Study works to find bipolar disorder markers

13 December 2016

The rapid development of medical technology, particularly in genetics and brain imaging, is opening up new pathways to better diagnose and treat bipolar disorder, a debilitating condition that affects hundreds of thousands of Australians. Researchers using cutting edge technology within the Brisbane Diamantina Health Partners, and in a collaboration with the Black Dog Institute, are studying 200 people between the ages of 15 and 30 to find early markers for bipolar disorder. “The idea is to predict those who are going to develop this disorder,” said Professor Michael Breakspear, a psychiatrist and researcher at QIMR Berghofer Research Institute and the Royal Brisbane and Women’s Hospital. “At the moment, there’s a two-year gap between the onset of the disorder and the moment when the disorder is diagnosed by a clinician. We’re trying to reduce that gap.” One and a half percent of the population, or 345,000 Australians, will develop bipolar disorder, which is characterised by periods of depression and periods of mania. “Bipolar, when it emerges between the ages of 15 and 30, is often misdiagnosed and treated as depression,” said Professor Breakspear. “Doctors miss the preceding minor manic episodes and patients don’t realize their significance. But it’s important to diagnose bipolar immediately so it can be treated immediately, before it causes too much damage.” If not understood, the onset of the disorder can cause work and relationship problems. People who experience their first manic episode can end up a psychiatric ward, which can be traumatizing, and untreated, the disorder has a high suicide rate. “In fact, the death rate from bipolar disorder is not that much worse than the death rate of breast cancer,” said Professor Breakspear. “It's a huge burden on society.” But there’s increasing hope that powerful brain imaging technology, and an increasing understand of the genetic origins of the disease, will lead to faster and more accurate diagnosis. Professor Breakspear, a psychiatrist with a PhD in computational neuroscience, is using what’s called “diffusion weighted MRI imaging” at the new Herston Imaging Research Facility at the Royal Brisbane and Women’s Hospital, to look for early signs for bipolar disorder in people at risk. The Herston Imaging Research Facility is a collaboration between The University of Queensland, the Metro North Hospital and Health Service, the Queensland University of Technology and the QIMR Berghofer Medical Research Institute. In the past, people could look only at the anatomy of the brain, but with powerful new imaging machines, the circuitry of the brain is on display and is being mapped for the first time. “We study communication within the brain,” said Professor Breakspear. “We look at the connections. “The brain is basically a complex network and what we can see is a sort of Google map of the brain; the highways and streets that are the connections. So then we compare those connections of healthy young people with those who have bipolar disorder and those who we know are at high risk.” It’s those roads, or networks in the brain, that are important. In people at higher risk of bipolar disorder, the connections between key areas of the brain can be weaker or stronger. It’s those discoveries that provide clues not just for early diagnosis, but for future potential treatments. The current study is looking for those tell-tale differences in the brains of people who are genetically at higher risk of developing bipolar disorder. “The interesting thing we’ve already found is that it is the high risk people whose brains are the most different,” said Professor Breakspear, “more so than those with the disorder.” Ultimately, this information could be used to screen people who are at risk because of their family history. 1.5 percent of the population will develop bipolar disorder, but if people have a first degree relative with the disorder, a sibling or a parent, the risk is about 10 percent. “And we also have similar projects with depression and dementia, which are more prevalent in family members. But the work with bipolar already has key findings, which we have recently published.” If a method of screening is successfully developed, it means earlier intervention, and that has the potential to reduce the burden of illness and possibly even avert some suicides. “For people who have a high risk of bipolar disorder, education is important,” said Professor Breakspear. “So, psycho education, teaching people what bipolar disorder is, what the symptoms are, and to make sure that they go and see a doctor if they have had a mood disturbance; those things can really help. Education of GPs is also important. Doctors need to be aware of the genetic links with bipolar disorder as well as telltale warning signs.”

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