Daily Archives: August 21, 2016

Cognition and White Matter Alterations in Schizophrenia, Bipolar Disorder

Basically what this study is saying is in terms of the parameters they looked at [fractional anisotropy (FA) measures connectivity in the brain, number of fiber tracts (NofT), tract length (Le), and tract volume (vol)] people who had bipolar disorder were much closer to normal controls than people who had schizophrenia. That is, there is much less damage in the brain of people who have bipolar disorder and bipolar disorder is a much less severe illness than schizophrenia. Something I am acutely aware of and so thankful that if I had to have one of the two, at least I have the less severe one. Something about bipolar disorder for which to be thankful for a change. Nothing is perfect, but neither is it as bad as it could be…


According to new findings, published in Journal of Affective Disorders by investigators affiliated with Goethe University in Germany, Cardiff University in the United Kingdom, and Federal University of Ceará in Brazil, white matter, microstructural changes in the fornix are associated with cognitive ability in patients diagnosed with schizophrenia but not in those individuals diagnosed with bipolar disorder.
Schizophrenia and bipolar disorder are characterized by significant genetic overlap, as well as significant overlap in the presentation of clinical symptoms. Brain white matter abnormalities are known to exist in patients diagnosed with psychosis, but until now, the direct comparison of white matter changes between individuals with schizophrenia or bipolar disorder has not been performed. According to new findings, published in Journal of Affective Disorders by investigators affiliated with Goethe University in Germany, Cardiff University in the United Kingdom, and Federal University of Ceará in Brazil, white matter, microstructural changes in the fornix are associated with cognitive ability in patients diagnosed with schizophrenia but not in those individuals diagnosed with bipolar disorder.

Schizophrenia and bipolar disorder are characterized by significant genetic overlap, as well as significant overlap in the presentation of clinical symptoms. Brain white matter abnormalities are known to exist in patients diagnosed with psychosis, but until now, the direct comparison of white matter changes between individuals with schizophrenia or bipolar disorder has not been performed.

Investigators used diffusion tensor imaging (DTI) to examine white matter tracts in 32 euthymic bipolar disorder type I patients (15 female), 26 schizophrenia patients (13 female), and 30 matched typical, healthy control participants (16 female). The mean age of onset of bipolar disorder in the sample was 32.9 (SD=10.95), and 24.31 (SD=4.88) for patients with schizophrenia. All participants were taking medications at the time of study enrollment, but patients did not receive benzodiazepine drugs for at least 1 month prior to any brain imaging procedures.

Investigators chose to examine 4 white matter tracts: the bilateral fornix, the bilateral cingulum, the corpus callosum, and the bilateral anterior thalamic radiation. Disruption in fornix integrity in schizophrenia patients has previously been shown. The volume of the fornix in individuals with either schizophrenia or bipolar disorder, however, was found previously not to be significantly different from that of control participants.

With respect to the cingulum, decreased fractional anisotropy (FA) values were observed in individuals with schizophrenia and bipolar disorder. White matter tract abnormalities in the corpus callosum were also reported in both groups of individuals. Finally, microstructural changes in the anterior thalamic radiation were previously observed in patients with schizophrenia, and these abnormalities were linked to cognitive deficits.

In the current study, data show widespread white matter tract abnormalities in patients with schizophrenia compared with control participants [ie, differences were observed in all 4 regions and all indices of microstructral integrity, including fractional anisotropy (FA), number of fiber tracts (NofT), tract length (Le), and tract volume (vol)]. Differences in tract integrity were much smaller when these indices were compared between patients with bipolar disorder and controls, and alterations were noted only in the bilateral fornix.

Additionally, the alterations of the fornix have a functional relevance for cognitive performance (ie, reduced executive functioning and psychomotor speed) in patients with schizophrenia, but not bipolar disorder. These data “suggest that cognitive symptoms are closely associated with white matter changes in the fornix, at a greater (and significant) extent in schizophrenia than in bipolar disorder,” the authors wrote in their publication. 

Tapped Out, Maxed Out, Overdrawn

So I thought after getting the meet the teacher night over, I’d start feeling less anxious and more…alive. Ha. If you think, you stink. (I am forever indebted to Skid Row’s Sebastian Bach for that line, so very true, Bas.)

The entire outing drained me and other than paying car insurance and buying Spook some food on Friday…I’ve not left the lot all weekend and don’t want to. I did wash bedding yesterday, woo hoo, what a powerhouse of functionality I am. Just…I got nothing. My stomach is still churning, I am still tense, and the idea of an outing with my kid in tow makes me want to curl up in a closet.

Nope. We have food to avoid starvation. The whole store thing can wait until tomorrow when she is safely ensconced in school and I am safely able to breathe a bit. Of course, there’s no guarantee I will feel like doing it tomorrow, either…

Just kind of how it is when you’ve overdrawn on your own strength reserves.

