Mental Health America is applauding legislation introduced by a bipartisan group of U.S. Senators to establish national centers of excellence for the treatment of depression and bipolar disorders.

The centers will create a national network to help diagnose people in need and improve access to evidence-based, quality care.

The bill, called the “ENHANCED Act” was introduced by U.S. Senators Debbie Stabenow (D-Mich.), George Voinovich (R-Ohio), Sherrod Brown (D-Ohio), and John Kerry (D-Mass.). Senator Kay Bailey Hutchison (R-Tex.) is also a co-sponsor.

The legislation is based on efforts catalyzed by the University of Michigan Depression Center with 15 other leading academic medical centers across the nation. Joining together, these universities created a network of depression centers positioned to take academic research and translate it into practice, standardize diagnoses, treat early and more effectively, and prevent recurrences of depression and bipolar disorders.

In a letter to Stabenow applauding her leadership in crafting the bill, Mental Health America said:

“These centers are especially critical at this time given the strong evidence that economic uncertainty and recession increase the rates of psychiatric symptoms and demand for services. Depression is associated with poorer health outcomes and higher health care costs. Rates of depression and suicide-already at a staggering level of nearly 33,000 persons a year (roughly twice the number of homicides)-tend to climb during times of economic tumult. Our nation must prioritize the integration and coordination of mental health with general health care.” (View the full letter PDF)

The ENHANCED Act of 2009:

- Creates a national network with a pathway for developing and expanding up to 30 depression centers of excellence to increase access to the most appropriate and evidence-based depression care.

- Develops evidence-based treatment standards, clinical guidelines, and protocols to improve accurate and timely diagnosis of depression and bipolar disorders.

- Expands multidisciplinary, translational, and patient-oriented research by fostering the collaboration of academic and community-based service centers.

- Establishes a sustainable national resource for public and professional education and training, to advance knowledge and eradicate the stigma associated with depression and mood disorders.

Mental Health America looks forward to working with the Senate sponsors to win enactment of the legislation.

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Mental Health America

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Current cigarette smoking is a predictor for current and 9-month suicidal ideation and behavior in bipolar disorder (BD) patients, suggest US study results.

Studies have shown that BD patients are four times as likely to have nicotine dependence than the general population. Furthermore, cigarette smoking in BD individuals has been associated with suicidal behavior, although the precise relationship between the two remains unclear.

To investigate, Michael Ostacher (Harvard Medical School, Boston, Massachusetts) and colleagues examined the association between smoking, suicidality, and prospective suicide attempts in 116 BD patients over a 9-month period.

In total, 27% of patients were smokers who showed significantly higher rates of lifetime substance abuse disorders (61% vs 33%), were younger (37.3 vs 46.7 years), and had an earlier age of BD onset (14.4 vs 18.4 years) compared with non-smokers.

Current smoking was associated with higher baseline and 9-month follow-up Suicide Behaviors Questionnaire (SBQ) scores after adjusting for smoking status, gender, anxiety comorbidity, recovery status, age at first episode, and lifetime substance abuse.

However, this association was not significant after adjusting for impulsivity, using Barratt Impulsiveness Scale scores, suggesting that “the link between suicide may in part be explained by impulsivity, although power was limited by the relatively small number of smokers, and SBQ scores were higher in this model,” say the researchers.

Overall, eight (7%) patients attempted suicide between baseline and 9-month follow-up, with smokers 5.25-fold more likely to attempt suicide than nonsmokers (16.1% vs 3.5%).

“While the predictive value of smoking in and of itself for the identification of patients with BD at risk for suicide is small, it may be a useful addition to other clinical risk factors in a comprehensive assessment of suicide risk,” say the researchers.

They call for further research to better understand the link between smoking and elevated suicidality in BD, “with attention to personality characteristics, impulsivity, and the effect of periods of fluctuating nicotine use, withdrawal, and discontinuation.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

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• Having Parents With Bipolar Disorder Associated With Increased Risk Of Psychiatric Disorders

Postpartum bipolar II disorder may be mistakenly diagnosed as major depressive disorder, say Canadian and US scientists who make recommendations as to how patients should be treated.

Bipolar postpartum depression is commonly overlooked and mistaken for unipolar major depression. However, while bipolar I disorder is a reliable and relatively stable diagnosis, bipolar II disorder is less easily diagnosed and may be dismissed as a milder form of bipolar I disorder.

To examine the detection, diagnosis, and treatment of bipolar II postpartum depression Verinder Sharma, from the University of Western Ontario in London, Canada, and colleagues conducted a search of the PubMed database and reference lists for relevant articles published between 1998 and 2009.

Estimates of the prevalence of hypomania in non-clinical populations ranged from 9.6% to 20.4% on day 3 postpartum, at an average of approximately 15.0%. Furthermore, almost 20% of patients with hypomanic symptoms at day 3 postpartum developed postpartum depression in one study, with a significant proportion diagnosed with bipolar II disorder or bipolar disorder not otherwise specified (NOS).

Crucially, the team says in the Journal of Affective Disorders that, although there are formal rating scales for assessing bipolar spectrum disorder and unipolar postpartum depression, there are no validated instruments for screening, diagnosing, or monitoring bipolar disorder during pregnancy or postpartum, with even the Highs scale not validated as a diagnostic instrument.

There have only been three randomized controlled trials and six open-label studies of the pharmacologic treatment of postpartum depression, and three studies of the treatment of bipolar disorder during postpartum depression.

While the evidence suggests that postpartum bipolar depression should follow the same guidelines as for non-puerperal bipolar depression, the team says there is a lack of evidence-based treatment options. Women should be monitored closely, they argue, and prophylactic treatment may be considered.

The researchers conclude: “The lack of data on postpartum bipolar II and bipolar disorder NOS is surprising given the high prevalence of hypomanic symptoms immediately after delivery, the unique pharmacologic challenges posed by bipolar depression, and the heightened risk for suicide associated with bipolar spectrum disorder. and illness course that are commonly used to establish the bipolar diathesis of a clinical condition.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

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Mutations in the dystrobrevin binding protein 1 gene (DTNBP1) are associated with bipolar disorder, say European researchers in findings that reinforce the genetic overlap between schizophrenia and bipolar disorder.

As there is evidence to suggest a degree of overlap in genetic susceptibility between schizophrenia and bipolar disorder, the DTNBP1 gene, which has been linked to schizophrenia, has come under scrutiny for its potential associations with bipolar disorder.

To investigate further, Darya Gaysina, from King’s College London, UK, and colleagues genotyped 515 bipolar disorder patients and 1316 ethnically matched healthy controls for eight single nucleotide polymorphisms (SNPs), conducting an association analysis in 452 bipolar disorder patients and 956 controls.

The results, published in the American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics, showed that two SNPs ??” rs760761 and rs3213207 ??” were significantly associated with bipolar disorder, at odds ratios of 1.26 and 1.41, respectively, although only the former survived Bonferroni correction with borderline significance.

Furthermore, the G-C-G haplotype of the combined SNPs rs16876571-rs2619539-rs3213207, and the G-C-G-T haplotype of the combined SNPs rs16876571-rs2619539-rs3213207-rs760761, were significantly associated with bipolar disorder.

“Our results are consistent with previous studies in terms of a general association between the DTNBP1 and bipolar disorder,” the researchers conclude.

“They also provide additional molecular genetic evidence that a portion of the genotypic overlap between schizophrenia and bipolar affective disorder is attributable to this gene.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

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