Mania slowly eats your brain (seriously)

Mania, the horrible mistress of bipolar disorder. We sometimes take it for granted in it’s early stages, hypomania, but in a full blown out manic episode, everything can go to hell. Many people accidentally kill themselves in manic episodes. But did you know, that during an episode, you’re killing your brain?

“Episodes of mania and depression may cause damage to learning and memory systems”(1)

Long term patients showed more cognitive impairment than those younger, or newly diagnosed. Bipolar disorder and time are not your friends. After 5-7 years, the newly diagnosed showed some cognitive impairment.

It can be blamed on medications, but that’s untrue. They can cause cognitive slowing but they aren’t a culprit. Some medications even repair parts of the brain, and are considered to have neuroprotective properties.

The brain breaks down as the disease goes on, and it isn’t able to process information the way it used to. (Remember, bipolar is a kindling disease, if left untreated, it just gets worse and worse, and the damage increases per episode)

“People with bipolar disorder suffer from an accelerated shrinking of the brain”(2)

Gray matter in the brain is lost during an episode, in the areas of the brain that control memory, face recognition and co-ordination.

“Evidence has been overwhelming that bipolar disorder is a disease of the brain, like Parkinson’s or MS”(3)

Those with bipolar disorder have enlarged ventricles in the brain and extra white matter, for example. Impaired awareness (50% of those with bipolar disorder are aware of their disease, diagnosed or not) is because of decreased activity in the pre-frontal area. This is similar to a stroke victim.

Results of MRI’s from the mentally interesting and people without mental illness show that those without mental illness had more gray matter in their brains.(4) Gray matter is consisted of nerve cells. An essential amino acid, called NAA, was monitored in bipolar patients and the amount decreased as the illness progressed, which indicates damage to neurons. These findings are comparable in Alzheimer’s.

In conclusion, if you’ve been diagnosed with bipolar disorder and want to make the best of your life, take your medications, live a healthy lifestyle, don’t drink or do drugs and learn some insight to get proper treatment before an episode happens.

And just remember this: What goes up, must come down.

  1. http://www.healthyplace.com/bipolar-disorder/articles/brain-damage-from-bipolar-disorder/

  2. http://www.sciencedaily.com/releases/2007/07/070720103036.htm

  3. http://www.pendulum.org/disease.htm

  4. http://www.ehow.com/about_5245785_effects-bipolar-disorder-brain.html

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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.

Bipolar Disorder vs. Epilepsy

How are they connected?

 Epilepsy is a condition in the brain that causes seizures or brain dysfunction due to excessive neuron discharge. Psychiatric disturbances are common in epilepsy.

 Mood disorder’s are often comorbid with epilepsy, these two conditions share many biochemical and pathophysiological underpinnings, such as kindling, change in neurotransmitters, and modifications in messenger systems1. Both are episodic conditions that can worsen over time (kindling) and become chronic. Mood instability is frequent in those with epilepsy, but they don’t always meet the criteria for an actual affective (mood) disorder. There is a link between neurobehavioural disorders and temporal lobe epilepsy, as well as a strong link with complex partial epilepsy2.

I’m not going to get into excessive definitions of epilepsy, as this is a bipolar blog, but I will try to be as descriptive as possible.

 One problem with the consensus that epilepsy is comorbid with mood disorders is that the sampling could be incorrect because of inadequate control groups. But for the most part, professionals believe the link between mood disorders and epilepsy is quite strong, though a few disagree.

In studying the relationship between epilepsy and psychiatric disorders, care must be taken to differentiate between the following:

  • Psychiatric disorders caused by the seizures of the epilepsy – Ictal disorders, postictal disorders, and interictal disorders
  • Epileptic and psychiatric disorders caused by common brain pathology
  • Epileptic and psychiatric disorders that happen to coexist in the same patient but are not causally related

Factors in the relationship between epilepsy and behavioural & mood disorders

Epilepsy and mood disorders share a neuropathology3 , genetic predisposition and developmental disturbances. There can be problems with hormones and alteration of receptor sensitivity (receptors not working the way they should). Both could be caused by complications of medical or surgical treatment., and consequence of psychosocial burden of epilepsy itself2.

