3.25 (4 votes)
Andy Irons' autopsy results have finally been released and his family posted a lengthy statement regarding the tragedy that took place last November when Irons, a three-time world surfing champion from Hawaii, to a combination of a heart attack and drugs in his system. Heart attack was ruled cause of death, but the family was open about Irons' battle with bipolarism and medications. Andy Irons was 32 years old.
Dr. Vincent Di Maio, a prominent forensic pathologist in San Antonio, TX was asked to review and explain the autopsy results to the family. He stated:
"This is a very straightforward case. Mr. Irons died of a heart attack due to focal severe coronary atherosclerosis, i.e., 'hardening of the arteries.' He had an atherosclerotic plaque producing 70%-80% narrowing of his anterior descending coronary artery. This is very severe narrowing. A plaque of this severity, located in the anterior descending coronary artery, is commonly associated with sudden death. The only unusual aspect of the case is Mr. Irons' age, 32 years old. Deaths due to coronary atherosclerosis usually begin to appear in the late 40's. Individuals such as Mr. Irons have a genetic predisposition to early development of coronary artery disease. In about 25% of the population, the first symptom of severe coronary atherosclerosis is sudden death. There were no other factors contributing to the death."
Irons was found in his hotel room in Texas. In the room, the police discovered prescription bottles for Alprazolam, used to treat anxiety, and Zolpidem, a sleep aid, along with tablets containing methadone, a narcotic used to treat pain and opiate addiction. Toxicology tests showed Irons also had cocaine and methamphetamine in his system.
Andy had a grandmother, 77, and a grand-uncle, 51, both on his father's side, who died of congestive heart failure. The family mentioned that Andy complained of chest pains and occasional intense heartburn for the first time last year and also recalls a holistic health practitioner, whom he sought out in Australia for vitamin therapy offhandedly mentioning he "had the heart of a 50-year-old." In addition, Andy contracted Typhoid Fever five years ago, which can result in damage to the heart muscle. Andy shrugged it all off and led no one to believe he was in ill health.
After winning championships from 2002 through 2004, and cementing his reputation as one of the greatest competitive surfers, Irons baffled the surfing world with erratic behavior. He abruptly quit the 2008 tour, and sat out the 2009 season before making a comeback in 2010.
The family's statement continues:
"Andy was prescribed Xanax and Zolpidem (Ambien) to treat anxiety and occasional insomnia, a result of a bipolar disorder diagnosed by his family doctor at age 18. This is when Andy first began experiencing episodes of manic highs and depressive lows. The family believes Andy was in some denial about the severity of his chemical imbalance and tended to blame his mood swings on himself and his own weaknesses, choosing to self-medicate with recreational drugs. Members of his family, close friends, and an industry sponsor intervened over the years to help Andy get clean, but the effort to find balance in his life was certainly complicated by his chemical makeup."
In December, Irons' widow, Lyndie, received a six-month injunction from releasing the autopsy report from a Texas judge. On May 20, she received another 30-day injunction. This week the results were finally made public.
Source: SURFER Magazine
Written by Sy Kraft
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
Monday, June 13, 2011
Saturday, May 28, 2011
Case Western Reserve Receives $7.8M To Study Mania In Children
4 (1 votes)
The Department of Psychiatry at Case Western Reserve University School of Medicine has received a $7.8 million renewal grant from the National Institute of Mental Health (NIMH) for the long-term study of manic symptoms in children.
The grant from the NIMH, one of the National Institutes of Health (NIH), funds the continuation of a study launched five years ago in which 707 children between the ages of six and 12 years were screened and evaluated for elevated symptoms of mania (ESM), a common indicator of bipolar disease and other childhood psychiatric disorders.
By studying the course of a child's ESM over time, which can include periods of rapid mood swings and intense irritability, researchers hope to learn more about what factors make children with ESM more likely to develop a bipolar spectrum disorder.
"We want to develop the means by which to more accurately diagnose bipolar disease in children," says Robert L. Findling, MD, the Rocco L Motto, M.D. Professor of Child & Adolescent Psychiatry at the School of Medicine, and director of the Division of Child and Adolescent Psychiatry at University Hospitals (UH) Case Medical Center. He is the study's coordinating principal investigator.
