Tackling the Clutter Demon With Bipolar Disorder

For those of us living with bipolar disorder, the battle to control the mess in our houses is very real.

Anyone who has ever been depressed knows that cleaning is a struggle, to put it mildly, especially when you can’t even shower or feed yourself. And when we’re manic, we either can’t concentrate to clean the clutter, start new tasks without picking up our messes, or purchase frivolous items to soothe anxiety. In persons with bipolar I specifically, the wiring in their frontal lobes is so tangled that they suffer these executive functioning difficulties even during stable periods.

konmari
The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing, by Marie Kondo. Also known as the Kon Mari Method.

Studies have even shown that hoarding is linked to bipolar, for the same reasons. We’re just wired to create messes.

But there is hope. I’ve just started decluttering using the KonMari method, based on the book The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing, by Marie Kondo. In short, you tidy by category. In order to start the process, you first search the house for items (clothes, books, papers, miscellany, and then sentimental clutter). Then you lay them out on the floor. Then you hold each item and ask if it “sparks joy” before making a decision to keep it and put it away, donate it, or toss it.

I feel a little silly doing this, but so far the method has really worked to tidy up my clothes closet. I got through my closet and dresser in three hours, and donated two full garbage bags. I now only have five items hanging up, one full-sized drawer full of clothes, and an underwear drawer. I’m exhausted.

One caveat to the method for bipolar I people especially is that I can easily see how it could trigger a hypomanic episode. The elation from throwing things out is very real, and it might be difficult for a person with mental illness to stop once he or she has started. It’s almost ritualistic, which might spell trouble for people suffering from Obsessive Compulsive Disorder.

This is also not a method to use when you’re depressed. Laying out all my clothes on the floor was overwhelming, and I was fortunate to have my sister to walk me through the KonMari process. I confess that first, we had to clean up the floor to make enough room to sort through the clothes, which took half the time we’d allotted to going through them (three hours total).

So, I have a mixed review of the KonMari method. It’s effective, but dangerous. I’ll hold off on giving a full review until I’ve completed the six months the book says the method takes.

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Family Study Emphasizes Distinct Origins for Bipolar Disorder Subtypes

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The most common subtypes of bipolar disorder, bipolar I and bipolar II, stem—at least in part—from different biological causes, according to a new study published in Biological Psychiatry. Despite genetic overlap between the two subtypes, each subtype tended to cluster within families, suggesting a distinction between bipolar disorders I and II.

The study, by Dr. Jie Song of the Department of Clinical Neuroscience, Karolinska Institutet, Sweden, and colleagues helps settle controversy over the relationship between bipolar I and bipolar II disorders. Although genetic similarities indicate overlap between the subtypes, the new findings emphasize different origins. According to Song, this is contrary to a common notion among many clinicians that bipolar II disorder is merely a milder form.

“We have tended to view the two forms of bipolar disorder as variants of the same clinical condition. However, this new study highlights important differences in the heritable risk for these two disorders,” said Dr. John Krystal, Editor of Biological Psychiatry.

The study is the first nationwide family study to explore the difference between the two main subtypes of bipolar disorder. Dr. Song and colleagues analyzed the occurrence of the bipolar disorder subtypes in families from the Swedish national registers. Although a strong genetic correlation between bipolar I and bipolar II disorder suggests that they are not completely different, the family occurrence for each subtype was stronger than co-occurrence between the subtypes, indicating that bipolar I and bipolar II disorders tend to “run” in families separately, rather than occurring together.

“Within the context of our emerging appreciation of polygenic risk, where gene variations are implicated in several disorders, the new findings point to only partial overlap in the risk mechanisms for these two forms of bipolar disorder,” said Dr. Krystal.

The study also provided some additional clues that bipolar I and II disorders have distinct origins. Only bipolar disorder II showed gender differences—the proportion of females to males was higher in bipolar disorder II but not bipolar disorder I. And bipolar I clustered together in families with schizophrenia, which was not apparent for bipolar disorder II.

