Genetic testing bipolar
Bipolar Disorder Treatment and Pharmacogenetic Testing
Everyone experiences mood swings from time to time, but bipolar disorder takes those highs and lows to a more severe level. Approximately 4% of all U.S. adults will experience bipolar disorder, with women and men equally likely to be affected.
Whether a close friend is dealing with bipolar disorder or you’re struggling with it yourself, getting effective treatment can be crucial. Here’s what you need to know about bipolar disorder, including how pharmacogenetic testing (PGx) can be a helpful tool in your treatment.
What is Bipolar Disorder?
Bipolar disorder is a mental health disorder that causes someone to experience significant shifts in mood. This affects everything from their demeanor to their energy levels as well as their basic ability to function and make it through the day. An individual with bipolar disorder may experience manic, hypomanic, and/or depressive stages.
Dealing with changes in moods and emotions can seem confusing, and it may be difficult to recognize the signs of bipolar disorder.
What does a manic episode feel like?
Some common manic symptoms of bipolar disorder may include:
- Feeling jumpy, wired, or irritable.
- Needing less sleep than usual.
- Having racing thoughts.
- Talking louder, faster, or having pressured speech.
- Having an inflated ego, for example thinking you can do things that normally you could not do.
What does a depressive episode feel like?
Some common depressive symptoms of bipolar disorder may include:
- Feeling sluggish or restless.
- Increased or decreased appetite.
- Sleeping too much or having trouble falling asleep.
- Difficulty focusing or making decisions.
- Losing interest in things you ordinarily enjoy.
- Having suicidal thoughts.
These mood swings don’t always happen consecutively.
An individual may go through a manic episode, feeling heightened energy and self-confidence, only to fall into a depressive state a few days or weeks later. Alternatively, they may return to normal functioning for weeks or months before the next depressive or manic episode occurs.
Types of Bipolar Disorder
It is the intensity of manic episodes that helps us further categorize bipolar disorder. There are three main types:
- Bipolar I is defined by manic episodes that last at least seven days, and typically lead to hospitalization. Bipolar I can also include depression lasting up to two weeks, or frequent switches between manic and depressive episodes.
- Bipolar II is characterized by hypomania, or a milder manic episode. This is an elevated mood or state of mind that may cause high energy levels and make it more difficult to focus. Symptoms must be present for at least four days in order to be defined as hypomania. Bipolar II always involves depressive episodes as well, which mirror clinical depression.
Usually depressive periods occur more often than hypomanic episodes. - Cyclothymic Disorder is characterized by mild hypomanic and depressive symptoms that occur over the course of two years but are not serious enough to be defined as episodes.
If you think you may have bipolar disorder, it’s important to speak to your healthcare clinician about your symptoms.
Bipolar Disorder Treatments
The first step to treating bipolar disorder is to make an appointment with your primary healthcare provider. They will likely start with a physical exam to rule out other causes of symptoms, then refer you to a specialist, such as a psychiatrist. From there, your treatment plan may include a combination of cognitive behavior therapy, lifestyle modifications, and medication.
There are several prescription medications used to treat bipolar disorder, such as mood stabilizers (like lithium), antipsychotics, and antidepressants, which may help stabilize your mood and may prevent the swing between manic and depressive episodes.
Possible Side Effects of Bipolar Medication
While medication may be an important and essential part of treating bipolar disorder, certain drugs may cause side effects. Potential side effects with medications used to treat bipolar disorder include:
- Weight gain.
- Increased blood pressure or blood sugars and altered cholesterol levels.
- Feeling lethargic (sluggish) or sedated.
- Akathisia, or feeling restless and unable to physically sit still.
Research published in the Journal of Affective Disorders states that these side effects may lead to non-adherence, or individuals not taking their medication as directed.
Can Bipolar Be Genetic?
There is no single bipolar gene that determines if an individual will be diagnosed with bipolar during their lifetime, but there is a hereditary component to the disorder. One review published in Neuroscience found that bipolar is one of the most heritable medical disorders.
