![Page 1: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/1.jpg)
Understanding Bipolar Disorder
Melvin McInnis, M.D.Research Director
Heinz C. Prechter Bipolar Research FundUniversity of Michigan Depression Center
![Page 2: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/2.jpg)
Celebrities with Bipolar Disorder
Ted Turner Sylvia Plath Kay Redfield Jamison, Ph.D.
Margot Kidder Jean-Claude Van Damme Ben Stiller
Axl Rose
![Page 3: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/3.jpg)
• Kraepelin proposed affect to consist of 3 components
o Volition • Energy & Drive
• Emotion• Happy / Sad
o Intellect• Rate of thoughts• Content of thoughts
Understanding Affective Disorders
![Page 4: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/4.jpg)
• Volition – the drive to care for our offspring
• Emotion – the love for our children
• Intellect – the thoughts & speech related to our interactions with family and loved ones
Affect - Affection
![Page 5: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/5.jpg)
Normal Affect
Volition
Emotion
Intellect
Moods and disposition fluctuate over time
![Page 6: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/6.jpg)
5
0
10
Volition
Emotion
Intellect
Mania
![Page 7: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/7.jpg)
Mixed Affect
Volition
Emotion
Intellect
![Page 8: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/8.jpg)
• BP disorder is 80% geneticso …and 100% environmental!
• Having a BP sibling or parent increases likelihood of developing BP fivefold compared to general population.
o Risk increases with increasing number of affected infamily.
• Overlap with genetic risk for other mood, anxiety, and psychotic disorders.
BP Disorder & Genetics
![Page 9: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/9.jpg)
Epidemiological Catchment Area Survey (ECA): Comorbidity and Bipolar Disorder
Regier DA et al. JAMA. 1990;264:2511-2518; Chen YW, Dilsaver SC. Am J Psychiatry. 1995;152:280-282; Chen YW, Dilsaver SC. Psychiatry Res. 1995;59:57-64.
![Page 10: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/10.jpg)
Bipolar DisorderUnstable Periodic Illness - Difficult to predict -
Need Biomarker
~4% attempt suicide/year
-Personal Devastation
Energy BaselineMania
Depression
![Page 11: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/11.jpg)
BP Disorder – Challenge:
Unstable illness states – difficult to predict
5
15
25
Year
PHQ940 participants with BPI
![Page 12: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/12.jpg)
PRIORI Research Project –Predicting Individual Outcomes
30,000 calls
40
6 – 12 mos
Acoustic Biosignals
冣
AUC 0.70 – 0.81
AI
![Page 13: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/13.jpg)
NOBEL 2012Shinya Yamanaka & John B. Gurdon
iPSC to model neurological diseases using patients’ somatic cells (e.g. skin)
![Page 14: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/14.jpg)
Neurons differentiated from Control and BP iPSCform neurons (A,B) and synapses (C,D)
A C
B D
C
BP
MAP2/Tau Syne1
![Page 15: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/15.jpg)
![Page 16: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/16.jpg)
Lithium pretreatment normalizes bipolar neuron calcium dynamics
Chen, Yoo, Herron
mse
c
![Page 17: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/17.jpg)
• Bipolar disorder with co-existing substance-use disorder is associated with an increase in
o suicide attemptso suicidal ideaso seeking hospital admissiono hospital admission o violenceo aggressive behavioro doubled risk of suicide
Substance-Use Disorder & BP
Potash JB et al. Am J Psychiatry. 2000;157:2048-2050; Scott H et al. Br J Psychiatry. 1998;172:345-350; Comtois KA et al. Biol Psychiatry. 2004;56:757-763; Strakowski SM, DelBello MP. Clin Psychol Rev. 2000;20:191-206; Strakowski SM et al. Arch Gen Psychiatry. 2005;62:851-858.
![Page 18: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/18.jpg)
• Less likely to respond to treatment 1
• Less likely to adhere to medications1,2o Less likely to adhere to lithium treatment
• Less likely to gain full remission and resolve symptoms
• Remission during hospitalization less likely to occur vs. no substance-use disorder
Substance-Use in BP: Treatment Issues
1. Goldberg JF et al. J Clin Psychiatry. 1999;60:733-740; 2. Aagaard J, Vestergaard P. J Affect Disord. 1989;12:259–266; 3. Strakowski SM et al. Arch Gen Psychiatry. 1998;55:49-55.
![Page 19: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/19.jpg)
• Patients with bipolar disorder have a higher risk of suicide than patients with any other psychiatric or medical illness
o Odds ratio for suicide attempts is 6.2 -- higher than any otherdisorder, including depression
Suicide Risk in Bipolar Disorder
Woods SW. J Clin Psychiatry. 2000;61(Suppl 13):38-41; Chen YW, Dilsaver SC. Biol Psychiatry. 1996;39:896-899; Goldberg JF, Harrow M. J Affect Disord. 2004;81:123-131.
![Page 20: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/20.jpg)
• Bipolar disorders are a category of mood disorders -with a broad range of severity.
• Bipolar disorder is eminently treatable.o But requires treatment to be ongoing
• Collaboration between treatment team and patient
• Bipolar disorder is a serious illness.o Lives, families, and careers are affectedo People can die from it.
Bipolar Disorder Concluding Statements…
![Page 21: Melvin McInnis, M.D. Research Director...Axl Rose • Kraepelin proposed affect to consist of 3 components o Volition • Energy & Drive • Emotion • Happy / Sad o Intellect •](https://reader036.vdocuments.mx/reader036/viewer/2022081614/5fcf6c03a78d4e72353679d0/html5/thumbnails/21.jpg)
• For more information: www.prechterfund.orgwww.depressioncenter.org
• Toll‐free phone number:1‐877‐UM GENES 1‐877‐864 3637
• Email: [email protected]
Prechter Bipolar Genes Project
Heinz C. Prechter1942‐2001