From the point of enrollment, children participating in the study's initial phase have been evaluated every six months for their psychiatric diagnoses, symptoms, use of mental health services and medication, and psychosocial function. The NIMH renewal grant allows researchers to continue these six-month evaluations among participants, who will now be between eight and 17 years of age. This will enable the collection of data during a period when study participants are at greater risk of developing a bipolar spectrum disorder, Dr. Findling says.
Researchers will also incorporate both neurocognitive testing (evaluations that assess how well a person processes new data, as well as their ability to process information and pay attention) and neuroimaging. The aim is to identify possible biomarkers that signal or reflect underlying biological mechanisms that predispose individuals to bipolar disease, a type of mood disorder that affects an estimated 5.7 million Americans who often report symptoms that can be traced back to their childhood.
"We're particularly excited about adding neuroimaging to this next phase of the study to examine brain functioning in these children," Dr. Findling says. "This research component is very innovative and will lay the groundwork for future studies between the child and adolescent psychiatry and radiology departments through collaborations involving neuroimaging in children." Neuroimaging involves the use of functional magnetic resonance imaging (MRI), a type of brain scan that maps brains activity. In this area, Dr. Findling is collaborating with neuroradiologist Jeffrey Sunshine, MD, PhD, associate professor and vice chair of the Department of Radiology at the School of Medicine and UH Case Medical Center.
The continued research will further document the trajectories of children with ESM and related psychiatric disorders to better determine the most appropriate points for intervention. Study goals include assessing the nature of manic symptoms over time in relation to changes in mood. Researchers hope to enhance their understanding of the predictive value of manic symptoms, alone and in combination with other symptoms, developing evidence-based criteria for diagnosing the spectrum of bipolar disorders in children; and identifying risk factors associated with poor functional outcomes among youth with manic symptoms.
The investigators will examine the relationships between mood episodes and clinical outcomes over time. They will also evaluate neurocognitive performance, together with functional abnormalities, to better understand how these relate to ESM and the development of bipolar disorder in childhood through early adulthood.
In addition to the School of Medicine and UH Case Medical Center, children enrolled in the study have been recruited from three other collaborating sites: University of Pittsburgh Medical Center, The Ohio State University Medical Center, and Cincinnati Children's Hospital.
Source:
Case Western Reserve University
The Department of Psychiatry at Case Western Reserve University School of Medicine has received a $7.8 million renewal grant from the National Institute of Mental Health (NIMH) for the long-term study of manic symptoms in children.
The grant from the NIMH, one of the National Institutes of Health (NIH), funds the continuation of a study launched five years ago in which 707 children between the ages of six and 12 years were screened and evaluated for elevated symptoms of mania (ESM), a common indicator of bipolar disease and other childhood psychiatric disorders.
By studying the course of a child's ESM over time, which can include periods of rapid mood swings and intense irritability, researchers hope to learn more about what factors make children with ESM more likely to develop a bipolar spectrum disorder.
"We want to develop the means by which to more accurately diagnose bipolar disease in children," says Robert L. Findling, MD, the Rocco L Motto, M.D. Professor of Child & Adolescent Psychiatry at the School of Medicine, and director of the Division of Child and Adolescent Psychiatry at University Hospitals (UH) Case Medical Center. He is the study's coordinating principal investigator.
From the point of enrollment, children participating in the study's initial phase have been evaluated every six months for their psychiatric diagnoses, symptoms, use of mental health services and medication, and psychosocial function. The NIMH renewal grant allows researchers to continue these six-month evaluations among participants, who will now be between eight and 17 years of age. This will enable the collection of data during a period when study participants are at greater risk of developing a bipolar spectrum disorder, Dr. Findling says.
Researchers will also incorporate both neurocognitive testing (evaluations that assess how well a person processes new data, as well as their ability to process information and pay attention) and neuroimaging. The aim is to identify possible biomarkers that signal or reflect underlying biological mechanisms that predispose individuals to bipolar disease, a type of mood disorder that affects an estimated 5.7 million Americans who often report symptoms that can be traced back to their childhood.
