If the mother contracts the flu, the child has a nearly four-fold increased chance of developing bipolar disorder in adulthood, say researchers.

The findings add to mounting evidence of possible shared underlying causes and illness processes with schizophrenia, which some studies have also linked to prenatal exposure to influenza.

“Prospective mothers should take common sense preventive measures, such as getting flu shots prior to and in the early stages of pregnancy and avoiding contact with people who are symptomatic,” said Alan Brown, M.D., M.P.H, of Columbia University.

“In spite of public health recommendations, only a relatively small fraction of such women get immunized. The weight of evidence now suggests that benefits of the vaccine likely outweigh any possible risk to the mother or newborn.”

Brown and colleagues reported their findings online in the journal JAMA Psychiatry.

Although researchers have suspected a linkage between maternal influenza and bipolar disorder, the new study is the first to prospectively follow families using physician-based diagnoses and structured standardized psychiatric measures.

The research was made possible by use of comprehensive electronic medical records by Kaiser-Permanente, in association with county and Child Health and Development Study databases.

This shared health care data repository allowed the evaluation of more cases with detailed maternal flu exposure information than in previous studies.

Among nearly a third of all children born in a northern California county during 1959-1966, researchers followed, 92 who developed bipolar disorder, comparing rates of maternal flu diagnoses during pregnancy with 722 matched controls.

The nearly fourfold increased risk implicated influenza infection at any time during pregnancy, but there was evidence suggesting slightly higher risk if the flu occurred during the second or third trimesters.

Moreover, the researchers linked flu exposure to a nearly six-fold increase in a subtype of bipolar disorder with psychotic features.

Prior research suggested a threefold increased risk for schizophrenia associated with maternal influenza during the first half of pregnancy.

Autism has similarly been linked to first trimester maternal viral infections and to possibly related increases in inflammatory molecules.

“Future research might investigate whether this same environmental risk factor might give rise to different disorders, depending on how the timing of the prenatal insult affects the developing fetal brain,” suggested Brown.

Bipolar disorder shares with schizophrenia a number of other suspected causes and illness features, the researchers note.

For example, both share onset of symptoms in early adulthood, susceptibility genes, run in the same families, affect nearly one percent of the population, show psychotic behaviors and respond to antipsychotic medications.

Source: NIH/National Institute of Mental Health

Bipolar disorder causes unusual shifts in mood, energy, activity levels and the ability to carry out basic tasks. Although some people have their first symptoms during childhood, the disorder often develops in the late teens or early adult years.

“We don’t fully understand this,” said study co-author Alan Brown, M.D. “The best guess is it’s an inflammatory response. It could also be a result of fever.”

Brown, a professor of clinical psychiatry and clinical epidemiology at the Columbia University College of Physicians and Surgeons in New York City, said, “Mothers should stay away from people who have the flu.”

Brown added that “women should not be greatly concerned, because a fourfold increase is pretty high from an epidemiological standpoint, but still the vast majority of the offspring did not get bipolar disorder.”

Brown further explained that “the risk of bipolar disorder in the population is about 1 percent, so if it’s increased fourfold that would make it a 4 percent risk.”

Furthermore, the study only looked at one risk factor for bipolar disorder, not all risk factors, which could skew these results, he noted.

For the study, researchers at Columbia University and Kaiser Permanente identified cases of bipolar disorder by database linkages of a Northern California health plan and a county health care system, along with data from a mailed survey.

The study participants were mothers who gave birth between 1959 and 1966 and their offspring. Researchers found 92 cases of bipolar disorder and compared them with 722 people matched in terms of occurrence of maternal influenza during pregnancy.

Although the research found a link between pregnant women getting the flu and a higher risk of bipolar disorder in their offspring, it didn’t establish a cause-and-effect relationship.

“There is no understanding of the causal factors of this,” said Alan Manevitz, M.D., a clinical psychiatrist at Lenox Hill Hospital in New York City. He was not involved with the study.  “Pregnancy itself puts extra stress on women in general,” he pointed out. “Pregnancy also affects the immune system and increases the risk of getting the flu.”

Flu during pregnancy increases the risk of miscarriage, premature birth and low birth-weight infants, Manevitz said.

Other studies have shown a similar connection between flu during pregnancy and the child’s risk for autism and schizophrenia — now there is a link with bipolar disorder, Manevitz said.

