health

Bipolar, Schizophrenia, and the Microbes Inside You

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This post is a reblog of a post by Candida Fink, MD.

I found it very interesting and hope you like it too! The post can be found on her blog: bipolar beat at psych central

Can the bacterial community that lives in your gut actually be related to psychiatric illnesses such as schizophrenia and bipolar disorder? Research on the human microbiome and its effects on health and illness has exploded into the worlds of medicine and research. It is increasingly clear that the microorganisms in the human intestinal tract, and the genes produced by all of these microscopic living things, play critical roles in an individual’s patterns of overall wellness — far beyond helping us digest food effectively.

Microbiota and Microbiome Defined

Microbiota is the ecological community of microorganisms (mostly bacteria, but also fungi, viruses, and so on) that live in a particular location, such as your gut. Microbiomerefers collectively to the genes harbored in these microorganisms. Researchers must understand the patterns of both the organisms and the genes to help clarify the roles these microscopic creatures play in the body’s health and function. So, if you read something about the microbiome that’s about only the bacteria and not the genes, you know it is an incomplete discussion. Also, while most of the discussions are about the gut microbiota and microbiome, humans actually have colonies of microorganisms living in other areas in and on their bodies, including their skin, reproductive tract, and the mouth and throat (which are technically part of the gut but sometimes are not thought of in that way).

A study in the journal Brain, Behavior, Immunology (May 2017), entitled “The microbiome, immunity, and schizophrenia and bipolar disorder,” summarizes some of the current research looking at the microbiome as it relates to schizophrenia and bipolar disorder. The article reports that many studies in animal models have shown that the gut microbiome could affect thinking and behavior through effects on the immune system. Some human studies have shown that people with psychiatric conditions took antibiotics more frequently than people without these disorders. Humans take antibiotics to kill off unwanted bacterial infections, but these medications also kill off some of the microbiota, changing the person’s microbiome. The question that comes up then is whether these microbiome changes were related to the development of the psychiatric conditions. This article also points to studies that found different microbiota in the mouths and throats (oro-pharyngeal microbiota) of people with schizophrenia compared to those without.

Babies are born with “sterile” guts; they don’t have any gut microbiota. But in the birth process, microorganisms colonize the baby’s mouth and intestine, starting off their process of building a microbiome that eventually looks like an adult’s. Many researchers are exploring how the developing microbiome might affect the developing brain and nervous system. While it seems clear that there are effects, the exact processes mediating the effects and what exactly gets changed or affected remains very unclear. While the immune system is thought to be one pathway, other mechanisms are also being investigated.

Many other areas of research show promising results when looking at the microbiota, microbiome, and illness. Autism researchers are looking at the “gut-microbiome-brain” connection, and there are strong indicators that the microbiota and microbiome have some relationship to autism. Obesity — not a mental illness but of concern to so many people living with mental illness — has been shown to have some very interesting connections to the microbiota in mouse studies. Changing the patterns of bacteria in mouse guts can transform the mouse from lean to obese and vice versa without changing diets. A study from China last month in the World Journal of Gastroenterologyreports a case of a 20-year-old with Crohn’s disease and seizures. They treated her with fecal microbiota transplantation — giving her the gut microbiota of a healthy person — and her gastrointestinal symptoms and seizures improved significantly.

The potential benefits to understanding how the microbiota and microbiome interact with the brain and central nervous system could be enormous. Understanding microorganism mechanisms that increase the likelihood of mental illness such as bipolar disorder or neurodevelopmental condition like autism would make room to build new interventions that target those mechanisms. The research in these areas is still in early stages, and there is much more to do, but this is an intriguing and promising story in the quest to understand and treat disorders of the brain.

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Preparation

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Three nights with little sleep is hard. This is the third night I`ve woken up early, trying in vain to catch more hours of blissful nothingness. Luckily my boss is very understanding, so I can call work in some hours and tell them I must be home. The main reason for my unstable sleep, is probably my pregnancy. My baby is now 7 months, and he is growing faster and faster. My stomach is finally getting bigger, but still you don`t always see there is a baby in there if I wear baggy clothes.