“Hopefully, our findings increase awareness of the need for refined distinctions between subtypes of mood disorder,” said Dr. Song. The distinction between the subtypes also has implications for treatment strategies for patients. Dr. Song added that future research is warranted to characterize new biomarkers to improve treatment and prognosis.

Text provided by Elsevier.

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People With Bipolar Disorder More Likely to Die From Age-Related Diseases

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Bipolar disorder may involve accelerated epigenetic aging, which could explain why persons with the disorder are more likely to have–-and die from–age-related diseases, according to researchers from The University of Texas Health Science Center at Houston (UTHealth).

The findings were published in Translational Psychiatry, a Nature Publishing Group journal.

While chronological age is measured in the amount of time that a person has been alive, epigenetic age measures molecular markers of chemical modifications to DNA.

“Bipolar disorder has been previously associated with accelerated aging but the mechanisms are largely unknown,” said Gabriel R. Fries, Ph.D., first author and post-doctoral research fellow in the Department of Psychiatry and Behavioral Sciences at McGovern Medical School at UTHealth. “We aimed to understand from our study the biology of what’s driving the accelerated aging. What we found is that patients with bipolar disorder showed an accelerated epigenetic aging compared to healthy controls.”

The chemical modifications could be precipitated by the disorder itself or by poor lifestyle habits in diet, exercise, tobacco use and illegal substance use.

“Controlling these factors is just as important as taking medications,” Fries said.

Senior author of the study was Joao L. de Quevedo, M.D., Ph.D., professor and director of the Translational Psychiatry Program in the Department of Psychiatry and Behavioral Sciences at McGovern Medical School.

Using blood samples, the researchers compared 22 patients with bipolar disorder, 16 siblings of bipolar patients and 20 healthy controls. They also found that while older bipolar disorder patients had significantly accelerated epigenetic aging compared to controls, no difference was found in younger patients.

“We believe a difference wasn’t detected in younger patients because they haven’t had as much exposure to stressful events,” Fries said. “This gave us a hint that cumulative chronic exposure to stress would relate to accelerated aging. We would see it more in older people who have experienced a lifetime of stress in dealing with the disease.”

Along with the epigenetic clock, the study included two other biologic clocks: telomere length and mitochondrial DNA copy numbers.

“The epigenetic acceleration correlated with the number of copies of mitochondrial DNA, suggesting that the cross-talk between the nucleus and the mitochondria might be underlying the premature aging in bipolar disorder,” Fries said.

Text provided by UTHealth.

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Bipolar Disorder Diagnosable By a 15-minute Electrocardiogram, Study Finds

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A groundbreaking Loyola Medicine study suggests that a simple 15-minute electrocardiogram could help a physician determine whether a patient has major depression or bipolar disorder.

Bipolar disorder often is misdiagnosed as major depression. But while the symptoms of the depressive phase of bipolar disorder are similar to that of major depression, the treatments are different and often challenging for the physician.

In bipolar disorder, formerly called manic depression, a patient swings between an emotional high (manic episode) and severe depression. Treatment for the depressed phase includes an antidepressant along with a safeguard such as a mood stabilizer or antipsychotic drug to prevent a switch to a manic episode. A physician who misdiagnoses bipolar disorder as major depression could inadvertently trigger a manic episode by prescribing an antidepressant without a safeguard mood stabilizing drug.

The study found that heart rate variability, as measured by an electrocardiogram, indicated whether subjects had major depression or bipolar disorder. (Heart rate variability is a variation in the time interval between heartbeats.) The study, by senior author Angelos Halaris, MD, PhD and colleagues, was published in the World Journal of Biological Psychiatry.

“Having a noninvasive, easy-to-use and affordable test to differentiate between major depression and bipolar disorder would be a major breakthrough in both psychiatric and primary care practices,” Dr. Halaris said. Dr. Halaris said further research is needed to confirm the study’s findings and determine their clinical significance.

Dr. Halaris is a professor in Loyola’s department of psychiatry and behavioral neurosciences and medical director of adult psychiatry.

Major depression is among the most common and severe health problems in the world. In the United States, at least 8 to 10 percent of the population suffers from major depression at any given time. While less common than major depression, bipolar disorder is a significant mental health problem, affecting an estimated 50 million people worldwide.