Source:  JAMA Psychiatry

BDD sufferers feel they are disfigured and ugly, even when they look normal to others. The discovery that abnormal connections between regions of the brain lead to problems in visual and emotional processing builds upon earlier research.

The findings, published in the May edition of the journal Neuropsychopharmacology, suggest that these patterns in the brain may relate to impaired information processing.

“We found a strong correlation between low efficiency of connections across the whole brain and the severity of BDD,” Feusner said. “The less efficient patients’ brain connections, the worse the symptoms, particularly for compulsive behaviors, such as checking mirrors.”

People suffering from BDD tend to fixate on minute details, such as a single blemish on their face or body, rather than viewing themselves in their entirety.

They become so distressed with their appearance that they often can’t lead normal lives, are fearful of leaving their homes and occasionally even commit suicide.

Patients frequently have to be hospitalized. BDD affects approximately 2 percent of the population and is more prevalent than schizophrenia or bipolar disorder. Despite its prevalence and severity, scientists know relatively little about the neurobiology of BDD.

In the current study, Feusner and his colleagues performed brain scans of 14 adults diagnosed with BDD and 16 healthy controls. The goal of the study was to map the brain’s connections to examine how the white-matter networks are organized.

White matter is made up of nerve cells that carry impulses from one part of the brain to another.

Researchers used a sensitive form of brain imaging called diffusion tensor imaging, or DTI to perform the study. DTI is a variant of magnetic resonance imaging that can measure the structural integrity of the brain’s white matter.

From these scans, they were able to create whole brain “maps” of reconstructed white-matter tracks. Next, they used a form of advanced analysis called graph theory to characterize the patterns of connections throughout the brains of people with BDD and then compared them with those of healthy controls.

The researchers found people with BDD had a pattern of abnormally high network “clustering” across the entire brain. This suggests that these individuals may have imbalances in how they process “local” or detailed information.

During the research, investigators discovered specific abnormal connections between areas involved in processing visual input and in brain regions involved in recognizing emotions.

“How their brain regions are connected in order to communicate about what they see and how they feel is disturbed,” said Feusner.

“Their brains seem to be fine-tuned to be very sensitive to process minute details, but this pattern may not allow their brains to be well-synchronized across regions with different functions,” he said. “This could affect how they perceive their physical appearance and may also result in them getting caught up in the details of other thoughts and cognitive processes.”

Feusner says the study advances the understanding of BDD by providing evidence that the “hard wiring” of patients’ brain networks is abnormal.

“These abnormal brain networks could relate to how they perceive, feel and behave,” he said. “This is significant because it could possibly lead to us being able to identify early on if someone is predisposed to developing this problem.”

Source: UCLA

Abstract of brain networking photo by shutterstock.

The problem appears to be specific to emotion recognition, say the researchers, because schizophrenia patients performed as well as bipolar disorder patients and mentally healthy controls when asked to figure out the age of people with angry facial expressions.

The study included 27 patients with schizophrenia, 16 with bipolar I disorder, and 30 mentally healthy controls.

“A better understanding of facial emotional recognition deficits in the two severe mental disorders might assist with diagnostic clarification, as well as inform treatment development and selection,” according to the researchers, psychologists Drs. Vina Goghari of the University of Calgary and Scott Sponheim of the University of Minnesota.

During the study, schizophrenia patients correctly identified angry facial expressions just 60 percent of the time, most often mistaking these faces as frightened, followed by happy, sad, and then neutral.

Similarly, the patients with bipolar disorder tended to mistake anger as fear, significantly more so than the controls.

However, they were more accurate overall than schizophrenia patients, correctly labeling 75 percent of the angry faces, which was not very different from the controls, who got 78 percent correct.

“Greater facial emotion recognition deficits in schizophrenia patients compared to bipolar patients found in this study may be a reflection of greater degree of brain abnormalities in regions associated with facial emotion recognition, such as in the amygdala and hippocampus, in schizophrenia patients,” said the researchers.

While trying to identify the other facial expressions — fear, sad, happy, and neutral — both the schizophrenia and bipolar groups were as accurate as the controls. The three groups also had similar ability in identifying the age of the faces.

