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Stem cell research: Bipolar

Stem cell research in bipolar disorder

When most of us think of stem cells, we think of ethical controversy, umbilical cord blood banks, growing new tissues and other commonly discussed topics in medical research. 

I would venture that not many think of stem cell research in relation to psychiatric conditions and what we might learn about them. 

Researchers at the University of Michigan are using stem cells from skin fibroblasts of people with bipolar disorder to gain more understanding of this difficult mental illness. 

By observing how the stem cells behave and change, researchers have already discovered a few ways in which cells from individuals with bipolar disorder are different from those with no bipolar disorder. Differences lie in how often certain genes are expressed, how they differentiate, how they communicate, and also how they respond to lithium.

Gene expression

Examining gene expression in cells from those with and without bipolar disorder as they differentiated into neurons, researchers found the cells from bipolar patients express more genes involved with sending and receiving calcium signals between cells. This is particularly interesting because calcium signals are known to be important to neuron development and function, and other studies have already linked bipolar disorder to problems with neuronal calcium balance. 

Signalling patterns changed in the presence of lithium among the cells from bipolar patients – the lithium didn’t completely normalize the calcium signalling, but did made a noticeable difference and showed that lithium (a mainstay in treatment for bipolar disorder) affects the metabolism of calcium.

Researchers also noticed differences in what is called microRNA expression in the cells from bipolar patients, and this suggests bipolar disorder likely occurs as a result of a combination of genetic susceptibilities.

Preliminary findings, but exciting

These are preliminary findings, but exciting. The more we learn about the way cells act and react in bipolar disorder and other psychiatric conditions, the better we’ll understand about causes and possible interventions to help people living with these illnesses. 

I anticipate much more to come from this and other groups examining stem cells in hope of discovering more about mental illness. I look forward to the day when this kind of research enables more personalized treatment and prevention tools. 

Help is available now

In the meantime, bipolar disorder and other mental illnesses can be effectively managed. Speak with your doctor and get a referral to a mental health professional if you think you or a loved one are experiencing mental health symptoms. Help is available now.

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Autism: New findings

Autism spectrum disorder is a neurodevelopmental condition surrounded by a lot of misinformation, rumours and fear. 

Characterized by social and communication difficulties and often including compulsive repetitive behaviours, autism can make daily functioning extremely difficult. The condition is now understood to include a wide spectrum with symptoms ranging from quite mild to debilitating. 

Much of the fear surrounding autism is based on its apparent increase in prevalence lately, and our lack of understanding about what causes the disorder. Data from 2014 indicates that autism affects roughly one in every 68 children, which is an increase of 30 percent from estimates of one in 88 children just two years earlier. 

Because it often becomes noticeable in toddlerhood at around the same age that children receive vaccines, there was fear by many parents that perhaps the vaccines caused the disorder. Many studies have examined this potential link and all have shown the two are not linked. 

One study provided some direct evidence that autism begins during brain development before birth. Researchers at the University of California examined genes in post-mortem brain tissue of children with and without autism. They discovered patches of disruption in the development of cortical layers in the brains of children with autism. The brain develops six cortical layers at an early stage and researchers discovered disruption in both the frontal and temporal cortex – areas involved with communication, social cues and language. 

In this study, the majority of children with autism showed disrupted development in the cortical layers and researchers found it particularly surprising to see the similarity across all patients in spite of the diversity of symptoms experienced and the genetic complexity of the condition.

Since the cortical defects discovered in this study are patchy rather than uniform in nature, researchers believe this may explain why early and ongoing treatment can be so helpful to children with this condition. It may sometimes be possible for the brain to rewire connections and bypass some of the deficits. 

More research will be necessary to further explore this discovery and learn more about the biology behind autism. These findings could lead to new interventions as well as earlier screening and a more optimistic outlook for children and families impacted by this condition.

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The health gap

I have written many times about the impact of poverty on mental and physical health. The Canadian Medical Association lists poverty as the leading factor determining health in our country. 

Issues such as a lack of affordable housing, inadequate ability to purchase nutritious food, lack of access to medications or other treatments, and other poverty related social issues have a major impact on the health of individuals, and all contribute to a growing health gap between affluent and lower income Canadians.

