lure of a psychotic flight through the rings and moons of Saturn, share the terror of a experiencing a bloody hallucination, and even gain an understanding of the dark obsession with death and the pressures and rationalizations that led the author to a near-fatal suicide attempt. The importance of mixed episodes - the agitated merge of mania and depression - is emphasized in painful detail. Dr. Jamison makes an excellent case, through her own experiences, for the need to treat manic depression with both medication and psychotherapy. And the precautionary agreement she describes making with her family and psychiatrist in the event she should become a danger to herself is something anyone who has experienced suicidal impulses should consider. I found this book almost impossible to put down.

Want to meet Dr. Jamison? CBF is hosting her for a very special dinner September 4th. Tickets begin at $300. For more information or to purchase tickets, please contact: contact@CaliforniaBipolarFoundation.org

Children's Beliefs About Causes of Childhood Depression and ADHD: A Study of Stigmatization

Psychiatric Services, 07/17/09
Coleman D et al. - This study demonstrated a consistent presence of stigmatization in children's beliefs about the causes of childhood mental health problems. Low effort, parenting, and substance abuse together tapped a moralistic and blaming view of mental health problems. The results reinforce the need to address stigmatization of mental disorders and the relative stigmatization of different causal beliefs. The findings of variation by ethnicity and diagnosis can inform and target antistigmatization efforts.

Methods
A national sample of 1,091 children were randomly assigned to read vignettes about a peer with depression, ADHD, or asthma and respond to an online survey.
Causal attributions and social distance were assessed, and correlations were examined.
Logistic regression models for each causal item tested main effects and interaction terms for conditions, demographic characteristics, and self-reported diagnosis.

Results
The beliefs that parenting, substance abuse, and low effort caused the condition were all strongly intercorrelated and were moderately correlated with social distance.
The depression condition was the strongest predictor of endorsement of the most stigmatizing causal beliefs.
Stigmatizing causal beliefs were evident for ADHD, but with more modest effects.
Children who reported a diagnosis were more likely to endorse parenting and substance abuse as causes (attenuated for ADHD).
Modest to moderate effects were found for variation in causal beliefs across ethnic groups.

Gene variations hinder mental illness tests

By Kate Kelland
LONDON (Reuters) - As many as 30,000 different gene variations may underlie schizophrenia and bipolar disease, meaning any kind of quick test to predict either disease is a long way off, scientists said on Wednesday.

Three studies by a multinational group of researchers analyzed the DNA of 10,000 people with schizophrenia, and 20,000 without, and found 30,000 common gene variations linked with the mental illness.

They also show just how complex such diseases are, the researchers told a news conference.
"It's like we've got a 'join-the-dots picture', and we now know we have several thousands of dots to be joined," Mick O'Donovan of London's Institute of Psychiatry, who worked on one of the studies, told reporters. "But we don't even have numbers on them yet so we don't know in what order to connect them up."
The scientists stressed that although the large scale of the combined studies meant their results were robust as building blocks, they could not be used yet to predict an individual's risk of developing the disease.

"We are far away from being able to tell a family: 'Your child will develop schizophrenia' or not," said Pablo Gejman of North Shore University Health System Research Institute in Evanston, Illinois, who worked on one study.

O'Donovan said it would be "entirely unscrupulous" for the studies' findings to be used to offer any kind of genetic test.

DEVASTATING DISEASES
Schizophrenia is a chronic and often devastating psychiatric disorder that affects about one in 100 people. Patients experience hallucinations and disordered thinking and although some antipsychotic drugs, such as AstraZeneca's Seroquel and Eli Lilly's Zyprexa, can ease symptoms, they do not offer a cure and may have side-effects.

The scientists, working together under the International Schizophrenia Consortium, found the same genetic patterns linked to bipolar disorder -- a finding researchers said was significant as it adds to recent evidence challenging previous thinking that the two disorders were distinct.

"Discoveries such as these are crucial for teasing out the biology of the disease making it possible for us to begin to develop drugs targeting the underlying causes and not just the symptoms of the disease," said Kari Stefansson, chief executive of Decode Genetics of Iceland, who worked on one of the studies published in the journal Nature.

