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Bipolar disorder evolves differently in patients who also binge eat, a study by Mayo Clinic, the Lindner Center of HOPE and the University of Minnesota found. Binge eating and obesity often are present among bipolar patients, but the mood disorder appears to take a different path in those who binge eat than it does in obese bipolar patients who do not, the researchers discovered. The findings are published online in the Journal of Affective Disorders.

Up to 4 percent of Americans have some form of bipolar illness, and of those, just under 10 percent also have binge eating disorder – a higher rate of binge eating than seen in the general population, says co-author Mark Frye, M.D., a psychiatrist and chair of the Department of Psychiatry/Psychology at Mayo Clinic in Rochester. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) update released this spring recognizes binge eating disorder as a distinct condition, he noted.

Bipolar patients who binge eat are more likely to have other mental health issues such as suicidal thoughts, psychosis, anxiety disorders and substance abuse, the study found. People with bipolar disorder who are obese but do not binge eat are more likely to have serious physical problems such as arthritis, diabetes, high blood pressure and heart disease.

It was more common for women than men with bipolar disorder to binge eat or to be obese, the study showed.

“The illness is more complicated, and then by definition how you would conceptualize how best to individualize treatment is more complicated,” Dr. Frye says. “It really underscores the importance of trying to stabilize mood, because we know when people are symptomatic of their bipolar illness their binge frequency is likely to increase. We want to work with treatments that can be helpful but not have weight gain as a significant side effect.”

The researchers used the Mayo Clinic Bipolar Biobank, a collaborative effort by Mayo Clinic, the Lindner Center of HOPE, University of Minnesota and Mayo Clinic Health System. More research is planned to see whether there is a genetic link to binge eating disorder in bipolar disease.

“Patients with bipolar disorder and binge eating disorder appear to represent a more severely ill population of bipolar patients. Identification of this subgroup of patients will help determine the underlying causes of bipolar disorder and lead to more effective and personalized treatments,” says co-author Susan McElroy, M.D., chief research officer at the Lindner Center of HOPE.

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Researchers have discovered that five major mental disorders may be linked to the same common inherited genetic variations, according to a study published in the journal Nature Genetics.

Scientists from the Cross Disorders Group of the Psychiatric Genomic Consortium (PGC) used genome-wide genotype data in an analysis of people with five psychiatric disorders, alongside controls.

The mental health conditions monitored were:
◾Schizophrenia
◾Bipolar disorder
◾Major depressive disorder
◾Autism spectrum disorders
◾Attention-deficit hyperactivity disorder (ADHD).

Previous research from the group reported the first link between the disorders, revealing that people with these disorders were more likely to have variation within the same four chromosomal sites.

However, this most recent study has investigated the links in more detail, by using the same genome-wide information and large data sets.

The researchers analyzed genetic variation in thousands of people with each of the five disorders, and compared the genetic codes with those of people who did not have the conditions. The researchers calculated to what extent pairs of disorders were linked to the same genetic variants.

Results of the analysis showed the following overlaps in heritability between particular psychiatric disorders as a result of common genetic variation:
◾Schizophrenia and bipolar disorder – 15%
◾Bipolar disorder and depression – 10%
◾Schizophrenia and depression – 9%
◾Schizophrenia and autism – 3%.

Overall, the researchers found that common genetic variation accounted for between 17-28% of risk of all five disorders.

Naomi Wray of the University of Queensland, Australia, says:

“Since our study only looked at common gene variants, the total genetic overlap between the disorders is likely higher.

Shared variants with smaller effects, rare variants, mutations, duplications, deletions, and gene-environment interactions also contribute to these illnesses.”

The researchers say that these results, particularly the genetic evidence of the link between schizophrenia and depression, may have important implications for diagnostics and research.

The study was part-funded by the National Institutes of Health (NIH). Bruce Cuthbert, director of the National Institute of Mental Health, says:

“Such evidence quantifying shared genetic risk factors among traditional psychiatric diagnoses will help us move toward classification that will be more faithful to nature.”

