CAT & PET Scans for Diagnosis Bipolar Disorder

CAT (sometimes referred to as CT, computer axial tomography) scans are a diagnostic tool for problems in the brain. It’s a painless procedure, takes less time than an MRI, and doesn’t have the risks from the magnetic fields. It is used mainly to rule out other disorders before a diagnosis of bipolar disorder can be made.(1) Generally if there is something found abnormal on the CT scan, an MRI is ordered.

 “Information gathered from a CT scan isn’t useful in making a bipolar diagnosis”

 PET (Positron Emission Technology) Scans work differently. It uses radiation (eek!) or nuclear medicine imaging to produce a 3-D picture of the human body.(2) The machine detects pairs of gamma rays emitted indirectly by a positron(3) emitting radionuclide, which is in the body on an active molecule. The images are constructed on a computer, and many machines take a CT scan and X-ray during the procedure. Again, this is a painless procedure, just boring.

 PET scans are used to diagnose health conditions, or find out how an existing condition is developing, to see how the treatment is working.

 And now onto the mental illness part.

Pharma companies have been saying mental disorders are chemically based for years, but actually, there isn’t really any proof.(4) A PET scan is changing that, they are finding interesting results comparing PET scans from the mentally interesting to the normals.

 Research:

  • Depressed brains are more active

  • PTSD sufferer’s brains are less active

 The other side of the fence(5)

What Brain Scans Can Do

  • Show damage to brain tissue, the skull, or blood vessels in the brain

  • Be used with other medical tests to help doctors find the right diagnosis for mood and behavioral problems

  • Help researchers study healthy brain development, effects of mental illnesses or effects of mental health treatments on the brain.

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What Brain Scans Cannot Do

  • Diagnose mental illness when used by themselves

  • Predict risk of getting a mental illness.

 There is a lot of controversy surrounding brain scans and mental illness. Some say yes, some say no. Specific scans can show the damage done by drug use, however. They are mostly used to rule out neurological disorders. Perhaps in future years, technology will allow us to see into the brain more carefully.

 

 

 

 

 

  1. http://www.answerbag.com/q_view/1928160

  2. http://www.medicalnewstoday.com/articles/154877.php

  3. Positively charged particles

  4. http://gaia-health.com/gaia-blog/2011-11-27/pet-scans-proof-that-depression-is-a-chemical-imbalance-or-a-psychiatric-delusion/

  5. http://www.nimh.nih.gov/health/publications/neuroimaging-and-mental-illness-a-window-into-the-brain/neuroimaging-and-mental-illness-a-window-into-the-brain.shtml

 

Can EEG (Electroencephaolography) Be Used as a Diagnostic Tool?

Some say yes, some say no, many say maybe.

First, let’s examine what Electroencephaolography (I’m going to call it an EEG, its way easier to type that) is. Electrodes are painlessly stuck to your scalp (this sucks if you have long hair, washing the goop out later) to detect electrical activity in your brain(1). There are always active brain cells, even when you’re sleeping. This test is commonly used to rule out seizure disorders, or determine what part of the brain is causing the seizure.

However, an EEG is not for use to diagnose mental illness, but there are studies that show the electrical circuits in the brain that are different in the mentally interesting than the “normal population”.

The EEG was used to test schizophrenics, a condition similar to bipolar disorder that has a “hybrid” of schizoaffective disorder. The study of patients indicates a higher number of them with abnormal records decreased in alpha activity. There are left side abnormalities, and some coherence abnormalities. (2) Further testing needed.

This study(3) claims that schizophrenia can be diagnosed before major symptoms happen, using EEG technology.

 

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“What we found, in terms of disease, was quite striking – defects in the genes that encode these human synapse proteins are really a major cause of disease,” he said. “There are over 135 nervous system diseases, psychiatric and neurological, that arise because of defects in these synaptic proteins. These are common and rare diseases – schizophrenia, bipolar disorder, autism.”

Although there are those doubting the EEG being used a diagnostic tool, it could help in the future as research continues, to decide on the best medications to use, and also to create new medications.

