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.
After reading Volumes 26 through 28 about the Progress in Research, I was very excited and encouraged that a new understanding of juvenile bipolar disorder’s having a possible genetic component has been identified and recognized and that, clearly, the “dimensional approach” is far superior than the traditional (and, obviously, “flawed”) “categorical” approach. This is wonderful new and bodes well for the very young and also yet to be born children affected by this disorder. There are so many “positives” with all of this but (yes, unfortunately there’s always a “but”) it may be many years until all of the mental health providers who treat our children get “on board” with accepting and understanding these new discoveries and use this information to treat children affected properly. And, I fear that the insurance companies who use the “categorical” approach (by using the DSM) will be even more resistant to change. My son was diagnosed with having juvenile bipolar disorder in 2006 Dr. Papolos. My son was 7 at the time but is now 13 and not a lot has changed for him in terms of his getting the proper treatment and for us (his parents) to stop spending many hours arguing with insurance companies for even partial reimbursement. And we adopted our son and the biological father is unknown so we cannot take advantage of identifying any genetic marker. But I do want to end on a positive. I recently attended my 35th High School reunion where many of my classmates remember the time when there was absolutely zero recognition of juvenile bipolar disorder and even of the ADHD commorbidity and teachers actually tied several students to chairs. Thank God we are past that. And while my husband and I struggle to get our son adequate help, I’m hoping that this new research and diagnostic approach will prevent our possible future grandchildren who might inherit the genetic component from their father (our son) will be adequately treated. Thank you for your continued and restless commitment.