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Smorgasbord: Week in Review

Posted Aug 24 2008 9:36pm
Home bipolar disorder test causes stir . My first story this week is not actually on eating disorders at all. Rather, I found a story on bipolar disorder . Several major genetic markers have been found on specific genes in people with bipolar disorder. Like many complex disorders (and all mental illnesses/brain diseases), more than one gene has been identified. And none of these genes specifically causes bipolar disorder; rather, they are more common in people with bipolar disorder, and are thought to increase a person's risk for the disease.

Enter this home test. Basically, you order a test kit, and then you spit in a sterile tube. In your saliva are some cheek cells that have sloughed off, from which DNA is extracted and tested. The company, Psynomics , run by UCSD psychiatric geneticist John Kelsoe, will test for each of these genetic markers. The problem is that none of these markers is a guarantee that you will develop the illness; it is just a sign that you are at increased risk. There are treatments for bipolar, but no cures. It is managed with medications and therapy to help deal with symptoms and stay on the meds.

Medical ethicists are concerned because a) people might consider this test a diagnosis when it's not, b) people might start medications without having the disorder, and c) it could be used by insurance companies to discriminate.* Also, it is unlikely that not having these markers means you won't develop bipolar disorder. Which are all highly problematic.

One of the problems with bipolar disorder (as I well know) is that it often takes many years to diagnose properly. It might be thought of as hard-to-treat depression. Or something else. Untreated bipolar disorder can be self-medicated through addiction. As well, family history of biopolar disorder may be just as telling of your risk of devloping bipolar as any sort of spit-in-the-cup-hundreds-of-dollar-test.

Personally, I feel this test doesn't yield enough information to counter the risks involved, at least for people with no real personal or family history of bipolar disorder. I do think something like this (a more refined version) would be useful in testing people presenting with major depression. Why? Because bipolar disorder can take so long to diagnose and treat. You would probably get fewer false positives and more usefulness out of testing a smaller population.

Eating disorders, alcoholism add up to a new problem. That addictions go along with eating disorders really isn't news to most people with eating disorders. Approximately one in five people with eating disorders also have an addiction. Just as starving, bingeing, purging, overexercising, etc, tend to numb emotions, so do things like drugs and alcohol. Research shows that addiction tends to develop after the onset of the eating disorder, though it may very well develop before a person presents for treatment. There are also many addictive aspects to eating disorders, though I do not think they are an addiction per se.

"Drug abuse and alcohol compete in the brain for the same reinforcement sites as food," said University of Florida psychiatrist Mark Gold. "Drug reward is greatest when the person is starving or hungry and least when they are full."

A few paragraphs later, this:

"Drinking relieves them from their self-imposed restrictions, rules and obsessive thinking about weight," said Susan Sorrentino, a Salem-based psychologist specializing in eating disorders. "They want to get so drunk that they won't be able to think."

This, I understand. And I also understand that I am prone to abuse alcohol or drugs because of my underlying mental illness, as well as my family history. So I stay away.

*Then again, they'll just refuse to cover things after a person is diagnosed, so does it really matter? Apparently, no one has told them about the fact that mental illness = brain disease.
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