Sandra lives with bipolar disorder. I am her psychiatrist or p-doc or shrink (as in Dr. Fink, the shrink). Sandra (not her real name), and I have worked together for many years. At today's appointment, she is moving a little slowly due to some back pain, but she tells me that her mood and energy have remained steady. That is outstanding news, because until a couple of months ago she was experiencing a terrible mood episode that rocked her life—a difficult mixed episode (mania and depression), along with substance use and memory and thinking problems. Her symptoms disrupted relationships with her family and worsened existing financial troubles. But, fortunately, her mood and energy level have not wavered to any clinically significant degree. Today she smiles and tells me about her volunteer work and playing tennis with a friend. Then she stops, and she cries softly and asks me how to help her parents understand what is wrong with her. While the good news is that many people in Sandra's life are starting to grasp that bipolar disorder is the problem (and that Sandra is not the problem), her own family of origin shuns and shames her, telling her that they have been advised to "stop enabling" her "bad behavior." They will not let her come to stay with them, and she has been excluded from family events. Sandra is heartbroken.
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The American Heart Association has released a statement (circ.ahajournals.org/content/early/2015/08/10/CIR.0000000000000229.abstract) identifying major depressive disorder and bipolar disorder in adolescents as specific risk factors for the early development of cardiovascular disease. Their review of numerous studies shows consistently higher risks of cardiovascular disease in adolescents with mood disorders compared to those without. Increased rates of heart disease in adults with depression and bipolar disorder have been well documented, but this is the first full examination of the data in young people with mood disorders.
Recently, a young adult child of a friend of mine was admitted to a hospital for a first manic episode. She presented in the most typical of ways with sudden changes in energy, sleep, mood, thinking, behavior, and judgment. She did not see that there was anything wrong, but was eventually hospitalized, against her will, due to dangerous behaviors.
A recent article in the American Journal of Psychiatry sheds light on the vexing challenge of treating depression in individuals who have an underlying bipolar disorder: For many people with bipolar disorder, depression occurs more frequently and damages function more severely than mania, but treating bipolar depression with antidepressants carries the risk of triggering manic symptoms.
A study published last month in a journal called Translational Psychiatry entitled "Transcripts involved in calcium signaling and telencephalic neuronal fate are altered in induced pluripotent stem cells from bipolar disorder patients" reported interesting findings about the development of brain cells in people with bipolar disorder compared to controls — people without bipolar disorder. The study was unique in two important ways: The study was based on the increasingly accepted concept that even subtle changes in early embryonic brain development can cause symptoms of mental illness that appear later in life. The researchers took advantage of evolving technology that creates stem cells — the origin cells in embryos that evolve into all the different cells types in the body — from adults rather than taking them from embryos. This allows researchers to have access to many more stem cells and also offers the opportunity to compare the stem cells from adults with certain diseases to those without and to see differences in the way they develop.
I recently attended the National Alliance on Mental Illness (NAMI) Indiana's Criminal Justice Summit in Indianapolis, IN. The morning's keynote speaker was Major Sam Cochran (ret.), who is nationally known for his work in developing the Crisis Intervention Team (CIT) model in Memphis, TN. Cochran's message was clear: CIT is not just a law enforcement program; CIT is a community program and should be recognized as a community priority. It should involve not only law enforcement officers and dispatchers, but also prosecutors, judges, emergency room personnel, physicians, nurses, psychiatrists, therapists, the community mental health center, and other community resource centers.