Comments for The International Review of Bipolar Disorders http://www.irbd.org/irbd-blog An open forum for debate and discussion on all topics relating to Bipolarity and Bipolar Disorders. Fri, 13 Aug 2010 10:45:48 +0000 hourly 1 http://wordpress.org/?v=3.0.1 Comment on Even professionals can suffer from bipolar disorder: strength or weakness? by Dr. Carlo Fornesi http://www.irbd.org/irbd-blog/even-professionals-can-suffer-from-bipolar-disorder-strength-or-weakness-87.html#comment-9 Dr. Carlo Fornesi Fri, 13 Aug 2010 10:45:48 +0000 http://www.irbd.org/irbd-blog/?p=87#comment-9 Thanks! Here in Italy self-disclosure (which I learned to use "appropriately and in a timely manner" in Ireland, in a counseling course at Hazelden, regarding alcoholism), is viewed as a therapeutic mistake, a "setting problem" and even (one of my client told me that) as a way to sexually seduce the client. This person in particular,after I used self disclosure to make examples about failed relationships in the case of lack of communication, has been "counseled" by two "expert" friends (a shop assistant and a math teacher), in a cafeteria during a discussion based on popular scandalistc magazines where anything that sells is published, not to see me for therapy anymore, because I was clearly trying to "seduce" her, as the only "real" serious therapist NEVER talks about anything, unless he wants to sleep with you, or he needs to warn you about the danger of discontinuing therapy, if you try to say something like "I feel better now, maybe I do not need 4 sessions a week anymore...". And those "friends" were sure because "younameit" magazine said that, in a page between an article on UFO abductions and another one on how regressive hypnosis can cure ANY disease, even cancer, bcause ANY cause is in your mind, and if you discover it you will be cured. Now my questions are: 1) if my dentist has cavities, is he not fit to cure me? and 2) when he cures me, does he stay silent for years listening to anything about my childhood, dreams, relationships and free associations of mind until we discover PRECISELY which kind of candy caused the cavity in my tooth, which will INSTANTLY HEAL ONLY because of that knowledge, or (using protocols studied in medical school, validated through decades of experiments) will he take sterile instruments, TOOLS, and drill and clean, and disinfect and close the cavity, without showing any interest whatsoever in thecause, unless for the simple sake of prevention (like "wash your teeth after eating, especially candies")??? I know I sound polemic, but after 16 years of bs like this I am"full". Thanks again for your message of support! Thanks! Here in Italy self-disclosure (which I learned to use “appropriately and in a timely manner” in Ireland, in a counseling course at Hazelden, regarding alcoholism), is viewed as a therapeutic mistake, a “setting problem” and even (one of my client told me that) as a way to sexually seduce the client. This person in particular,after I used self disclosure to make examples about failed relationships in the case of lack of communication, has been “counseled” by two “expert” friends (a shop assistant and a math teacher), in a cafeteria during a discussion based on popular scandalistc magazines where anything that sells is published, not to see me for therapy anymore, because I was clearly trying to “seduce” her, as the only “real” serious therapist NEVER talks about anything, unless he wants to sleep with you, or he needs to warn you about the danger of discontinuing therapy, if you try to say something like “I feel better now, maybe I do not need 4 sessions a week anymore…”. And those “friends” were sure because “younameit” magazine said that, in a page between an article on UFO abductions and another one on how regressive hypnosis can cure ANY disease, even cancer, bcause ANY cause is in your mind, and if you discover it you will be cured. Now my questions are: 1) if my dentist has cavities, is he not fit to cure me? and 2) when he cures me, does he stay silent for years listening to anything about my childhood, dreams, relationships and free associations of mind until we discover PRECISELY which kind of candy caused the cavity in my tooth, which will INSTANTLY HEAL ONLY because of that knowledge, or (using protocols studied in medical school, validated through decades of experiments) will he take sterile instruments, TOOLS, and drill and clean, and disinfect and close the cavity, without showing any interest whatsoever in thecause, unless for the simple sake of prevention (like “wash your teeth after eating, especially candies”)???
I know I sound polemic, but after 16 years of bs like this I am”full”.
Thanks again for your message of support!

