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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by SLS on July 6, 2011, at 8:11:44
Hi.
This is me - exactly. I have always swayed back and forth, especially when attempting to walk in a straight line.
- Scott
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Off Balance? Postural Problems May Point to Bipolar DisorderDeborah Brauser
June 7, 2011 Problems with postural control may be a core feature of bipolar disorder (BD) and not just a random symptom, new research suggests.In a small comparison study of 32 patients, those with BD showed a "greater sway magnitude" compared to healthy controls, especially when asked to close their eyes.
"The findings suggest that individuals with [BD] have deficits in sensorimotor integration and a reduced range of timescales available, which are needed to help them to make greater postural corrections," lead author Amanda Bolbecker, PhD, research scientist in the Department of Psychological and Brain Sciences at Indiana University in Bloomington, told Medscape Medical News.
Dr. Amanda Bolbecker"In addition, changes in their visual system really had some profound effects on their ability to maintain their balance," she added.
The investigators note it is possible that motor abnormalities may appear before other symptoms, signalling an increased risk for BD. The findings also raise the question of whether therapies for improving motor symptoms could also help with mood disorders.
"For a number of psychological disorders, many different psychiatric treatments and therapies have been tried, with marginal effects over the long term. Our study suggests that brain areas traditionally believed to be responsible for motor behavior might represent therapeutic targets for BD," added Dr. Bolbecker.
This study was published online May 18 in PLoS ONE.
Motor Function and Mood
According to the investigators, structural, neurochemical, and functional abnormalities have been identified in the brains of individuals with BD, including in key brain structures implicated in postural control, such as the cerebellum, brainstem, and basal ganglia.
"The brain area that I've been most interested in for a while is the cerebellum, which is connected to a lot of areas important for mood and cognition. People have traditionally thought of it mostly as being involved with motor coordination, but it's also been implicated in a number of psychiatric disorders," said Dr. Bolbecker, adding that she also wants to assess other mood and motor brain areas.
She noted that "it is well known" that patients with attention-deficit/hyperactivity disorder often have some motor abnormalities and that schizophrenia has been known to include movement abnormalities that precede illness onset.
"This has been looked at a couple of times in BD, but nobody has really looked at postural sway. And we chose that because we wanted to use a task that was quite sensitive."
For the study, 16 patients with BD (45% women; mean age, 38.6 years) and 16 age-matched healthy controls (55% women; mean age, 38.4 years) were enrolled at Larue Carter Memorial Hospital in Indianapolis.
All participants stood barefoot on a force platform for 2 minutes while instructed to be as still as possible. During that time, they were evaluated under 4 conditions: eyes open while standing with feet placed shoulder-width apart (open base), eyes closedopen base, eyes open with feet together (closed base), and eyes closedclosed base.
The investigators measured postural sway (the degree of adjustments made while standing by the participants), as well as center of pressure motion along the anterior-posterior and medio-lateral axes.
"Visual cues stabilize posture on longer time-scales, whereas proprioceptive [stance difference] cues are responsible for short timescale corrections. Therefore, if deficits in postural control exist in BD, manipulation of sensory input may be revealing with respect to specific domains in which sensory integration is affected," write the study authors.
Greater Sway
Results showed that patients with BD showed a significantly greater sway area, indicating reduced postural control, compared to the healthy controls (P < .01) and "decreased complexity in the medio-lateral direction," report the investigators.
Patients with BD also had a greater sway area than did the controls when their eyes were closed (P < .05), suggesting that "BD participants were impaired in their ability to make corrections to their sway pattern when no visual information was available."
No significant differences were found between open-base or closed-base stances, and none of the results were affected by mood or disorder severity.
"Overall, the evidence presented here is consistent with earlier findings of motor abnormalities in BD and is consistent with the proposed deficits in the cerebello-striatal-prefrontal circuit," write the researchers.
"Although the literature in this area is limited, a picture is emerging in which mood and motor dysfunction are comorbid pathophysiological features with closely overlapping core components."
Dr. Bolbecker reported that this was "a first pass study" and would next like to see research done that looks at these measures in a medication-naive population or in groups that is at risk for the disorder. "That will tell us a lot about whether motor symptoms are truly risk factors for onset of this illness."
She added that the investigators would also like to examine these risks in family members of patients with BD and to assess other tasks that are related to movement.
The study was funded by a grant from the National Institute of Mental Health and a 2007 National Alliance for Research on Schizophrenia and Depression Young Investigator Grant to Dr. Bolbecker. The study authors have disclosed no relevant financial relationships.