Previous scientific studies have already identified a genetic basis to schizophrenia and suggested that rather than one crucial gene being responsible for the disorder, a large number of genes and genetic combinations could cause it.

Edward Scolnick of the Stanley Center for Psychiatric Research at Massachusetts General Hospital and Harvard Medical School in Boston said work to identify some of the genetic patterns underlying the disorders could eventually "help improve the diagnostic and therapeutic options for patients."

Stanford's Bipolar Education Day (look for the CBF table - we'll be there!)

STANFORD, Calif. - (Business Wire) The Stanford University School of Medicine will host its fifth annual Bipolar Education Day on July 25. Individuals with bipolar disorder, their families, caregivers, friends and interested community members are invited to attend. The free event will be held at the William R. Hewlett Teaching Center at 370 Serra St., located on the main campus.

More than 5.7 million Americans have bipolar disorder, a psychiatric illness that causes unusually intense shifts in mood, energy and behavior. Bipolar Education Day gives scientists and clinicians an opportunity to discuss the previous year's research findings with individuals and families affected by the disorder.

This year's speakers include Terence Ketter, MD, professor of psychiatry and behavioral sciences and chief of Stanford's Bipolar Disorders Clinic; Po Wang, MD, and Jenifer Culver, PhD, from the Stanford Bipolar Disorders Clinic; Manpreet Singh, MD, from the Stanford Pediatric Bipolar Disorders Program; and representatives from the National Alliance on Mental Illness and the Depression and Bipolar Support Alliance. Speakers will discuss treatment options that can help patients manage their symptoms. An afternoon question-and-answer session will follow the talks. "I'm looking forward to a chance to share some of the latest advances in research at this year's Education Day," said Ketter.

The program runs from 8:30 a.m. to 2:30 p.m. and includes complimentary morning beverages and an afternoon snack. Pre-registration is required. For more information or to register, please visit www.bipolar.org or contact Meredith Childers at mchilder@stanford.edu.

The Stanford University School of Medicine consistently ranks among the nation's top 10 medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For information about all three, please visit http://stanfordmedicine.org/about/news.html.

Stanford University School of Medicine
Margarita Gallardo, 650-723-7897
mjgallardo@stanford.edu

Bodin Expands Services

Bodin Educational Consulting has expanded their services to now include EarlyCare. EarlyCare fills the gaps bewtween out-patient therapy and out-of-home interventions. It is a practical solution to assist families in making a smooth and successful transition from residential treatment to the home environment.

For more information, contact Brenda at bloringer@thebodingroup.com or call 800-874-2124.

Offices in San Diego, Salt Lake City, Lafayette, Los Angeles, and Los Altos. www.thebodingroup.com

Looking at Leisure to Promote Mental Illness Recovery

July 8, 2009, Philadelphia, PA - It's well known that those who suffer from mental illness can benefit greatly from an active lifestyle. But most of the existing research focuses almost solely on physical activity, and while exercise is certainly important for mind and body, Temple researcher Yoshitaka Iwasaki says it's not the only aspect of an active lifestyle.

"Living actively encompasses social, emotional, spiritual and cultural features of life as well," he said. "Active living is also defined within the ways people express themselves, interact with others, and find meanings of life through actively pursuing leisure that is valued by and important for them."

That's why Iwasaki and co-principal investigators Kathy Coyle and John Shank, all professors of therapeutic recreation at the College of Health Professions, will study how members of diverse, urban communities who are recovering from mental illness can benefit from this aspect of an active lifestyle, called actively engaged leisure, thanks to a two-year grant of more than $412,000 from the National Institutes of Health.

Iwasaki says examples of actively engaged leisure can range from practicing Tai-Chi, to doing things with friends, to playing music or dancing, and the research team will focus particularly on this as a context for promoting recovery, health and life quality.

He distinguishes actively engaged leisure as a key part of active living, and one that focuses more on a person's enjoyment, meaningfulness and enrichment than their level of physical activity.

"For example, when a person regularly walks only for a health reason without experiencing enjoyment and good feelings, and without gaining meaningful and enriching experiences, she/he is not experiencing leisure," he said.