 

Because of the phenomenology of epilepsy, the close association between epilepsy and psychiatry has a long history. The traditional approach to epilepsy care has been to focus on the seizures and their treatment. Concentrating only on the treatment of the seizures, which occupy only a small proportion of the patient’s life, does not seem to address many of the issues that have an adverse impact on the quality of life of the patient with epilepsy.”

Statistics

20-30% of those with epilepsy have psychiatric disturbances of some kind. Tucker reports that 70% of those with complex partial epilepsy met criteria for at least one disorder in the DSM. 58% of those patients suffered from depression, 32% had an anxiety disorder and 13% had psychosis. The most common conditions in epilepsy are depression, anxiety and psychosis.

There is a risk of psychosis in epilepsy 6-12x’s that of the general population.

Psychiatric Disorder

Controls

Patients With Epilepsy

Major depressive disorder

10.7%

17.4%

Anxiety disorder

11.2%

22.8%

Mood/anxiety disorder

19.6%

34.2%

Suicidal Ideation

13.3%

25.0%

Others

20.7%

35.5%

 

A number of studies have demonstrated that affective disorders in epilepsy represent a common psychiatric comorbidity; however, most of the classic neuropsychiatric literature focuses on depression, which is actually prominent, but little is known about bipolar depression, and very little about mania, in epilepsy4

 

The Frontal Lobe

According to NAMI, bipolar disorder is caused by a chemical imbalance in the frontal lobe of the brain. In a manic state, activity in the frontal lobe increases signifigantly5. With depression, activity in the frontal lobe decreases. MRI’s show that there are small inconsistencies in the white matter of the brain, caused by loss of myelin.

 

Frontal lobe epilepsy is the second most common type of epilepsy, with temporal lobe epilepsy being the first6. It is often genetic. The frontal lobes are large areas that control a good portion of the brain and body, so when a seizure begins in the frontal lobes, it goes haywire and spreads to other parts of the brain causing a tonic-clonic (lying on the ground jerking around) seizure.

 

How does that relate them?

Because the same area of the brain is affected, mood stabilizers (except for lithium) called anti-consultants can work on someone with bipolar disorder and someone with epilepsy. There is little known on exactly why this happens. The two conditions can be considered comorbid because the same medications can be used to treat them. (And many with epilepsy are also mentally ill)

 

Medications

The class of medications, anti-consultants, target the same area of the brain for epilepsy and bipolar disorder. The medications target the GABA and glutamate neurotransmitters. Glutamate in high amounts is associated with bipolar disorder mania and epilepsy. This relates them because the same neurotransmitters are targeted and dysfunctional7. Bipolar disorder and epilepsy can also occur after a head injury. Estrogen also makes bipolar disorder and epilepsy worse.

 

Conclusion

So there you have it, links between epilepsy and bipolar disorder. There still needs to be a lot of research done, but evidence is pointing that the two may be comorbid (existing together) conditions.

 

 

  1. http://www.ncbi.nlm.nih.gov/pubmed/20021317

  2. http://emedicine.medscape.com/article/1186336-overview

  3. A deviation from the norm in the nervous system

  4. http://nro.sagepub.com/content/13/4/392.abstract

  5. http://www.ehow.com/facts_4813697_frontal-lobe-effects-bipolar-disorder.html

  6. http://www.epilepsy.com/epilepsy/epilepsy_frontallobe

  7. http://www.bipolarworld.net/Phelps/ph_2000/ph8.htm

     

Psychosurgery Part 2 – Capsulotomy and Anterior Capsulotomy

*Note: This surgery is also used for cataracts and laser eye surgey, except in the eye, not the skull.