A 2014 report from the BC Healthy Living Alliance examined a decade of chronic disease in our province to determine strategies for prevention. 

Among other things, the report – On the Path to Better Health – identified a disproportionate amount of disease among some populations in our province. Not surprisingly, low income British Columbians are more likely to die early (24-91% more likely) from a number of diseases  - cancer (24%), respiratory diseases (53%), circulatory diseases (65%) and diabetes (91%). 

The report also takes time to emphasize the connection between physical and mental health. Quoting the National Centre for Disease Control and Health Promotion, the BC report underlines the “extensive evidence connecting mental illness to chronic diseases, such as cardiovascular, diabetes, obesity, asthma, arthritis, epilepsy, and cancer.”

It goes on to say that positive interventions encouraging regular exercise, good nutrition, social networks, and emotional resilience offer a protective effect when it comes to lifelong mental and physical health outcomes. 

Unfortunately, poverty impacts people’s ability to lead healthy lives. It is a barrier to healthy eating, physical activity, safe housing and social connection – all determinants of long term physical and mental health.

If we are concerned about closing the health gap and ensuring a society with equal opportunities to live healthy lives, we need to address poverty. If we are worried about continuously escalating healthcare costs, we need to address poverty. 

Affordable housing, a living wage, access to healthy food, early childhood development, social support and other basic human needs must be available to all Canadians. 

These are not impossible issues to solve. With some focused attention and leadership at all levels of government, we can eliminate poverty and move toward a healthier, happier and more equitable society. In my opinion this is the single most important issue to address in improving mental health care in Canada.

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Suicide: The darkest face

Suicide is the darkest face of mental illness. It is tragic when someone takes their own life in a desperate bid to end mental suffering. 

In Canada, about 4,000 people die each year as a result of suicide, and many more attempt to end their lives. 

We know that at least 90 percent of individuals who commit suicide are known to experience some form of mental illness or substance abuse disorder. We also know suicide is likely preventable in the majority of cases. 

A recent review of studies related to suicide among individuals with depression and bipolar disorder was published in the Canadian Journal of Psychiatry. It offers some consolidated information about the underlying reasons and risk factors for suicide. When these factors are understood, we may have a better chance of developing effective suicide prevention strategies. 

Among individuals with bipolar disorder, the lifetime risk of completed suicide is between five and six percent. In depressed individuals the risk is a little higher. 

Not surprisingly, people with these conditions experience a 20-40 fold increase in suicide attempts during active major depressive episodes than when they are not in a depressed state. 

This leads to the obvious conclusion that one of the most likely ways to prevent suicide is to effectively treat depression – reducing the duration and frequency of mood episodes. 

Other risk factors in suicide attempts include co-existing substance use or personality disorders, feelings of hopelessness, and aggressive or impulsive traits. Childhood adversity and current life events are also risk factors, as is the feeling of having little social support.

Identifying and observing these risk factors in individuals with depression and bipolar disorder gives us a tool to use when determining a person’s likelihood of attempting suicide. 

The review did not examine studies of the effectiveness of treatment or other intervention at preventing suicide. More research in this area would likely prove useful from a clinical perspective. 

In my view, one of the most important ways we can prevent the tragedy of suicide is to continue to battle the stigma that often surrounds mental illness. In order to reach out for help, a person needs to feel as though they will not be judged or penalized for their illness. Our societal goal should be to create an environment where seeking help for a mental illness is no different from seeing your doctor for other chronic health issues such as diabetes or high blood pressure. 

In the meantime, if you or a loved one are feeling hopeless and are considering suicide, please know there is help available in our community. Speak to your doctor and get professional help immediately. You don’t need to continue suffering.

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About the Author

Paul Latimer has over 25 years experience in clinical practice, research, and administration.

After obtaining his medical degree from Queen's University in Kingston, Ontario, he did psychiatric training at Queen's, Oxford and Temple Universities. After his residency he did a doctorate in medical science at McMaster University where he was also a Medical Research Council of Canada Scholar.

Since 1983 he has been practicing psychiatry in Kelowna, BC, where he has held many administrative positions and conducted numerous clinical trials.

He has published many scientific papers and one book on the psychophysiology of the functional bowel disorders.

He is an avid photographer, skier and outdoorsman.

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The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet does not warrant the contents.

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