i was diagnosed with bipolar disorder in 1984, i was 14. i had been cutting myself since i was 8 yo. my journey over the next 10 years would involve 11 hospitalizations, 30+ medicines, as well as shock treatments. i am very happy to say that i am happily married with three beautiful children. i am looking to pen a book ok my experiences, and reach out to adolescents who need a common shoulder for support. any ideas on how to get this project off the groung, i'm all ears. cheers to all the survivors out there, and hang on, there is excellent help for those in need. jyl bookman ellis jylbeth@gmailcom
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The Biology of Bipolar Disorder
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Adelaide Robb, child psychiatrist, Children's National Medical Center, Washington, DC: "I think we don't know all the effects of medication. What we do know from our adult work is that many of the adults who entered into treatment 10 years ago never got treatment as children. And we know untreated bipolar disorder leads to a lot of bad outcomes—more symptoms, increased resistance to treatment, less achievement, lost social interaction. It's really hard to finish high school and it's very hard to keep a job or have anybody in your family support you. We talk about medicines having side effects, but the risk of not treating also has side effects."
Janet Wozniak, assistant professor of psychiatry, Harvard Medical School, Boston: "Our tools are not advanced enough to fully explain the extraordinary complexity of the brain. We have a general knowledge about, for example, dopamine: some drugs act as dopamine antagonists. But please don't believe the idea that we understand everything that this medicine is doing. I think part of our job as clinicians is to help parents understand how little we know. This is not an experiment or a wild guess. We are doing evidence-based medicine. But there is still very much that is unknown. The question is, what are the long-term effects of treatment vs. the long-term effects of no treatment? Part of making the decision of using a treatment that may have unknown long-term effects is having some respect for how the disorder can wreak havoc. It's easy to talk about the miseries of treatment. And the treatments are terrible. On the other hand, is life compatible with not treating? For most of the kids I'm seeing, the answer is no."
What do we know about the genetics of bipolar disorder?
Baldessarini: "People have tried genetic studies, but they haven't gotten all that far. It's been difficult in adults, and it's at least that fuzzy in children. This illness probably has very subtle genetics, a lot like heart disease and diabetes. It certainly runs in families, probably more than any other psychiatric illness. But there's not a nice, crisp single gene."
Wozniak: "In psychiatry all we have is the symptoms. We don't have the tests yet. One of the things we're trying to do is collect large enough samples to thoughtfully look for genes in the lab. But in general, with psychiatric illness, mapping the genome in and of itself hasn't provided us with easy answers. We also need to figure out which genes might be protective against bipolar disorder, and whether environmental factors determine which genes get expressed."
Leibenluft: "Most children who are at risk for bipolar disorder by virtue of having a parent with the illness will not themselves develop it. People have the mistaken idea that most children of bipolar parents will develop it themselves, and most don't. Somewhere between 15 and 30 percent, maybe around 20 percent, will develop it. But we do certainly know it's a heritable illness. We've identified a number of genes associated with small increases in risk, not big ones. There does appear to be some overlap in adult samples between genetics for bipolar disorder and the genetics for schizophrenia. It's a very, very rapidly evolving field. But there's a lot of work that still needs to be done."
Chang: "Right now, there's really no good way we have to integrate what we've found so far regarding biological markers into our clinical practice. [But] it's starting to happen. John Kelsoe is marketing a test for a gene that may, in 3 to 6 percent of cases, have some relevance. He's a well-respected researcher. But this is such a complex disorder—there are so many genes that could contribute."
© 2008
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