The Balanced Mind Foundation eBulletin January 2007
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Items of Interest
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Genetics of Early-Onset Bipolar Disorder
The Balanced Mind Foundation PAC Member on Team of 3-Year Study
Psychiatric researchers from The Zucker Hillside Hospital campus of The Feinstein Institute for Medical Research announced today they have launched a collaborative research project spearheaded by James Watson, Ph.D., the co-discoverer of the DNA double helix, and a team of researchers at Cold Spring Harbor Laboratory (CSHL) to identify key genetic underpinnings of bipolar disorder (BPD), a mental illness that is known to run in families. Expected to last two to three years, the study will focus on early-onset BPD and will involve children with the illness and their parents.
“For complex illnesses like bipolar disorder that vary dramatically in symptoms and severity among affected individuals, especially children and adolescents, identifying genetic underpinnings is very difficult,” said Anil Malhotra, M.D., lead investigator for The Feinstein Institute. “It is also critical to accelerating and confirming a bipolar diagnosis and developing more rational and effective treatments. Collaborating with Cold Spring Harbor Laboratory will help make this a reality.”
The collaboration will allow the team to leverage the unique clinical populations at Zucker Hillside, a renowned psychiatric hospital in Glen Oaks, NY, with state-of-the-art molecular tools available at CSHL in Cold Spring Harbor, NY, and The Feinstein Institute in Manhasset, NY.
“The clinical and scientific expertise of the physician-scientists at The Feinstein Institute combined with CSHL’s breakthrough genetics research is a perfect match,” said Dr. Watson. “I expect this collaboration to contribute a great deal to our understanding of the genes involved in bipolar disorder and to the diagnosis and treatment of this illness.”
More than 2.3 million American adults are diagnosed with bipolar disorder, and research suggests that at least a quarter of a million children and adolescents are also affected by bipolar spectrum disorders, though some estimates are much higher.
Bipolar disorder usually develops in the teens or early twenties but can also affect children. Diagnosis of early-onset BPD is tough, though, because some of the symptoms mimic emotions and behaviors that are initially thought to be typical of children. Unlike normal mood changes, however, bipolar disorder significantly impairs functioning in school with peers and at home with family. Diagnosis is also hampered by the symptoms often being confused with other childhood-onset mental disorders such as attention deficit-hyperactivity disorder (ADHD) or oppositional defiant disorder.
Children and adolescents who were diagnosed with BPD between the ages of 7 and 18 and who have two living parents will be invited to participate in the study. The researchers will analyze DNA from blood samples of the children and both parents. The participants will also undergo cognitive and behavioral tests and brain MRIs. The Feinstein research team members, including The Balanced Mind Foundation PAC member Vivian Kafantaris, M.D., and Todd Lencz, Ph.D., in addition to Dr. Malhotra, plan to enroll 1,500 participants in the study -- 500 children and 1,000 parents.
According to the National Institute of Mental Health, bipolar disorder that begins in childhood or early adolescence may be a different, possibly more severe, form of the illness than older adolescent- and adult-onset bipolar disorder. Using novel genetic technologies, the research team hopes to identify for the first time genes that influence the risk of developing bipolar disorder at an early age. Such knowledge could help researchers develop preventative strategies and better treatments for this disabling illness.
The CSHL research team includes Jonathan Sebat, Ph.D., and Sydney Gary, Ph.D. Researchers at Johns Hopkins University in Baltimore, MD, and within the intramural research program at the National Institute of Mental Health in Bethesda, MD, are also collaborating on the study. This project is funded by a generous grant from the Stanley family.
Additional Genetic Studies:
Genomic Studies of ADHD, Bipolar Announced
Would you like your child to participate in a Clinical Trial or Research Study?
The Balanced Mind Foundation has a list of trials and studies that are currently recruiting.
Click here for more information.
ADHD and Bipolar
Why Does My Child Have Both?