"We're particularly excited about adding neuroimaging to this next phase of the study to examine brain functioning in these children," Dr. Findling says. "This research component is very innovative and will lay the groundwork for future studies between the child and adolescent psychiatry and radiology departments through collaborations involving neuroimaging in children." Neuroimaging involves the use of functional magnetic resonance imaging (MRI), a type of brain scan that maps brains activity. In this area, Dr. Findling is collaborating with neuroradiologist Jeffrey Sunshine, MD, PhD, associate professor and vice chair of the Department of Radiology at the School of Medicine and UH Case Medical Center.
The continued research will further document the trajectories of children with ESM and related psychiatric disorders to better determine the most appropriate points for intervention. Study goals include assessing the nature of manic symptoms over time in relation to changes in mood. Researchers hope to enhance their understanding of the predictive value of manic symptoms, alone and in combination with other symptoms, developing evidence-based criteria for diagnosing the spectrum of bipolar disorders in children; and identifying risk factors associated with poor functional outcomes among youth with manic symptoms.
The investigators will examine the relationships between mood episodes and clinical outcomes over time. They will also evaluate neurocognitive performance, together with functional abnormalities, to better understand how these relate to ESM and the development of bipolar disorder in childhood through early adulthood.
In addition to the School of Medicine and UH Case Medical Center, children enrolled in the study have been recruited from three other collaborating sites: University of Pittsburgh Medical Center, The Ohio State University Medical Center, and Cincinnati Children's Hospital.
Source:
Case Western Reserve University
Friday, May 27, 2011
Study: Premenstrual Mood Changes Predictive Of Greater Bipolar Disorder Severity
4 (2 votes)Article Opinions: 4 posts
A study of nearly 300 women with bipolar disorder showed that those reporting flare-ups of mood symptoms before menstruation had more depressive episodes and more severe symptoms during the following year, compared with bipolar women without premenstrual mood changes.
The study was part of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) and was conducted by Rodrigo Dias, M.D., and colleagues at Massachusetts General Hospital in Boston. The report will be published online at AJP in Advance, the online advance edition of The American Journal of Psychiatry, the official journal of the American Psychiatric Association.
The study results provide evidence that premenstrual mood exacerbation may be a clinical marker predicting a worse presentation and course of bipolar disorder in reproductive-age women. The authors note that estrogen and other reproductive hormones influence mood symptoms through their action in the central nervous system. In women with bipolar disorder, the time following childbirth and the menopause transition are also periods of increased vulnerability to illness relapse. The susceptibility of mood to fluctuating hormone levels may result in greater mood instability in general.
The number of diagnosed illness episodes differed only for depressive episodes, not those characterized by mania or hypomania. Also, the women with premenstrual exacerbations were no more likely to have the extreme form of bipolar disorder known as rapid cycling (defined as four or more episodes per year). They did, however, have shorter gaps between symptomatic intervals.
Dr. Dias pointed out the implications for clinical practice: "The results reinforce the importance of identifying mood fluctuations across the menstrual cycle in women with bipolar disorder. The women with premenstrual mood changes may benefit from more intensive monitoring. The value of antidepressants isn't clear, since on the one hand, these women were less likely to be taking antidepressants and might have benefited from them, but on the other hand, antidepressants can trigger manic symptoms in bipolar patients." The article will appear on Feb. 15 at AJP in Advance. STEP-BD is funded by the National Institute of Mental Health; this study was funded in part by a donation from the Thompson Motta Family to the Bipolar Research Program, Institute of Psychiatry of the Hospital das Clinicas, University São Paulo Medical School. Financial support received by the individual authors is reported in the article.
Source: American Psychiatric Association
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
A study of nearly 300 women with bipolar disorder showed that those reporting flare-ups of mood symptoms before menstruation had more depressive episodes and more severe symptoms during the following year, compared with bipolar women without premenstrual mood changes.
The study was part of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) and was conducted by Rodrigo Dias, M.D., and colleagues at Massachusetts General Hospital in Boston. The report will be published online at AJP in Advance, the online advance edition of The American Journal of Psychiatry, the official journal of the American Psychiatric Association.
