Young May Outgrow Bipolar Disorder

Young Adults May Outgrow Bipolar Disorder

30 Sep 2009

Bipolar disorder, or manic-depression, causes severe and unusual shifts in mood and energy, affecting a person's ability to perform everyday tasks. With symptoms often starting in early adulthood, bipolar disorder has been thought of traditionally as a lifelong disorder. Now, University of Missouri researchers have found evidence that nearly half of those diagnosed between the ages of 18 and 25 may outgrow the disorder by the time they reach 30.

"Using two large nationally representative studies, we found that there was a strikingly high peak prevalence of bipolar disorders in emerging adulthood," said David Cicero, doctoral student in the Department of Psychological Sciences in the College of Arts and Science and lead author of the paper. "During the third decade of life, the prevalence of the disorder appears to resolve substantially, suggesting patients become less symptomatic and may have a greater chance of recovery."

By examining the results of two large national surveys, MU researchers found an "age gradient" in the prevalence of bipolar disorder, with part of the population appearing to outgrow the disorder. In the survey results, 5.5 to 6.2 percent of people between the ages of 18 and 24 suffer from bipolar disorder, but only about 3 percent of people older than 29 suffer from bipolar disorder.

"Young adults between the ages of 18 and 24 are going through significant life changes and social strain, which could influence both the onset and course of the disorder," said Kenneth J. Sher, Curators' Professor in the Department of Psychological Sciences and co-author of the study. "During this period of life, young adults are exploring new roles and relationships and begin to leave their parents' homes for school or work. By the mid 20s, adults have begun to adjust to these changes and begin to settle down and form committed relationships."

Researchers predict the prevalence of the disorder also could be affected by brain development, particularly the prefrontal cortex. The prefrontal cortex, the very front part of the brain, is thought to control perception, senses, personality and intelligence. In particular, it controls reactions to social situations, which can be a challenge for people with bipolar disorder.

"The maturing of the prefrontal cortex of the brain around 25 years of age could biologically explain the developmentally limited aspect of bipolar disorder," Cicero said. "Other researchers have found a similar pattern in young adults with alcohol or substance abuse disorders."

While some scholars suggest that the difference could be due to discounting factors such as early mortality, the sheer number of those who are recovering rules out this possibility, Sher said.

The study, "Are There Developmentally Limited Forms of Bipolar Disorder?" was published in the Journal of Abnormal Psychology. It was co-authored by Cicero, Sher and Amee Epler, a doctoral student in the Department of Psychological Sciences.

Source:
Kelsey Jackson
University of Missouri-Columbia

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Article URL: http://www.medicalnewstoday.com/articles/165712.php

Main News Category: Bipolar

Also Appears In: Neurology / Neuroscience, Psychology / Psychiatry,

Possible link between inflammation and bipolar disorder

Body and Brain
Tina Hesman Saey

Bipolar disorder scrawls a molecular John Hancock across the brains of some people. The signature is sometimes visible even before symptoms start, researchers in the Netherlands report.

A team led by Hemmo Drexhage, a clinical immunologist at Erasmus Medical Center in Rotterdam, found that certain white blood cells, called monocytes, pump up activity of various genes in people who have bipolar disorder. Many of the genes are involved in inflammation as well as cell movement, cell death or survival, and a pathway that allows cells to respond to chemicals that promote cell growth.

The signature of elevated gene activity in monocytes could help diagnose and classify bipolar disorder and other psychiatric disorders. Published in the April issue of Archives of General Psychiatry, the discovery also suggests that anti-inflammatory drugs could help treat the disorders.

Monocytes and other white blood cells called macrophages help fight infections and clean up dead and dying cells from injury sites.

"Everywhere in your body you have these cells, but they're not just lying around waiting for bugs to come around," Drexhage says.

The cells are involved in inducing fever. They also play an important role in the brain. They are some of the cells that make up the microglia, which are support cells for neurons. Microglial cells help regulate the brain's chemical communication system, as well as neuron growth and the formation of connections between neurons.

Drexhage became interested in the link between inflammation and psychiatric illnesses when he learned that people with bipolar disorder have a three times greater than average chance of developing autoimmune thyroid disease, an inflammatory disorder. Other data suggest that the risk for type I diabetes and some other inflammatory diseases may also be elevated in people with psychiatric disease.

"It's not just a disease of the brain, it affects the entire system," Drexhage says.

His team isolated monocytes from mentally healthy people and from people with bipolar disorder. Activity levels of 19 genes were altered in people with bipolar disorder. Twenty-three of 42 people (55 percent) with bipolar disorder carried the signature alterations, while only seven of 38 healthy people (18 percent) did.

Children of bipolar patients also bore the disorder's signature more often than did offspring of healthy people, even before symptoms of the disorder were apparent. During the course of the study, three of the children of people with bipolar disorder developed depression. All of them carried the bipolar signature in their monocytes before they developed the illness. The bipolar markers were also found in 85 percent of the children who already had mood disorders when the study started, compared with 45 percent of children without mood disorders. Only 19 percent of the offspring of healthy parents carried the signature.

Lithium, a drug commonly used to treat bipolar disorder, brought activity levels of inflammatory genes down. But that's probably not the only effect the drug has on the brain, says Robert Yolken, director of the Stanley Neurovirology Laboratory at Johns Hopkins School of Medicine in Baltimore. Researchers need to develop a better picture of how the activity of inflammatory genes varies among the population before the signature recognized in the Dutch study can be used for widespread screening and diagnosis, Yolken says.
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References:
Padmos, R.C. . . . and H.A. Drexhage. 2008. A discriminating messenger RNA signature for bipolar disorder formed by an aberrant expression of inflammatory genes in monocytes. Archives of General Psychiatry 65(April):395–407. Abstract available at http://archpsyc.ama-assn.org/cgi/content/abstract/65/4/395.

Sources:
Hemmo A. Drexhage
Department of Immunology
Erasmus Medical Center
P.O. Box 1738
3000 DR Rotterdam
Netherlands

Robert H. Yolken
Stanley Neurovirology Lab
Johns Hopkins University
600 North Wolfe Street
Baltimore, MD 21207
Web site: http://www.stanleylab.org

http://www.sciencenews.org/articles/20080412/fob3.asp

From Science News, Vol. 173, No. 15, April 12, 2008, p. 228.