This involves drilling holes in the skull. That sounds pretty scary, but it’s actually pretty safe! This surgery was originally performed in Sweden. Small holes are drilled into the skull and electrodes are inserted into the brain, then heated up and small areas of tissue are destroyed. If there is no response, a second surgery is performed. 20% of the surgeries done are being performed again.

Since this surgery was introduced, some neurosurgeons use gamma knives to avoid drilling into the skull.

In the first 116 patients operated on by Leksell, 50% of patients with obsessional neurosis and 48% of depressed patients had a “satisfactory” response. Only 20% of patients with anxietyneurosis and 14% of patients with schizophrenia showed any improvement. In this classification system, only patients who were free of symptoms or markedly improved were judged as having a satisfactory response.

Of the patients who were rated as worse after capsulotomy, nine were schizohphrenic, four were depressives and three obsessives.

Percentages of Success and Failure with Capsulotomy Psychosurgery

Satisfactory Response to Capsultomy

  • Obsessional Neurosis – 48%

  • Anxiety Neurosis – 20%

  • Schizophrenia – 14%

Rated Worse After Capsultomy Psychosurgery – 14%”1

Side effects from this surgery include: emotional blunting, indifference, low initiative, fatigue and urinary incontinence. Studies2 have shown that the procedure is relatively safe.

However, at the 1-year follow-up, 7 patients reported fatigue, 4 reported poor memory, 2 felt more talkative, and 2 reported carelessness. In a recent study 13 of 15 patients had a permanent behavior disorder after postoperative brain edema, but the other 14 did not have any permanent adverse effects, and the study therefore indicates that the procedure is relatively safe.“2

Safety:

Brain surgery sounds dangerous, and it can be! There are risks to any surgery, though, especially when a general anesthetic is used. A case study2 shows that 9 patients attempted suicide before undergoing the procedure and one committed suicide after the surgery. One of the 9 patients developed radiation necrosis (infection), apathy, memory problems and executive dysfunction. This can be caused by using too strong a gamma ray.

It appears to be weight neutral, but can effect libido, a side effect of many medications.

I found an interesting case study on a woman killing herself through anorexia with obsessive-compulsive disorder, here it is:

Successful anterior capsulotomy in comorbid anorexia nervosa and obsessive-compulsive disorder: case report.

BACKGROUND AND IMPORTANCE:

State-of-the-art treatment of anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) often proves ineffective. Both disorders have common features, and anterior capsulotomy is a last-resort treatment for OCD. We document the effect of bilateral anterior capsulotomy in a patient with comorbid AN and OCD.

CLINICAL PRESENTATION:

A 38-year-old woman with life-threatening, chronic, treatment-refractory AN and OCD underwent anterior capsulotomy. Psychiatric and neuropsychological evaluations at baseline and at follow-up document the severity and progress of the case. Bilateral anterior capsulotomy resulted in normalization of eating pattern and weight and a significant decrease of food-related and overall obsessive-compulsive symptoms. Psychiatric evaluations and exposure to food cues confirmed the clinical improvement that was evident immediately after surgery and sustained at 3-month follow-up.

CONCLUSION:

This case report suggests that bilateral anterior capsulotomy can be a therapeutic option for patients with comorbid AN and OCD. However, a well-controlled study is warranted.3”

 

Controversy

A 58 year old woman underwent the surgery and became mute and robotic (sort of like catatonic) Due to the location of the surgery the frontal lobes can get damaged badly, there can be damage to high mental functions, judging, insight, future planning, social awareness and creativity. It really is a modern day lobotomy, with a different name.

This is something I would never try, the fail rates are too high and the benefit outweighs the risk.

  1. http://www.winmentalhealth.com/psychosurgery_lobotomy_cingulotomy.php

  2. http://archpsyc.jamanetwork.com/article.aspx?articleid=210096

  3. http://www.ncbi.nlm.nih.gov/pubmed/21471837

  4. http://breggin.com/index.php?option=com_content&task=view&id=148