Twin studies have corroborated this, estimating bipolar disorder to be 60-80% heritable. For example, having a parent who has bipolar can make you more genetically susceptible to having bipolar as well. Your risk increases if more than one immediate family member, say your other parent, has the condition too.
However, as with most mental health disorders, genetics is only part of the equation. Mental health is a combination of genetics, experiences, lifestyle choices, and your surrounding environment, both past and present.
Genetic Testing for Bipolar Medication
Your personal genetic profile can provide information on the likelihood of effectiveness and side effects with various medicines, as well as information on how your body processes medications. This does not have to be something you find out by trial and error. By being proactive and getting this information before starting a medication, your clinician can make more informed decisions when prescribing medication(s).
This is done through genetic testing for medication response.
The Genomind Pharmacogenetic (PGx) test looks at 24 genes related to mental health treatment and can be used to help determine medication options to manage bipolar disorder. It provides guidance across 130 medications used to treat a multitude of neuropsychiatric disorders to help clinicians determine:
- Which medications may be more or less likely to be effective.
- Which medications may be more or less likely to show side effects.
- How you metabolize medications for personalized dosing guidance.
The Genomind PGx test can be done at a clinician’s office—or from the comfort of your home. It requires a prescription, and Genomind can help connect you with a verified Genomind provider near you. Get started by filling out this form.
Is Your Bipolar Medication Working for You?
Bipolar disorder can be a difficult condition to manage, and difficulty in finding medication(s) that relieve symptoms and/or a stable treatment plan can be discouraging to both patients and providers.
Genetic assay testing provides insight into how your genes may play a part in your response or tolerability to different prescriptions. This pharmacogenomic testing gives your clinician information they can leverage to help you avoid trial and error and find appropriate treatment.
Largest Genetic Study of Bipolar Disorder Identifies 64 Regions of the Genome That Increase Risk for the Condition | Mount Sinai
- Press Release
International consortium of leading psychiatric genetics scientists studied thousands of DNA sequences, more than doubling the number of regions previously identified
Niamh Mullins, PhD
Mount Sinai Health System
Newsroom
- New York, NY
- (May 13, 2021)
In the largest genetic study of bipolar disorder to date, researchers have identified 64 regions of the genome containing DNA variations that increase risk of bipolar disorder - more than double the number previously identified.
The research team also found overlap in the genetic bases of bipolar disorder and other psychiatric disorders. Furthermore, the study supports a role of sleep habits, alcohol, and substance usage in the development of bipolar disorder, although further research is needed to confirm these findings. The study results are published May 17 in Nature Genetics.
Bipolar disorder, a complex psychiatric disorder characterized by recurrent episodes of severely high and low mood, affects an estimated 40 to 50 million people worldwide. It typically begins in young adulthood, often takes a chronic course, and carries an increased risk of suicide, making it a major public health concern and cause of global disability.
To help elucidate the underlying biology of bipolar disorder, an international team of scientists from within the Psychiatric Genomics Consortium conducted a genome-wide association study. This means they scanned the DNA of lots of people, looking for genetic markers that were more common in those who had bipolar disorder.
This involved scanning more than 7.5 million common variations in the DNA sequence of nearly 415,000 people, more than 40,000 of whom had bipolar disorder. The study identified 64 regions of the genome that contain DNA variations that increase risk of bipolar disorder.
“It is well-established that bipolar disorder has a substantial genetic basis and identifying DNA variations that increase risk can yield insights into the condition’s underlying biology,” says Niamh Mullins, PhD, Assistant Professor of Psychiatric Genomics at the Icahn School of Medicine at Mount Sinai and lead author of the paper. “Our study found DNA variations involved in brain cell communication and calcium signaling that increase risk of bipolar disorder.
The findings suggest that drugs, such as calcium channel blockers that are already used for the treatment of high blood pressure and other conditions of the circulatory system, could be investigated as potential treatments for bipolar disorder, yet it's important to note that future research to directly assess whether these medications are effective is essential.