The study results provide evidence that premenstrual mood exacerbation may be a clinical marker predicting a worse presentation and course of bipolar disorder in reproductive-age women. The authors note that estrogen and other reproductive hormones influence mood symptoms through their action in the central nervous system. In women with bipolar disorder, the time following childbirth and the menopause transition are also periods of increased vulnerability to illness relapse. The susceptibility of mood to fluctuating hormone levels may result in greater mood instability in general.
The number of diagnosed illness episodes differed only for depressive episodes, not those characterized by mania or hypomania. Also, the women with premenstrual exacerbations were no more likely to have the extreme form of bipolar disorder known as rapid cycling (defined as four or more episodes per year). They did, however, have shorter gaps between symptomatic intervals.
Dr. Dias pointed out the implications for clinical practice: "The results reinforce the importance of identifying mood fluctuations across the menstrual cycle in women with bipolar disorder. The women with premenstrual mood changes may benefit from more intensive monitoring. The value of antidepressants isn't clear, since on the one hand, these women were less likely to be taking antidepressants and might have benefited from them, but on the other hand, antidepressants can trigger manic symptoms in bipolar patients." The article will appear on Feb. 15 at AJP in Advance. STEP-BD is funded by the National Institute of Mental Health; this study was funded in part by a donation from the Thompson Motta Family to the Bipolar Research Program, Institute of Psychiatry of the Hospital das Clinicas, University São Paulo Medical School. Financial support received by the individual authors is reported in the article.
Source: American Psychiatric Association
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
A New Clue To The Genetics Of Bipolar Disorder
3.88 (8 votes)Article Opinions: 2 posts
Understanding the genetics of bipolar disorder could lead to new treatments, but identifying specific genetic variations associated with this disorder has been challenging.
A new study in Biological Psychiatry implicates a brain protein called Piccolo in the risk for inheriting bipolar disorder. In the orchestra of neuronal proteins, Piccolo is a member of a protein family that includes another protein called Bassoon. Piccolo is located at the endings of nerve cells, where it contributes to the ability of nerve cells to release their chemical messengers.
Choi and colleagues conducted a creative study to implicate the gene coding for Piccolo (PCLO) in the heritable risk for bipolar disorder.
They compared gene expression patterns in postmortem cortical tissue from people who were diagnosed with bipolar disorder to tissue from people who did not have psychiatric illnesses prior to their death. This analysis identified 45 genes and genetic variations that had significantly altered mRNA levels, and they used this information to narrow the part of the genome that they explored in their genetics study.
They then tested genetic markers (small DNA sequence variations called single nucleotide polymorphisms or SNPs) that are close to the genes that had altered expression levels in the postmortem tissue. A marker for PCLO, SNP rs13438494, emerged as significant in this analysis, suggesting that variation in PCLO contributes to the risk for bipolar disorder.
"We have taken an innovative approach in correlating gene expression with genetic variation data from well-characterized postmortem brains and then combining with a large scale meta-analysis of genome-wide association studies," explained Dr. Kwang Choi. "If replicated, this study could finally forge a link between gene expression and genome-wide association studies in a complex genetic disorder."
"This study is an example of how better knowledge of brain biology may help to guide our genetics studies," added Dr. John Krystal, Editor of Biological Psychiatry.
Sources: Elsevier, AlphaGalileo Foundation.
Understanding the genetics of bipolar disorder could lead to new treatments, but identifying specific genetic variations associated with this disorder has been challenging.
A new study in Biological Psychiatry implicates a brain protein called Piccolo in the risk for inheriting bipolar disorder. In the orchestra of neuronal proteins, Piccolo is a member of a protein family that includes another protein called Bassoon. Piccolo is located at the endings of nerve cells, where it contributes to the ability of nerve cells to release their chemical messengers.
Choi and colleagues conducted a creative study to implicate the gene coding for Piccolo (PCLO) in the heritable risk for bipolar disorder.
They compared gene expression patterns in postmortem cortical tissue from people who were diagnosed with bipolar disorder to tissue from people who did not have psychiatric illnesses prior to their death. This analysis identified 45 genes and genetic variations that had significantly altered mRNA levels, and they used this information to narrow the part of the genome that they explored in their genetics study.