]]> Comment on Even professionals can suffer from bipolar disorder: strength or weakness? by Bernadette Kubicki http://www.irbd.org/irbd-blog/even-professionals-can-suffer-from-bipolar-disorder-strength-or-weakness-87.html#comment-8 Bernadette Kubicki Mon, 09 Aug 2010 16:48:34 +0000 http://www.irbd.org/irbd-blog/?p=87#comment-8 Great point! I believe having been in the throws of mental illness and conquering it to the point of functionality is definitely a plus. It allows for easier identification of symptomatic behavior in clients and helps a mental health professional better identify with the client's issues. It also would aid in the therapist/client relationship if disclosure was used appropriately and in a timely manner. Great point! I believe having been in the throws of mental illness and conquering it to the point of functionality is definitely a plus. It allows for easier identification of symptomatic behavior in clients and helps a mental health professional better identify with the client’s issues. It also would aid in the therapist/client relationship if disclosure was used appropriately and in a timely manner.

]]> Comment on The pharmacological treatment of Bipolar Disorder in Children and Adolescents by Prof Youngstrom http://www.irbd.org/irbd-blog/the-pharmacological-treatment-of-bipolar-disorder-in-children-and-adolescents-2-9.html#comment-7 Prof Youngstrom Tue, 27 Jul 2010 08:32:58 +0000 http://www.irbd.org/irbd-blog/?p=9#comment-7 Great opening to the blog! The past year has seen a lot of advances in terms of treatment options for youths with bipolar disorder. The Food and Drug Administration approved two new compounds in addition to lithium for the acute treatment of mania in adolescents, and several more are under review. There have been big gains in our understanding of psychotherapy, too. There was a symposium at the most recent American (and Canadian) Psychological Association meeting in Toronto (August, 2009) that had three talks describing recent progress with psychosocial interventions. Mary Fristad described the findings for her family psychoeducation intervention (the key findings are in the current issue of Archives of General Psychiatry). Tina Goldstein described her work adapting Dialectical Behavior Therapy (DBT) for adolescents in bipolar disorder -- showing significant and clinically meaningful increases in the number of days well, in addition to reductions in mood symptoms. Amy West reported on work with CBT in the "RAINBOW" Clinic at Chicago. I believe that the abstracts, and possibly even the slides, will be available at www.apa.org. In addition, David Miklowitz is continuing to develop family focused therapy for youths and teens with bipolar, and Stephanie Hlastala is adapting Interpersonal and Social Rhythms Therapy (Ellen Frank's IPSRT) for bipolar youths. All of these groups have projects funding by the National Institute of Mental Health (NIMH) for the USA.... It is great to see NIMH starting to support treatment development in this area. There are lots of changes, and many new resources becoming available. This blog can be a helpful way of sharing the "breaking news" and pointing people towards this new information. Great opening to the blog!

The past year has seen a lot of advances in terms of treatment options for youths with bipolar disorder. The Food and Drug Administration approved two new compounds in addition to lithium for the acute treatment of mania in adolescents, and several more are under review. There have been big gains in our understanding of psychotherapy, too. There was a symposium at the most recent American (and Canadian) Psychological Association meeting in Toronto (August, 2009) that had three talks describing recent progress with psychosocial interventions. Mary Fristad described the findings for her family psychoeducation intervention (the key findings are in the current issue of Archives of General Psychiatry). Tina Goldstein described her work adapting Dialectical Behavior Therapy (DBT) for adolescents in bipolar disorder — showing significant and clinically meaningful increases in the number of days well, in addition to reductions in mood symptoms. Amy West reported on work with CBT in the “RAINBOW” Clinic at Chicago. I believe that the abstracts, and possibly even the slides, will be available at http://www.apa.org.

In addition, David Miklowitz is continuing to develop family focused therapy for youths and teens with bipolar, and Stephanie Hlastala is adapting Interpersonal and Social Rhythms Therapy (Ellen Frank’s IPSRT) for bipolar youths. All of these groups have projects funding by the National Institute of Mental Health (NIMH) for the USA…. It is great to see NIMH starting to support treatment development in this area.

There are lots of changes, and many new resources becoming available. This blog can be a helpful way of sharing the “breaking news” and pointing people towards this new information.