I have still not told many of my clients about my pregnancy, but must do so the following weeks. Maternity leave will start the first week of march, so there is really not much time. Luckily the next weeks won`t be too busy, since my client list has shrunk the last couple of months. I also work with a different group of clients now, where it isn`t so much therapeutic conversations we offer, but more practical and social help. I work more together with nurses and other health professionals, so we are more helpers, which means that my role is more relaxing, sometimes being a coordinator rather than a therapist.

I have to start planning my return to work soon. I am not completely sure if I should go back to my former position or if I should ask if I can go back to working with trauma. I will be back in February, and know it will be challenging to start working again, since the baby is only 8 months old and still will need breast-feeding during the night. That would mean that going back to work in the team I`m in now, could make the transition back to work, more manageable. Starting to work with weekly clients again, having a long list of people I have to see, will probably be harder. I will discuss this with my current boss soon, and that will probably help me figure out what to do.

But that is not what I´m thinking about the most at the moment. In two months time, a little baby will be in my life. He will probably drive me insane, and it will be hard. But I can`t wait anyway. I know that when you love somebody, the good moments means so much that the bad is forgotten after a while. I look forward to being there for someone all the time, to know someone inside out.

I will try to go back for maybe one more hour of sleep. Fingers crossed!

Different parts

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This week has been calm at work. I haven’t had many client conversations, but one of them has been very much on my mind. Usually I don’t think too much about my clients between sessions, but when I get worried about a client it’s hard not to. The client has dissociative identify disorder, and one of the parts is suicidal. The part is young and doesn’t trust other humans, understandably so. Life has been unsafe and unpredictable, so the part has done what everyone would do in a similar situation: keeping its guard up. I asked this part if he is familiar with the people in my clients life today, and my client told me he knows about them, but he doesn’t connect with them emotionally. My client has been in therapy for many years, and even if things are somewhat better, my client still suffers every day. Nightmares, lack of sleep, daily dissociative episodes, and at the moment, a feeling of hopelessness.

I wonder, how can I help this part to recognize that his circumstances are different now? That he has people in his life who care and would be shattered if he disappeared for good? How can we work together on ways to regulate the intense pain he lives with everyday, when he has no experience with coping when things gets too much?

22 July

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Yesterday I finally had the courage to see 22 July. In Norway that day will never be the same. It’s our 9/11, our tragedy. Norway is a small country, so we were all directly or indirectly touched by Anders Behring Breivik’s mass murder of 77 innocent people the 22th of July. Seeing the movie was hard, but necessary. I remember how surprised I was by the reactions after the attack. How the trial focused on our core values, democracy and not giving in to fear and love. I remember how people gathered in our cities, showing their respect with roses that littered the streets. News headlines from other countries also reflected the surprise: Where was the outrage ? We were suffering, but we didn’t respond with bullets or hate.

Fear is dangerous. Maybe I’m a bit naive, but the answer is not to monitor everyone to be more secure. Crimes does occur and we must always try to minimize it. I have worked with trauma through my career, and know the pain sufferers and survivors endure. But the solution is not to become overly suspicious. Some countries are closing their borders after terror attacks, to protect their own people. But we are all humans, and by having a court system where we defend people who’s committed crimes we condone, we feel stronger. Revenge seldom helps, but trying to move on and focusing on what’s important, can. This doesn’t mean that feelings of hate and rage aren’t valid. We must be allowed to feel grief and the unfairness of meaningless acts from a person like Breivik. Healing is being able to feel different emotions at the same time and realize that it’s okay. We can feel strong and weak at the same time, love and hate. But how we act on those feelings, is what matters.

Living well with bipolar disorder

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This is a reblog from the blog the bipolar writer. The post if written by Allie, and I found it very informative and inspiring.

Reading it felt even more useful after the first day on a conference I’m on, where Allen Frances, a main contribution to the DSM-IV spoke. He told us more about the American mental health care system, and how hard it can be to get adequate help. Posts like these can help those who suffer from a mental health problem.

