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In research using patient medical records, investigators from Johns Hopkins and Sheppard Pratt Health System report that people with serious mental disorders who were hospitalized for mania were more likely to be on antibiotics to treat active infections than a group of people without a mental disorder.

Although the researchers caution that their study does not suggest cause and effect, they note that it does suggest that an infection, use of antibiotics or other factors that change the body’s natural collection of gut and other bacteria may individually or collectively contribute to behavioral changes in some people with mental disorders.

Their findings, published in Bipolar Disorders, add to evidence that the body’s immune system, the so-called gut brain axis, and the particular bacterial microbiome each person has play an integral part in the ebb and flow of psychiatric symptoms and psychiatric disorders, including bipolar disorder and schizophrenia.

“More research is needed, but ours suggests that if we can prevent infections and minimize antibiotic treatment in people with mental illness, then we might be able to prevent the occurrence of manic episodes,” says Robert Yolken, M.D., the Theodore and Vada Stanley Distinguished Professor of Neurovirology in Pediatrics at the Johns Hopkins University School of Medicine. “This means we should focus on good-quality health care and infection prevention methods for this susceptible population and pay extra attention to such things as flu shots, safe sex practices and urinary tract infections in female patients.”

Yolken says his team’s study grew out of an interest in long-observed connections among infections, the microbiome and symptoms of mental illness. For example, numerous studies have shown that experimental alterations in the microbiome of animals can alter their behavior.

Because antibiotics kill bacteria and can disrupt the makeup of the microbiome, Yolken and his research colleagues looked at records of antibiotic use in patients treated at the Sheppard Pratt – a psychiatric hospital in Baltimore – either as an inpatient or day hospital patient. Just over 64 percent of the patients were female, and all were 18 to 65. Two hundred and thirty-four people were hospitalized for mania, 101 for bipolar disorder, 70 for major depression and 197 for schizophrenia. Patients taking antibiotics were receiving a wide range of medications, including tetracycline, penicillin, sulfonamide, cephalosporin, fluoroquinolone and macrolides for skin, respiratory, urinary tract and mouth infections.

For comparison, they surveyed 555 healthy controls ruled not to have a mental disorder, including 347 women and 208 men between the ages of 20 and 60, about their current antibiotic use.

The researchers examined antibiotic usage as an indirect way to measure for the presence of infection. Antibiotic usages were assessed through medical records with the patients and through an interview with participants in the comparison group.

Of those hospitalized for mania, episodes of heightened energy and overactivity often associated with bipolar disorder – 18 participants, or 7.7 percent, were taking antibiotics, compared to only 1.3 percent of the controls. This represents a more than fivefold increase in the odds of being in the mania group if taking antibiotics. On the other hand, just over 3 percent of people hospitalized for schizophrenia, 4 percent of people hospitalized for bipolar depression and 2.9 percent of people hospitalized for major depression were taking antibiotics.

The researchers investigated whether the site of infection, such as mouth, skin or respiratory system, correlated with hospitalization, and they found that location of the infection didn’t seem to matter, although 15 women had urinary tract infections, which didn’t occur in any men.

Yolken says there are several ways that infection and antibiotic use could directly or indirectly impact psychiatric symptoms. Among the possibilities are that systemic inflammation caused by the infection itself may lead to psychiatric symptoms or, alternatively, that antibiotics disrupt the gut’s microbiome by killing off “good bacteria,” which may also affect the mind by increasing inflammation if more “bad bacteria” are present.

Yolken says that the research team is currently looking for how these connections might actually work. One study is investigating, for example, whether suppressing inflammation in the gut with probiotics in people with mental illness will reduce the recurrence of manic episodes.

The study was funded by grants from the Stanley Medical Research Institute and the National Institute of Mental Health (grant number PA 50 MH942680).

Article: Individuals hospitalized with acute mania have increased exposure to antimicrobial medications, Robert Yolken, Maria Adamos, Emily Katsafanas, Sunil Khushalani, Andrea Origoni, Christina Savage, Lucy Schweinfurth, Cassie Stallings, Kevin Sweeney and Faith Dickerson, Bipolar Disorders, doi: 10.1111/bdi.12416, published online 17 July 2016.

Long delays mean missed opportunities for early intervention to reduce the severity of episodes of bipolar disorder.

Crucial opportunities to manage bipolar disorder early are being lost because individuals are waiting an average of almost six years after the onset of the condition before diagnosis and treatment.

That is the key finding of a joint UNSW Australia and Italian study published in the Canadian Journal of Psychiatry.

The meta-analysis of 9,415 patients from 27 studies, the largest of its kind, was led by clinical psychiatrist and Conjoint Professor Matthew Large from UNSW’s School of Psychiatry and his colleague, Dr Giovanni de Girolamo, from the St John of God Research Centre, Italy.

Many patients experience distressing and disruptive symptoms for many years until receiving proper treatment for bipolar disorder, which was previously known as manic depressive illness.

According to the lead researcher, Professor Large, a psychiatrist at Prince of Wales Hospital, the delay is often longer for young people because moodiness is sometimes mistaken by parents and doctors as the ups and downs of the teenage years rather than the emergence of bipolar disorder, which can be effectively treated with mood stabilising medication.

“This is a lost opportunity because the severity and frequency of episodes can be reduced with medication and other interventions,” Professor Large said.

“While some patients, particularly those who present with psychosis, probably do receive timely treatment, the diagnosis of the early phase of bipolar disorder can be difficult”.

“This is because mental health clinicians are sometimes unable to distinguish the depressed phase of bipolar disorder from other types of depression.”