The researchers note that although the study results “attach numbers” to molecular evidence showing the importance of heritability linked to common genetic variation that causes these five psychiatric disorders, much of the inherited genetic contribution to these disorders is unexplained, as are non-inherited genetic factors.

The study authors provide an example of how common genetic variation accounts for 23% of schizophrenia patients, and evidence from twin and family studies estimate schizophrenia’s total heritability at 81%.

Thomas Lehner, chief of the genomics research branch at the National Institute of Mental Health, says:

“It is encouraging that the estimates of genetic contributions to mental disorders trace those from more traditional family and twin studies. The study points to a future of active gene discovery for mental disorders.”

Written by Honor Whiteman

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Scientists say new brain imaging methods that measure blood flow could help diagnose bipolar disorder in its early stages, as well as differentiate it from depression, according to a study published in the British Journal of Psychiatry.

Researchers from the University of Pittsburgh analyzed 44 females for the study. Of these, 18 had bipolar-I disorder, 18 had unipolar depression and 18 served as a control group, with no form of mood disorder or depression.

The researchers carefully matched the women for demographic and clinical variables and the women were all experiencing an episode of depression throughout the study assessment.

Using a new imaging method called “Arterial Spin Labeling,” the researchers were able to measure the participants’ blood flow in order to monitor the brain regions linked to depression.

This new imaging method revealed an 81% accuracy in determining which women suffered from bipolar and which women had unipolar depression.

Another new method was also used, called “Pattern Recognition Analysis,” which enables the researchers to monitor brain differences specific to each individual.

Dr. Jorge Almeida, assistant professor of psychiatry at the University of Pittsburgh, says:

“Earlier and more accurate diagnoses can make an enormous difference for patients and their families, and may even save lives.

This is a very promising finding that highlights the usefulness of neuroimaging to help identify biological markers associated with different mental health conditions.”

According to the National Institute of Mental Health, bipolar disorder affects around 5.7 million adults in the US.

Research has shown that bipolar disorder has higher prevalence in the US than any other country, with 4% prevalence compared with the worldwide average of 2%.

The disorder is not easy to diagnose, as symptoms such as mood changes and lack of energy and activity levels can frequently be diagnosed as other problems. The researchers add that a fifth of people with bipolar disorder are incorrectly diagnosed when first assessed by a physician – an accurate diagnosis can take up to 10 years.

“These results also suggest that we may one day be able to predict future bipolar behavior in younger adults who haven’t shown any symptoms, allowing for earlier and more accurate treatment,” adds Dr. Almeida.

The researchers say that these two new technologies will now be used to conduct research in larger samples and in a multi-center study.

Written by Honor Whiteman

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We live in the most exciting and unsettling period in the history of psychiatry since Freud started talking about sex in public.

On the one hand, the American Psychiatric Association has introduced the fifth iteration of the psychiatric diagnostic manual, DSM-V, representing the current best effort of the brightest clinical minds in psychiatry to categorize the enormously complex pattern of human emotional, cognitive, and behavioral problems. On the other hand, in new and profound ways, neuroscience and genetics research in psychiatry are yielding insights that challenge the traditional diagnostic schema that have long been at the core of the field.

“Our current diagnostic system, DSM-V represents a very reasonable attempt to classify patients by their symptoms. Symptoms are an extremely important part of all medical diagnoses, but imagine how limited we would be if we categorized all forms of pneumonia as ‘coughing disease,” commented Dr. John Krystal, Editor of Biological Psychiatry.

A paper by Sabin Khadka and colleagues that appears in the September 15th issue of Biological Psychiatry advances the discussion of one of these roiling psychiatric diagnostic dilemmas.

One of the core hypotheses is that schizophrenia and bipolar disorder are distinct scientific entities. Emil Kraepelin, credited by many as the father of modern scientific psychiatry, was the first to draw a distinction between dementia praecox (schizophrenia) and manic depression (bipolar disorder) in the late 19th century based on the behavioral profiles of these syndromes. Yet, patients within each diagnosis can have a wide variation of symptoms, some symptoms appear to be in common across these diagnoses, and antipsychotic medications used to treat schizophrenia are very commonly prescribed to patients with bipolar disorder.