1 in 4 Americans suffer from a mental disorder, and out of those millions of Americans, 5.7 million Americans suffer from bipolar disorder, characterized by erratic moods consisting of mania (an elated state of being) and the more familiar depressive episodes. I am one of those 5.7 million Americans.

Bipolar disorder is often considered the “artist’s disease,” from Sylvia Plath to Vincent van Gogh exemplifying the creative bursts of energy, severe depressions, and unstable highs and lows that come with the disorder. There is a range of creative treatments that safeguard mood stability, including traditional medications and therapies that are universally recommended to treat bipolar disorder. Often, mood stabilizers, antipsychotics, and psychotherapy are the first lines of defense, alongside a good support system, to prevent mania and depression. However, three simple life changes can safeguard against serious bipolar episodes and help those who suffer from bipolar disorder maintain a stable, healthy lifestyle.

Early to Bed, Early to Rise – Healthy and Wise

Sleep is perhaps the most important preventer of manic relapses and a strong source of mood stability. Bipolar disorder is directly related to insomnia. The fewer people with bipolar disorder sleep, the more likely they are to become manic. The Center for Disease Control recommends seven hours of sleep daily for adults. Having a healthy sleep routine, such as an established bed time and avoidance of caffeine after 2:00 PM can help people with bipolar disorder achieve a good night’s rest. As someone who is diagnosed with bipolar disorder and has worked for years to combat insomnia, I have found that turning off screens (from televisions, phones, computers, tablets, etc.) an hour before bedtime and having a strong sleep routine where I turn in around the same time each night works wonders. If insomnia persists, one can talk to a doctor about sleep aids available by prescription and consider using Melatonin or a Circadian rhythm stabilizer (available over-the-counter).

Healthy Body, Healthy Mind

Exercise is another great mood booster, especially during depressive episodes and to combat the side effects of bipolar medications that often cause weight gain. The NIH recommends 150 minutes of moderate exercise a week. When you are active, dopamine floods your brain and gives you feelings of happiness similar to a runner’s high. This is especially important for bipolar disorder sufferers, whose serotonin levels are often imbalanced. However, staying active can be a challenge during depressive lows. I like to hike or cycle, which leaves me feeling satisfied and helps keep the pounds off from medicine. Find an activity you enjoy, whether it is biking or running, and watch as your mood improves.

Nourishing Your Brain, Nourishing Your Soul

Finally, good nutrition is directly linked to mental health, especially for those with bipolar disorder. Nourishing one’s body with healthy foods like whole grains, veggies, and lean meats, while reducing intake of fatty and sugary foods, and using probiotic supplements can improve mental health, buffering mood swings. I rediscovered my love of cooking healthy meals and have seen vast mood improvements since choosing a diet that works for me, specifically the low carb diet. Perhaps the Mediterranean or vegetarian diets will suit you? Experiment with food groups you like and remember to take probiotic supplements for a happy gut and brain.

Your brain, body, and emotions are all linked, bipolar or not, and with these healthy lifestyle changes, supplemented by the proper medication and therapy, bipolar disorder patients can not only survive but thrive.

Stavanger

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I am at the airport right now, waiting for my flight to Stavanger. In Stavanger I will attend a three-day long conference where the main theme is ‘connections’. One of the main headliners is Judith Beck, widely known for her work with developing cognitive behavioral therapy. I’ve read some of what she’s written, and am excited to hear her talk about the therapeutic relationship. There will also be other known scientists and others who will talk about their work, and it will actually be hard to decide which mini-seminars I should attend while I’m there.

In addition to getting inspired, I will finally meet some old class-mates again. I’ve kept in contact with both of them since we became psychologists together, but since then one of my friends now has a little baby I still haven’t seen.

It is nice to sit here and wait for the plane. The last couple of weeks has been filled with everyday chores. We recently moved house, and that is a challenge in the best of circumstances. With two kids, it is even more busy and stressful, so sitting here, not needing to do anything, is luxurious.

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