I think the start of school is the start of sanity for me again, to an extent. Oh, I loathe getting up early (they want them there by 7:45 for these new morning pep talks based on the habits of highly effective people, wtf, my kid can’t even pull her underwear up without getting them tucked into her pants, teach her that effective habit first!). I don’t breathe for five nights, terrified I will oversleep and make her late. But in spite of those pitfalls, it’s a structure and that comforts me. Me, the rebel, who hates routine and schedules because my brain makes committing to them so difficult, and yet…I am craving structure. I truly am insane.

I don’t doubt I’m going to need a week or two before I even recover from 3 months of having my Uzi child firing away at my brain. It also signals “oh, she doesn’t need a babysitter, now I can make demands of her time because I am bored and don’t want to be alone or order my own parts” from R. Yeah, well, I am even giving myself a week off from his crap. If he never speaks to me again…At this point, it’d be a relief.

I also gotta get my paperwork back to public aid. For the first time in 5 years, they are requesting a face to face interview with me about us having the medical card. I know what this meeting is. “Why haven’t you gotten a job yet?”  To which I will happily reply, “Find something I can do from home on the internet so my mental disabilities aren’t triggered to the point of breakdowns and I will be all work for you.”


That’s the thing, ain’t it. If you use a cane or a wheel chair, they can find all kinds of ways to make a job work with your capabilities and limitations.

If your mind is what is disabled…Fuck you, you don’t matter.

I wish that were my bad attitude. Sadly…It’s fact. Society simply does not care about mental illness the way it does other disabilities.

Just thinking about it is making me start to break out in hives in addition to the pretzel gut.

That is why I am medicated for everyone else’s safety.

Idget society.

The Therapeutic Hug

People Group Teamwork Holding Logo. 3D Rendering illustration

Big Group Hug

The common wisdom is that a person needs four hugs a day for survival, eight for maintenance, and twelve for growth. I doubt that this is confirmed by any scientific studies and I doubt that it is true. If it were, there would be millions of people on Earth who would not survive.

I would be one of them. Despite being married to one of the two truly world-class huggers I’ve met in my life, I do not get my four-a-day. And certainly not twelve. Assuming eight hours a day for sleep and eight hours a day for work, that would leave eight hours to work in twelve hugs. That’s one and a half hugs per hour, and I suspect half a hug just won’t do.

In fact, I know it won’t. Scientific research has been done on the 20-second hug. It releases oxytocin, a pleasure and bonding chemical in the brain. Half a hug would need to be 40 seconds long to do the proper amount of good, and young lovers and newlyweds tend to be the only people who give hugs of that duration.

Then there’s the question of what constitutes a hug. For greatest oxytocin effect, I would recommend the full body hug – toe to toe, torso to torso, heads on shoulders, arms tightly squeezing. But you probably can’t give that particular hug when you run into an acquaintance in the supermarket, especially not 20 seconds worth, without blocking the aisles.

Other variations of hugs that may be less effective are the side-by-side one-shoulder squeeze (and the multi-person variant, the Big Group Hug), the manly back-thumping, and the A-frame hug (standing a distance apart and leaning in for a hug from the shoulders up). Then there are the virtual hug, usually written ((hug)), with the number of parens indicating the length/intensity of the hug, and the proxy hug, in which you delegate a person to pass along a hug when you’re not able to be there. None of these seem really conducive to the 20-second, made-for-thriving hug.

But, on some level, we know that hugs are therapeutic. Oxytocin or whatever, they make us feel better. Lots of hugging goes on at support and 12-step groups, and people who go to those daily might indeed make their recommended quota.

I go to private psychotherapy, however. I’ve never hugged my therapist, and am not even sure whether it’s appropriate for therapist and client to hug. It would be awkward to ask, “Can I have a hug?” only to hear, “No. That’s unethical.” But I suppose it depends on the therapist and the client and how each feels about the subject. I know sex is unethical, but hugs may be a gray area. Perhaps someone can enlighten me.

Of course, there are people who do not like to – or are afraid to – touch other people. Think Sheldon Cooper on The Big Bang Theory. People who are aware of and skilled in responding to others’ body language may be able to see the little (or, let’s face it, large) cringe when one person sees another moving forward with open arms. If the non-hugger is quick enough, he or she can quickly stick out a hand for a hearty handshake, or the potential hugger will abort the hug and retreat to a friendly tap on the shoulder.

But there are people who will swoop in and envelop you in an unwanted embrace and maybe even air kisses with smacking noises. I suspect these would be more likely to shut down oxytocin entirely, and possibly release adrenaline instead in a fight-or-flight response.

As with sex, the safest route is to ask for consent – “Can I have a hug?” – and take no – “I’d rather not” – for an answer, without taking offense or pressuring – “Aw, c’mon” – and making things even more awkward.

Still, the best advice I can give is to be proactive about hugging. Say, “I need a hug” when you do. Ask “Do you need/want a hug?” when a person you know seems to be in distress.

Avoid hugging strangers, though. That hardly ever helps. At least wait until you’ve been properly introduced.



Filed under: Mental Health Tagged: bipolar disorder, coping mechanisms, friends, hugs, husband, mental health, mutual support, my experiences, psychotherapy, social skills, support systems

30 Days of Sandy Sue Altered: 27





Down To Earth


She'll Make you a Sandwich

Why Not Me?