The team will work directly within the community to learn about the experiences of African-, Hispanic-, Asian-, and Caucasian-Americans living with mental illness and, based on those wants and needs, develop a program to promote actively engaged leisure, grounded in social, cultural, and environmental systems, as a way to support mental health and well-being.

"Unfortunately, the existing mental health system does not appropriately meet the unique needs of culturally diverse groups of Americans - such as those residing in urban areas - living with mental illness, especially their needs to pursue actively engaged and meaningful living in their community," said Iwasaki.

The community-centric method that Iwasaki and his team use, called Community-Based Participatory Research (CBPR), is unique in that it is conducted as a partnership between academics and members of a community, who share and participate equally in all aspects of the research process - from resources to results to credit.

"Our team will integrate the expertise of our partners that represent mental health advocacy, psychiatric care, community-based mental health care and academic domains in working with individuals with mental illness to produce meaningful and valuable outcomes that are grounded in the realities of the lives of those individuals," said Iwasaki.

Other researchers on this study are David Baron from Temple University; Mark Salzer of the University of Pennsylvania; Glenn Koons of the National Alliance on Mental Illness; Lynda Mitchell of RecCare: Recreational Therapy Support Services; and Andrea Ryan, the Philadelphia community representative for persons with mental illness.

Source: Temple University

IT'S TIME TO SoundOFF!

In each issue of bp Magazine, bp asks a question and in the following issue, selected responses are printed. In the Fall issue, answers to this SoundOFF! question will be printed:

Many persons struggle not only with bipolar disorder, but with the secondary issue of substance abuse (alcohol, drugs or both). If you are someone who has been able to overcome substance abuse, can you share some helpful words of advice with bp readers?

Click here http://www.bphope.com/community/SoundOff.aspx to SOUNDOFF! Share your thoughts and comments in 75 words or less by August 7th, 2009.

Introducing How to Find a Good Therapist

By John M Grohol PsyD
July 13, 2009

One of the common questions we receive here at Psych Central is, "You always talk about the importance of finding a good therapist in order to be successful in psychotherapy; so how do I go about doing that?" Over the years, I've written an article or two about this topic. Now I'm pleased to present something better - a complete, free online e-book to finding a good therapist.

How to Find a Good Therapist is a simple how-to guide written by Ben Butina. Ben Butina is a therapist and trainer, and is the executive director of Westmoreland Marriage. You can learn more about this book and how to order bulk paper or e-book copies of at the book's website, www.howtofindagoodtherapist.com.

Psychotherapy is often a process shrouded in some mystery. How does one go about making decisions about this treatment process that will mostly likely result in personal success? How does one even get started, when there are so many different choices of types of therapies and types of professionals that practice psychotherapy? It can be quite overwhelming.

The book covers, in a succinct and easy-to-digest format, the different kinds of therapy, payment, the professions that practice psychotherapy, the importance of a psychotherapist's experience, setting priorities, interviewing and making a selection decision. I encourage you to check it out and if you find it helpful, let others know about this great new online free resource (through the share options on this post).

New free online e-book: How to Find a Good Therapist http://psychcentral.com/find-therapist/

Psychiatric Drug Sought on Streets

Seroquel debuted 12 years ago as a novel drug for adult patients with schizophrenia and bipolar disorder, a powerful pill that would help stabilize their emotional lives. Psychiatrists began prescribing these tablets to others - children with serious mental illnesses and adults with anxiety or depression.

But these days, the use of Seroquel is growing in popularity in a different group: men and women living on the margins who simply want a good night's rest.

"Seroquel puts you to sleep,'' said Luis Lopez, 28, a patient at Men's Addiction Treatment Center in Brockton who used to buy Seroquel tablets from drug dealers. "We all know from the streets that's how it works.''

The street use of Seroquel as a sedative is yet another example of how many prescription drugs cross over into the illicit drug market, creating incentives for dealers to illegally obtain the drug and dangers for users ignorant of its side effects. If misused, doctors say, Seroquel can heighten the risk of diabetes, heart and blood pressure problems, involuntary twitches, and rapid weight gain.