The only other difference found was that bipolar disorder patients took much longer to figure out emotional expressions than they did to determine age.  Schizophrenia patients and controls took a similar length of time to complete both tasks.

“This finding may have clinical implications for treatment development in schizophrenia as it suggests that schizophrenia patients may have a different strategy when viewing faces compared to bipolar patients, which may result in lower accuracy,” said the researchers.

Source:  Comprehensive Psychiatry

Man with angry expression photo by shutterstock.

A new research effort reviews the medications people take for bipolar disorder — drugs that keep people from swinging into manic or depressed moods.

The University of Michigan Medical School study of brain tissue helps reveal what might actually be happening. And further research using stem cells programmed to act like brain cells is already underway.

Using genetic analysis, the new study suggests that certain medications may help “normalize” the activity of a number of genes involved in communication between brain cells.

The study is published in the journal Bipolar Disorders.

Researchers studied brain tissue from deceased people with and without bipolar disorder. Investigators then analyzed the tissue to see how often certain genes were activated, or expressed.

“We found there are hundreds of genes whose activity is adjusted in individuals taking medication – consistent with the fact that there are a number of genes that are potentially amiss in people with bipolar,” said senior author Melvin McInnis, M.D.

“Taking the medications, specifically ones in a class called antipsychotics, seemed to normalize the gene expression pattern in these individuals so that it approached that of a person without bipolar.”

The mechanism for bipolar disorder is influenced by genetic differences in the brain — though scientists are still searching for the specific gene combinations involved.

McInnis and his colleagues have now embarked on research developing several a lines of induced pluripotent stem cells derived (iPSC) from volunteers with and without bipolar disorder, which will allow even more in-depth study of the development and genetics of bipolar disorder.

The new study looked at the expression, or activity levels, of 2,191 different genes in the brains of 14 people with bipolar disorder, and 12 with no mental health conditions.

The brains were all part of a privately funded nonprofit brain bank that collected and stored donated brains, and recorded what medications the individuals were taking at the time of death.

Seven of the brains were from people with bipolar disorder who had been taking one or more antipsychotics when they died.

These drugs include clozapine, risperidone, and haloperidol, and are often used to treat bipolar disorder. Most of the 14 brain donors with bipolar disorder were also taking other medications, such as antidepressants, at the time of death.

When the researchers compared the gene activity patterns among the brains of bipolar disorder patients who had been exposed to antipsychotics with patterns among those who weren’t, they saw striking differences.

Then, when they compared the activity patterns of patients who had been taking antipsychotics with those of people without bipolar disorder, they found similar patterns.

Researchers say the similarities were strongest in the expression of genes involved in the transmission of signals across synapses – the gaps between brain cells that allow cells to ‘talk’ to one another.

Furthermore, there were also similarities in the organization of nodes of Ranvier — locations along nerve cells where signals can travel faster.

Using “gene chip” analysis to measure the presence of messenger RNA molecules that indicate gene activity, and sophisticated data analysis, investigators were able to map the expression patterns from the brains and break the results down by bipolar status and medication use.

The bipolar and control (non-bipolar) brains were matched by age, gender and other factors.

“In bipolar disorder, it’s not just one gene that’s involved — it’s a whole symphony of them,” said McInnis, who has helped lead U-M’s bipolar genetics research for nearly a decade.

“Medications appear to nudge them in a direction that aligns more with the normal expression pattern.”

Among those that were “nudged” were genes that have already been shown to be linked to bipolar disorder, including glycogen synthase kinase 3 beta (GSK3β), FK506 binding protein 5 (FKBP5), and Ankyrin 3 (ANK3).

McInnis believes future studies of cell culture studies will provide more information on how medications for bipolar disorder work, and will allow analysis of new molecules that could serve as potential new medications.

Source: University of Michigan

Monitoring population mental illness trends has been an historic challenge for scientists and clinicians alike. Telephone surveys have been the primary method to determine the prevalence of mental issues, but this approach is limited because respondents may be reluctant to honestly discuss their mental health.

This approach also has high material costs and a low return rate. As a result, investigators have not had the data they need.

In the study to be published in the May issue of the American Journal of Preventive Medicine, researchers now believe the Internet, and specifically Google, can provide an accurate barometer of mental health trends.