(1) http://www.mayoclinic.com/health/eeg/MY00296
(2) http://www.eeginfo.com/research/bipolar_main.html
(3) http://www.guardian.co.uk/science/2010/jul/05/brain-scans-predict-schizophrenia

Diagnostic Tools Part 1 – MRI and fMRI

They’re always looking for a way to diagnose mental illness using the physical body, assuming the physical and mental are somehow interconnected. I’m going to go over popular diagnostic tools and sho how effective they are in diagnosing, or confirming a bipolar disorder diagnosis.

 

Image

MRI

Magnetic resonance imaging is in the works of becoming a diagnostic tool for bipolar disorder, according to the researchers at the Royal College of Psychiatrists International Congress.(1)

A function MRI (or fMRI) can be used to scan the neural pathways and DTI (Diffusion Tension Imaging) can scan the brains white matter.

So far, scans of brains of those with depression or bipolar disorder have shown differences from the brains of those who do not have these conditions. “Functionally coupled” activity is shown in two parts of the brain: the amygdala(2) and the pre-frontal cortex(3).

Those with bipolar disorder had an increased right lateral ventricular(4), left temporal lobe(5) and right putamen(6) volume. If the patients were taking lithium, hippocampal(7) and amygdala(2) volume were significantly increased. Cerebral volume reduction was associated with illness duration in bipolar individuals.

 

In conclusion, there is hope out there for a fairly simple diagnostic test for bipolar disorder. It can even be used to predict bipolar disorder.

 

 

  1. http://www.medicalnewstoday.com/releases/192747.php

  2. The amygdala processes emotions.

  3. The pre-frontal cortex is important for emotional regulation.

  4. Protects the brain from trauma.

  5. Information retrieval, reading, emotional stability, memory, sensory processing

  6. Regulate movements and influence various types of learning.

  7. Plays a role in memory, spatial navigation and control of attention.

Scary Side Effects Part 2 – Neuroleptic Malignant Syndrome

I’m not writing this because I’m anti-medications or anything. I’m a big fan of being on my medications or I wouldn’t be functional at all. But when you introduce different chemicals into the body, it can affect more than what it’s meant to do. I took Seroquel for many, many years, and eventually switched to Zeldox (Geodon). I switched back to Seroquel, and at 400mg, I could hardly get out of bed to go to the washroom after I took my night dose. The highest dose I had been on was 900mg. 300Mg’s 3 times a day.

Then I noticed some weird side effects. I couldn’t swallow. Then I would start to panic, get up, drugged out, drink water, try to sleep, have to pee, wash rinse repeat. I also noticed fluttering in my chest, my heart kept beating “wrong”. Too fast, too slow. I would panic until I was eventually knocked out by the ‘quel but it took a while since I’m quite the insomniac. Upon hearing my symptoms, the Seroquel was discontinued and I heard of something called neuroleptic malignant syndrome, and it fit. I mostly had symptoms of dysautonomia.

 What is Neuroleptic Malignant Syndrome?

NMS is a neurological disorder generally caused by some (not all, and very rarely) antipsychotics.(1) It is potentially deadly and starts in the first two or three weeks of antipsychotic use. It is a bit more common in the original antipsychotics (for example, Thorazine), and happens on the occasional atypical antispychotic, which is the new treatment for psychosis and mood stabilization.(2)

 What are the symptoms of NMS?

  • high fever, sweating, unstable blood pressure, stupor, muscle rigidity and dysautonomia(3).

  • Dysautonomia is a disease in itself. It is a medical term used for a group of conditions caused by the autonomic nervous system (ANS). Symptoms include:

  • — tachycardia (extremely fast heart rate)
    — bradycardia (slow heart rate), palpitations
    — chest pain
    — dangerously low blood pressure
    — wide swings/sudden drops in blood pressure
    — orthostatic intolerance (the inability to remain upright)
    — excessive  fatigue exercise intolerance
    — dizziness, fainting/near fainting
    — gastrointestinal problems
    — nausea, insomnia
    — shortness of breath
    –anxiety tremulousness
    — frequent urination
    — convulsions
    — cognitive impairment
    — visual blurring or tunneling
    — migraines

What causes NMS?

