Misreading of Faces May be Risk Marker

"Youngsters with pediatric bipolar disorder and healthy peers who have first-degree relatives with bipolar disorder share the same difficulty labeling facial emotions, NIMH researchers have discovered. Reporting in the February 2008 online edition of the American Journal of Psychiatry, the scientists suggest that the facial emotion recognition impairment might be part of an inherited predisposition to the illness.

Two related imaging studies traced face emotion labeling deficits in youngsters with pediatric bipolar disorder to weak connections and differences in activity of a brain circuit responsible for interpreting the meaning of social and emotional stimuli. Evidence suggested that the differences were stable traits, unrelated to effects of medications or mood states.

“Since we know more about the circuitry of basic processes like facial emotion processing than we do about the circuitry of complex psychiatric symptoms like mania and depression, it serves as a kind of Rosetta Stone for unearthing new clues,” explained Ellen Leibenluft, M.D., chief of the intramural NIMH Section on Bipolar Spectrum Disorders, Mood and Anxiety Disorders Program, which is conducting the studies.

Understanding such specific vulnerabilities in emotional processing may someday lead to improved treatment, diagnosis, and ultimately prevention of bipolar disorder in children, say the researchers."

Read the rest of the article here.

Let's Go To The Movies

I have given some thought to how the mentally ill are portrayed in films. Mostly it's awful - another way in which our National Stigma Institute continues to pump out vitriol to support discrimination against a biological disease. "One Flew Over the Cuckoo's Nest" comes immediately to mind. Or "Psycho."

But a few films stand out in my mind as sympathetic. A few actually manage to shed a little light into the corners - educating as well as entertaining. So I thought I'd like to share some of my favorites:

A Beautiful Mind - Probably the most powerful look at the functioning life of a paranoid schizophrenic that you'll find. Furthermore it addresses the issues of what constitutes recovery. Russell Crowe was brilliant...

Reign Over Me - This look at Post Traumatic Stress is genuine and sympathetic and Adam Sandler and Don Cheadle are wonderful.

Mr. Jones - Richard Gere stars in a very real portrayal of Bipolar Disorder. Points off for romantic involvement with his doctor, but still really good.

As Good As It Gets - Jack Nicholson (who usually just plays himself) portrays a rather crusty case of Obsessive-Compulsive Disorder in this delightful film. It's all about acceptance, folks.

Off the Map - This one is a little out there, but it shows an intimate portrait of clinical depression even if the characters are... shall we say... different. Starring Sam Elliot and Joan Allen as a couple living a minimalist lifestyle with a precocious daughter and a confused IRS agent in the mix. I found this film realistic in it's interpretation of depression and its impact both on the sufferer and those around him. It's a little bit of a fairy tale, but I enjoyed it.

I'll try to think of more.

Famous Faces of Mental Illness

"For many years, Margaret Trudeau thought her up and down moods were just part of her life. After all, her story resembled a movie script. She won the heart of Canadian Prime Minister Pierre Trudeau while vacationing as a teenager with her family in Tahiti, and at the age of 22, became the youngest First Lady in Canadian history.

She was one of the world's most glamorous and scrutinized women in the '70s, an A List celebrity as capable of attracting headlines as Princess Diana.

"I thought my life was just taking me high and low," she says. "I had been given so many rich opportunities in my life."

In 2001, Trudeau ended years of denial and checked herself into an Ottawa hospital where she was diagnosed with bipolar disorder. Five years later, when she felt her recovery was as complete as it needed to be, Trudeau announced at a hospital fund-raiser she had been struggling with bipolar for years, and had been misdiagnosed for decades.

Consider this the latest chapter of Trudeau's remarkable life: She's an eloquent and compelling advocate for people with a mental illness, in particular those living with bipolar. Instead of running from reality, she flies across North America to discuss that reality with eager audiences. Now she uses her celebrity (celebrity she says once used to be "infamy") to bring attention to world-wide causes.

"Bipolar is an exaggeration of your emotions, so when you do get knocked down by life -- which you will because everyone will be knocked down at some point -- it's very hard to bounce back. Some people can live with sorrow for awhile and get on with their lives. I didn't have that ability. I got very knocked down and it was very hard for me. What learned is that it's awfully hard to do it on your own.

"And that's my message: to reach out and get help."

Read the entire article by Charles Anzalone here.

Blood Tests for Brain Disorders?

According to an article for MSNBC by Steve Mitchell, we could be on the brink of genetic blood testing for mental illness.

"A blood test could be used to diagnose and assess the severity of certain mental illnesses, such as bipolar disorder, according to a new study. But some experts think this raises ethical concerns about prying into a person's mental status.

Lab tests that can accurately detect mental illnesses have long been considered the “Holy Grail” of psychiatry. Currently, bipolar disorder and other conditions such as depression are diagnosed based on the patient's description of their symptoms and the physician's judgment, sometimes making it difficult to get an accurate diagnosis or determine the severity of a patient's condition. But now researchers have shown that 10 genes that can be detected in the blood could provide a better way to assess a patient.

“Patients aren’t sure how ill they really are, and neither is the clinician — sometimes dismissing their symptoms, sometimes overestimating them,” said Dr. Alexander Niculescu, III, a psychiatrist at the Indiana University School of Medicine in Indianapolis, who led the research published Tuesday by the journal Molecular Psychiatry. “Having an objective test for disease state, disease severity, and especially to measure response to treatment, would be a big step forward.”