“The Internet is a game changer,” said lead investigator John W. Ayers, Ph.D. “By passively monitoring how individuals search online we can figuratively look inside the heads of searchers to understand population mental health patterns.”

Using Google’s public database of queries, the study team identified and monitored mental health queries in the United States and Australia for 2006 through 2010.

All queries relating to mental health were captured and then grouped by type of mental illness, including ADHD (attention deficit-hyperactivity disorder), anxiety, bipolar, depression, eating disorders (including anorexia or bulimia), OCD (obsessive-compulsive disorder), schizophrenia, and suicide.

Using advanced mathematical methods to identify trends, the authors found all mental health queries in both countries were consistently higher in winter than summer.

The research showed eating disorder searches were down 37 percent in summers versus winters in the U.S., and 42 percent in summers in Australia. Schizophrenia searches decreased 37 percent during U.S. summers and by 36 percent in Australia.

Bipolar searches were down 16 percent during U.S. summers and 17 percent during Australian summers; ADHD searches decreased by 28 percent in the U.S. and 31 percent in Australia during summertime. OCD searches were down 18 percent and 15 percent, and bipolar searches decreased by 18 percent and 16 percent, in the U.S. and Australia respectively.

Searches for suicide declined 24 and 29 percent during U.S. and Australian summers and anxiety searches had the smallest seasonal change – down 7 percent during U.S. summers and 15 percent during Australian summers.

Researchers said they were startled by the discovery of apparent seasonal trends for mental illness.

While some conditions, such as seasonal affective disorder, are known to be associated with seasonal weather patterns, the connections between seasons and a number of major disorders were surprising.

“We didn’t expect to find similar winter peaks and summer troughs for queries involving every specific mental illness or problem we studied,” said co-author James Niels Rosenquist, M.D., Ph.D. “However, the results consistently showed seasonal effects across all conditions – even after adjusting for media trends.”

“It is very exciting to ponder the potential for a universal mental health emollient, like Vitamin D (a metabolite of sun exposure). But it will be years before our findings are linked to serious mental illness and then linked to mechanisms that may be included in treatment and prevention programs,” said Ayers.

“Is it biologic, environmental, or social mechanisms explaining universal patterns in mental health information seeking? We don’t know.”

“Our findings can help researchers across the field of mental health generate additional new hypotheses while exploring other trends inexpensively in real-time,” said Benjamin Althouse, a doctoral candidate at Johns Hopkins Bloomberg School of Public Health and researcher on the study.

“For instance, moving forward, we can explore daily patterns in mental health information seeking … maybe even finding a ‘Monday effect.’ The potential is limitless.”

Source: Elsevier

Abstract of person and light photo by shutterstock.

Although some research has found links between cannabis use and mental illness, until now, the exact numbers and prevalence of cannabis use had not been investigated.

Cannabis is the most widely used illicit substance globally, with an estimated 203 million people reporting use.

“We know that people with mental illness consume more cannabis, perhaps partially as a way to self- medicate psychiatric symptoms, but this data showed us the degree of the correlation between cannabis use, misuse, and mental illness,” said lead research Shaul Lev-ran, M.D.

“Based on the number individuals reporting weekly use, we see that people with mental illness use cannabis at high rates. This can be of concern because it could worsen the symptoms of their mental illness,” said Lev-ran.

Researchers also found that individuals with mental illness were 10 times more likely to have a cannabis use disorder.

In this new study, published in the journal Comprehensive Psychiatry, researchers at Toronto’s Centre for Addiction and Mental Health (CAMH) analyzed U.S. data from face-to-face interviews with over 43,000 respondents over the age of 18 from the National Epidemiologic Survey on Alcohol and Related Conditions.

Using structured questionnaires, the researchers assessed cannabis use as well as various mental illnesses including depression, anxiety, drug and alcohol use disorders and personality disorders, based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Among those will mental illness reporting at least weekly cannabis use, rates of use were particularly elevated for those with bipolar disorder, personality disorders and other substance use disorders.

In total, 4.4 percent of individuals with a mental illness in the past 12 months reported using cannabis weekly, compared to 0.6 percent among individuals without any mental illness.

Cannabis use disorders occurred among 4 percent of those with mental illness versus 0.4 per cent among those without.

Researchers also noted that, although cannabis use is generally higher among younger people, the association between mental illness and cannabis use was pervasive across most age groups.

