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What Part Of The Brain Is Affected By Bipolar Disorder

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Changes In Ventricular Size And Cerebral Gray Matter Volume

The Brain Circuitry of Bipolar Disorder: A View from Brain Scanning Research

Strakowski et al. utilized MRI to compare cerebral ventricle volumes in healthy controls vs. patients suffering their first bipolar episode or those who had experienced multiple episodes . Lateral ventricles were significantly larger in patients with multiple episodes than in the first episode or healthy subjects. In particular, increased volume of the lateral ventricles directly correlated with the number of manic episodes the patients had suffered. These findings have been supported by a different group of researchers who also noted an association between ventricular volume and number of previous affective episodes. Taken together, these studies indicate that bipolar illness may be progressive and deleterious, contributing to brain tissue deterioration in the course of recurrent episodes .

How Do Medications Factor In

Treating bipolar disorder with medication can be something of a delicate balance. Antidepressants that help ease depressive episodes can sometimes trigger manic episodes.

If your healthcare provider recommends medication, they might prescribe an antimanic medication such as lithium along with an antidepressant. These medications can help prevent a manic episode.

As you work to develop a treatment plan with your care provider, let them know about any medications you take. Some medications can make both depressive and manic episodes more severe.

Also tell your care provider about any substance use, including alcohol and caffeine, since they can sometimes lead to mood episodes.

Some substances, including cocaine, ecstasy, and amphetamines, can produce a high that resembles a manic episode. Medications that might have a similar effect include:

  • high doses of appetite suppressants and cold medications
  • prednisone and other steroids
  • thyroid medication

If you believe youre experiencing a mood episode or other symptoms of bipolar disorder, its always a good idea to connect with your healthcare provider as soon as possible.

The Hippocampus Which Plays An Important Role In Memory And Special Navigation Shows Differences In People With Major Depressive Disorder And People With No Psychiatric Diagnosis

HOUSTON A volume decrease in specific parts of the brains hippocampus long identified as a hub of mood and memory processing was linked to bipolar disorder in a study led by researchers at The University of Texas Health Science Center at Houston . The research was published today in Molecular Psychiatry, part of the Nature Publishing Group.

Our study is one of the first to locate possible damage of bipolar disorder in specific subfields within the hippocampus, said Bo Cao, Ph.D., first and corresponding author and a postdoctoral fellow in the Department of Psychiatry and Behavioral Sciences at McGovern Medical School at UTHealth. This is something that researchers have been trying to answer. The theory was that different subfields of the hippocampus may have different functions and may be affected differently in different mood disorders, such as bipolar disorder and major depression disorder.

Cao hopes the study, which was funded in part by the National Institute of Mental Health , will pioneer future research on details within the hippocampus as a marker for precise diagnosis and positive treatment response of bipolar disorder.

The research team used a combination of magnetic resonance imaging and a state-of-the-art segmentation approach to discover differences in the volumes of subfields of the hippocampus, a seahorse-shaped region in the brain. Subjects with bipolar disorder were compared to healthy subjects and subjects with major depressive disorder.

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Let Us Help You Manage & Treat Bipolar Disorder

As debilitating as bipolar disorder can be, it doesnt have to control your life. Here at StoneRidge Centers, we have programs that can help you manage the mood disorder and any other co-occurring disorders you may be living with. Were passionate and focused on restoring the brain to its optimal state of health. Thats why we have designed our programs to include the best of what brain science has to offer.

At the same time, we know that living with and managing a mood disorder can be challenging and overwhelming, so our approach to care is compassionate and comprehensive. Call us today at 928-583-7799 if you or a loved one are living with bipolar disorder and are ready to manage it in a healthy, wholesome way.


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Integrated Neurobiology Of Bipolar Disorder

Bipolar Disorder
  • 1Department of Neuropsychiatry and Behavioral Sciences, University of South Carolina School of Medicine, Columbia, SC, USA
  • 2Department of Psychiatry, University of Arizona, Tucson, AZ, USA
  • 3Norton School of Family and Consumer Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, USA

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Global Study Reveals Thinning Of Gray Matter In Brain Regions Responsible For Inhibition And Emotion

In the largest MRI study to date on patients with bipolar disorder, a global consortium published new research showing that people with the condition have differences in the brain regions that control inhibition and emotion.