]]> Comment on Hypomania and the BRIDGE study by Prof Youngstrom http://www.irbd.org/irbd-blog/hypomania-and-the-bridge-study-80.html#comment-6 Prof Youngstrom Tue, 27 Jul 2010 08:30:56 +0000 http://www.irbd.org/irbd-blog/?p=80#comment-6 The BRIDGE study is exciting -- it reveals how helpful it can be to use the same methods across a variety of different countries and cultures. Using the same "mood meter sticks" will reveal many differences as well as similarities. Please let us know as more findings become available from this line of inquiry. The BRIDGE study is exciting — it reveals how helpful it can be to use the same methods across a variety of different countries and cultures. Using the same “mood meter sticks” will reveal many differences as well as similarities. Please let us know as more findings become available from this line of inquiry.

]]> Comment on Consider Hormones that Control Sodium Levels by Dr Jacobson http://www.irbd.org/irbd-blog/consider-hormones-that-control-sodium-levels-59.html#comment-5 Dr Jacobson Tue, 27 Jul 2010 08:23:46 +0000 http://www.irbd.org/irbd-blog/?p=59#comment-5 Research into electrolytes has a long history in bipolar disorder, focussing mainly on the sodium pump. It perhaps commenced with Naylor’s observations in the 1970s that erythrocyte membrane Na,K-ATPase activity was altered in manic patients. El-Mallakh’s group in the USA found that the Na,K-ATPase-inhibiting compound, ouabain, increases the intracellular sodium concentration and induces manic activity in animals. These effects can be normalized by lithium (Huang et al, 2007). They also reported that ouabain increased the expression of the glial-specific alpha2 isoform of the sodium pump in the basal ganglia and the alpha3 isoform in the frontal cortex. These findings, in association with human post mortem studies finding that alpha2 is underexpressed in the temporal cortex of bipolar subjects, suggest that Na pump isoform expression may be of particular interest in the pathophysiology of mania (Hamid et al, 2009). By contrast, there is less recent research on alterations in serum sodium in bipolar disorder. In a separate field, it has long been known that about 5% of people of African origin with hypertension respond to amiloride. The T594M polymorphism of the epithelial sodium channel, which is found in approximately 5% of people of African origin, is significantly associated with high blood pressure. Baker et al (2002) reported that amiloride is effective in controlling blood pressure in those hypertensive individuals of African origin with this polymorphism. It is to be hoped that greater understanding of electrolyte pathophysiology will lead to innovative treatments in affective disorder. Like Prof Young, I can neither comment on an individual case nor recommend treatment by excessive salt intake, which is a recognised cause of hypertension. Baker et al Amiloride, a specific drug for hypertension in black people with T594M variant? Hypertension, 2002, Jul;40(1):13-7. Hamid et al. Effect of ouabain on sodium pump alpha-isoform expression in an animal model of mania. Prog Neuropsychopharmacol. Biol Psychiatry, 2009, Oct1;33: 1103-1106. Huang et al. Lithium normalizes intracellular sodium. Bipolar Disorders, 2007; 9: 298-300. Research into electrolytes has a long history in bipolar disorder, focussing mainly on the sodium pump. It perhaps commenced with Naylor’s observations in the 1970s that erythrocyte membrane Na,K-ATPase activity was altered in manic patients. El-Mallakh’s group in the USA found that the Na,K-ATPase-inhibiting compound, ouabain, increases the intracellular sodium concentration and induces manic activity in animals. These effects can be normalized by lithium (Huang et al, 2007). They also reported that ouabain increased the expression of the glial-specific alpha2 isoform of the sodium pump in the basal ganglia and the alpha3 isoform in the frontal cortex. These findings, in association with human post mortem studies finding that alpha2 is underexpressed in the temporal cortex of bipolar subjects, suggest that Na pump isoform expression may be of particular interest in the pathophysiology of mania (Hamid et al, 2009). By contrast, there is less recent research on alterations in serum sodium in bipolar disorder. In a separate field, it has long been known that about 5% of people of African origin with hypertension respond to amiloride. The T594M polymorphism of the epithelial sodium channel, which is found in approximately 5% of people of African origin, is significantly associated with high blood pressure. Baker et al (2002) reported that amiloride is effective in controlling blood pressure in those hypertensive individuals of African origin with this polymorphism. It is to be hoped that greater understanding of electrolyte pathophysiology will lead to innovative treatments in affective disorder. Like Prof Young, I can neither comment on an individual case nor recommend treatment by excessive salt intake, which is a recognised cause of hypertension. Baker et al Amiloride, a specific drug for hypertension in black people with T594M variant? Hypertension, 2002, Jul;40(1):13-7. Hamid et al. Effect of ouabain on sodium pump alpha-isoform expression in an animal model of mania. Prog Neuropsychopharmacol. Biol Psychiatry, 2009, Oct1;33: 1103-1106. Huang et al. Lithium normalizes intracellular sodium. Bipolar Disorders, 2007; 9: 298-300.