Experts believe the findings suggest those with mental illness may benefit from screening for frequent and problem cannabis use, so that targeted prevention and intervention may be employed as necessary.

Source: Centre for Addiction and Mental Health

Person smoking marijuana photo by shutterstock.

Emotions are central to the human experience, as is being able to identify and report on these feelings. In the new study, investigators determined that the human report of emotion relies on three distinct systems: one system that directs attention to affective states (“I feel”), a second system that categorizes these states into words (“good”, “bad”, etc.); and a third system that relates the intensity of affective responses (“bad” or “awful”?).

The systems are activated when friends ask us how we are doing, when we talk about professional or personal relationships, when we meditate, and so on.

However, the ease of reporting what we are feeling can lead us to overlook just how important such reports are — and how devastating the impairment of this ability may be for individuals with clinical disorders ranging from major depression to schizophrenia to autism spectrum disorders.

Thankfully, progress in brain science has steadily been improving our knowledge of the circuits and processes that underlie mood states.

In the study, reported in the journal Biological Psychiatry, Kevin Ochsner, Ph.D., director of the Social Cognitive Neuroscience Lab at Columbia University, looked at the neural bases of social, cognitive and affective processes.

Ochsner and his team set out to study the processes involved in constructing self-reports of emotion, rather than the effects of the self-reports or the emotional states themselves for which there is already much research.

To accomplish this, they recruited healthy participants who underwent brain scans while completing an experimental task that generated a self-report of emotion. This effort allowed the researchers to examine the neural architecture underlying the emotional reports.

“We find that the seemingly simple ability is supported by three different kinds of brain systems: largely subcortical regions that trigger an initial affective response, parts of medial prefrontal cortex that focus our awareness on the response and help generate possible ways of describing what we are feeling, and a part of the lateral prefrontal cortex that helps pick the best words for the feelings at hand,” said Ochsner.

“These findings suggest that self-reports of emotion — while seemingly simple — are supported by a network of brain regions that together take us from an affecting event to the words that make our feelings known to ourselves and others,” he added.

“As such, these results have important implications for understanding both the nature of everyday emotional life — and how the ability to understand and talk about our emotions can break down in clinical populations.”

Dr. John Krystal, Editor of Biological Psychiatry, said, “It is critical that we understand the mechanisms underlying the absorption in emotion, the valence of emotion, and the intensity of emotion.

“In the short run, appreciation of the distinct circuits mediating these dimensions of emotional experience helps us to understand how brain injury, stroke, and tumors produce different types of mood changes. In the long run, it may help us to better treat mood disorders.”

Source: Elsevier

Human brain anatomy photo by shutterstock.

Over 80 percent of people with serious mental illnesses are overweight or obese, which contributes to them dying at three times the rate of the overall population, according to researchers. The leading causes of death are the same as for the rest of the population: Cardiovascular disease, diabetes and cancer.

Although antipsychotic medications can increase appetite and cause weight gain in these patients, it is not the only culprit.

Like the general population, sedentary lifestyle and poor diet also play a part. Lifestyle modifications such as diet and exercise should work for these patients, yet they are often left out of weight loss studies.

“People with serious mental illnesses are commonly excluded from studies to help them help themselves about their weight,” said Gail L. Daumit, M.D., of Johns Hopkins University, and the study’s lead author.

“We sought to dispel the perception that lifestyle programs don’t work in this population. There’s this really important need to find ways to help this population be healthier and lose weight. We brought a weight-loss program to them, tailored to the needs of people with serious mental illness. And we were successful.”

The researcher noted that many people with serious mental illnesses can’t afford or can’t get to physical activity programs like health clubs. Some also suffer from social phobia or have poor social interactions, and are simply afraid to work out in a public area, she said.

Daumit’s group attempted to solve these issues by bringing the gyms and nutritionists to places most of these patients frequent — psychiatric rehabilitation outpatient programs.

Under the trial name ACHIEVE (Achieving Healthy Lifestyles in Psychiatric Rehabilitation), the researchers recruited 291 overweight or obese patients with serious mental illness. About half, 144, were randomly placed in an intervention group, while 147 made up the control group. The intervention took place at 10 Baltimore area outpatient psychiatric rehabilitation day facilities that already offer vocational and skills training, case management and other services for people with mental illness not well enough to work full time.