PLoS ONE. Published online May 18, 2011.
Posted by Phillipa on July 6, 2011, at 11:04:10
In reply to Bipolar Disorder and Imaired Balance / Posture., posted by SLS on July 6, 2011, at 8:11:44
Scott that is sure a new theory to me. You sway when walking? Must be very subtle as don't see people swaying when walking. Is this treated and controlled or not treated and uncontrolled?.Phillipa
Posted by zonked on July 6, 2011, at 11:15:08
In reply to Bipolar Disorder and Imaired Balance / Posture., posted by SLS on July 6, 2011, at 8:11:44
Me too. As a child, my Mom had me see a podiatrist because I walked a bit off and have always been clumsy. I was a year late starting kindergarten because my motor skills were underdeveloped. Later, the school wanted to advance of two or three grades because I was intellectually precocious. Without telling me until years later, they decided against it. When I found out, I was pissed, but in retrospect I think they made the correct decision.
Posted by SLS on July 6, 2011, at 12:22:52
In reply to Re: Bipolar Disorder and Imaired Balance / Posture. » SLS, posted by Phillipa on July 6, 2011, at 11:04:10
> Scott that is sure a new theory to me. You sway when walking? Must be very subtle as don't see people swaying when walking. Is this treated and controlled or not treated and uncontrolled?.Phillipa
For me, this symptom goes away when the depression goes away. It really isn't subtle when one is walking down a straight narrow hall or trying to walk without drifting side-to-side down a sidewalk.
- Scott
Posted by morgan miller on July 6, 2011, at 12:37:45
In reply to Bipolar Disorder and Imaired Balance / Posture., posted by SLS on July 6, 2011, at 8:11:44
That's strange, many athletes are bipolar and have great balance, posture and coordination. I fall into this category. Same goes for actors and politicians, great posture, not so sure about the balance.
Posted by morgan miller on July 6, 2011, at 12:50:22
In reply to Bipolar Disorder and Imaired Balance / Posture., posted by SLS on July 6, 2011, at 8:11:44
This study was done on people that were already diagnosed correct? Are they still on medication? Maybe the medication and the damage done by the disorder played a role? My balance and motor skills, while still better than average, has been impaired since my massive mixed episode that sent me to the hospital 3 1/2 years ago. I also contribute this to getting older and all of the physical trauma and loss of muscle strength.
My brother has pretty bad hand eye coordination and balance, always has, and he is the most stable one in the family. I know this is only one case.
I'd like to see more studies on this, diagnosing bipolar early on before medical intervention. I just don't think this is a very strong argument for the idea that the majority of bipolars have some kind of motor function or balance impairment.
Posted by morgan miller on July 6, 2011, at 12:52:40
In reply to Re: Bipolar Disorder and Imaired Balance / Posture. » Phillipa, posted by SLS on July 6, 2011, at 12:22:52
>For me, this symptom goes away when the depression goes away. It really isn't subtle when one is walking down a straight narrow hall or trying to walk without drifting side-to-side down a sidewalk.
So it could very well be one of your mind's way of reacting to depression.
Posted by SLS on July 6, 2011, at 13:38:38
In reply to Re: Bipolar Disorder and Imaired Balance / Posture., posted by morgan miller on July 6, 2011, at 12:52:40
> >For me, this symptom goes away when the depression goes away. It really isn't subtle when one is walking down a straight narrow hall or trying to walk without drifting side-to-side down a sidewalk.
> So it could very well be one of your mind's way of reacting to depression.
You are wrong.
Instead of trying to explain everyone's experience with mental illness according to your particular school of thought, why not just listen?
What makes you think that you are bipolar?
- Scott
Posted by bleauberry on July 6, 2011, at 18:43:23
In reply to Bipolar Disorder and Imaired Balance / Posture., posted by SLS on July 6, 2011, at 8:11:44
Hey, that article makes total sense to me. It describes me just about exact. In my case it is a very common symtom among lyme or lyme-like situations. Total guess here, but it wouldn't surprise me if in another few years they figure out it's because of sheath damage covering nerve endings.
I haven't really found anything to help with that particular symptom. I guess maybe we just get used to it because our other symptoms are worse?
Posted by SLS on July 6, 2011, at 19:11:02
In reply to Re: Bipolar Disorder and Imaired Balance / Posture., posted by bleauberry on July 6, 2011, at 18:43:23
> Hey, that article makes total sense to me. It describes me just about exact. In my case it is a very common symtom among lyme or lyme-like situations. Total guess here, but it wouldn't surprise me if in another few years they figure out it's because of sheath damage covering nerve endings.