”
The study also found overlap in the genetic basis of bipolar disorder and that of other psychiatric disorders and confirmed the existence of partially genetically distinct subtypes of the disorder. Specifically, they found that bipolar I disorder shows a strong genetic similarity with schizophrenia and bipolar II disorder is more genetically similar to major depression.
“This research would not have been possible without the collaborative efforts of scientists worldwide that enabled the study of hundreds of thousands of DNA sequences,” said Ole Andreassen, MD, PhD, Professor of Psychiatry, Institute of Clinical Medicine and Oslo University Hospital and senior author of the paper. “Through this work, we prioritized some specific genes and DNA variations which can now be followed up in laboratory experiments to better understand the biological mechanisms through which they act to increase risk of bipolar disorder.”
The biological insights gained from this research could ultimately lead to the development of new and improved treatments or precision medicine approaches to stratify patients at high genetic risk who may benefit from targeted treatment or intervention strategies.
Understanding causal risk could aid clinical decision-making in the prevention or management of the illness. Future genetic studies in larger and more diverse populations are now needed to pinpoint the genes relevant to risk of bipolar disorder in other areas of the genome.
The Psychiatric Genomics Consortium (PGC) is an international consortium of scientists dedicated to studying the genetic basis of psychiatric disorders and includes over 800 researchers, from more than 150 institutions from over 40 countries.
Tags: Icahn School of Medicine at Mount Sinai, Niamh Mullins, PhD
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Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, over 400 outpatient practices, nearly 300 labs, a school of nursing, and a leading school of medicine and graduate education.
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Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.
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Bipolar Disorder Transcriptome Study - PCR News
Prepared by
Ksenia Vekhova
American scientists examined the transcriptome of 511 post-mortem brain samples from people with and without bipolar disorder and identified 962 differentially expressed genes. Among them were genes associated with Alzheimer's disease, inflammatory and immune pathways, and synaptic signaling.
nine0005
Prepared by
Ksenia Vekhova
Bipolar disorder (bipolar affective disorder, BAD; manic-depressive disorder) is a severe mental illness with a high degree of heritability: according to some estimates, up to 80%. The results of numerous genome-wide association searches (GWAS) suggest that identifying specific genetic variants that could explain the heritability of BD is possible, and this is a very important task. The search for changes at the transcriptome level was performed by a team led by researchers from the Johns Hopkins University School of Medicine. nine0005
The authors of an article in Nature Neuroscience sequenced RNA from 511 post-mortem brain samples from 295 people, of which 138 were diagnosed with bipolar disorder, and the remaining 157 formed the control group. Two areas of the brain were chosen for study - the amygdala (amygdala) and part of the anterior cingulate cortex, namely its subgenual part (subgenual anterior cingulate cortex, sACC).
These regions are involved in the formation of emotions and motivation, regulation of behavior and mood, and therefore play a special role in the development of bipolar disorder. nine0005
Of the 962 genes that are differentially expressed in people with and without bipolar disorder, 858 were identified in sACC and 145 in the amygdala. These were mainly protein-coding genes (86.8%), 6% were long non-coding RNAs. Only 4.3% (41 genes) had significant expression in both sACC and amygdala.
The scientists found 20 modules of co-expressed genes associated with bipolar disorder. The module most strongly associated with ALS contained genes that were silenced in the amygdala and sACC in bipolar disorder; many have been linked to inflammatory and immune pathways, including those mediated by microglia. These data indicate the role of microglia in the development of BD. nine0005
This block included 31 differentially expressed genes. It is noteworthy that four of them ( A2M , TREM2 , CTSB and PLCG2 ) are associated with Alzheimer's disease, and another eight ( CD4 , IKBKB , CX3CR1, , Pycard , Pycard , Pycard , Pycard , Pycard , SYK , BLNK and TNFAIP8L2 ) directly or indirectly activate NF-κB, the nuclear transcription factor kappa-bi that controls the expression of immune response and apoptosis genes.
nine0005
The second most important module consisted of 224 genes, which were also characterized by suppressed expression in bipolar disorder. Among them were genes associated with synaptic pathways. One of the most significant genes, TAMALIN , plays an important role in the organization of group 1 metabotropic glutamate receptors in synapses.
