Two studies have helped to identify novel pathways and markers for diagnosis and treatment of the disease.
The first study, presented by Husseini K. Manji, M.D., chief of the Laboratory of Molecular Pathophysiology at the National Institute of Mental Health (NIMH), suggests that bipolar disorder arises from abnormalities in neuronal plasticity cascades , the complex machinery inside of nerve cells that regulates numerous processes inside the body. Using animal and cellular models, Dr. Manji and colleagues at NIMH showed that disruptions in these pathways resulted in many of the core symptoms of bipolar disorder and explained many other observations about the disease. The findings suggest a new avenue for treating the underlying cause of bipolar, rather than treating flare-ups of depression or mania, and also provide new targets, for improved medications many of which are being tested in clinical trials.
Mary Phillips, M.D., professor of psychiatry at the University of Pittsburgh School of Medicine and director of functional neuroimaging in emotional disorders at Western Psychiatric Institute and Clinic of UPMC, will discuss the emerging role of brain imaging techniques in psychiatry in general as well as in bipolar disorder. Using neuroimaging, Dr. Phillips has identified patterns of abnormalities in the neural systems that underlie emotional processing and cognitive control unique to the bipolar brain. Such abnormalities are valuable biomarkers for the illness and have the potential to help clinicians diagnose bipolar disorder earlier and more efficiently. Dr. Phillips also will present data illustrating how imaging can be used to identify biomarkers and how these markers can help clinicians determine which patients will respond best to certain treatments. Neuroimaging also can help predict which patients of those who are genetically predisposed to bipolar disorder will develop symptoms of the disease.
upmcScale of the problem. Of the 1.3 million Americans diagnosed with cancer in 2005, 95 percent of the people scheduled to receive chemotherapy or radiation expected to experience fatigue. Studies show the frequency of actual fatigue during chemo ranges from 70 to 100 percent; likewise, 90 percent of patients who receive radiation therapy report fatigue. Also, up to 40 percent of patients report unusual fatigue upon diagnosis, a sign that fatigue is an early symptom of malignancy as well as a consequence of treatment. Underlying causes. Cancer fatigue disrupts several interrelated systems: physiological, biochemical, psychological. The effect varies among individuals and also during different phases of treatment. It likely involves changes in the endocrine system, circadian rhythms, metabolism, cytokines and seratonin production. Predisposing factors must be understood before researchers can develop useful prevention or treatment strategies. Measurement of a subjective symptom. More than 20 different assessments are used to diagnose fatigue, from single-question scales to multidimensional measurements of a patient's physical, emotional and cognitive functioning. Most patients can easily rate their fatigue on a scale from 0 to 10, researchers said. However, it is important for physicians to distinguish cancer fatigue from other ailments such as depression, and treat accordingly. Fatigue and cancer-related sleep disorders. Approximately 25 to 50 percent of all prescriptions that doctors write for cancer patients are for hypnotics. Studies show that sleep disturbances are more severe in the most fatigued patients, suggesting a reciprocal relationship between these two distinct conditions. Drug remedies. The first step to managing cancer fatigue is to treat conditions that may contribute to it, such as anemia, pain or depression. Studies show that anemia medications alleviate cancer fatigue to some degree. Other classes of drugs called psychostimulants have shown promise in open-label trials. Further research is needed. Non-drug remedies. A growing body of evidence shows that exercise and support groups help people with cancer fatigue the most. Additional studies into nutrition therapy, yoga, mindfulness stress reduction, and polarity therapy also show promise. Many people with cancer already use non-drug behavioral therapies on their own, researchers said, but it's important that the scientific community continue to fund and study these interventions.