While the control group received the usual care, which included nutrition and physical activity information, the intervention group got six months of intensive intervention consisting of exercise classes three times a week, along with individual or group weight loss classes once a week.

Both groups were followed for an additional year, during which the weight loss classes of the intervention group tapered down but the exercise classes remained constant.

At the 18-month point, the intervention group lost, on average, seven more pounds than the control group.

Nearly 38 percent of the intervention group lost 5 percent or more of their initial weight, as compared with 23 percent of the control group.

More than 18 percent of those in the intervention group lost more than 10 percent of their body weight after 18 months, compared with 7 percent in the control group.

Participants also lost more weight as the intervention went on. This suggests it took a while to make behavioral changes, but once these modifications took hold, the changes yielded positive results, Daumit said.

Of the people in the study, 50 percent had schizophrenia, 22 percent had bipolar disorder, and 12 percent major depression.

On average, each participant was on three psychotropic medications, with half on lithium or mood stabilizers, all known to cause weight gain. But no matter what they were on, they lost the weight, she said.

“We’re showing behavioral interventions work regardless of what they’re taking,” Daumit said.

Daumit thinks the weight-loss program could be adopted by other psychiatric rehabilitation facilities.

“This population is often stigmatized,” she said. “This study’s findings should help people think differently about people with serious mental illness. Our results provide clear evidence that this population can make healthy lifestyle changes and achieve weight loss.”

The study was published in the New England Journal of Medicine.

Source: National Institutes of Health/National Institute of Mental Health and John Hopkins Medicine

Overweight woman exercising by shutterstock.

Bipolar disorder and schizophrenia share several elements including age of onset, family history patterns, as well as similar symptoms leading up to the disorder.  Patients who develop bipolar psychosis have even more in common with those who develop schizophrenia.

However, until now, there has been minimal research into how cognitive impairment in childhood and adolescence differs between individuals who later develop schizophrenia compared with those who go on to develop bipolar disorder or bipolar psychosis.

To further investigate these early risk factors, Larry J. Seidman, Ph.D., of the Department of Psychiatry at Harvard Medical School recently conducted a study using data from 99 patients with either bipolar psychosis or schizophrenia as well as data from 101 nonpsychotic control participants.

Seidman assessed the participants’ IQs and cognitive abilities using data from school tests when they were seven years old and also looked at family history to determine its influence on future psychosis.

He found that although bipolar disorder, bipolar psychosis, and schizophrenia all shared early risk factors, the participants with schizophrenia had more severe cognitive impairments and memory and attention deficits in childhood than the participants with bipolar disorder or bipolar psychosis.

Family history greatly increased the risk for psychosis in all of the participants — most prominently in those who developed schizophrenia. The patients with bipolar had the lowest levels of cognitive impairment and academic problems in childhood, followed closely by those who later developed bipolar psychosis.

Seidman hopes that these study findings will give educators valuable information that can be used to identify children most at risk for future psychotic problems. He also believes that these findings could help prevent children from being misdiagnosed with other conditions that often mimic symptoms arising before the actual illness, such as defiance issues or attention deficit hyperactivity (ADHD).

Children with neuropsychological problems, especially those with a family history of psychosis, should be closely monitored and targeted for early identification of schizophrenia, bipolar disorder or bipolar psychosis, said Seidman.

“Future work should assess genetic and environmental factors that explain this [family history] effect,” he said.

Source:  Psychological Medicine

 
Abstract of schizophrenia by shutterstock.

In the study, researchers found children and adolescents with major depression or sub-threshold forms of bipolar disorder — and who had at least one first-degree relative with bipolar disorder — responded better to a 12-session family-focused treatment than to a briefer educational treatment.

Researchers identified 40 youth (average age 12 years) who were at risk for developing bipolar disorder.

The participants had diagnoses of major depressive disorder, cyclothymic disorder, or bipolar disorder, not otherwise specified (brief and recurrent episodes of mania or hypomania that did not meet full diagnostic criteria for bipolar disorder), and had at least one first-degree relative (usually a parent) with bipolar I or II disorder.

Study participants were randomly assigned to family-focused treatment (FFT) consisting of 12 family sessions over 4 months of psychoeducation (learning strategies to manage mood swings), communication skills training, or problem-solving skills training; or 1-2 family informational sessions (educational control, or EC).