“The diagnosis of bipolar disorder can also be missed because it relies on a detailed life history and corroborative information from carers and family, information that takes time and care to gather”.

“Clinicians should look more closely at a patient’s history of mood symptoms, looking for distinct changes in mood, and other risk factors, for example, a family history and mood swings caused by external events such as treatment withantidepressants, overseas travel and taking drugs,” Professor Large said.

The researchers are calling for a consistent approach to the recording of the onset of symptoms of bipolar disorder, further studies on the early symptoms and predictors of bipolar disorder and the reasons for treatment delay.

The study was conducted in collaboration with researchers from St Vincent’s Hospital, Sydney and Italy’s St John of God Clinical Research Centre and University of Bari.

Brain scans have revealed how a genetic mutation linked to major psychiatric disorders affects the structure, function and chemistry of the brain.

The study offers further clues about how the mutation increases the risk of schizophrenia, bipolar disorder anddepression.

Experts say the findings could help in the quest for new treatments.

Researchers led by the University of Edinburgh scanned the brains of people that have a specific genetic mutation that causes part of one chromosome to swap places with another.

The mutation results in disruption of a gene called DISC1, which is associated with schizophrenia, bipolar disorder and recurrent major depression.

The team found that people with the genetic mutation had changes in the structure of their brain. These changes were linked with the severity of their symptoms of mental ill health.

They also showed that carriers of the mutation had lower levels of a chemical called glutamate in certain areas of their brain. Reduced glutamate levels have been strongly linked with schizophrenia in previous studies.

Researchers say their findings confirm that the DISC1 mutation is associated with a significantly increased risk of psychiatric illness.

They hope that continuing to study people with the mutation will reveal new insights to the biological mechanisms that underpin these conditions.

The DISC1 mutation was first identified in a Scottish family that showed unusually high rates of major psychiatric disorders. Scientists have been studying generations of the family for 40 years but this is the first time they have scanned their brains.

The study is published in the Nature partner journal Schizophrenia and was funded by the Translational Medicine Research Collaboration – a consortium of Scottish universities and NHS Health Boards, Scottish Enterprise and Pfizer.

Professor Stephen Lawrie, Head of the Division of Psychiatry at the University of Edinburgh, said: “This study confirms and extends the genetics of DISC1, and shows how that and similar genetic effects can increase the risk of major mental illnesses.”

Article: Balanced translocation linked to psychiatric disorder, glutamate, and cortical structure/function, Pippa A Thomson, Barbara Duff, Douglas H R Blackwood, Liana Romaniuk, Andrew Watson, Heather C Whalley, Xiang Li, Maria R Dauvermann, T William J Moorhead, Catherine Bois, Niamh M Ryan, Holly Redpath, Lynsey Hall, Stewart W Morris, Edwin J R van Beek, Neil Roberts, David J Porteous, David St. Clair, Brandon Whitcher, John Dunlop, Nicholas J Brandon, Zoë A Hughes, Jeremy Hall, Andrew McIntosh & Stephen M Lawrie, Schizophrenia, doi:10.1038/npjschz.2016.24, published online 10 August 2016.

Major depression and bipolar disorder put teenagers at greater risk for heart disease and should be considered as independent risk factors for the condition. This is according to a scientific statement from the American Heart Association, published in the journal Circulation.

Previous research has associated mood disorders in adults with greater risk for heart problems. In February 2014, for example,Medical News Today reported on a study claiming depression is acausal risk for coronary heart disease among adults.

What is more, studies have indicated that adults with major depression and bipolar disorder are more likely to suffer heart disease at an earlier age.

Lead author of the scientific statement Dr. Benjamin I. Goldstein – a child-adolescent psychiatrist at Sunnybrook Health Sciences Centre and the University of Toronto in Canada – and colleagues systematically assessed published research investigating the risk of heart disease among adolescents with mood disorders.

The team found that teenagers with major depression or bipolar disorder were more likely to have a number of risk factors for heart disease – including hypertension, high cholesterol, obesity, type 2 diabetes and atherosclerosis – compared with teenagers without these mood disorders.

The increased cardiovascular risk factors identified among adolescents with bipolar or major depression were not fully explained by other factors, such as lack of exercise, smoking or drug abuse, according to the statement authors.

While medication for mood disorders is associated with weight gain, hypertension, high cholesterol and increased blood sugar levels, the team notes that the majority of the teenagers included in the studies were not receiving such medication.

Dr. Goldstein and colleagues are unable to explain the biological causes behind their findings, but they point to previous studies that have associated adolescent mood disorders with increased inflammation and other forms of cell damage.

Early action needed to lower heart disease risk in teens with mood disorders

According to the National Institute of Mental Health, in 2012, around 2.2 million American teenagers aged 12-17 had a major depressive episode in the past year, while a 2012 study estimated that around 2.5% of adolescents aged 13-18 in the US have met the criteria for bipolar disorder in their lifetime.

Based on their findings, Dr. Goldstein and colleagues conclude that major depression and bipolar disorder should be classified as moderate risk factors for heart disease in teenagers. He says:

“Mood disorders are often lifelong conditions, and managing cardiovascular risk early and assertively is tremendously important if we are to be successful in ensuring that the next generation of youth has better cardiovascular outcomes.

These disorders indicate an increased risk of heart disease that requires increased vigilance and action at the earliest possible stage.”

Dr. Goldstein hopes that the scientific statement will prompt adolescents with depression or bipolar, their families and health care providers to take early action to reduce heart disease risk.

In June, MNT reported on a study that found individuals who suffer from panic disorder may be at greater risk of heart attack and heart disease later in life.