They then tested genetic markers (small DNA sequence variations called single nucleotide polymorphisms or SNPs) that are close to the genes that had altered expression levels in the postmortem tissue. A marker for PCLO, SNP rs13438494, emerged as significant in this analysis, suggesting that variation in PCLO contributes to the risk for bipolar disorder.
"We have taken an innovative approach in correlating gene expression with genetic variation data from well-characterized postmortem brains and then combining with a large scale meta-analysis of genome-wide association studies," explained Dr. Kwang Choi. "If replicated, this study could finally forge a link between gene expression and genome-wide association studies in a complex genetic disorder."
"This study is an example of how better knowledge of brain biology may help to guide our genetics studies," added Dr. John Krystal, Editor of Biological Psychiatry.
Sources: Elsevier, AlphaGalileo Foundation.
Study Examines Prevalence And Severity Of Bipolar Disorder Worldwide
Despite international variation in prevalence rates of bipolar spectrum disorder, the severity and associated disorders are similar and treatment needs are often unmet, especially in low-income countries, according to a report in the March issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
"Bipolar disorder (BP) is responsible for the loss of more disability-adjusted life-years than all forms of cancer or major neurologic conditions such as epilepsy and Alzheimer disease, primarily because of its early onset and chronicity across the life span," the authors write as background information in the article. "Few prior international studies of BP have included information on severity or disability associated with this condition."
Kathleen R. Merikangas, Ph.D., of the National Institute of Mental Health, Genetic Epidemiology Research Branch, Bethesda, Md., and colleagues conducted cross-sectional, face-to-face, household surveys to describe the prevalence, symptom severity, patterns of co-existing illnesses, and patterns of service utilization for bipolar spectrum disorder (BPS) in the World Health Organization World Mental Health Survey Initiative. Surveys of 61,392 community adults were carried out in the United States, Mexico, Brazil, Colombia, Bulgaria, Romania, China, India, Japan, Lebanon, and New Zealand.
"In a combined sample of 61,392 adults from 11 countries, the total lifetime prevalences were 0.6 percent for BP-I, 0.4 percent for BP-II, and 1.4 percent for sub-threshold BP, yielding a total BPS prevalence estimate of 2.4 percent worldwide," the authors report.
The severity of symptoms was greater for depressive than manic episodes. Approximately 74.0 percent of respondents with depression and 50.9 percent of respondents with mania reported severe role impairment.
Three-quarters of those with BPS also met criteria for at least one other disorder. Anxiety disorders, especially panic attacks, were the most common comorbid condition.
The surveys found that treatment needs for BPS are often unmet. "Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries, where only 25.2 percent reported contact with the mental health system," the authors write.
The authors believe their findings document the magnitude and major impact of BP worldwide and underscore the urgent need for increased recognition and treatment facilitation.
Arch Gen Psychiatry, 2011;68
Americans More Likely To Have Bipolar Disorder Than Anybody Else In The World
3.88 (8 votes)Article Opinions: 11 posts
Approximately 4.4% of Americans have had a diagnosis of bipolar disorder at some time during their lives, compared to a global average of 2.4%, and just 0.1% in India, researchers have revealed in Archives of General Psychiatry. The authors add that even though prevalence rates for bipolar spectrum disorder vary considerably around the globe, the associated disorders and their severities are not significantly different.
Unfortunately, a considerable number of bipolar disorder sufferers do not receive proper treatment, especially in low-income nations.
The authors wrote:
"Bipolar disorder (BP) is responsible for the loss of more disability-adjusted life-years than all forms of cancer or major neurologic conditions such as epilepsy and Alzheimer disease, primarily because of its early onset and chronicity across the life span. Few prior international studies of BP have included information on severity or disability associated with this condition."
Kathleen R. Merikangas, Ph.D., of the National Institute of Mental Health, Genetic Epidemiology Research Branch, Bethesda, Md., and team sought to find out what the prevalence of the disorder might be worldwide. They also aimed to describe its symptom severity, patterns of co-existing illnesses, and service utilization patterns for BPS (bipolar spectrum disorder) in the World Health Organization World Mental Health Survey Initiative. The survey included 61,392 adults from New Zealand, the Lebanon, Japan, India, China, Romania, Bulgaria, Columbia, Brazil, Mexico, and the USA.
