Postural Problems a Sign of Bipolar Illness?

Postural Problems a Sign of Bipolar Illness?Although motor deficits often accompany a mood or psychiatric disorder, most researchers have not targeted motor areas as a method to improve mental health. In a new study, researchers at Indiana University suggests that postural control problems may be a core feature of bipolar disorder, not just a random symptom. The investigators believe attention to the postural problems can provide insights both into areas of the brain affected by the psychiatric disorder and new potential targets for treatment. Bipolar disorder is a severe psychiatric disorder characterized by extreme, debilitating mood swings and unusual shifts in a person’s energy and ability to function. Balance, postural control and other motor control issues are frequently experienced by people with mood and psychiatric disorders such as bipolar disorder and schizophrenia, and neurological disorders such as Huntington’s and Parkinson’s disease. In this study, published in the journal PLoS ONE, researchers surmised that problems with postural control — maintaining balance while holding oneself upright — are a core component of bipolar disorder. As such, the researchers believe it is possible that the motor abnormalities could appear before other symptoms, signaling an increased risk for the disorder. According, researchers wanted to know if therapies that improve motor symptoms may also help mood disorders. “For a number of psychological disorders, many different psychiatric treatments and therapies have been tried, with marginal effects over the long term. Researchers are really starting to look at new targets,” said Amanda Bolbecker, Ph.D., lead author of the study. “Our study suggests that brain areas traditionally believed to be responsible for motor behavior might represent therapeutic targets for bipolar disorder.” The link between motor and mental is not as distant as some would believe. For example, try as we might, humans cannot stand perfectly still. “Instead, we make small adjustments at our hips and ankles based on what our eyes, muscles, ligaments, tendons, and semi-circular canals tells us,” said S. Lee Hong, Ph.D., a study co-author. “The better these sensory sources are integrated, the less someone sways.” Areas of the brain that are critical for motor control, mainly the cerebellum, basal ganglia and brain stem, also aid in mood regulation and are areas where abnormalities often are found in people with bipolar disorder. Postural sway — a measure of the endless adjustments people make in an attempt to stand still — is considered a sensitive gauge of motor control that likely is affected by these abnormalities. In the study, participants who had bipolar disorder displayed more postural sway, particularly when their eyes were closed, than study participants who had no psychological disorders. The troubles, which involved the study participants’ proprioception, or ability to process non-visual sensory information related to balance, were not affected by their mood or the severity of their disorder. “It appears that people with bipolar disorder process sensory information differently and this is seen in their inability to adapt their movement patterns to different conditions, such as eyes open vs. eyes closed or feet together vs. feet apart,” said Hong, whose research focuses on how humans control motion. “The different conditions will cause people to use the information their senses provide differently, in order to allow them to maintain their balance.” Additional research is called for as investigations involving motor control, mood and psychiatric disorders are complicated by the fact that the primary treatment for these disorders is medication, which can have severe side effects including motor control problems. Source: Indiana University

Disaster Plans Should Include Those with Mental Illness

Disaster Plans Should Include Those with Mental IllnessWhen disaster strikes — whether a deadly supercell tornado, a flood, or man-made catastrophe — it is not just those with physical injuries and trauma-related disorders who suffer. Johns Hopkins University researchers say more attention should be devoted to triaging and managing those identified as having mental disorders. In a commentary appearing in the June issue of the journal Biosecurity and Bioterrorism, Peter Rabins, M.D., M.P.H., said, “Disasters limit the availability of resources, and these groups are especially vulnerable because they cannot advocate for themselves. “But little attention has been given to the ethical challenges that arise when resources are limited, to the importance of identifying these ethical issues ahead of time, and for establishing mechanisms to address these moral dilemmas.” The researchers said disaster-response planning has generally overlooked the special needs of people who suffer from pre-existing and serious mental conditions. Disaster survivors can include those diagnosed with conditions such as schizophrenia, dementia, addictions and bipolar disorder. In the article, Rabins and Nancy Kass, Sc.D., said many of the mentally ill are dependent on caretakers and aren’t fully capable of making sound decisions on their own. Emergency planners are ethically obligated to ensure that immediate and adequate mental health services are provided alongside more traditional triage. “Disaster-response managers and those on the front line are well aware that survivors may succumb to PTSD and other mental disorders,” said Rabins. “But sudden devastation also puts people with both lifelong and acquired intellectual disabilities in grave danger as well.” One study the authors cited found that 22 percent of Hurricane Katrina survivors who had pre-existing mental disorders faced limited or terminated treatment after the disaster. Beyond patients with dementia and others who are mentally impaired, the authors say that this vulnerable group includes those who suffer from chronic pain and may be dependent on opiates, as well as substance abusers who receive treatment in the form of powerful sedatives classified as benzodiazepines. Withdrawal from these medications can be life threatening, the authors noted. As a first step, the authors recommend that disaster-response planners proactively identify and anticipate what needs might arise by meeting with clinicians and public health officials. Those discussions would then guide comprehensive advance planning. As licensed professionals are often unavailable (because of demand) immediately after a disaster, planners should consider training emergency medical technicians (EMTs) and other first-responders to identify those with pre-existing mental conditions and recognize those in need of prompt attention. The training should include volunteers from the community, such as religious leaders and trained civilians, to distribute basic materials and temporary services to at-risk individuals. In an effort to reduce adverse outcomes, the researchers advise that secondary prevention measures may take priority. This action could be in the form of EMTs distributing sedatives to manage short-term anxiety-related symptoms. But the authors say that policies would need to be developed to expand the list of those authorized to prescribe such drugs, as they are at present strictly regulated by federal law. The authors note that sedatives were distributed in New York City immediately after the Sept. 11, 2001, terrorist attacks. They also recommend that planners focus on ethical challenges likely to arise when assisting the mentally disabled during and after a disaster. These challenges may be partially addressed by adopting a “crisis standard of care” consistent with guidelines from the Institute of Medicine. Special attention should be given to assisted-living and long-term care facilities that house many residents with significant cognitive impairment, such as dementia. If these people are forced to evacuate, they may not fully comprehend the crisis and may be at risk for extreme emotional distress. Hence, disaster-preparedness training for first-responders should also include information about how to interact with such individuals in a way that respects their dignity, the authors said. Source: Johns Hopkins Medical Institutions
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