We created the first global map of bipolar disorder and how it affects the brain, resolving years of uncertainty on how peoples brains differ when they have this severe illness, said Ole A. Andreassen, senior author of the study and a professor at the University of Oslo.

Bipolar disorder affects about 60 million people worldwide, according to the World Health Organization. It is a debilitating psychiatric disorder with serious implications for those affected and their families. However, scientists have struggled to pinpoint neurobiological mechanisms of the disorder, partly due to the lack of sufficient brain scans.

The study was part of an international consortium led by the USC Stevens Neuroimaging and Informatics Institute at the Keck School of Medicine of USC: ENIGMA spans 76 centers and includes 26 different research groups around the world.

Bipolar Disorder And Endocrinology

Neurotransmitters are not the only important chemical messengers in the body. The body also uses hormones as chemical messengers. Produced in the endocrine system, hormones circulate from one organ to another through the bloodstream. Receiving organs in the body interpret hormonal signals and respond to their messages.

The endocrine and nervous systems are linked by the hypothalamus. This is a centrally located ‘switching station’ within the brain. The hypothalamus is an exceptionally complex brain region. It controls many different body functions such as blood pressure, appetite, immune responses, body temperature, maternal behavior, and body rhythms dealing with circadian and seasonal rhythms. This coordination of circadian and seasonal body rhythms is particularly important when discussing bipolar disorder. .

Another component of the endocrine system which is known to cause mood fluctuations when not being regulated correctly is the reproductive system. As reproductive hormones are known to affect mood, most prominently in women, the source of this effect is thought to be the ovaries which secrete estrogen and testosterone. Although the role sex hormones play in mood conditions are well documented , exactly how these hormones affect mood is unclear. There is little information available currently regarding their possible role in causing or maintaining bipolar symptoms.

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Mental Illness In Adults

Scientists estimate that one of every four people is affected by mentalillness either directly or indirectly.

Even if you or a family member has not experienced mental illness directly, it isvery likely that you have known someone who has. Estimates are that at least onein four people is affected by mental illness either directly or indirectly. Consider the followingstatistics to get an idea of just how widespread the effects of mental illnessare in society: , ,

  • According to recent estimates, approximately 20 percent of Americans,or about one in five people over the age of 18, suffer from adiagnosable mental disorder in a given year.
  • Four of the 10 leading causes of disabilityâmajordepression, bipolar disorder, schizophrenia, andobsessive-compulsive disorderâare mental illnesses.
  • About 3 percent of the population have more than one mental illnessat a time.
  • About 5 percent of adults are affected so seriously by mental illnessthat it interferes with their ability to function in society. Thesesevere and persistent mental illnesses include schizophrenia,bipolar disorder, other severe forms of depression, panicdisorder, and obsessive-compulsive disorder.
  • Approximately 20 percent of doctor’s appointments are related toanxiety disorders such as panic attacks.
  • Eight million people have depression each year.
  • Two million Americans have schizophrenia disorders, and 300,000 newcases are diagnosed each year.

The Effects Of Bipolar Disorder

The Brain & Bipolar Disorder

Bipolar disorder is identified by periods of manic episodes.

During a manic phase, you have above-average energy levels, and may not sleep much. You can also experience irritability, restlessness, and an increased sex drive.

If you develop depression, this phase can have the opposite effects on the body. You may feel a sudden lack of energy and require more sleep, along with feeling depressed and hopeless.

Appetite changes can also occur if the person develops depression. As with mania, depression can also cause irritability and restlessness.

Its also possible to experience a mixed-state of mania and depression. You might notice symptoms from both phases.

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Underlying Mechanism For Cell Loss

Activation of the HPA axis appears to play a critical role in mediatinghippocampal atrophy, as was already discussed. In addition to directly causingneuronal atrophy, stress and glucocorticoids also appear to reduce cellularresilience, thereby making certain neurons more vulnerable to other insults,such as ischemia, hypoglycemia, and excitatory aminoacid toxicity.