The authors wrote:
"In a combined sample of 61,392 adults from 11 countries, the total lifetime prevalences were 0.6 percent for BP-I, 0.4 percent for BP-II, and 1.4 percent for sub-threshold BP, yielding a total BPS prevalence estimate of 2.4 percent worldwide."
They found that depressive episodes were linked to more severe symptoms than manic ones. About 74% of those with depression and 50.9% of those with mania reported severe role impairment.
Approximately three-quarters of respondents with a bipolar spectrum disorder appeared to have at least another disorder as well - they met the criteria for it (them). The most common comorbid conditions were anxiety disorders, particularly panic attacks.
A significant proportion of people worldwide with a BPS do not receive the treatment they need.
The authors wrote:
"Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries, where only 25.2 percent reported contact with the mental health system."
Experts from the National Institute of Mental Health, Bethesda, USA, who contributed to this study, say more research is required to define the thresholds and boundaries of bipolar symptoms more clearly and accurately. We also need to improve our understanding of why and how BP tends to start during adolescence and persists into adulthood, and how it intersects with comorbid mental disorders.
The researchers stressed that there is an urgent need for access to proper treatment and better recognition of BPS.
They concluded:
"Despite cross-site variation in the prevalence rates of BPS, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior, and comorbidity across each diagnostic category provide evidence for the validity of the concept of BPS. Treatment needs for BPS are often unmet, particularly in low-income countries."What is bipolar disorder?Bipolar disorder, also known as BP, manic-depressive illness or manic depression is a mental illness. The patient experiences instability in mood which is typically serious and disabling. An individual with BP has abnormal shifts in mood, energy, and their ability to function properly is affected - these shifts can go on for weeks, sometimes even months. The general "ups" and "downs" we experience in everyday life have nothing to do with BP. BP symptoms are severe and can destroy relationships, job prospects, and academic performance - put simply, they can ruin a person's life. Symptoms may become so severe that some patients either attempt to or manage to commit suicide.
Fortunately, bipolar disorder is treatable. Millions of patients worldwide manage to lead full and productive lives thanks to effective therapy.
The signs and symptoms of bipolar disorder vary, depending on whether the patient is on a high (mania) or low (depression).
Manic (mania) episodes signs and symptoms can include:ElationAggressive and intrusive behavior Agitation and extreme irritabilityReduced need for sleep Refusing to accept that anything is wrongDrug abuse, particularly cocaine, alcohol, and sleep aidesExtremely "high," overly good mood Increased drive to perform or achieve goals Increased energy, activity, and restlessness Increased sexual drive Exaggerated self-esteem lack of proper judgment Rapid speechRacing thoughtsRisky behavior Spending sprees Tendency to be easily distracted and difficulty concentratingUnrealistic beliefs in one's abilities and powers Depressive (depression) episodes signs and symptoms can include:Anxiety, overly worriedAppetite problems Concentration problemsDifficulty making decisionsGuilt, worthlessness, and helplessnessHopelessnessIrritability Loss of interest in daily activities Low libidoPessimism Reduced energySadness, gloomSensation of emptinessSleeping difficultiesSuicidal thoughts or behavior Tiredness Unexplained chronic painUnintended weight gain or loss"Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative"
Kathleen R. Merikangas, PhD; Robert Jin, MA; Jian-Ping He, MD; Ronald C. Kessler, PhD; Sing Lee, MB, BS, FRCPsych; Nancy A. Sampson, BA; Maria Carmen Viana, MD, PhD; Laura Helena Andrade, MD, PhD; Chiyi Hu, MD, PhD; Elie G. Karam, MD; Maria Ladea, MD, PhD; Maria Elena Medina-Mora, PhD; Yutaka Ono, MD; Jose Posada-Villa, MD; Rajesh Sagar, MD; J. Elisabeth Wells, PhD; Zahari Zarkov, MD
Arch Gen Psychiatry. 2011;68(3):241-251. doi:10.1001/archgenpsychiatry.2011.12
Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
Approximately 4.4% of Americans have had a diagnosis of bipolar disorder at some time during their lives, compared to a global average of 2.4%, and just 0.1% in India, researchers have revealed in Archives of General Psychiatry. The authors add that even though prevalence rates for bipolar spectrum disorder vary considerably around the globe, the associated disorders and their severities are not significantly different.