Nicknamed Susie Q, Quell, Q, or Squirrel, these pills appear so far to be more psychologically than physically addictive. The drug, made by AstraZeneca, is often sought on the street by former drug addicts or inmates who were first prescribed them to reduce anxiety while confined in institutional settings.

In a 2007 letter published in the American Journal of Psychiatry, Dr. Emil Pinta, who worked with drug abusers in an Ohio prison, said some inmates were known to fake psychotic symptoms just to continue a Seroquel habit to help them sleep. He urged clinicians to be more wary in prescribing this medication, known by its chemical name of quetiapine, and urged studies "to explore the addiction potential'' of the drug.

There are no statistics to measure the abuse of the drug, but many clinicians who work in drug treatment programs said they noticed an uptick in Massachusetts over the past five years.

In Lawrence, police are investigating relatives' accounts in the death of 32-year-old Roberto Plaza last month that may have been related to his efforts to get Seroquel to help him sleep. He died of gunshot wounds near a house associated with drug trafficking.

Dr. Alex Walley, a substance abuse specialist with the Boston Public Health Commission, said Seroquel gained street value as the tablets began filling the medicine cabinets of a broader cross-section of psychiatric patients. Even though the Food and Drug Administration has approved Seroquel for adults with schizophrenia and bipolar disorder, psychiatrists are allowed to use their judgment and prescribe "off-label'' for other purposes.

Over the years, with a shortage of other effective psychiatric medications, Seroquel has been prescribed for children with schizophrenia, and bipolar disorder, and for adults with anxiety and depression.

FDA advisory panels, in fact, this year have recommended broadening the authorized uses of Seroquel. Dr. Joseph Glenmullen, a psychiatrist and clinical instructor at Harvard Medical School, said Seroquel's emergence as a street drug is further proof that psychiatrists have to be more careful with their prescription pads, resisting the trend in which "antipsychotics are being overprescribed for off-label uses.''

Some clinicians say they are profoundly saddened by the idea that people on the streets are using a powerful antipsychotic drug just to fall asleep; even some schizophrenics loathe the drug, saying it makes them feel like a zombie. "It's not thought of as a fun drug,'' said Michael Otto, director of the Center for Anxiety and Related Disorders at Boston University.
But Seroquel has its appeal, said a 30-year-old from Webster who asked to remain anonymous because of his past illegal drug use. He said he bought Seroquel off the streets because it's strong enough to "take you out of your element.'' He said some people mix Seroquel with other recreational drugs to achieve a more calm, measured high.
When he bought Seroquel illegally, it cost about $3 to $5 for a 200 milligram pill, and was relatively easy to get on the streets compared with other prescription drugs. The retail price of a 200 milligram pill of Seroquel is about $10, though most people obtain it for far less through insurance or treatment centers.

In New England, the prescription drugs most commonly abused are OxyContin, Xanax, and Vicodin, all of which are controlled substances, said Nancy Coffey, diversion program manager of the Drug Enforcement Administration in New England. She said the DEA does not monitor Seroquel because it is not a controlled substance.

Officials at AstraZeneca condemned the misuse of Seroquel, which is one of the top-selling drugs worldwide, with more than $4 billion in sales last year. "Unfortunately, drug abuse extends not just to illicit substances, but also to medicines that are safe, effective, and necessary when used according to doctors' prescriptions and advice,'' said Kirsten Evraire, a spokeswoman for the company. She said AstraZeneca supports the efforts of government enforcers to work on the "misuse and abuse of prescription medicines.''

Clinicians at many drug treatment programs and prisons have begun to curb Seroquel prescriptions to minimize abuse. Nicholas Tenaglia, program director of Men's Addiction Treatment Center in Brockton, said the staff noticed a few months ago that many patients were selling their pills, so now they have drastically cut back orders for Seroquel. The motivation to secretly acquire the pills, he said, is sleep. "That's what I get 99 percent of the time when I ask someone why they abuse Seroquel,'' he said. "They say it's not to get high - it's to knock them out.''
more:
http://www.boston.com/news/local/massachusetts/articles/2009/07/13/psych...
Boston Globe