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.

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.

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.

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.

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.

Treatable Condition Could be Mistaken for Bipolar Disorder

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Researchers at Houston Methodist will pioneered a new study that will hopefully show that a significant number of people may have a treatable immune system condition often mistaken for either bipolar disorder or schizophrenia. This study could impact millions of people.

“We suspect that a significant number of people believed to have schizophrenia or bipolar disorder actually have an immune system disorder that affects the brain’s receptors,” said Joseph Masdeu, M.D., Ph.D., the study’s principal investigator and a neurologist with the Houston Methodist Neurological Institute. “If true, those people have diseases that are completely reversible – they just need a proper diagnosis and treatment to help them return to normal lives.”

In 2007, scientists discovered anti-NMDA receptor encephalitis, a disease which can be treated with immunotherapy medications that causes symptoms similar to bipolar disorder or schizophrenia. The encephalitis forces the immune system to attack N-methyl-D-aspartate (NMDA) receptors in the brain instead of invading agents.

The NMDA receptors control decision-making, thoughts, and perceptions, which is why this illness is often mistaken for bipolar disorder or schizophrenia. The encephalitis can also cause sufferers to hear voices or become paranoid.

The study will collect cerebral spinal fluid from 150 patients diagnosed with bipolar disorder or schizophrenia and 50 healthy controls between the ages of 18 to 35. The fluid will be examined for antibodies attacking NMDA and other brain receptors. If abnormal antibodies are found, the researchers will notify the patient so he or she may consider treatment.

Masdeu plans to use the findings for development of further studies about antibodies.

Materials provided by Houston Methodist.

Researchers Create Global Map of How Bipolar Disorder Affects the Brain

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In the largest magnetic resonance imaging (MRI) study to date, researchers have created a roadmap of bipolar disorder and how the illness affects the brain. Scientists found that people who suffer from bipolar disorder possessed differences in the brain regions that control inhibition and emotion.

 

Using MRI scans of 6,503 individuals, including 2,447 adults with bipolar disorder and 4,056 healthy controls, the researchers created a map of bipolar disorder. Also measured was the age of onset for the disorder, history of psychosis, mood state, age, sex, and commonly used prescription medications.

According to the study, patients with bipolar disorder showed thinning of grey matter in the frontal and temporal regions of the brain, which control motivation and inhibitions. The research also demonstrated that lithium has a protective effect on the brain, associated with less thinning of gray matter.

The international report includes research from 76 centers and 26 different groups around the world. Published in Molecular Psychiatry, the findings demonstrate the underlying mechanisms of bipolar disorder.

Researchers hope to use the study in early detection efforts, as well as to determine which medications will protect the brain.

Bipolar? Your Brain is Wired to Make Poor Decisions

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Struggling to plan and make decisions while depressed or manic are common problems. But have you ever had trouble doing the same while relatively stable? New research may show why.

 

Researchers examined ninety patients’–forty-five with bipolar disorder in stable moods, and forty-five controls without bipolar disorder–brains, and discovered that, in the bipolar sufferers, there are certain areas of the brain that have reduced activation regardless of mood due to structural damage.

This is the first study to look at the relationship between functional magnetic resonance imaging (MRIs) and structural MRIs in bipolar disorder. The scientists found that the patients with bipolar suffered from reduced cortical thickness and thus had less activity in areas of the brain that controlled impulses, or contributed to making decisions.

The study was published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, and conducted by scientists at the University of California, Los Angeles.

As this is the first study to find a link between structure and function, the results are exciting. The research proves that bipolar disorder damages your brain. You’re not stupid; your brain is just wired to make impulsive decisions and be poor at planning.

The scientists who conducted the study hope that their research will be used in future intervention studies. Good news!

Six-Year Delay Between Onset of Bipolar Disorder and Diagnosis, Study Finds

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A new international study conducted by researchers in both Australia and Italy has found that there’s an average of six years between the onset of bipolar disorder and diagnosis of the disease. An analysis of 9,415 patients from 27 studies, the largest of its kind, the study notes that crucial opportunities to catch bipolar disorder at its onset, when mood episodes aren’t as severe, are being missed.

 

While patients with concurring disorders such as psychosis do generally receive timely treatment, most people suffer for years before being able to address their mental illness with proper medications and therapies.

Professor Large, a psychiatrist at Prince of Wales hospital, claims that the delay is most severe for young people, whose symptoms may be attributed to teenaged moodiness. Diagnosing a bipolar depressive episode is also difficult, as that is often mistaken for unipolar depression.

Doctors have to look to detailed medical histories of their patients, as well as symptoms triggered by external events, such as manic or hypomanic phases triggered by antidepressants.

Depression Changes Our Language

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Depression. A pit of despair for many people. Scientists have attempted to pin down the relationship between depression and language for a long time now, and technology has just given researchers the breakthrough they needed.

In the past, field studies were carried out by scientists who took notes on what people said. Now, computers can analyze banks of data in seconds, picking up on patterns that a human analyst might miss. Researchers fed personal essays, diary entries, and blog posts to their computers and found some interesting patterns in the language of people suffering from depression.

It should come as no surprise that people who deal with depression use more negative language, with words such as “lonely,” “sad,” and “miserable.” But what surprised the scientists was the use of first-person pronouns, such as “I,” “myself,” and “me.” People who suffer from depression apparently don’t use very many second- and third-person pronouns, such as “you,” “they,” and “them,” indicating that depression is a self-focused disease. Researchers found that the pronoun usage was more indicative of depression than the negative language.

However, on an examination of 64 different forums, absolutist language, using words such as “always,” “never,” and “completely,” was a better indicator of mental health issues than negative language or pronouns. On suicidal ideation forums, the use of absolutist language was 80% greater than language used by 19 control forums. This shows that people who suffer from depression have a black-and-white outlook.

Scientists hope that computers will soon be able to classify mental disorders from blog posts. Such classification is already outperforming trained therapists.