Of the 40 participants, 60 percent were taking psychiatric medications upon entry, and continued taking recommended medications throughout the study.

Participants in the family-focused treatment group recovered from their initial depressive symptoms in an average of 9 weeks, compared to 21 weeks in the educational control group.

Participants who received FFT also had more weeks in full remission from mood symptoms over the study year. Improvements in mania symptoms on the Young Mania Rating Scale were greater in the FFT group as well.

The study participants who lived in families that were rated high in expressed emotion, a measure of critical comments or emotional overprotectiveness in parents, took almost twice as long to recover from their mood symptoms as those in families rated low in expressed emotion.

A secondary analysis indicated that youth from high expressed emotion families who were treated with family-focused treatment spent more weeks in remission over the year than those treated with just education.

Study authors David J. Miklowitz, Ph.D., of the UCLA School of Medicine, and Kiki D. Chang, M.D., of Stanford University School of Medicine, cautioned that the length of follow-up (one year) was too short to determine whether these children would develop full bipolar disorder.

“Nonetheless,” he said, “catching bipolar disorder at its earliest stages, stabilizing symptoms that have already developed, and helping the family to cope effectively with the child’s mood swings may have downstream effects that improve the long-term outcomes of high-risk children.”

The article appears in the Journal of the American Academy of Child and Adolescent Psychiatry.

Source: Elsevier

Bipolar sign photo by shutterstock.

In fact, they may just be different manifestations of the same underlying condition, according to a group of international researchers.

Several years ago, scientists from 19 countries formed the Psychiatric Genomics Consortium. Since then, the group has analyzed DNA from 33,000 people with major depression, bipolar disorder, schizophrenia, autism, or attention-deficit hyperactivity disorder and another 28,000 without one of these disorders.

Scientists were able to identify a handful of genes that are shared by people with these disorders. The findings may lead to new and better ways to diagnose and treat mental illness.

In the participants with mental illness, the same variations were found in four regions of the genetic code. The team’s report, published in the journal The Lancet, was led by Dr. Jordan Smoller, director of psychiatric genetics at Massachusetts General Hospital and professor of psychiatry at Harvard Medical School.

Two of the affected genes help control the movement of calcium in and out of brain cells. This movement provides a key way for brain cells to communicate.

Even subtle differences in the flow of calcium can create problems that, depending on other genes or environmental factors, could eventually lead to a full-blown mental disorder.

It’s been known for a long time that certain mental disorders run in families. This is especially true for bipolar disorder, major depression and schizophrenia. Scientists are making progress in pinpointing the genes tied to certain mental health diseases, but they still have a long way to go.

The new findings, for example, won’t immediately help clinicians either diagnose mental illness or give individuals a warning that they are at risk for it. This is because the genetic variants the researchers discovered are weak risk factors for the five diseases.

“Each one of them, by themselves, still accounts for a small amount of the risk,” said Smoller.  “The fascinating thing is there might be such variants that cross our clinically distinct syndromes.”

There are many paths to mental illness. This study shows that that five seemingly different mental health disorders — major depression, bipolar disorder, schizophrenia, autism, and attention-deficit hyperactivity disorder — may be more alike than we think.

These findings could change the way we view mental illness, open the door to more effective therapies, and possibly even lead to prevention.

Source:  The Lancet

 
Abstract of mental health photo by shutterstock.

Past research has shown that people with schizophrenia have clear cognitive deficits with respect to emotional perception.

Individuals with bipolar share many of the same genetic and environmental risk factors as those with schizophrenia, yet it has been unclear whether or not they share the same functional impairments.

To investigate this further, Jonathan K. Wynn, Ph.D., of the VA Greater Los Angeles Healthcare System in California recently conducted a study which included 30 patients with schizophrenia, 57 with bipolar, and 30 with no history of any mental health problem.

About half of the participants with bipolar were on antipsychotic medication during the study. Wynn showed the participants pictures of faces displaying emotions of fear, sadness, happiness, anger, or disgust.

He then had had them look at neutral facial expressions. The participants were instructed to identify the emotion on the first experiment and the gender of the face on the second experiment.