An adverse reaction to an antipsychotic or neuroleptic drug.

What is the treatment?

Immediate discontinuation of the medication, the symptoms are treated (mostly the fever) and a dopamine agonist can be useful. There is no diagnostic test.

What happens if it goes untreated?

It can be fatal.

  1. http://www.ninds.nih.gov/disorders/neuroleptic_syndrome/neuroleptic_syndrome.htm

  2. http://emedicine.medscape.com/article/288482-overview

  3. http://www.uptodate.com/contents/neuroleptic-malignant-syndrome

  4. http://www.medicalnewstoday.com/releases/76785.php

Different Diagnosis and Co-morbid Disorders

Differential Diagnosis

Determination of which one of two or more diseases with similar symptoms is the one from which the patient is suffering. Also called differentiation.” (1)

 

Other conditions to be considered before a bipolar disorder diagnosis are as follows:(2)

Epilepsy

Epilepsy is a disorder of the brain caused by sudden, large discharges of electrical impulses from brain cells. This disturbance affects the brain’s normal functions and produces changes in a person’s movement, behavior or consciousness.

 

Fahr Disease

A rare, inherited, progressive brain disorder that is characterized clinically by involuntary movements, prolonged muscle contractions, anddementia. It is characterized by abnormal deposits of calcium in the basal ganglia and cerebral cortex of the brain. There is no cure for Fahr syndrome.Treatment is directed toward relieving symptoms.

 

AIDS

As HIV and AIDS progress, many symptoms show up, some of them mental, including mood swings, depression and suicidal ideation.

 

Brain Tumor/Head Injury

Any condition affecting the central nervous system can affect emotional stability as well.

 

Medications

Many people don’t see a doctor when they’re manic, because it has a tendency to feel good, but they’ll go during a depressed episode. Often, the bipolar disorder is “missed” and they are given medications for depression (usually an SSRI or SNRI) which can cause irritability, anger, and mixed or manic episodes.

 

Circadian rhythm desynchronization

An interruption in the regular recurrence in cycles of about 24 hours from one point to another, such as certain biological activities that do this regardless of long periods of darkness or other changes in environmental conditions.

 

Sodium Imbalance

Too much or too little sodium in the system can cause drastic mood swings, confusion and irritability.

 

Cushing syndrome

This is an imbalance in the pituitary gland, which is part of the brain(6). This causes depression by causing hormonal and metabolism changes, which can cause dramatic mood swings, or just major depression.

 

Hyper or hypothyroidism

If too much of the hormone is found, it causes nervousness. If too little of it is found, it can cause extreme fatigue.

 

Multiple Sclerosis

MS damages white matter in the brain, in that the central nervous system controls most of the bodies functioning. It most commonly mimics bipolar disorder.

 

Neurosyphyilis

If syphilis (an STD) reaches the brain, it can cause dementia and other psychiatric disturbances.

 

Lyme Disease

This is a serious bacterial infection that in late stages, affects the neurology of the brain causing, depression, psychosis and bipolar-like mood swings.

 

Lupus

Lupus is an autoimmune (the body attacking itself)| disease which can affect the central nervous system functioning.

 

Co-morbid Disorders(3)

Most (95%) of the respondents with BPD in the National Comorbidity Survey met criteria for 3 or more lifetime psychiatric disorders(4)

 

Anxiety

Anxiety is often diagnosed with bipolar disorder and it can have devastating effects on treatment and diagnosis. There can be social impairment and the risk of suicide is much higher.(7)

 

Substance abuse disorder

Up to 50% of those diagnosed with bipolar disorder have abused substances in their life. They are often self medicating(8) but some of the symptoms of substance use disorder are the same as bipolar disorder, such as poor impulse control and poor judgement.

 

ADHD

21.2% of those diagnosed with ADHD also meet the criteria for bipolar disorder.