Children who have pediatric bipolar disorder often have Attention Deficit Hyperactivity Disorder (ADHD) and vice versa. Studies suggest that this dual diagnosis occurs so often that it cannot simply be due to chance. A recent study by Drs. Singh, Delbello*, Kowatch*, and Strakowski, published in the December issue of Bipolar Disorders, examines four possible explanations for this:
1. Bipolar disorder is expressed in children in such a way that it leads to an overdiagnosis of ADHD;
2. ADHD is an early manifestation of pediatric-onset bipolar disorder;
3. ADHD and associated factors (e.g., psychostimulants) lead to the onset of pediatric BPD;
4. ADHD and BPD share common underlying biological factors.
By comparing studies that looked at different experiential, genetic, family, neuroimaging, and treatment studies, the authors suggest while there is evidence to support all four explanations, the greatest amount of evidence suggests that ADHD is an early manifestation of pediatric-onset bipolar disorder. Thus, bipolar disorder where ADHD is present may be a developmentally specific look of early onset bipolar disorder. The study also suggests that the underlying cause of bipolar disorder and ADHD has many different factors. The authors call for further research to study the way in which ADHD and BPD overlap. Click here to learn more.
*The Balanced Mind Foundation Scientific Advisory Council members
Manpreet K. Singh, Melissa O. DelBello, Kobert A. Kowatch, Stephen M. Strakowski (2006)
Co-ocurrence of bipolar disorder and attention deficit hyperactivity disorders in children. Bipolar Disorders 8(6), 710-20.
© Blackwell Munkgaard, 2006.
Teen Insight
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'Hakeem' (meaning 'insight') is a 15 year old
boy with bipolar disorder who shares his
firsthand perspectives and experiences with
The Balanced Mind Foundation members through this column.
Dear Hakeem:
Is there anything that I can do to help my son regain control when he loses it in a rage or meltdown? Are there ways for me to work with him when he's calm to teach him to control his rage?
-The Balanced Mind Foundation Messageboard Mom
Dear "CMM":
I asked my mother what she did when I went into rages. One of the things that helped me when I was very young (age 2-7) was for my parents to come close to me, hold my head with their hands, and look me in the eyes, calling my name. I think it was a way for me to come back to myself. Many rages were ended in that manner.
When your child is calm, after a rage, talk to him/her about what he/she did, and ask her why. The fact is she may not know why. The one thing I remember most about rages is that I felt I wasn't in control. I think some kids describe bipolar as "the monster inside them", I think that is very true. I look back on it now, and see that I did things I was telling myself not to. I was not in control of my own body. I felt lost, alone.
The best thing you as a parent can do is to stay in control of yourself. Try to project an air of calm, even if you do not feel calm. As a child gets older, when they are in a rage, leave them be. Find a safe place, with few dangerous objects, and let them be. They need time to cool down, with nothing to rage against. It is as though they have lost their inner being, and need this time alone to find themselves again.
Dear Hakeem:
My teen daughter refuses to go to school some days. Today, she refused because she had an embarrassing situation yesterday, and she was also very anxious about taking a test today. She was miserable all day at home and says she knows that it will be harder to go back on Monday, after being out for 3 days. Any suggestions?
-Tested Dad in NY
Dear "Tested":
I have gone through several schools; I had the exact same problem with school. I think what may have really helped was a good IEP. As for anxiety with tests, the best things she can do are simple-- be prepared, maybe talk it over with a classmate or adult the day before the test. The one thing I have to say is this: my parents forced me to go to school, no matter how bad I felt. Sometimes I did have a horrible day, but often, once I got there it turned out alright. Maybe she just needs a push; after a little adjustment, I've done quite well in high school.
Dear Hakeem:
At what age(s) did you really understand the illness and the importance of taking your medications?
-Rex (Rx) in RI
Dear "Rex":
I began to understand why I was taking meds at the age of 10. I knew I needed to take them before then, but I didn't know why. I think I was scared something was really wrong with me. My parents told me about my illness when I was first diagnosed, but I couldn't quite grasp the concept yet. I had to read about it for myself to really understand. I asked for my parents' books on bipolar when I was around 13. I read The Bipolar Child, and asked my parents more questions about bipolar. I really wanted to learn about my illness, so I could help myself. It was hard not understanding myself, so I learned what I was, and am.
Have a question for 'Hakeem'? Please click here to submit a question. We are unable to provide personal responses, but will try to address questions in upcoming eBulletin issues.
Child in Crisis
Have the Police in Your Community Been Trained?
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| Nanci Schiman, The Balanced Mind Foundation Program Coordinator |
A child living with bipolar disorder is often out of control. As parents, we do all the things we hope will defuse the situation. But what do we do when our child is raging, threatening their own safety or that of family members? To whom do we turn if our child runs away, or needs to be transported to a hospital, and we are unable to get him into the car? Often the next step, the only step, is to call the police for help.
