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March 2nd, 2011
12:24 PM ET

Sheen has us asking: What's bipolar?

Over the last couple days, I have found it interesting how many people have watched the antics and interviews with Charlie Sheen, and immediately diagnosed him as either being on drugs or in the middle of a manic episode. Could be – but who knows, maybe it is all a big ruse. His erratic behavior is not in question, but arriving at a diagnosis based on a TV interview is impossible. In fact, my colleagues in the psychiatry community say it can be challenging even after completing a full assessment.

Bipolar disorder is characterized by the occurrence of at least one manic episode during the patient’s lifetime. Most patients also, at other times, have one or more
depressive episodes. In the intervals between these episodes, most patients return to their normal state of well-being. This is according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). When looking for evidence of mania, doctors often cite symptoms like being overly euphoric, agitated behavior, racing speech and impulsive behavior to name a few. Just reading that gives you an idea of why arriving conclusively at a diagnosis can sometimes be so difficult.

That is why I was so interested in a paper I recently read. Scientists at UCLA took on the goal of peering deep into someone’s brain, while the person was in the middle of a manic episode, to better understand what was happening. Now, as you might imagine, getting someone who is manic to agree to sit still in a functional MRI scanner wasn’t easy, but eventually the researchers recruited 18 patients into the study, nine of whom met the criteria for a manic episode, and nine other patients, who were healthy and served as controls.

What they found was fascinating. When given certain tasks to perform, the manic patients had a decrease in activity in part of the frontal lobe. Think about that - the frontal lobes are sort of your behavioral filter, and the activity there was much lower than in a healthy person. It is the part of the brain that makes you think before you speak or evaluate before you act. If there is low activity, those filters are turned way down, and you may start to see the impulsive, racing behavior associated with a manic episode. Those same patients also had higher than normal activity in the amygdala, which is associated with emotion.

When you look at these brain scans, consider this - you are seeing evidence of what a manic episode really looks like. And, in another study with depressed patients, the findings were very nearly the opposite. The filters were turned way up and the frontal lobe area shined brightly, whereas the emotional part of the brain had lower activity.

For now, patients with true mental illness can get outstanding diagnosis and treatment. This is a glimpse, though, of where the mental health field may be headed. Could we be approaching a day when a person with concerns about mental illness could get a special scan to find out? And, might that information also answer the question about the best treatment options as well? What do you think the pros and cons are, if scans like this became available?


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