One study found that the symptoms of elation, grandiosity, flight of ideas/racing thoughts, less need for sleep, and hypersexuality were best for distinguishing between ADHD and bipolar disorder in a sample of prepubertal and adolescent youth. However, this same study found that the symptoms of irritability, hyperactivity, accelerated speech, and distractibility were all common in both bipolar disorder and ADHD, and were therefore not as useful for making good differential diagnoses.”

 

Cluster B personality disorders

Because of their overlapping phenomenology and mutually chronic, persistent nature, distinctions between bipolar disorder and cluster B personality disorders remain a source of unresolved clinical controversy. The extent to which comorbid personality disorders impact course and outcome for bipolar patients also has received little systematic study.”(10)

Borderline personality disorder is often misdiagnosed or comorbid with bipolar disorder.

 

Cardiovascular disease

There is a link between the heart and mind and bipolar patients are more likely to die of cardiovascular disease than people that are not mentally interesting. It is frequently undiagnosed and treated.(11) Those will bipolar disorder should get regular physicals and have their hearts checked more than those without bipolar disorder. (EKG, echo, stress test, and so on)

 

Type 2 diabetes mellutis and other endocrin disorders

Because their bodies cannot regulate blood sugar and glucose, so the high’s and low’s in blood sugar can cause irritability, fatigue, and other symptoms associated with depression or bipolar disorder.

 

Migraines

47% of people that have migraines are clinically depressed(12). Bipolar disorder and migraines is, in fact, a subtype of bipolar disorder itself.

 

Eating disorders

Studies show that there is an associated between subthreshold bipolar disorder and eating disorders, particularly in adolescents, and between hypomania and eating disorders, especially in binge eating disorders, which is more likely to be an adult. Clinical studies show that many with bipolar disorder overlap with eating disorders. There are many parallel’s between bipolar disorder and eating disorders, such as: eating dysregulation, mood dysregulation, impulsivity and compulsivity, craving for activity or exercise.(13)

* I personally suffered from an eating disorder for 8 years: ED-NOS and my moods were most turbulent through those times.

 

PTSD

11% to 39% of those with bipolar also qualify for the diagnosis of Post Traumatic Stress Disorder.(14)

Many with bipolar disorder have had traumatic experiences in life, for example, taking a serious risk during a manic episode.

 

Before a diagnosis is made, all other conditions must be ruled out. On average, it takes five years to get a correct bipolar diagnosis.(5)

 

  1. http://medical-dictionary.thefreedictionary.com/differential+diagnosis

  2. http://emedicine.medscape.com/article/286342-differential

  3. http://www.psychiatrictimes.com/image/image_gallery?img_id=1391585&t=1237832000655

  4. http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=2516

  5. http://bipolar.about.com/cs/menu_diagnosis/a/diag_physcond.htm

  6. http://health.gather.com/viewArticle.action?articleId=281474978229499

  7. http://www.ncbi.nlm.nih.gov/pubmed/16426110

  8. http://www.medscape.com/viewarticle/515954

  9. http://www.medscape.org/viewarticle/549973

  10. http://www.ncbi.nlm.nih.gov/pubmed/15766300

  11. http://www.ncbi.nlm.nih.gov/pubmed/19794361

  12. http://headaches.about.com/od/comorbidconditions/a/BipolarMx.htm

  13. http://www.ncbi.nlm.nih.gov/pubmed/15935230

  14. http://ptsd.about.com/od/relatedconditions/a/PTSDBipolarDisorder.htm

 

The Fisher Wallace Unit: Worth it?

ImageThe Fisher Wallace Unit.

 

I personally haven’t tried this thing out, because I can’t afford it, and I haven’t done the research. It almost seems too good to be true, so I’ve gone investigating on if this device helps or not. It is said to be used for anxiety, insomnia, and depression.

It is supposed to work relatively fast, they claim it will “relieve your symptoms within 60 days of receipt” or you get a refund(1).

 

How does it work?

