This is the first of a three-part series created to
familiarize you with some exciting and hopeful information regarding research
that has been conducted on juvenile bipolar disorder.
In order to get to the end
of any journey, you must travel in the correct direction. In terms of understanding juvenile
bipolar disorder, the The Juvenile Bipolar Research Foundation (JBRF) Research
Consortium has taken some impressive steps down the right path.
The prevailing view of
psychiatric illness has been that each mental disorder is unique and separate
from all other mental disorders.
As such, each behavioral symptom belongs solely to one or another of the
identified illnesses. This is
referred to as a categorical approach because each symptom is assigned to a
discreet category. Practically
speaking, all the diagnostic, clinical and research work of the last 30 years
has used the categorical approach as its foundation. It is important to note that this
foundation derives from ideas, not facts, and that the diagnostic
categories it created were never intended to be permanent.
Psychiatric diagnoses do
not have the benefit of biological evidence like medical diagnoses do. This is not surprising given the fact
that our extraordinary brains and all-powerful DNA have, until recently, been
pretty much beyond our reach to explore.
Lacking biological evidence, ideas were the next best thing.
While the most passionate
and well informed people were involved in the development of this approach,
times have changed and knowledge has advanced. However, this underlying view has not. Fortunately,
geneticists and neuroscientists have started to question the merit of the
categorical approach to diagnosis.
In fact, some investigators have reached the conclusion that this
underlying framework may prove to be a principal obstacle that has led to
stagnation of the research in the quest to untangle complex mental illnesses
such as bipolar disorder.
"Big deal" you might
say. It doesn't really matter what
you call it or how you define it; what really matters is dealing with the
individual's symptoms as they present.
But it isa big deal;
because the individual will never get relief until we can truly understand the
problem. In today's cutting edge
scientific practices, where microscopically small differences and enormously
complicated mechanisms are in play, to start from a correct foundation
matters.
The perspective that has
emerged is that we need to study mental illnesses from the view that there is
an inevitable overlap of symptoms between psychiatric conditions as they are
now defined. What may distinguish
one condition from the other is how those clusters of overlapping symptoms come
together. This is called the dimensional
approach to defining psychiatric disorders. Once this "new", more diverse profile of
symptoms is established, the next step in the research process is to refine the
profile in order to be able to link it to a specific biological source.
This dimensional approach is
what the investigators of the JBRF Research Consortium have adopted. Proceeding down this path, researchers
have arrived at a novel description of juvenile bipolar disorder that describes
more directly and accurately the symptoms these children actually
experience. This new perspective
has quickly led to a model of the underlying biology that may help to explain
this illness at a more fundamental level.
It has opened up new research priorities and treatment
opportunities. This view has led
to the identification of a potential biomarker (measurable biological
indicator) of the illness. Its
accuracy makes the chances for meaningful genetic studies much more likely.
In the second part of this
series, we will describe this profile in more detail and in the third part we
will tell you what researchers are trying to do with this information. There
are no answers that will turn your life around today. But we are confident that we are on the right path to
provide those answers tomorrow.
Alissa Bronsteen and Demitri Papolos, M.D.