Who Has Bipolar Disorder

Nearly 6 million adults in America are affected by bipolar disorder, which can also affect children and adolescents. The onset of the disorder most commonly begins in young adulthood , but it can also start in childhood or as late as in a persons 50s.

Men and women are equally likely to develop the disorder, which tends to run in families. People with a parent or sibling with the condition are more likely to develop it. This indicates there may be a genetic factor involved. However, its important to know that having a family member with the condition does not mean that you will get it too. In addition, remember that your genetics are not your destiny. A growing body of evidence shows that your lifestyle habits can either turn on or turn off your genes.

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Imaging Studies Of Euthymia/remission

A number of studies have examined remitted patients with bipolar disorder in similar imaging protocols to those employed in mania. The Stroop test, where color words are presented in congruent or incongruent inks, has been widely validated for use in neuroimaging. This paradigm yields a robust signal in the anterior cingulate cortex during presentation of incongruent, stimuli, where the natural tendency to read the color word must, be overriden. Gruber et al reported reduced anterior cingulate activity in remitted bipolar patients compared with controls, which may indicate a failure to recruit prefrontal cortex during effortful executive control.- Remitted bipolar patients have also been reported to show deactivation in orbital and medial prefrontal cortex during the incongruent Stroop blocks,- an effect that was also seen in manic and depressed bipolar groups, suggesting a trait, marker of pathophysiology in the orbitofrontal cortex.

The Causes Of Mental Illnesses5

Functional brain changes in bipolar disorder. Based on ...

At this time, scientists do not have a complete understanding of what causes mentalillnesses. If you think about the structural and organizational complexity of thebrain together with the complexity of effects that mental illnesses have onthoughts, feelings, and behaviors, it is hardly surprising that figuring out thecauses of mental illnesses is a daunting task. The fields of neuroscience,psychiatry, and psychology address different aspects of the relationship between thebiology of the brain and individuals’ behaviors, thoughts, and feelings, and howtheir actions sometimes get out of control. Through this multidisciplinary research,scientists are trying to find the causes of mental illnesses. Once scientists candetermine the causes of a mental illness, they can use that knowledge to develop newtreatments or to find a cure.

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Cognitive Effects Of Bipolar Medications

Studies examining cognitive function and neural systems in bipolar disorder are typically confounded by medication status. It is common for patients in research studies to be maintained on mood-stabilizing medications, and many studies also include subgroups of patients receiving neuroleptics, antidepressants and sedatives. These medications may act directly to influence cognitive function in either a beneficial or detrimental manner. A number of studies have investigated the effects of lithium medication on cognition, . These studies have employed a variety of designs, cither comparing bipolar patients on and off lithium medication, comparing lithium-treated euthymic patients against, controls, or studying the effects of lithium versus placebo in healthy volunteers.- These studies have shown reliable effects on psychomotor speed, consistent, with frequent complaints of mental slowing from patients. There is also some evidence for impaired learning and memory function, but higher-level executive function and attention appear to be spared, and there is no evidence for cumulative effects of long-term treatment. A number of the neuropsychological studies in euthymic bipolar patients have also performed post-hoc analyses to examine potential confounding effects of lithium treatment- and have generally found patients receiving lithium to perform similarly to those not receiving lithium.

Information About Specific Mental Illnesses9

A diagnosis of mental illness is rarely simple and straightforward. There are noinfallible physiological tests that determine whether a person has a mental illness.Diagnosis requires that qualified healthcare professionals identify several specificsymptoms that the person exhibits. Each mental illness has characteristic signs andsymptoms that are related to the underlying biological dysfunction. The followingsections describe the symptoms and outcomes of three mental illnesses that arehighlighted in this curriculum supplement: depression, attention deficithyperactivity disorder, and schizophrenia.

