Just got back from a dinner function at the 9th International Conference on Bipolar Disorder in Pittsburgh. A few quick observations before I hit the sack:
At the opening session on Medical Life Style Management, Fouzia Laghrissi-Thode of Hoffman-La Roche advised that we have to look away from psychiatric conditions as isolated conditions. Rather, we are talking about systemic illnesses, involving many systems. Other speakers on the panel made much the same observations, pointing out the interconnections involving cardiovascular and metabolic diseases, bad sleep, mood disorders, and no end of other stuff. Said Michael Ostacher of Stanford, our focus needs to shift from solely on improving mood to improving well-being.
The second session involved the DSM-5. The panel, comprising members and consultants on the work group responsible for coming up with changes to the bipolar diagnosis, all pointed out that mood disorders existed on a spectrum, “analogous to blood pressure,” as legendary Swiss diagnostician Jules Angst put it. Dr Angst pointed out three dimensions to the spectrum: 1) from depression to mania 2) severity (from “normal” to pronounced symptoms) 3) temperament (a permanent condition over a lifetime).
The catch though, said Ellen Frank of the University of Pittsburgh, was that although the reality is not categorical, the DSM has to be in order to give names and provide cut-off points. Major catch. Is a “mixed” depression, for instance mandate at least two mania symptoms or three? Is two days long enough for hypomania or should it be four?
A couple of psychiatrists I talked to later compared the exercise to counting angels on the head of a pin. The distinctions were way too subtle for the real world of clinical practice, they pointed out. The research psychiatrists I talked to stressed they need these fine distinctions for research purposes. Why can’t they make it simple, I asked one research psychiatrist - feeling good-feeling shitty. The clinical terms are euphoric-dysphoric.
I’ve been very critical of the DSM-5 on this blog, but I want to point out that the experts on the panel over the years, in particular Ellen Frank and Trisha Suppes of Stanford, have been very helpful to me in pointing out the ins and outs of the mood spectrum, mixed states, and the many faces of hypomania. But nothing I heard today alters any of my previous criticisms.
After lunch, Nora Volkow, head of the National Institute of Drug Abuse, delivered a tour-de-force presentation on the fine points of everything about the brain. The brain doesn’t work in isolation, she noted. The brain works in networks. The brain takes 20 years to develop as opposed to the heart. Genetic time-bombs may be triggered anywhere from the fetus to right now. Our genetic predisposition to how we react to the environment may determine whether our behavior is controlled or automatic. In essence, when things go wrong, the prefrontal cortex fails to effectively modulate the amygdala.
“Resting functional connectivity” - you will hear a lot more on that in future blog posts, along with an area of the brain called the “habenula.”
Another session on circadian rhythms and brain imaging, poster session, chill break, dinner function. I run into my longtime friend Bill Ashdown from Canada, very active in international advocacy, great catching up.
More later. To bed. This is John McManamy, live from Pittsburgh ...