The researchers conducted an additional analysis of quantitative trait loci of significant expression (expression quantitative trait loci, eQTL; loci, variants of which cause changes in the expression of any genes). The analysis led to the conclusion about the possible role of genes SCN2A and GRIN2A in BAR development. Both genes code for membrane proteins involved in neuronal signaling. Product SCN2A is the alpha subunit of the sodium ion channel, which is actively expressed in excitatory glutamatergic neurons of the brain. Previously shown role SCN2A in early developmental disorders of the brain and the emergence of autism spectrum disorders.
The data obtained indicate specific genes and pathways that may be involved in the development of pathological processes in bipolar disorder at the molecular level. “By identifying these genes, we can begin to look for molecular changes that cause severe mood volatility,” says study leader Thomas Hyde. nine0005
Source
Zandi, P. et al. Amygdala and anterior cingulate transcriptomes from individuals with bipolar disorder reveal downregulated neuroimmune and synaptic pathways // Nature Neuroscience, published March 2022. DOI: 10.1038/s41593-022-01024-6
Neurology Gene expression
Test for Bipolar II Disorder (HCL-32) • Psychologist Yaroslav Isaikin
Russian version for detecting hypomanic states. Typically used to detect type II bipolar disorder among patients with a current diagnosis of RDD (recurrent depressive disorder). nine0005
In case of exceeding 14 points, "a suspicion of bipolar affective disorder type II" is set, and a consultation with a psychiatrist is recommended on this issue.
Bipolar affective disorder (obsolete MDP - manic-depressive psychosis) is an endogenous mental disorder. A feature of BAD is the sequential alternation of “phases”, some of which are manic, and some are depressive. Phases can have different severity, duration, alternation and frequency of occurrence, which determines the specific clinical picture. Since manic episodes are a much more specific manifestation of bipolar disorder than depressive episodes, the diagnosis of bipolar disorder in the framework of the questionnaire is based on diagnosing a manic phase of a certain severity (the main part) and the presence of a sign of alternating "phases" of mood. nine0084
Other Bipolar Spectrum Tests:
Bipolar Spectrum Diagnostic Scale for Bipolar Spectrum Disorders
Mood Disorder Questionare for Type I Bipolar Disorders
Instructions:
Try to remember a period of "elevated" condition that was not caused by drugs or alcohol and LASTED MORE THAN A COUPLE OF DAYS (4-6 consecutive days)
How did you feel then?
Please answer questions no matter how you feel now.
nine0005
1. I needed less sleep
Yes
No
2. I had more energy and was (was) more active
Yes
No
3. I was (was) more confident
Yes
No
4. Work gave me more pleasure
Yes
No
5. I became more sociable (phoned more often, corresponded with people more often, left the house more)
Yes
No
6. I wanted to travel and actually traveled much more
Yes
No
7. I took risks more often, for example, I began to drive a car at a higher speed
Yes
No
8. I spent more (too much) money
Yes
No
9. In everyday life, I often found myself in risky situations (both at work and in other circumstances)
Yes
No
10. I began to move more (go in for sports, walk, etc.)
Yes
No
11. I had many plans, projects
Yes
No
12.
I became more inventive, I had many ideas
Yes
No
13. I became less shy and "notorious"
Yes
No
14. I dressed (dressed) more brightly and extravagantly (I used brighter make-up)
Yes
No
15. I wanted to meet people more often, and I really communicated with many
Yes
No
16. I became more interested in sex than usual, sexual desire increased
Yes
No
17. I flirted more often and/or was more sexually active
Yes
No
18. I talked a lot
Yes
No
19. I was thinking faster than usual
Yes
No
20. I joked and punned a lot
Yes
No
21. I am easily distracted
Yes
No
22. I have a lot of new things to do
Yes
No
23. My thoughts jumped from one to another
Yes
No
24. I did everything much faster and easier than usual
Yes
No
25.