All too often, the police have responded to domestic violence in ways that, while appropriate for criminal activity, often does nothing to help the family of a child with bipolar disorder, or may in fact make things worse. Police are taught to quickly take charge of a situation, intervene and move on. This is appropriate in most criminal situations, but often a recipe for disaster when applied to an unstable child.
The Balanced Mind Foundation parents share their experiences:
"He had been going through months of some pretty bad rages, mixed with illegal drug use...when the police came, I was sitting on top of my son restraining him and I had bite marks up and down both arms. When I explained what was going on, the officer said (in front of my son) that he was just being a normal 13 year old. I couldn't believe it, I felt completely hopeless."
"The police tried to calm my daughter down and talk to her but it wasn't going well....I explained the situation. The officer asked if she was adopted (which was obvious because of the difference in skin color). When I told him she was, his reply was "I'd give her back". His tone just cut right through me. This was so early in our diagnosis that I really didn't know how to respond but was quite shaken.
Getting the Help You Need
The tide, however, is beginning to turn. With appropriate training, officers are able to apply interventions that provide individuals and their families with the support and help that they need during a crisis.
"I did let the police know of my son's diagnosis and state of functioning when I called them...they approached the situation in a very effective way, keeping very calm, reassuring him, etc. I was lucky, because it seemed obvious to me that these guys had received training, and that the appropriate and effective handling of situations like this had been made a priority. If they had been uninformed and insensitive, it could have been totally different."
"Our current town's police department has had special training to handle the mentally ill mandated by our county sheriff. We have met with several officers in reporting our son missing and they have been helpful and compassionate."
Crisis Intervention Training (CIT) programs are springing up in police departments around the country as a result of a program that originated in the late 1980's in Memphis, TN. After a mentally ill man was shot by Memphis police, the Memphis police department, in conjunction with the local chapter of the Alliance for the Mentally Ill, started a program to develop understanding and sensitivity towards dealing with mental health issues.
Known as the "Memphis Model", the focus of the training is on slowing down the call, de-escalating the situation, and connecting the individual with appropriate resources. Officers receive a total of 40 hours of classroom and practical (interactive) training that teaches them to reduce external distracters, use nonverbal language that is consistent with their verbal language, and understand the benefits of early intervention.
In communities where CIT programs exist, the efforts are paying of for both the police department and the community. The Memphis Police Department, for example, reports that since the program began:
- Arrests and use of force has decreased
- Patient violence and use of restraints in the ER has decreased
- Officers' injuries during crisis events has decreased
- Officers are better trained and educated in verbal de-escalation techniques
- Officer appreciation and recognition by the community has increased
- Cost savings
What You Can Do
The Balanced Mind Foundation encourages parents to contact their police department to see if there is a CIT program available in your area. If one is in place in your community, you may want to ask for a CIT-trained officer during a crisis situation. As well, if your child has multiple episodes that lead to contact with law enforcement (cutting behaviors, suicide attempts, running away, drug use, etc.), it may be beneficial to inform the CIT officers of your child's diagnosis in advance so that they may better handle any situations that may arise.
Says one The Balanced Mind Foundation family:
“I met with my village’s police department and told them about my son’s bipolar diagnosis BEFORE I ever needed to call them in an emergency. They were understanding, cooperative and made a note in our file. Since that time, we have had to call 911 twice to transport my son to the hospital and the police were effective in getting him to calm down. It was still a very traumatic experience for me, but I guess it could have been a whole lot worse."
If a CIT program doesn't exist in your community, talk to the local department about setting one up. The Memphis PD was able to set up their CIT program with no added cost to the city. Refer your local department to the Memphis model as well as others across the country. Contact your local NAMI (National Association of Mental Illness) chapter as NAMI has been instrumental in setting up CIT programs in different communities across the nation.
Learn More
For more information about the Memphis Model and Crisis Intervention Training click here:
Improving Police Response to Mentally Ill People
Help instead of Handcuffs
The Memphis Police CIT Program
Unmet Needs For Services and Interventions Among Adolescents
Findings reveal that youths with public health insurance were more likely to receive services in health care sectors than their peers with either private insurance or no insurance, suggesting that out-of-pocket costs and other financial barriers may need to be overcome to improve access to mental health care. Click here to learn more
Antipsychotics and Weight Gain
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A new study shows that metformin, a widely prescribed diabetes drug, prevented children and teens who take medications for bipolar disorder, schizophrenia, and other mental illnesses from gaining weight or developing a risk factor for type 2 diabetes.
Click here to read the research journal article
Click here to read the press release