]]> Comment on Consider Hormones that Control Sodium Levels by Prof Allan Young http://www.irbd.org/irbd-blog/consider-hormones-that-control-sodium-levels-59.html#comment-4 Prof Allan Young Tue, 27 Jul 2010 08:23:25 +0000 http://www.irbd.org/irbd-blog/?p=59#comment-4 Firstly, I should make it very clear that I cannot comment on an individual\'s case in this blog. However, a few general comments may be in order. Sodium is vital for health and abnormal levels are associated with a number of illnesses. The first objective should be to exclude frank endocrine disorders and a consultation with a suitably qualified physician should be arranged. I would not advise anyone to treat symptoms of bipolar disorder by consuming excess salt but rather establish the cause of any putative hyponatraemia. Sodium does have a possible role in the pathophysiology of severe affective disorder and this may be related to hormones (e.g., aldosterone) or membrane mechanisms (the sodium pump) but there are no treatments based on this at present. Firstly, I should make it very clear that I cannot comment on an individual\’s case in this blog. However, a few general comments may be in order. Sodium is vital for health and abnormal levels are associated with a number of illnesses. The first objective should be to exclude frank endocrine disorders and a consultation with a suitably qualified physician should be arranged. I would not advise anyone to treat symptoms of bipolar disorder by consuming excess salt but rather establish the cause of any putative hyponatraemia. Sodium does have a possible role in the pathophysiology of severe affective disorder and this may be related to hormones (e.g., aldosterone) or membrane mechanisms (the sodium pump) but there are no treatments based on this at present.

]]> Comment on Complex Treatments for a Complex Condition by Mrs Calvett http://www.irbd.org/irbd-blog/complex-treatments-for-a-complex-condition-53.html#comment-3 Mrs Calvett Tue, 27 Jul 2010 08:21:26 +0000 http://www.irbd.org/irbd-blog/?p=53#comment-3 As a teacher I am interested in learning and understanding more about preventative and supportive care for children/students at risk of developing Bipolar Disorders. I also seek to better understand familial risk factors(parents with clinically diagnosed BD) co-morbid familial risk factors: substance abuse, unemployment, low socio-economic status, and environmental stressors such as abuse and trauma. I am seeking specialist advice on current best practice. of course involving non-pharmacological treatments which can improve children\'s resilience and increase protective factors suitable for educational settings. Focussing on early childhood settings that is Early Intervention. I am interested in empirical efficiacy of: • specific nutritional therapies e.g. utility of fish oils- omega, •role of improving nutrition •use of increased fitness programs, • hydration improving /controlling levels throughout day •cognitive-behavioural therapies- Learned optimism -programs you recommend suitable for use in classroom •effective relaxation techniques My background is Psychology and Anthropology B.A.(Adelaide Uni) Education:-Dip Ed. & Masters of Special Education, Grad Dip in Neuroscience(Flinders Uni,2009, Australia) Cert. in Mental Health for Teaching Professional(Monash-ongoing) 25 years practice as early years(5-8) teacher in mainstream settings. I understand Multi-variate analysis of variance(Audit Prof. John Keeves- Flinders, Australia) My personal focus of interest children/students with learning difficulties/disabilities and co-morbid presentations of anxiety, depression, aggressive/impulsive externalising behaviours which interfere with their ability to succeed academically, socialise and enjoy life. Interaction of trauma and abuse and resultant changes in neurological chemistry, observable sensitivity to noise/ stress/ threat factors. I have obviously only a sketchy grasp of factors and possible interactions but with your scaffolding and support hope to contribute to improved practice in educational settings in a small way in my sphere of influence. In anticipation and with grateful thanks yours sincerely jane m. calvett As a teacher I am interested in learning and understanding more about preventative and supportive care for children/students at risk of developing Bipolar Disorders.

