In a study just published on PLoS One entitled “Lithium Impacts on the Amplitude and Period of the Molecular Circadian Clockwork,” researchers at the University of Manchester (Jian Li, Wei-Qun Lu, Stephen Beesley, Andrew S. I. Loudon, and Qing-Jun Meng) have discovered that lithium works as a pacemaker for the circadian clock, which may help to explain lithium’s mechanism of action – how it works.

I recently got a call from an aging family member who has suffered with bipolar disorder, untreated for most of his life. He explained to me about the police cars that had “surrounded” his home and were “monitoring” him, but really were trying to harm him because they were involved in a “conspiracy with the gangsters who live down the street.”

I sighed. This was just another in a long line of these kinds of episodes, and I was pretty sure it would resolve on its own with my relative hunkering down in his house for a while until he was sure the police had gone away.

But then I decided to go see him as soon as I could, because he just turned 80 and I began to wonder if I should be worried that in addition to his bipolar disorder he might not be showing some signs of dementia. I wasn’t sure about the overlap between bipolar and dementia. We know from studies that people with bipolar disorder often have cognitive problems – memory, executive function, and other thinking problems. But does this put them at higher risk for memory problems in old age?

A study published last week entitled “Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis” (Cipriani et al The Lancet 17 Aug 2011) reviewed many previous trials of medications for mania. It looked at results for any of the following medications: Aripiprazole (Abilify) , asenapine (Saphris), carbamazepine (Tegretol) , valproate (Depakote) , gabapentin (Neurontin), haloperidol (Haldol), Lamotrigine (Lamictal), lithium, Olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal) , topiramate (Topamax), and Ziprasidone (Geodon).

Several weeks ago, the British Psychological Society published a report online entitled “Understanding Bipolar Disorder.” (You can download the 88-page report for free; although you must go through the purchase process to “buy” it, you’re charged nothing for it. According to BPSShop.org.uk, the report will be available for free “for a limited period.”)

Although the report doesn’t make any groundbreaking revelations, it does contain some important reminders, including the following:

A new report from the British Psychological Society entitled “Understanding Bipolar Disorder” suggests that viewing bipolar disorder solely as an illness with a biological basis may not be the most effective approach. The report seeks to re-establish a balance of biological and behavioral. Here’s a summary:

This report provides an overview of the current state of knowledge about why some people tend to experience periods of extreme mood and what can help. Much has been written about the biological aspects of bipolar disorders: this report aims to redress the balance by concentrating on the psychological aspects, both in terms of how we understand the problems and also approaches to help and treatment. We hope this report will influence the way in which services are delivered, so that more people have access to psychological treatments and that services will no longer insist that users accept one particular view of their problem.

Please check out the report and let us know what you think.

Added later: Although the report is free, you must register for a free account, login, add the report to your basket, and then proceed through the checkout process, but you won’t be prompted to enter a credit card number or anything like that.

After checking out, you’ll see a receipt showing that you’ve been charged nothing and providing a link you can click to download the report in PDF format. The report is 88 pages long.

Photo by DeepBluC, available under a Creative Commons attribution license.

According the NPR health blog “Shots,” three psychiatrists at Harvard University who were leaders in research on bipolar disorder in children were punished over not disclosing payments from drug companies for research and other activities totaling more than $4.2 million dollars. (See “Harvard Punishes 3 Psychiatrists Over Undisclosed Industry Pay,” by Richard Knox.) The psychiatrists cannot accept any payments from industry for one year and must seek approval for any such payments after that period. Additionally they will suffer a “delay of consideration” for promotions and advancements in their institutions.

The doctors’ public response to this suggests that they felt that they operated in good faith and that they now realize they should have paid more attention to the details regarding disclosure.

In a recent study entitled “Postural Control in Bipolar Disorder: Increased Sway Area and Decreased Dynamical Complexity,” Indiana University researchers measured and compared the magnitude of postural sway between study participants with and without bipolar disorder. The study involved 32 participants, 16 of whom carried the bipolar diagnosis. The control group was made up of 16 age-matched non-psychiatric healthy participants. Participants were asked to stand as still as possible on a force platform for 2 minutes under 4 conditions: (1) eyes open-open base (feet apart); (2) eyes closed-open base; (3) eyes open-closed base (feet together); and (4) eyes closed-closed base.

The researchers postulated that because many of the structural, neurochemical, and functional abnormalities identified in the brains of those with bipolar disorder are also implicated in postural control, people with bipolar disorder would have less postural control and hence a greater magnitude of sway than those without a brain disorder. In other words, there’s a connection between motor and mood disorders. The results supported their hypothesis:

As a psychiatrist, every day I encounter families struggling with mental illness, especially in their children whose lives range from disrupted to shattered as a consequence of these challenges. In these daily battles I’m most frustrated and saddened by the jaw-dropping lack of compassion surrounding me and my patients regarding their family struggles and their child’s distress.

Unfortunately, many people still view mental illness as a moral rather than a medical or developmental issue. As a result, they readily dispense judgment when someone is struggling with emotional and behavioral symptoms – shutting down open discussion and squashing attempts to problem solve rather than blame.

Even worse, stigma and misunderstanding paralyze many people who might consider seeking help but don’t because they’re afraid of being judged or feel somehow to blame. Families are told they’re being manipulated by their loved one who’s suffering or that their parenting is impaired. Just “try harder” says the teacher, the coach, the neighbor, and the in-laws.

Abilify (aripiprazole) is an atypical antipsychotic medication commonly used to treat schizophrenia and acute mania. In 2005, the Food and Drug Administration (FDA) approved its use in the maintenance treatment of bipolar disorder – to prevent the recurrence of mood episodes. Unfortunately, evidence proving the effectiveness of Abilify as a maintenance medication for bipolar disorder is scarce and questionable.

Exposing the Truth

An article published this week in the open access journal PLoS Medicine (Tsai et al) looks critically at the scientific evidence that supports such widespread use of this medicine for maintenance treatment of bipolar disorder.

If brain chemistry can affect thoughts and behaviors, can thoughts and behaviors affect brain chemistry and perhaps even rewire the brain?

Yes.

An accumulating body of evidence supports the notion that non-medical interventions – especially mindfulness – can create changes in the body and brain that help reduce distress and improve brain function in a variety of ways.

MindfulnessA mental state of heightened awareness, free of distraction, and more conducive to deliberate thought and action.