It is portable and is considered “cranial electrotherapy stimulation” (CES). The name does sound kind of scary. It is delivers pulses to stimulate the brains production of serotonin and GABA(3) and beta-endorphins, three things that basically make you feel better. (2) It is FDA cleared and appears to have no side effects and has been in use for over 20 years. It is mainly used in depression, anxiety and insomnia but there are reports that it works well for alcohol withdrawal as well. No placebo effect was found(4).

 

It is used twice a day for 20 minutes. It delivers a mild current that is 1/1000th of the jolt given for ECT, so you’re sort of performing ECT on yourself. Let’s go on.. there is no memory loss. One in 500 people said they had a headache after using the CES. If the electrodes aren’t wet enough before being used, there can be irritation because of this. Some people say they feel nothing at all, others say they feel a slight tingling where the electrodes are placed.

 

Cranial Electrotherapy StatisticsImage(5)

 “It is concluded tht CES is a clinically significant addition to the treatment regimen for this patient population.”

 Is this too good to be true?

  1. The purchase price of the device will be refunded, minus a $69.95 processing fee to cover the costs of used disposables (sponges, headband, carry case) and device testing and processing. Shipping charges and the purchase of extra accessories (such as extra sponges) will not be reimbursed.” http://www.fisherwallace.com/cranial-stimulator-refund-policy

  2. http://www.fisherwallace.com/how-cranial-electrotherapy-stimulation-works

  3. GABA: A neurotransmitter that slows down the activity of nerve cells in the brain.

  4. http://www.ncbi.nlm.nih.gov/pubmed/3521373

  5. http://www.fisherwallace.com/uploads/Ray_Smith_CES_Monograph.pdf

Does semen help with depression in women?

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Well, sure, temporarily for the person receiving it. It feels good and it releases endorphins, plus it burns off calories. But what does it do to the recipient? Or the giver? Let’s taking a sexy scientific approach. And we’ll go on both sides of the fence, those who think it does and those that think it doesn’t.

Range of chemicals in semen ‘promote mental well-being and feelings of affection’, say researchers.”(1)

The State New York University conducted a study using surveying comparing 293 women to their sex life and mental health.

Apparently, semen fluid carries three “ingredients” that fight depression. Women having unprotected sex (you should always use protection!(me)) were less depressed and scored higher on cognitive tests.

Semen contains “spermatozoa” and cortisol, which causes affection and elevates mood. It also includes thyrotropin, another antidepressant, melatonin, which is used for sleep and serotonin itself, the main chemical factor in depression.

However, this isn’t new news. The studies were carried out 10 years ago. It basically compares women using condoms or other barrier methods, and women who are not.(2)

This study is full of holes and extreme caution should be used when interpreting anything from it”. 

The research began when scientists wanted to know if semen had an effect on mood in women, and that the chemicals in semen can be absorbed in the vagina. This research, done by anonymous survey, doesn’t show cause and effect.

The research involved: frequency of sex, number of days since they last had sex, and the type of contraceptive used. They were to fill out a survey on depression as well.

Statistics

  • 87% of the women were sexually active.

  • Women who had sex without condoms had lower depression scores than those who were abstraining.

  • Depression scores between women using condoms and not were very different.

  • Of the women who had never used condoms, 4.5% had attempted suicide, compared to 7.4% in the “sometimes use” group, 28.9% in the “usually use” group and 13.2% in the “always use” group.

* The 2002 study did not involve oral sex, only vaginal.

Sorry guys…

There just isn’t enough information to add up and conclude this study. It’s over 10 years old and there aren’t enough factors to make great statistics, or to prove that this is true. Women not using condoms may have poor impulse control, for example(3). Even if it does help with depression, you’d need a lot of semen to help, it’s definitely no cure, but hey, do what you’ve gotta do!

  1. http://www.dailymail.co.uk/health/article-2190863/Semen-good-womens-health-helps-fight-depression.html

  2. http://www.nhs.uk/news/2012/08august/Pages/semen-oral-sex-helps-women-fight-depression-claim.aspx

  3. http://www.alternet.org/gender/sorry-guys-just-because-one-study-claims-semen-cures-womens-depression-doesnt-mean-its-true