I also seek to better understand familial risk factors(parents with clinically diagnosed BD) co-morbid familial risk factors: substance abuse, unemployment, low socio-economic status, and environmental stressors such as abuse and trauma.

I am seeking specialist advice on current best practice. of course involving non-pharmacological treatments which can improve children\’s resilience and increase protective factors suitable for educational settings. Focussing on early childhood settings that is Early Intervention.

I am interested in empirical efficiacy of:

• specific nutritional therapies e.g. utility of fish oils- omega,
•role of improving nutrition
•use of increased fitness programs,
• hydration improving /controlling levels throughout day
•cognitive-behavioural therapies- Learned optimism -programs you recommend suitable for use in classroom
•effective relaxation techniques
My background is Psychology and Anthropology B.A.(Adelaide Uni) Education:-Dip Ed. & Masters of Special Education, Grad Dip in Neuroscience(Flinders Uni,2009, Australia) Cert. in Mental Health for Teaching Professional(Monash-ongoing) 25 years practice as early years(5-8) teacher in mainstream settings. I understand Multi-variate analysis of variance(Audit Prof. John Keeves- Flinders, Australia)

My personal focus of interest children/students with learning difficulties/disabilities and co-morbid presentations of anxiety, depression, aggressive/impulsive externalising behaviours which interfere with their ability to succeed academically, socialise and enjoy life. Interaction of trauma and abuse and resultant changes in neurological chemistry, observable sensitivity to noise/ stress/ threat factors.

I have obviously only a sketchy grasp of factors and possible interactions but with your scaffolding and support hope to contribute to improved practice in educational settings in a small way in my sphere of influence.

In anticipation and with grateful thanks yours sincerely jane m. calvett

]]> Comment on The First Step to Clinical Management of BD: Correct assessment and diagnosis by Mrs Calvett http://www.irbd.org/irbd-blog/the-first-step-to-clinical-management-of-bd-correct-assessment-and-diagnosis-23.html#comment-2 Mrs Calvett Mon, 26 Jul 2010 20:15:47 +0000 http://www.irbd.org/irbd-blog/?p=23#comment-2 I am an early childhood teacher with an interest in evidence based practice seeking guidance in effective principles for early intervention with children 5-8 years old suitable for adoption in educational settings. Can you provide me with expert advice on what you feel educators can do to promote resilience/ stress management/ quality of life outcomes for children who are at risk of developing BD for example some students with Learning difficulties/Learning disabilities/diagnosis of anxiety and depression, familial and environmental risk factors( one or two parents with clinical BD diagnosis, drug and substance abuse, low socio-economic, indigeneous, familial trauma and abuse). I have recently completed a Grad. Cert. in Neuroscience(2009), Mental health for teaching professionals(Monash,Australia 2004 -ongoing), Masters in Special Education 2002. B.A.Psychology/Anthroplogy. That is I have a limited/ sketchy knowledge base. I would sincerely appreciate guidance for appropriate(evidence-based) interventions in educational settings from patient, that is: prepared to scaffold experts in this field of knowledge interested in fostering productive exchange between fields of education and medicine/ mental health. yours sincerely jane m. calvett I am an early childhood teacher with an interest in evidence based practice seeking guidance in effective principles for early intervention with children 5-8 years old suitable for adoption in educational settings.

Can you provide me with expert advice on what you feel educators can do to promote resilience/ stress management/ quality of life outcomes for children who are at risk of developing BD for example some students with Learning difficulties/Learning disabilities/diagnosis of anxiety and depression, familial and environmental risk factors( one or two parents with clinical BD diagnosis, drug and substance abuse, low socio-economic, indigeneous, familial trauma and abuse).

I have recently completed a Grad. Cert. in Neuroscience(2009), Mental health for teaching professionals(Monash,Australia 2004 -ongoing), Masters in Special Education 2002. B.A.Psychology/Anthroplogy. That is I have a limited/ sketchy knowledge base.

I would sincerely appreciate guidance for appropriate(evidence-based) interventions in educational settings from patient, that is: prepared to scaffold experts in this field of knowledge interested in fostering productive exchange between fields of education and medicine/ mental health.

yours sincerely jane m. calvett

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