Not to sound like an old Judds song but seriously…WHY NOT ME?

My nephew turned 18 today, got his driver’s license, then promptly sent me a text about how he had spent the day driving is mom all over the state capitol.

In true narcissistic fashion, his triumph sent me into a tail spin, wondering why, at age 43, I still can’t manage a panic free “I’m not lost” trip just the same.

It pisses  me off for I am independent. I don’t relish asking for help. I don’t like losing my cool.

Yet over and over, even with directions printed out from Mapquest…Every time I venture out of t0wn…I  end up lost and stunned by panic.

I am supposed to relish life, see hope…

Yet here I am, once again, trying so fucking hard only to meet with failure, ad nauseum.

“If you want it enough and try hard enough, you can make it happen.”

Not sure what offends me more, the fact that it’s a lie or it’s a lie I read on some rand0m mental health blog.

WANTING it to be true…and reality presenting you with the tools to make it true…

Two VERY different things.


Sticker Shock

Now I understand why psychiatric patients go off their meds.

Some bureaucrat in his/her infinite wit and wisdom drew an arbitrary line that determines whether a person is poor enough to qualify for Medicaid. Well, my monthly income is about $30 too high, so I’m left to struggle with my medical care on my own…at least until Medicare kicks in on the first of October. I’ve already had to cancel three different appointments. And I’ve found out the hard way how bloody expensive my psych meds are.

Geodon 60 mg: $250+change for 30 capsules (one month’s supply). Geodon 20 mg: over $400 for 60 caps. Zyprexa 5 mg: $235 for 30 tablets. Lamictal 200 mg: $350 for 60 tabs. The cheapest is Trazadone 50 mg: $60 for 90 tabs, and Celexa 10 mg is a little less than $10 for a 30-day supply. And all of these are generics!

Now tell me, how the F is this affordable for a person receiving less than $1500/month in disability benefits? If I hadn’t had a few bucks in savings and help from family, I’d never have been able to purchase this month’s supply, and that’s without the Geodon 20 mg. (I figured that was the one I could most easily do without, and I was right—I remain stable and have avoided withdrawal because I’m still taking the 60 mg). But God knows how I’m going to get next month’s meds…and I’m literally in fear of what could happen if I’m forced to go without most of them.

I never realized how badly not having insurance affects everyday people. I’ve gone without it before, but I was always able to get my meds somehow and they weren’t THIS costly. In fact, I never paid more than $165 for one prescription in my life, and that was at my old pharmacy for the Geodon 20 mg. (Will somebody please tell my why the 20 mg version costs more than the 60 or the 80 mg?) I’m thinking about going back to that pharmacy temporarily, even though it’s in another town 25 miles away, because their prices for most of my meds are a little lower, except for the generic Zyprexa. But I like the convenience of the new one, and I’d go back to them in October anyway, so it seems like a lot of hassle to change pharmacies for only one month.

I’ll figure it out. I usually do. It’s just that this is yet another source of stress at a time when my life is already loaded with it. I’m still very early in the process of adjusting to an existence without my husband; in fact, it’s been so stressful that I’ve dropped 17 pounds without trying. I have no appetite—I only eat when I absolutely have to—and I get full so fast that I can only hold about half of what I used to. Not that weight loss is a bad thing, but this isn’t exactly the best way to do it.

Other than all that, life goes on and I’m trying every day to honor Will’s wishes in all I say and do. In the months before he passed, he made me promise several things, among them that I’d stay on my meds, stay sober…and stay alive. None of those are particularly easy tasks right now, but I understand why he wanted me to take those vows seriously: I tend not to make the effort on my own behalf, but I’ll do almost anything for someone I love. He knew this. I don’t think he anticipated my having such a hard time keeping that first promise, but if he’s watching me from above like I hope he is, he knows I’m doing the best I can.


Magical Mystery Tour

Sometimes I have these powerful, sensual feelings of empowerment. Bathed in a self fulfilling prophecy that I am love and light. I am the keeper of joy. Brought here to espouse the wonders of bliss. The journey is ours. I hold your hand and wipe the tear from your eye. Go forth my child in brilliance I shall be watching over you.
Yet, sometimes I flail in the darkness. Unable to find reason and purpose for my existence. My wings clipped and thrown aside. Any angelic auspices I might have once felt are smashed. Bits of my heart, soul and mind float along the painful abyss of bipolar disorder.
The cavernous fall seemingly came quick, but did it? Blinded once again by magnificent mania. Light footsteps carried me over the bridge of desire. Heavy hearted I can no longer rise. The magic of fast paced, bright colored, illustrious circumstance disappeared. I am left picking up the pieces to a timeless puzzle. Different day. Different me. Sense of self forever lost in the maze of uncertainty.
As I settle into the madness, a hopelessness so profound takes hold. Opening my eyes at dawn or at all takes such precious energy. Hours turn into days into weeks. All unbeknownst to me. The constant shadow is a forecast. In darkness I shall always remain. Until the manic fever causes shivers up and down my spine once again.

Sent from my iPhone