- 1
- 2
The Biology of Bipolar Disorder
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
- 1
- 2
Loading Menu
Member Comments
Posted By: jylbeth @ 05/29/2008 4:50:30 PM
Comment: 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
Posted By: Drpjones910 @ 05/24/2008 8:08:54 AM
Comment: I have a son 36 years old, heading for prison because of his uncontrolled behavior and impulses that led him to negative peers. He was introduced to drugs/alcohol and thus his problems escalated. He was diagnosred as hyperactive in the middle l970's, but was not given very much information other than that. I did research and did not find very much information at that time. Through out his life, he was predicted to be a high school drop out, he had no friends and my family and his father's family thought he was just bad. I knew that something was wrong with him, but my efforts to find help just ended with family, friends and social services agencies announcing that I was just over-protective.
The challenges that I faced in trying to be supported made him angry, accusing me of being too controlling, thus he rebelled against me. Nevertheless, I stood my grounds and continued to seek for answers for his behavior he was and is a very sensitive, highly intelligent and impressionable person.
He was diagnosed as bipolar this year as well as OCD, ADHD, social phobia, anxiety and the list goes on and on. The Mental Health Center prescribed him with several psychotrophic drugs, but being an adult, I couldn't make him take them. Because of the symptomology of bipolar, he ended up in jail and because he did not appear in court, not report to his probation officer, the judge decreed that he acted as if he did not care. I am, and have been his only ally all of his life and it has been a very long and painful journey. I am glad to have stumbled upon this website and the posted comments because now I do not feel alone.
I have long given up trying to educate family and friends because of my stigma of being the over doting parent. I have taken it as my personal mission to educate the criminal justice system, social service agencies who are funded to render services to this population. Their advice to me was simply, "put him out, wash your hands of him."
I understand the frustration of those suffering with the challenge as well those having loved ones who are afflicted. Only through education can we help them and support them. I support the comment offered, "do not ever give up."
Posted By: Laurend @ 05/22/2008 9:34:58 PM
Comment: My son now 17, was diagnosed at age 10, but he's been bipolar since birth... As research continues into this disorder perhaps the health system, and the school system can improve their knowledge. The disease and all its manifestations has been difficult enough to deal with but in my son's case the outside influences of uninformed teachers and school districts, and a health system that just doesn't have the ability or capacity to handle kids that aren't mentally "normal" has led to worse outcomes than the disease. He was expelled at age 11, reinstated at age 12 into a "twilight" program class with children who are juvenile delinquents, and became a HS drop out at age 16. Rather than help him the school district "housed" him for 6 hours a day with children who were certainly not the type of kids he needed to emulate, be around, etc. I was actually relieved when he dropped out! Finding a Psychaitrist was also very difficult, luckily I'm in the health profession and ended up getting him an excellent psychiatrist however he specializes in geriatrics, my son is his youngest pt. The meds have very significant problematic side effects, and I worry about long term damage, however to deal with him, or to have him face life without meds would be unfair to him, his family, and the community. I am very glad to see people discussing this disease, hopefully it will improve all these childrens outlook and enable them to become better members of society through others education and understanding.