>
> I haven't really found anything to help with that particular symptom. I guess maybe we just get used to it because our other symptoms are worse?You might be right. For me, the evidence lied in the many bumps and bruises I incurred from walking into things. Clumsy me.
Impaired balance is a symptom of a great many ailments, including Lyme Disease. I noticed my impaired ability to walk straight in 1982. Interestingly, I also found that high dosages of Lamictal produce a similar impairment. That so many different conditions can produce the same balance impairments does not negate the fact that bipolar disorder is among them. The brain controls balance. Bipolar disorder is an anomaly in brain function.
- Scott
Posted by Phillipa on July 6, 2011, at 20:11:17
In reply to Re: Bipolar Disorder and Imaired Balance / Posture., posted by SLS on July 6, 2011, at 19:11:02
I wonder if somehow it's connected to inner ear and the cystals that relieve dizzyness being in balance. I wonder if antivert would help with bipolar? Know it really relaxed me as a teen. Phillipa
Posted by linkadge on July 6, 2011, at 20:42:09
In reply to Re: Bipolar Disorder and Imaired Balance / Posture. » SLS, posted by Phillipa on July 6, 2011, at 20:11:17
Bipolar meds make it hard to walk in a straight line especially valproate.
Linkadge
Posted by morgan miller on July 6, 2011, at 21:53:28
In reply to Re: Bipolar Disorder and Imaired Balance / Posture. » morgan miller, posted by SLS on July 6, 2011, at 13:38:38
> > >For me, this symptom goes away when the depression goes away. It really isn't subtle when one is walking down a straight narrow hall or trying to walk without drifting side-to-side down a sidewalk.
>
> > So it could very well be one of your mind's way of reacting to depression.
>
> You are wrong.
>
> Instead of trying to explain everyone's experience with mental illness according to your particular school of thought, why not just listen?
>
> What makes you think that you are bipolar?
>
>
> - ScottScott, what's going on with you man? There could be a physiological reaciton to the biological depression that you are experiencing. Maybe I should have been more specific.
I am bipolar. Why are you questioning this? I've made it clear several times here. I don't need to go into the details with you.
Btw, life does affect our disorders, be them mostly biologically based or not. No one can deny this very fact.
Moragn
Posted by morgan miller on July 6, 2011, at 21:55:44
In reply to Re: Bipolar Disorder and Imaired Balance / Posture., posted by linkadge on July 6, 2011, at 20:42:09
> Bipolar meds make it hard to walk in a straight line especially valproate.
>
> LinkadgeExactly..We won't know if there is a real trend here unless there are studies done on young people that have been diagnosed but not treated.
Posted by morgan miller on July 6, 2011, at 22:00:31
In reply to Re: Bipolar Disorder and Imaired Balance / Posture., posted by SLS on July 6, 2011, at 19:11:02
Scott, you're the one who said you experience some of these symptoms when you are depressed. I wasn't saying, "It's all in your head man", I was just saying it could be a symptom of the depression, chicken before the egg.
Posted by 10derheart on July 7, 2011, at 0:37:27
In reply to Re: Bipolar Disorder and Imaired Balance / Posture. » Phillipa, posted by SLS on July 6, 2011, at 12:22:52
Fascinating.
I am not bipolar but I see it mentions in passing that something like this has long been known about people with ADD/ADHD. I don't recall hearing that, or if I did I've forgotten.
ADD/Inattentive is me and *this* is me. Years ago, I had to concentrate till smoke came from my ears trying to pass a sobriety test when stone cold sober and everyone, all my life, has hated walking abreast of me on a sidewalk (e.g., "what are you doing? quit pushing me off the sidewalk!") I couldn't help it - it just happens. Walking relaxed and straight as others do seems both impossible and almost...unnatural. It is no drunken stagger, but if you pay attention it is quite obvious to me and others.
These connections might lead to breakthroughs for MI sufferers. I have to hope so.
Posted by 10derheart on July 7, 2011, at 0:47:03
In reply to Re: Bipolar Disorder and Imaired Balance / Posture., posted by morgan miller on July 6, 2011, at 12:52:40
I've done it all my life, at least since I was a young teenager. And I was never depressed until my early 40s. But Scott is talking about BP and I am talking about ADD...very different animals. It stands to reason since I most certainly had ADD as a teen.
I find it all fascinating.
