Understanding Bipolar Disorder Melvin McInnis, MD

Understanding
Bipolar Disorder
Melvin McInnis, M.D.
Research Director
Heinz C. Prechter Bipolar Research Fund
University of Michigan Depression Center
Celebrities with Bipolar Disorder
Ted Turner
Sylvia Plath
Kay Redfield Jamison, Ph.D.
Axl Rose
Margot Kidder
Jean-Claude Van Damme
Ben Stiller
Understanding Affective Disorders
• Kraepelin proposed affect
to consist of 3 components
o Volition
• Energy & Drive
•
o
Emotion
• Happy / Sad
Intellect
• Rate of thoughts
• Content of thoughts
Affect - Affection
• Volition – the drive to
care for our offspring
• Emotion – the love for
our children
• Intellect – the thoughts
& speech related to our
interactions with family
and loved ones
Normal Affect
Moods and disposition fluctuate over time
Volition
Emotion
Intellect
Mania
10
5
Volition
Emotion
Intellect
0
Mixed Affect
Volition
Emotion
Intellect
BP Disorder & Genetics
• BP disorder is 80% genetics
o …and 100% environmental!
• Having a BP sibling or parent increases likelihood of
developing BP fivefold compared to general population.
o Risk increases with increasing number of affected in
family.
• Overlap with genetic risk for other mood, anxiety, and
psychotic disorders.
Epidemiological Catchment Area Survey
(ECA): Comorbidity and Bipolar Disorder
Regier DA et al. JAMA. 1990;264:2511-2518; Chen YW, Dilsaver SC. Am J Psychiatry. 1995;152:280-282; Chen YW, Dilsaver SC. Psychiatry Res.
1995;59:57-64.
Bipolar Disorder
Unstable Periodic Illness - Difficult to predict Need Biomarker
~4% attempt suicide/year
-Personal Devastation
Mania
Energy
Baseline
Depression
BP Disorder – Challenge:
Unstable illness states – difficult to predict
40 participants with BPI
PHQ9
25
15
5
Year
PRIORI Research Project –
Predicting Individual Outcomes
Acoustic Biosignals
AI
6 – 12 mos
冣
40
30,000 calls
AUC 0.70 – 0.81
NOBEL 2012
Shinya Yamanaka & John B. Gurdon
iPSC to model neurological diseases using patients’ somatic cells (e.g. skin)
Neurons differentiated from Control and BP iPSC
form neurons (A,B) and synapses (C,D)
A
C
B
D
C
BP
MAP2/Tau
Syne1
msec
Lithium pretreatment normalizes
bipolar neuron calcium dynamics
Chen, Yoo, Herron
Substance-Use Disorder & BP
• Bipolar disorder with co-existing substance-use disorder
is associated with an increase in
o suicide attempts
o
o
o
o
o
o
suicidal ideas
seeking hospital admission
hospital admission
violence
aggressive behavior
doubled risk of suicide
Potash JB et al. Am J Psychiatry. 2000;157:2048-2050; Scott H et al. Br J Psychiatry. 1998;172:345-350; Comtois KA et al. Biol Psychiatry. 2004;56:757-763;
Strakowski SM, DelBello MP. Clin Psychol Rev. 2000;20:191-206; Strakowski SM et al. Arch Gen Psychiatry. 2005;62:851-858.
Substance-Use in BP:
Treatment Issues
• Less likely to respond to treatment 1
• Less likely to adhere to medications1,2
o Less likely to adhere to lithium treatment
• Less likely to gain full remission and resolve symptoms
• Remission during hospitalization less likely to occur vs.
no substance-use disorder
1. Goldberg JF et al. J Clin Psychiatry. 1999;60:733-740; 2. Aagaard J, Vestergaard P. J Affect Disord. 1989;12:259–266; 3. Strakowski SM et al. Arch Gen
Psychiatry. 1998;55:49-55.
Suicide Risk in Bipolar Disorder
• Patients with bipolar disorder have a higher risk of
suicide than patients with any other psychiatric or
medical illness
o Odds ratio for suicide attempts is 6.2 -- higher than any other
disorder, including depression
Woods SW. J Clin Psychiatry. 2000;61(Suppl 13):38-41; Chen YW, Dilsaver SC. Biol Psychiatry. 1996;39:896-899; Goldberg JF, Harrow M. J Affect Disord.
2004;81:123-131.
Bipolar Disorder Concluding
Statements…
• Bipolar disorders are a category of mood disorders with a broad range of severity.
• Bipolar disorder is eminently treatable.
o But requires treatment to be ongoing
• Collaboration between treatment team and patient
• Bipolar disorder is a serious illness.
o Lives, families, and careers are affected
o People can die from it.
Prechter Bipolar Genes Project
• For more information: www.prechterfund.org
www.depressioncenter.org
• Toll‐free phone number:
1‐877‐UM GENES 1‐877‐864 3637
Heinz C. Prechter
1942‐2001
• Email: BPresearch@umich.edu