A molecular model for bipolar affective disorder

Reduction of synapsin in the hippocampus of patients with bipolar disorder and schizophrenia

Several studies suggest that decreased expression of presynaptic proteins may be characteristic of schizophrenia. We examined one such protein, synapsin, in schizophrenia and bipolar disorder. Samples of hippocampal tissue from controls (n = 13), patients with schizophrenia (n = 16), or bipolar disorder (n = 6), and suicide victims (n = 7) were used. The membrane and cytosolic fractions were analyzed by Western immunoblotting for synapsin using an antibody that detects synapsin Ia, IIa, and IIIa proteins. Synaptophysin was also measured for comparison. Total synapsin was decreased significantly in patients with schizophrenia (P = 0.034) and in bipolar disorder (P = 0.00008) as compared to controls. The synapsin/synaptophysin ratios were decreased in schizophrenia and bipolar disorder, and additionally in suicide victims (P = 0.014). Age, postmortem interval, percentage of protein extracted, and pH of brain were not different between groups. No changes in total synapsin or synaptophysin in the hippocampus were produced by injecting rats with either lithium or haloperidol for 30 days. Reductions in synapsin in both patients with schizophrenia (synapsin IIa and IIIa) and bipolar disorder (synapsin Ia, IIa and IIIa) imply that altered or reduced synaptic function in the hippocampus may be involved in these disorders.

Mania and bipolar disorder: Current concepts on assessment, diagnosis and management

Mania is a common psychiatric syndrome characterized by pathological mood elevation, grandiose thinking and motor overactivity. Although current consensus upholds a true distinction between unipolar depression and bipolar disorders, the distinction between various bipolar sub-categories is still a matter for debate, as is the exact distinction between schizophrenia and mania. Most cases are functional in origin but many organic causes have been identified as well as iatrogenic causes from prescribed medication, particularly in susceptible individuals. The underlying aetiology is still poorly understood, although a number of biochemical abnormalities have recently been identified, and the evidence for a genetic role is strong. Its prevalence is universal, with some differences between gender and ethnicity reported, and it displays marked Axis I and II comorbidity. Treatment, both acute and long term, still relies on various traditional combinations of neuroleptics, benzodiazepines and mood stabilisers, particularly Lithium, which now appears to be less effective than previously thought and a shift towards using other mood stabilisers from the anticonvulsant class is now apparent. The exact role for psychological treatment remains unclear with more research required. Good medical management includes; adequate treatment, physical and laboratory investigations, dedicated follow-up and supervision by hospital psychiatrists and community-based care agencies.