Unfortunately, a considerable number of bipolar disorder sufferers do not receive proper treatment, especially in low-income nations.
The authors wrote:
"Bipolar disorder (BP) is responsible for the loss of more disability-adjusted life-years than all forms of cancer or major neurologic conditions such as epilepsy and Alzheimer disease, primarily because of its early onset and chronicity across the life span. Few prior international studies of BP have included information on severity or disability associated with this condition."
Kathleen R. Merikangas, Ph.D., of the National Institute of Mental Health, Genetic Epidemiology Research Branch, Bethesda, Md., and team sought to find out what the prevalence of the disorder might be worldwide. They also aimed to describe its symptom severity, patterns of co-existing illnesses, and service utilization patterns for BPS (bipolar spectrum disorder) in the World Health Organization World Mental Health Survey Initiative. The survey included 61,392 adults from New Zealand, the Lebanon, Japan, India, China, Romania, Bulgaria, Columbia, Brazil, Mexico, and the USA.
The authors wrote:
"In a combined sample of 61,392 adults from 11 countries, the total lifetime prevalences were 0.6 percent for BP-I, 0.4 percent for BP-II, and 1.4 percent for sub-threshold BP, yielding a total BPS prevalence estimate of 2.4 percent worldwide."
They found that depressive episodes were linked to more severe symptoms than manic ones. About 74% of those with depression and 50.9% of those with mania reported severe role impairment.
Approximately three-quarters of respondents with a bipolar spectrum disorder appeared to have at least another disorder as well - they met the criteria for it (them). The most common comorbid conditions were anxiety disorders, particularly panic attacks.
A significant proportion of people worldwide with a BPS do not receive the treatment they need.
The authors wrote:
"Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries, where only 25.2 percent reported contact with the mental health system."
Experts from the National Institute of Mental Health, Bethesda, USA, who contributed to this study, say more research is required to define the thresholds and boundaries of bipolar symptoms more clearly and accurately. We also need to improve our understanding of why and how BP tends to start during adolescence and persists into adulthood, and how it intersects with comorbid mental disorders.
The researchers stressed that there is an urgent need for access to proper treatment and better recognition of BPS.
They concluded:
"Despite cross-site variation in the prevalence rates of BPS, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior, and comorbidity across each diagnostic category provide evidence for the validity of the concept of BPS. Treatment needs for BPS are often unmet, particularly in low-income countries."What is bipolar disorder?Bipolar disorder, also known as BP, manic-depressive illness or manic depression is a mental illness. The patient experiences instability in mood which is typically serious and disabling. An individual with BP has abnormal shifts in mood, energy, and their ability to function properly is affected - these shifts can go on for weeks, sometimes even months. The general "ups" and "downs" we experience in everyday life have nothing to do with BP. BP symptoms are severe and can destroy relationships, job prospects, and academic performance - put simply, they can ruin a person's life. Symptoms may become so severe that some patients either attempt to or manage to commit suicide.
Fortunately, bipolar disorder is treatable. Millions of patients worldwide manage to lead full and productive lives thanks to effective therapy.
The signs and symptoms of bipolar disorder vary, depending on whether the patient is on a high (mania) or low (depression).