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Prefrontal Cortical Abnormalities In Bipolar Disorder

Prefrontal cortical abnormalities are a common finding in bipolar disorder. Imaging studies have reported functional and structural changes in the vmPFC of adolescents and young adult bipolar patients relative to healthy controls . Dysfunction of vmPFC activity may be common to mood disorders and independent of mood state because it has been described in both unipolar and bipolar depression as well as in the context of elevated mood . The vmPFC has rich reciprocal connections with limbic formations and the hypothalamus. Together with the ACC and amygdala, the vmPFC may belong to an integrative network involved in processing emotionally relevant information, which coordinates autonomic and endocrine responses and influences behavior . Aberrant vmPFC activity in the context of bipolar illness may therefore be reflected in compromised ability to adapt to changes in emotional and social circumstances. Manic patients tend to be excessively preoccupied by hedonic interests, whereas depressed individuals demonstrate impaired emotional and endocrine homeostasis. Furthermore, endocrine disturbances are also a common feature of elevated mood states . The vmPFC is also a source of feedback regulation to monoaminergic brainstem nuclei, so its malfunction may be reflected in altered neurotransmission .

Mental Illness And The Brain4

Bipolar Disorder, Genetics, and the Brain (12 of 15)

The term mental illness clearly indicates that there is a problem with the mind. Butis it just the mind in an abstract sense, or is there a physical basis to mentalillness? As scientists continue to investigate mental illnesses and their causes,they learn more and more about how the biological processes that make the brain workare changed when a person has a mental illness.

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Early Identification And Intervention Improve Outcomes

Treatment interventions that improve PFC modulation might improve outcome

Can we find the molecular basis of BPD1 to enable therapeutic intervention and improve the lives of people with BPD1, asked Professor Strakowski.

Imaging and other measures can be used to identify those patients at high risk of BPD1, and treatment interventions that improve PFC modulation might be able to impact the course of the illness, Professor Strakowski said. Decreases in brain activation have been observed in patients being treated for BPD1, providing evidence for potential neuroanatomic treatment response markers in first-episode BPD1.2

The natural course of the illness is shortening intervals between episodes of BPD1 over time. Lateral ventriculomegaly is greater in BPD1 patients, who have had repeated manic episodes and is associated with the number of previous manic episodes.5 This is probably part of the progressive course, said Professor Strakowski. A similar finding has been found in the cerebellum, but further work is needed to clarify the changes.

The biggest predictor of treatment response is prior treatment response, concluded Professor Strakowski. Most importantly, patients who adhere to early treatment and who avoid recreational drugs and alcohol have much better outcomes, and most can lead normal lives with good management.

Bipolar Disorder: Where Does It ‘live’ In The Brain

Stephen M. Strakowski, MD

Hello. I am Dr Stephen M. Strakowski. I am a professor at the University of Cincinnati in the departments of psychiatry, psychology, and biomedical engineering, where I also serve within the affiliated UC Health system as senior vice president and chief strategy officer.

Today I want to talk about the functional neuroanatomy of bipolar disorderwhere in the brain bipolar disorder “lives.” There have been a lot of advances, particularly through neuroimaging techniques, to better understand where bipolar disorder lives in the brain and what brain regions are involved. We will review those today and then think about where the field is going next.

Figure 1. Prefrontal cortex loops nuancing behavior.

Figure 1 demonstrates the primary brain areas that we are going to talk about. In particular, on the left side of the brain is the orbitofrontal or ventral prefrontal cortex. This part of the brain is important in that it modulates deeper structures through iterative networks of loops, including the nucleus accumbens and striatum. These loop through the thalamus and globus pallidus and then are managed and innervated back and forth with the amygdala. The prefrontal cortex is a uniquely human structure that is underdeveloped in other animals. The ventral portion seems to be predominately involved in managing emotional behaviors. It is not a big stretch to imagine that mania involves abnormalities in these networks.


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What Treatments Are Available


Normal Synapse

Synapse With Reuptake Inhibitor

Medications used for controlling seizures work forsome people in particular, valproate and carbamazepine workin many cases either with lithium or as an alternative to lithium. Neweranticonvulsant drugs are being studied to determine how well they work at combatingthe symptoms of BD.

Some antipsychotic drugs such as clozapine or olanzapine mayprevent mania in some people with BD, but more research is needed to seeif long-term use is safe and effective.

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