Researchers at the University of Michigan have discovered that antipsychotics may work, at least in part, by restoring normal gene function in people with bipolar disorder. (Chen, H., Wang, N., Zhao, X., Ross, C. A., O’Shea, K. S. and McInnis, M. G. (2013), “Gene expression alterations in bipolar disorder postmortem brains.” Bipolar Disorders, 15: 177–187. doi: 10.1111/bdi.12039)

The research team did post-mortem (after death) examinations on the brains of three groups of people:

• People with bipolar disorder who never took antipsychotics
• People with bipolar disorder who had taken antipsychotics
• People without bipolar disorder (the control group)
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Researchers in Denmark have discovered that treatment in specialized mood disorder clinics following a hospitalization significantly reduce hospital readmission rates.

In their study, published in the British Journal of Psychiatry and titled “Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder: randomised clinical trial,” Lars Vedel Kessing et al. followed 158 patients who were discharged from their first, second, or third hospital admission with a single manic episode or bipolar disorder.

According to a recent study published in the journal Nature Communications entitled “A safe lithium mimetic for bipolar disorder,” British researchers are exploring a medication called ebselen as a possible treatment for bipolar disorder in humans. Originally developed to treat stroke, ebselen may be as effective as lithium in treating bipolar mania but carry fewer and less serious side effects than lithium.

As the article points out,

Lithium is the most effective mood stabilizer for the treatment of bipolar disorder, but it is toxic at only twice the therapeutic dosage and has many undesirable side effects.

October 15, 2012, researchers at Kings College in London published a study in the journal Biological Psychiatry, entitled “Replication study and meta-analysis in European samples supports association of the 3p21.1 locus with bipolar disorder” Biological Psychiatry. 2012 Oct 15;72(8):645-50. Vassos E, et al.) This study replicates earlier findings that connect changes at a particular gene region on chromosome 3p21.1 to bipolar disorder.

The Fall edition of the NAMI Advocate (2012) contains an interesting article by NAMI Communications Coordinator Brendan McLean entitled “The Hope for Mental Illness Research: Dr. Tom Insel Shares the Latest Data at NAMI Convention.” But it wasn’t the discussion about research that piqued my interest. Instead, it was what Dr. Insel said about stigma and the importance of engaging the family in the recovery process.

Stigma Versus Discrimination

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In the September issue of the American Journal of Psychiatry, researchers report a series of studies that suggest a strong association between one particular genetic variation and manic symptoms. (Studies in humans and mice implicate neurocan in the etiology of mania. Miró X, Meier S, Dreisow ML, Frank J, Strohmaier J, Breuer R, Schmäl C, Albayram O, Pardo-Olmedilla MT, Mühleisen TW, Degenhardt FA, Mattheisen M, Reinhard I, Bilkei-Gorzo A, Cichon S, Seidenbecher C, Rietschel M, Nöthen MM, Zimmer A. Am J Psychiatry, 2012 Sep 1;169(9):982-90.)

If the human brain were so simple we could understand it, we would be so simple we couldn’t.

–Emerson M. Pugh as quoted by George E. Pugh, The Biological Origin of Human Values, 1977

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).