Reporting Live from the American Psychiatric Association

John McManamy Health Guide
  • I’m in Toronto in a press room surrounded by a dozen journalists typing furiously to meet deadlines. Some two hundred more are out working their beats. The venue is the American Psychiatric Association Annual Meeting. Some 15,000 psychiatrists and related professionals are in town for six days to listen to some of the leading experts in the world talk on everything from the madness of King Saul to the fine points of brain science.

    In about an hour I will be heading out to attend a symposium I referred to in my last blog. This concerns that critical part of the mood spectrum where depression meets hypomania. But I also plan to cast my net further afield into such realms as attention disorders and personality disorders. This is because bipolar disorder simply doesn’t exist in a vacuum. Brain circuits have a way of intersecting.
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    But yesterday I took in six hours worth of bipolar disorder straight up – two symposia comprising 10 speakers. A quick sampling:

    Claudia Baldassano MD of the University of Pennsylvania pointed out that 37 percent of us are unemployed compared with 4.4 percent of the general population.

    Gary Sachs MD of Harvard reported on a study that found only eight percent of the patients in the study remained on their lithium after 76 days. As significant as this distressing finding may be is the fact that Dr. Sachs did not blame the patients. Lithium is an “efficacious” treatment, he said, but is not “highly effective.”

    Or, in the words of Holly Swartz MD of the University of Pittsburgh, “If a patient doesn’t stay on it, it is not effective, even if it works.”

    Small wonder only 30 percent of us stayed well, according to a study cited by Mark Rappaport MD of UCLA.

    Message to drug companies: Find us some decent meds. But that can’t happen till we find out how the brain works. The good news is we’re learning. Kiki Chang MD of Stanford reported that there is a two-way interaction between the deeper primitive structures of the brain (responsible for emotional processing) and the pre-frontal cortex (responsible for higher functions. One of these primitive structures is the amygdala. In a study, bipolar patients had their brains scanned while they listened to voice recordings of their mothers (who said both good and bad things about them). The amygdala response was significantly higher among the bipolar patients than the control subjects, but when they were on meds the response was blunted.

    What this means is the bipolar patients tended to overreact to both praise and criticism. This translates into higher highs and lower lows.

    Conceivably, 10 years from now, Dr Chang pointed out, a patient may get a gene scan and find out he carries 11 of 20 genes that predispose him to this illness, and that his genes show he has a preferential response to certain medications. Instead of waiting for 10 years or more to get a proper diagnosis, clinicians can concentrate on early intervention, which nearly always equates to better outcomes.

  • That’s it for now. John McManamy reporting “live” from the APA annual meeting, Toronto.
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Published On: May 22, 2006