But at the level of brain circuit function, do schizophrenia and bipolar differ primarily by degree or are there clear categorical differences? To answer this question, researchers from a large collaborative project called BSNIP looked at a large sample of patients diagnosed with schizophrenia or bipolar disorder, their healthy relatives, and healthy people without a family history of psychiatric disorder.

They used a specialized analysis technique to evaluate the data from their multi-site study, which revealed abnormalities within seven different brain networks. Generally speaking, they found that schizophrenia and bipolar disorder showed similar disturbances in cortical circuit function. When differences emerged between these two disorders, it was usually because schizophrenia appeared to be a more severe disease. In other words, individuals with schizophrenia had abnormalities that were larger or affected more brain regions. Their healthy relatives showed subtle alterations that fell between the healthy comparison group and the patient groups.

The authors highlight the possibility that there is a continuous spectrum of circuit dysfunction, spanning from individuals without any familial association with schizophrenia or bipolar to patients carrying these diagnoses. “These findings might serve as useful biological markers of psychotic illnesses in general,” said Khadka.

Krystal agreed, adding, “It is evident that neither our genomes nor our brains have read DSM-V in that there are links across disorders that we had not previously imagined. These links suggest that new ways of organizing patients will emerge once we understand both the genetics and neural circuitry of psychiatric disorders sufficiently.”

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Experiments with neutrons at the Technische Universitat Munchen (TUM) show that the antidepressant lithium accumulates more strongly in white matter of the brain than in grey matter. This leads to the conclusion that it works differently from synthetic psychotropic drugs. The tissue samples were examined at the Research Neutron Source Heinz Maier-Leibnitz (FRM II) with the aim of developing a better understanding of the effects this substance has on the human psyche.

At present lithium is most popular for its use in rechargeable batteries. But for decades now, lithium has also been used to treat various psychological diseases such as depressions, manias and bipolar disorders. But, the exact biological mode of action in certain brain regions has hardly been understood. It is well known that lithium lightens moods and reduces aggression potential.

Because it is so hard to dose, doctors have been reluctant to prescribe this “universal drug”. Nonetheless, a number of international studies have shown that a higher natural lithium content in drinking water leads to a lower suicide rate in the general population. Lithium accumulates in the brains of untreated people, too. This means that lithium, which has so far been regarded as unimportant, could be an essential trace element for humans.

Lithium detection with neutrons

This is what Josef Lichtinger is studying in his doctoral thesis at the Chair for Hadron and Nuclear Physics (E12) at the Technische Universität München. From the Institute for Forensic Medicine at the Ludwig-Maximilians-Universität Munich (LMU) he received tissue samples taken from patients treated with lithium, untreated patients and healthy test persons. The physicist exposed these to a focused cold neutron beam of greatest intensity at the measuring station for prompt gamma activation analysis at FRM II.

Lithium reacts with neutrons in a very specific manner and decays to a helium and a tritium atom. Using a special detector developed by Josef Lichtinger, traces as low as 0.45 nanograms of lithium per gram of tissue can be measured. “It is impossible to make measurements as precise as those using the neutrons with any other method,” says Jutta Schöpfer, forensic scientist at the LMU in charge of several research projects on lithium distribution in the human body.

Lithium concentrates at the nerve-tracts

Lichtinger’s results are surprising: Only in the samples of a depressive patient treated with lithium did he observe a higher accumulation of lithium in the so-called white matter. This is the area in the brain where nerve tracts run. The lithium content in the neighboring grey matter was 3 to 4 times lower. Lithium accumulation in white matter was not observed in a number of untreated depressive patients. This points to the fact that lithium does not work in the space between nerve cells, like other psychotropic drugs, but within the nerve tracts themselves.

In a next step Josef Lichtinger plans to examine further tissue samples at TUM’s Research Neutron Source in order to confirm and expand his results. The goal is a space-resolved map showing lithium accumulation in the brain of a healthy and a depressive patient. This would allow the universal drug lithium to be prescribed for psychological disorders with greater precision and control. The project is funded by the German Research Foundation (DFG).

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