The patients with schizophrenia had the hardest time correctly identifying the facial expressions. The participants with bipolar identified the emotions more accurately, but took much longer to do so. And when they did, their scores were still much lower than the control group’s results.

When Wynn evaluated gender recognition abilities, he found again that both bipolar and schizophrenic patients had problems recognizing facial gender. These results were similar for both the bipolar patients who were taking medication and those who were not.

“Schizophrenia patients show deficits at multiple stages of facial affect processing whereas the deficits in bipolar disorder seem to be less severe and appear at the later stage of affect decoding,” said Wynn.

Despite those differences, the study clearly shows that people with bipolar can face challenges in social settings due to delays and impairments in cognitive processing.

Source:  Psychological Medicine

Over an average 2.5-year period, this treatment greatly reduced the risk for hospital readmission by 40 percent compared with standard treatment, said psychiatrist Dr. Lars Vedel Kessing from the Copenhagen University Hospital, Denmark and his team.

“The main advantage of specialized mood disorder clinics is that focused treatment programs combining updated evidence-based pharmacological treatment with group psychological interventions such as group psychoeducation can be provided by a cross-disciplinary team of professionals that are specialized and scientifically up to date about bipolar disorder,” said the researchers.

For the study, 158 manic or bipolar patients who were being discharged from a psychiatric hospital for the first, second or third time were randomly assigned to receive treatment in a mood disorder clinic or standard care.

The 72 patients who were treated in the mood disorder clinic received evidence-based pharmacologic treatment as well as group psychoeducation once a week for 12 weeks, followed by three additional booster sessions.

The remaining 86 patients received treatment by a primary care physician, a private psychiatrist, or at the local community mental health center.

Patients who attended the mood disorder clinic were less likely to be readmitted to the hospital within a six-year period following discharge from the clinic, at a rate of 36.1 percent compared to 54.7 percent for the control group.

The time spent in the hospital during first readmission and all readmissions cumulatively were also shorter if patients had attended the mood disorder clinic — 12 versus 22 days and 33 versus 49 days, respectively.

Mood stabilizers and antipsychotic treatment were more often used by patients in the mood disorder clinic group and their satisfaction with treatment was higher compared to those in the standard care group.

“It is possible with early and sustained pharmacological and psychological treatment, like that offered in a mood disorder clinic, to improve the long-term course of illness in bipolar disorder,” said the researchers.

“These findings suggest that more focus should be put on early outpatient intervention among patients with severe mania/bipolar disorder.”

Source:  The British Journal of Psychiatry

Prior research has clearly shown that brain emotion circuitry is dysregulated in individuals diagnosed with bipolar disorder. It is thought that these disturbances impair one’s ability to control emotion and contribute to mood episodes.

A new study follows this line of research as scientists from Indiana University School of Medicine used functional magnetic resonance imaging (fMRI) to investigate which areas of the brain showed abnormal activation.

Researchers studied brain activity while patients in different mood phases of bipolar disorder tried to control their response to emotional and non-emotional material.

This methodology allowed the scientists the opportunity to analyze brain activation patterns based on patient mood (manic, depressed, or euthymic) and stimuli type (emotion versus no emotion and happy versus sad).

Because medication effects on brain activation have been observed in some studies, the researchers recruited only unmedicated volunteers. They found that bipolar depressed patients abnormally activated brain areas when they had to withhold responses to sad faces.

Manic patients, on the other hand, had abnormal activation regardless of whether they were trying to withhold response to sad faces, happy faces or non-emotional material.

Even the euthymic bipolar subjects showed abnormal activation of cortical areas of the brain while withholding responses to emotional faces.

Researchers believe these findings suggest that distinct circuit dysfunctions may contribute to different features of emotion dysregulation in bipolar disorder.

Professor and senior author Amit Anand, M.D., said, “This study provides important information regarding brain areas that may be important in controlling response to emotional material and the functional abnormalities in these areas in mood disorders.”

“It is interesting that subtly different circuits distinguish symptomatic and non-symptomatic patients with bipolar disorder when they are suppressing their happy and sad reactions,” commented Dr. John Krystal, editor of Biological Psychiatry.

“These findings may have implications for the refinement of circuit-based treatments for bipolar disorder including neurostimulation and psychotherapy.”

Source: Elsevier

Human brain and emotions abstract photo by shutterstock.