The Loyola study enrolled 64 adults with major depression and 37 adults with bipolar disorder.

All subjects underwent electrocardiograms at the start of the study. Each participant rested comfortably on an exam table while a three-lead electrocardiogram was attached to the chest. After the patient rested for 15 minutes, the electrocardiographic data were collected for 15 minutes.

Using a special software package, researchers converted the electrocardiographic data into the components of heart rate variability. These data were further corrected with specialized software programs developed by study co-author Stephen W. Porges, PhD, of Indiana University’s Kinsey Institute.

In measuring heart rate variability, researchers computed what is known to cardiologists as respiratory sinus arrhythmia (RSA). At the baseline (beginning of the study), the subjects with major depression had significantly higher RSA than those with bipolar disorder.

In a secondary finding, researchers found that patients with bipolar disorder had higher blood levels of inflammation biomarkers than patients with major depression. Inflammation occurs when the immune system revs up in response to a stressful condition such as bipolar disorder.

Text provided by Loyola University Health System.

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Gene Breakthrough on Lithium Treatment for Bipolar Disorder

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Genes linked to schizophrenia in psychiatric patients suffering from bipolar disorder are the reason why such patients don’t respond to the “gold standard” treatment for bipolar – the drug lithium – according to international research led by the University of Adelaide.

Lithium has been widely used as a treatment for bipolar disorder since the 1950s because of its mood stabilising effect. It has unique protective properties against both manic and depressive episodes, and an ability to decrease the risk of suicide.

However, about 30% of patients are only partially responsive, more than a quarter show no clinical response at all, and others have significant side-effects to lithium.

Until now, researchers have not understood why these patients have not responded to the common treatment, while others have responded well to the drug.

Published in the journal JAMA Psychiatry>, an international consortium of researchers led by the University of Adelaide’s Professor Bernhard Baune reports a major discovery that could affect the future quality of treatment for people with this significant mental health condition.

Known as the international Consortium on Lithium Genetics, the group has studied the underlying genetics of more than 2500 patients treated with lithium for bipolar disorder.

“We found that patients clinically diagnosed with bipolar disorder who showed a poor response to lithium treatment all shared something in common: a high number of genes previously identified for schizophrenia,” says Professor Baune, Head of the Discipline of Psychiatry at the University of Adelaide and lead author on the paper.

“This doesn’t mean that the patient also had schizophrenia – but if a bipolar patient has a high ‘gene load’ of schizophrenia risk genes, our research shows they are less likely to respond to mood stabilisers such as lithium.

“In addition, we identified new genes within the immune system that may play an important biological role in the underlying pathways of lithium and its effect on treatment response,” Professor Baune says.

Understanding the underlying biology of people’s response to lithium treatment is a key area of research and urgent clinical need in mental health.

“These findings represent a significant step forward for the field of translational psychiatry,” Professor Baune says.

“In conjunction with other biomarkers and clinical variables, our findings will help to advance the highly needed ability to predict the response to treatment prior to an intervention. This research also provides new clues as to how patients with bipolar disorder and other psychiatric disorders should be treated in the future.”

Text provided by the University of Adelaide.

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Light Therapy Helps Bipolar Disorder Patients Function

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Daily exposure to bright white light at midday significantly decreased symptoms of depression and increased functioning in people with bipolar disorder, a recent Northwestern Medicine study found.

 

Previous studies found morning bright light therapy reduced symptoms of depression in patients with Seasonal Affective Disorder (SAD). But patients with bipolar disorder can experience side effects such as mania or mixed symptoms from this type of depression treatment. This study implemented a novel midday light therapy intervention in an effort to provide relief for bipolar depression and avoid those side effects.

Compared to dim placebo light, study particpants assigned to bright white light between noon and 2:30 p.m. for six weeks experienced a significantly higher remission rate (minimal depression and return to normal functioning). More than 68 percent of patients who received midday bright light achieved a normal level of mood, compared to 22.2 percent of patients who received the placebo light.