Manic (mania) episodes signs and symptoms can include:ElationAggressive and intrusive behavior Agitation and extreme irritabilityReduced need for sleep Refusing to accept that anything is wrongDrug abuse, particularly cocaine, alcohol, and sleep aidesExtremely "high," overly good mood Increased drive to perform or achieve goals Increased energy, activity, and restlessness Increased sexual drive Exaggerated self-esteem lack of proper judgment Rapid speechRacing thoughtsRisky behavior Spending sprees Tendency to be easily distracted and difficulty concentratingUnrealistic beliefs in one's abilities and powers Depressive (depression) episodes signs and symptoms can include:Anxiety, overly worriedAppetite problems Concentration problemsDifficulty making decisionsGuilt, worthlessness, and helplessnessHopelessnessIrritability Loss of interest in daily activities Low libidoPessimism Reduced energySadness, gloomSensation of emptinessSleeping difficultiesSuicidal thoughts or behavior Tiredness Unexplained chronic painUnintended weight gain or loss"Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative"
Kathleen R. Merikangas, PhD; Robert Jin, MA; Jian-Ping He, MD; Ronald C. Kessler, PhD; Sing Lee, MB, BS, FRCPsych; Nancy A. Sampson, BA; Maria Carmen Viana, MD, PhD; Laura Helena Andrade, MD, PhD; Chiyi Hu, MD, PhD; Elie G. Karam, MD; Maria Ladea, MD, PhD; Maria Elena Medina-Mora, PhD; Yutaka Ono, MD; Jose Posada-Villa, MD; Rajesh Sagar, MD; J. Elisabeth Wells, PhD; Zahari Zarkov, MD
Arch Gen Psychiatry. 2011;68(3):241-251. doi:10.1001/archgenpsychiatry.2011.12
Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
Depression Needs A Second Opinion
4 (3 votes)Article Opinions: 1 posts
As he struggled for decades with a depression that often left him despondent, Eric Wilson never thought to get a second opinion.
"This might be true of many of us," he said. "We feel we have more ownership of what we see as our body and physical health so, if a doctor gives me a diagnosis I don't like, I'm likely to get a second opinion. It just wasn't the same for mental health."
After decades of broken relationships, multiple flirtations with suicide, and manic highs and lows, he received his final and accurate diagnosis of bipolar II mixed. This form of bipolar disorder is difficult to diagnose because its sufferers often are highly functioning and extremely productive. The highs can masquerade as general happiness. The difficulty is when the mood swings drastically and uncontrollably.
Researchers have found that as many as 69 percent of initial diagnoses of people with bipolar disorder were incorrect, underlining the importance of seeking a second opinion. With bipolar, the wrong medication can have devastating effects, plunging a patient into a deeper depression or into rapid cycles of highs and lows.
Wilson describes his journey from a dangerously moody teen to happily married father in "The Mercy of Eternity." He credits the loving persistence of his wife and the wonder of his daughter for pushing him beyond that first incorrect diagnosis of his disease.
He is sure he would never have sought additional help on his own.
"The idea that I had mental illness scared me," he said. "So I felt that any therapist I was seeing had a mastery of this strange, mysterious world of mental health, and I'd do whatever this person told me to do. I struggled with medications for a long time that simply were not working.
"It was a very long process that required a lot of patience and a lot of flexibility, but it's paid off beautifully."
Source: Wake Forest University
As he struggled for decades with a depression that often left him despondent, Eric Wilson never thought to get a second opinion.
"This might be true of many of us," he said. "We feel we have more ownership of what we see as our body and physical health so, if a doctor gives me a diagnosis I don't like, I'm likely to get a second opinion. It just wasn't the same for mental health."
After decades of broken relationships, multiple flirtations with suicide, and manic highs and lows, he received his final and accurate diagnosis of bipolar II mixed. This form of bipolar disorder is difficult to diagnose because its sufferers often are highly functioning and extremely productive. The highs can masquerade as general happiness. The difficulty is when the mood swings drastically and uncontrollably.
Researchers have found that as many as 69 percent of initial diagnoses of people with bipolar disorder were incorrect, underlining the importance of seeking a second opinion. With bipolar, the wrong medication can have devastating effects, plunging a patient into a deeper depression or into rapid cycles of highs and lows.
Wilson describes his journey from a dangerously moody teen to happily married father in "The Mercy of Eternity." He credits the loving persistence of his wife and the wonder of his daughter for pushing him beyond that first incorrect diagnosis of his disease.
He is sure he would never have sought additional help on his own.
"The idea that I had mental illness scared me," he said. "So I felt that any therapist I was seeing had a mastery of this strange, mysterious world of mental health, and I'd do whatever this person told me to do. I struggled with medications for a long time that simply were not working.
"It was a very long process that required a lot of patience and a lot of flexibility, but it's paid off beautifully."
Source: Wake Forest University
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