Read the rest of the article here.

Midlife suicide surge baffles experts

"A new five-year analysis of the nation's death rates recently released by the federal Centers for Disease Control and Prevention found that the suicide rate among 45- to 54-year-olds increased nearly 20 percent from 1999 to 2004, the latest year studied, far outpacing changes in nearly every other age group. (All figures are adjusted for population.)

For women 45 to 54, the rate leapt 31 percent. "That is certainly a break from trends of the past," said Ann Haas, research director of the American Foundation for Suicide Prevention.

By contrast, the suicide rate for 15- to 19-year-olds increased less than 2 percent during that five-year period -- and decreased among people 65 and older.

The question is why. What happened in 1999 that caused the suicide rate to suddenly rise primarily for those in midlife?

The lack of concrete research has given rise to all kinds of theories, including a sudden drop in the use of hormone-replacement therapy by menopausal women after health warnings in 2002, higher rates of depression among baby boomers or a simple statistical fluke.

At the moment, the prime suspect is the skyrocketing use -- and abuse -- of prescription drugs. During the same five-year period included in the study, there was a staggering increase in the total number of drug overdoses, both intentional and accidental, such as the one that killed the 28-year-old actor Heath Ledger. Illicit drugs also increase risky behaviors, CDC officials point out, noting that users' rates of suicide can be 15 to 25 times as great as the general population."

Read the whole article by Patricia Cohen of the New York Times here.

PTSD (another infamous set of initials)

Post Traumatic Stress Disorder is one of those things we hear a lot about in wartime. It is most often associated with soldiers returning from war - scarred by horrible memories that seem to return and return, the infamous "flashbacks" so prevalent in the movies. But in truth, PTSD affects some 8 million Americans and is actually more prevalent in women. And "flashbacks" aren't always in the equation.

Post Traumatic Stress Disorder is a type of anxiety disorder that is triggered by a traumatic event (duh.) What constitutes a trauma varies wildly from person to person and yes, it may be something as awful as witnessing the horrors of combat, or something as commonplace as a traffic accident. Rape, a mugging, physical or mental abuse can cause PTSD as well as natural disasters. After any of these events a person would normally be overwhelmed by strong emotions - fear, anger, guilt and such - but gradually the coping mechanisms of the brain start to take the edge off and the person would start to feel better. In PTSD, the process somehow gets off track, and those strong emotions can surface suddenly with all the intensity of those of the original event. (Think wormhole for feelings. Yuck.)

The symptoms of PTSD can be an annoyance or they can sideline your life. But it can be treated. There are medications to reduce the anxiety and therapies designed to help defuse the memories through gradual exposure or reduce your reaction to them through cognitive thought processing. Most folks with PTSD will improve dramatically with treatment. Good news here what with Iraq, Hurricane Katrina and 9-11. We've had enough trauma, Thank You.

Good movie on the subject: Reign Over Me with Adam Sandler.

Britney bipolar? You think?

Let's see. Spending money like it grows on trees? Check. Self medicating? Check. Hyper sexuality? Check. No clear concept of cause and effect? Check. Erratic behavior? Please. But is it just typical spoiled celebrity business as usual? Publicity stunts? Come on folks, I know that is takes at least nine years and six doctors for the average sufferer to be diagnosed, but this chick sounds classic.

So now that we've thoroughly enjoyed the continuing saga of Britney, her many adventures with her famous friends, her eclectic wardrobe or lack of it, her marriages and their fiery finales, her babies and parenting predicaments - perhaps we should consider the 26 year old woman who is spiraling out of control while everyone gets a giggle or makes a buck at her expense. This is a tragedy. And while everyone seems to have their nose plastered against the window to watch, why isn't anyone doing anything to help this girl?

I'm sure not blaming her family because I know well enough that once a child is "legal" there isn't a damn thing that parents can do with regard to getting someone treatment beyond suggesting it. And I'm pretty sure that one of Brit's symptoms is a startling lack of insight into her own illness - so she's not about to check herself into any hospital any time soon. But you'd think that the folks who hold her contracts might have a little influence by threatening to pull the plug on the money machine. But wait... they make even more money if her antics keep her in the news!

I've had a hard time with this one, often finding myself more contemptuous than sympathetic even though her behavior smells like full blown mania from here. After a lot of soul searching, I came to the conclusion that most of the people I know with bipolar disorder have to fight to be treated and are constantly at war with the insurance company or the VA or Social Security. They have few choices with regard to health providers and are nearly always struggling to pay for medications. They are under or unemployed and live with their parents or in low income housing. Some are homeless. Britney has every available option for treatment, but that doesn't make her less sick. In fact, it probably makes it worse - insulating her from reality and providing her with loads of enablers who profit from her pain.

People afflicted with bipolar disorder and untreated are disabled. In fact the World Health Organization considers them as disabled as paraplegics. Without proper treatment, Britney is not going to get better and is likely to end her life, by accident or with intent. I suppose that would be the Hollywood ending, but it would be such a waste. Those boys deserve their mother. Their mother deserves treatment.

(Ed. note: NAMI weighs in on Britney and the media here.)