The group receiving bright light therapy also had a much lower average depression score of 9.2 compared to 14.9 for the placebo group and significantly higher functioning, meaning they could go back to work or complete tasks around the house they hadn’t been able to finish prior to treatment.

The study was published Oct. 3, 2017 in the American Journal of Psychiatry.

“Effective treatments for bipolar depression are very limited,” said lead author Dr. Dorothy Sit, associate professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. “This gives us a new treatment option for bipolar patients that we know gets us a robust response within four to six weeks.”

Patients also experienced minimal side effects from the therapy. No one experienced mania or hypomania, a condition that includes a period of elation, euphoria, irritability, agitation, rapid speech, racing thoughts, a lack of focus and risk-taking behaviors.

“As clinicians, we need to find treatments that avoid these side effects and allow for a nice, stable response. Treatment with bright light at midday can provide this,” said Sit, also a Northwestern Medicine psychiatrist.

The study included 46 participants who had at least moderate depression, bipolar disorder and who were on a mood stabilizer. Patients were randomly assigned to either a 7,000 lux bright white light or a 50 lux placebo light. The light therapy patients were instructed to place the light box about one foot from their face for 15-minute sessions to start. Every week, they increased their exposure to the light therapy by 15-minute increments until they reached a dose of 60 minutes per day or experienced a significant change in their mood.

“By starting at a lower dose and slowly marching that dose up over time, we were able to adjust for tolerability and make the treatment suitable for most patients,” Sit said.

Sit and her colleagues also observed a noticeable effect of bright light therapy by four weeks, which is similar to other studies that test light therapy for non-seasonal depression and depression during pregnancy.

Light therapy has conventionally been tested using morning light at awakening because previous research has suggested that morning light helps reset circadian rhythms and can be helpful in the treatment of SAD, Sit said. However, the mechanism of response is unclear in bipolar disorder. To understand the possible effects of midday bright light on circadian rhythms in patients with depression and bipolar disorder, Sit and colleagues are planning new studies to investigate.

Text provided by Northwestern University.

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Brain Protein Targeted to Develop New Bipolar Disorder Therapies

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A new study by scientists from the Florida campus of The Scripps Research Institute (TSRI) has identified specific genetic variations closely associated with increased susceptibility to bipolar disorder and other conditions. The discovery may provide a target for new therapies.

 

In the new study, the researchers focused on a gene known as PDE10A, one of the many genes that has been linked to bipolar disorder, and the proteins this gene produces. These proteins help regulate intracellular levels of a messenger molecule called cAMP (cyclic adenosine monophosphate), which is involved in a variety of biological processes including learning and memory.

“We began with the idea that behavioral changes in bipolar subjects might be due to these genetic variations in the cAMP messenger pathway,” said Ron Davis, chair of TSRI’s Department of Neuroscience. “We did find that this was the case and, indeed, that these variations were in one specific gene for the cAMP messenger pathway called PDE10A. The variations that we found in the gene may alter the function of one form of PDE10A and lead to susceptibility to bipolar disorder.”

The research, published recently by the journal Translational Psychiatry, examined human brain tissue from patients with bipolar disorder, as well as brain tissue from individuals without the psychiatric disorder.

“The PDE10A19 protein is interesting because we previously didn’t know it even existed in the human brain and because it’s found only in other primates—not mice or rats,” said Research Assistant Courtney MacMullen, the first author of the study. “Once we understand how this protein helps neurons remain healthy, we might be able to develop medications to treat neurons when they function abnormally, such as in patients with bipolar disorder and schizophrenia.”

The results suggested abnormal variations in PDE10A19 might alter cAMP signaling by interacting with another protein known as PDE10A2, restricting its activity and disrupting the entire process.

Davis said that the complexity of gene expression in the human brain is greatly underestimated, and that future neurogenetic studies ought to begin with a deep study of each gene’s ability to code for proteins to avoid false conclusions, particularly when it comes to the development of potential therapies.

“We need to know much more about this large family of enzymes and the roles they play in disorders like bipolar disorder,” he said.

Text taken from the Scripps Research Institute.

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Children with Bipolar Disorder May Be Diagnosed with Vitamin D Blood Test In the Future

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Researchers at Ohio State University are searching for a way to and quickly and accurately test for bipolar disorder in children. The scientists think they may have found it: a blood test which looks for a protein associated with vitamin D.

 

Finding a blood test could reduce the current average diagnosis time of ten years, said Ouliana Ziouzenkova, the study’s lead author and an associate professor of human nutrition at Ohio State.

In the study of 36 young people, levels of the vitamin D binding protein were 36 percent higher in those with bipolar disorder than in those without a mood disorder. The study appears online in the journal Translational Psychiatry.

Ziouzenkova said it made sense to look at vitamin D binding protein because it potentially plays a role in brain inflammation. The researchers also looked at inflammatory markers in the blood, but found no significant correlations. Looking for the nutrient vitamin D in the blood, as opposed to the binding protein, appears to have low diagnostic power, she said.

Confirming that the blood test works will take time, but Ziouzenkova and her colleagues are excited about the potential to help kids and their parents.

Materials provided by Ohio State University.

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Bipolar Patients Treated with Lithium Rehospitalized Less

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Bipolar patients treated with lithium made fewer return trips to psychiatric wards, according to a new study by Karolinska Institutet in Sweden. Long-acting injections of antipsychotics were also effective.

 

Researchers in Finland followed 18,000 patients who had previously been hospitalized for bipolar disorder. Each patient was used as their own control, observed with and without treatment.

Lithium was found to reduce the risk of rehospitalizations by 30 percent. Injections of antipsychotics were found to reduce the risk by the same number, especially when compared to oral antipsychotic medications of the same type. For example, the most prescribed antipsychotic drug, quetiapine (Seroquel), which is given in tablet form, reduced the risk by only 7 percent.

“The prescription of lithium has decreased steadily in recent years, but our results show that lithium should remain the first line of treatment for patients with bipolar disorder. Long-acting injections might offer a safe, effective option for patients for whom lithium is not suitable,” says Jari Tiihonen, specialist doctor and professor at Karolinska Institutet’s Department of Clinical Neuroscience.

Materials provided by Karolinska Institutet.

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Scientists Conclude After 12-year Study That Bipolar Disorder Has Seven Causes

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After more than a decade of observing 1,100 study participants, University of Michigan researchers have classified bipolar disorder’s causes into seven different phenotypes, or observable characteristics.

 

In a new paper in the International Journal of Epidemiology, the U-M team reports the results of thousands of data points of the study participants, including genetics, emotions, life experiences, medical histories, motivations, diets, temperaments, sleep patterns and thought patterns. More than 700 research volunteers suffer from bipolar disorder, and 277 do not.

The research team is part of U-M’s Heinz C. Prechter Bipolar Research Program, funded by many donors and named after a successful Detroit car baron who battled bipolar disorder.

In addition to the standard measures doctors use to diagnose bipolar disorder, the seven “phenoclasses” include:

  • changes in thinking, reasoning, and the processing of emotions;
  • personality and temperament;
  • “motivated behaviors” — related to substance use or abuse;
  • family and intimate relationships;
  • sleep patterns; and
  • how patients respond to treatment.

Other key findings include:

  • Migraine headaches occure three and a half times more frequently in people with bipolar disorder. Eating disorders and anxiety disorders are also more common, as well as alcohol abuse.
  • People with bipolar disorder tend to have a history of childhood trauma.
  • People suffering from bipolar disorder eat more saturated fats, and levels of certain fat molecules in the blood of patients are associated with higher levels of symptoms.
  • There is less diversity of gut bacteria in people taking antipsychotic medications. Lower levels of a key bacteria type in the gut were also found.
  • Poor sleep affects depression in female participants. Other gender differences were found.
  • Neurotic people with bipolar disorder were more likely to have severe illness. Especially men.
  • People with bipolar disorder have poorer memories, executive functioning, and motor skills.
  • Speech patterns can predict mood states. 

     

    The research team hopes that their study will enable a multi-pronged approach to diagnosis and treatment of patients with bipolar disorder.

    Materials provided by Michigan Medicine – University of Michigan.

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