Posted by morgan miller on July 7, 2011, at 0:53:18
In reply to Re: Bipolar Disorder and Imaired Balance / Posture. » morgan miller, posted by 10derheart on July 7, 2011, at 0:47:03
> I've done it all my life, at least since I was a young teenager. And I was never depressed until my early 40s. But Scott is talking about BP and I am talking about ADD...very different animals. It stands to reason since I most certainly had ADD as a teen.
>
> I find it all fascinating.My brother has ADD/ADHD and likely an undiagnose learning disability, he exhibits all of these symptoms. Still, there are so many peole diagnosed with ADD and bipolar that are athletes with very good balance and coordination, I'm just not ready to buy into the idea that this issue is that much more common in certain pathologies than it is in the rest of the population. We are talking about one study, and a flawed one at that.
Posted by SLS on July 7, 2011, at 2:26:44
In reply to Re: Bipolar Disorder and Imaired Balance / Posture. » SLS, posted by morgan miller on July 6, 2011, at 22:00:31
> Scott, you're the one who said you experience some of these symptoms when you are depressed. I wasn't saying, "It's all in your head man", I was just saying it could be a symptom of the depression, chicken before the egg.
The egg most definitely came before the chicken. Biology 101.
- Scott
Posted by morgan miller on July 7, 2011, at 2:49:07
In reply to Re: Bipolar Disorder and Imaired Balance / Posture. » morgan miller, posted by SLS on July 7, 2011, at 2:26:44
Scott, I have to admit, I'm a little put off by what appears to me to be a bit of an attitude here, sorry if I am mistaken. I don't think anything I said warrants you responding the way you did with me. If you are not happy with life, don't take it out on me brotha. I'm in no mood to take any sh*t from you-doubting whether I'm bipolar and unreasonably responding to a perfectly reasonable post of mine. I really don't care if I get a silly little time out for my fairly benign statements here. And I don't give a f*ck if you felt accused in anyway.
Honestly, I think there are many people here that do not have the support they need and are not doing everything in their power to get better, not reach full remission(which I believe is unrealistic anyway, and striving for this may be part of the problem), just get better enough to enjoy life half the time. And I believe you fall into this category Scott. It really is quite frustrating. It's funny, I'm not even that fired up, I'm just speaking my mind, it's free world out there, unfortunately, not a free internet. Peace out.
Posted by morgan miller on July 7, 2011, at 2:58:03
In reply to Re: Bipolar Disorder and Imaired Balance / Posture. » morgan miller, posted by SLS on July 7, 2011, at 2:26:44
> > Scott, you're the one who said you experience some of these symptoms when you are depressed. I wasn't saying, "It's all in your head man", I was just saying it could be a symptom of the depression, chicken before the egg.
>
> The egg most definitely came before the chicken. Biology 101.
>
>
> - ScottI think it's one of those arguments that people have continued to debate over. I'm not so sure the idea of the egg coming before the chicken is either simple or confirmed. If you are speaking about the existence of life, the origins were definitely microscopic cells, than more evolved animals
You admitted it once before and now I see it, you can really be a bit of an *ss Scott. You're not the only one obviously, I can too.
Morgan
Posted by morgan miller on July 7, 2011, at 3:10:01
In reply to Re: Bipolar Disorder and Imaired Balance / Posture. » morgan miller, posted by SLS on July 7, 2011, at 2:26:44
Hold on, were you questioning me being bipolar as a way to make a point, getting me back for what you thought was me questioning the validity of your motor integration, balance, and posture issues having anything to do with your bipolar biology?
I'm just having a hard time figuring out why you would even ask me the question in the first place. I think you're being very immature here Scott.
I can't realy blame you though, after suffering as many years as you have the way you have, I would be immature, angry, and unreasonable at times also.
Posted by SLS on July 7, 2011, at 3:48:46
In reply to Re: Bipolar Disorder and Imaired Balance / Posture., posted by morgan miller on July 6, 2011, at 21:53:28
> > > >For me, this symptom goes away when the depression goes away. It really isn't subtle when one is walking down a straight narrow hall or trying to walk without drifting side-to-side down a sidewalk.
> >
> > > So it could very well be one of your mind's way of reacting to depression.
> >
> > You are wrong.
> >
> > Instead of trying to explain everyone's experience with mental illness according to your particular school of thought, why not just listen?
> >
> > What makes you think that you are bipolar?
> >
> >
> > - Scott
>
> Scott, what's going on with you man?
I am reacting to your replies to me. Imagine my telling you that your bipolar symptoms are really a conversion reaction to being psychogenically impotent, such that you are having dissonent feelings of guilt for molesting a toy poodle when you were peri-pubertal. Psychogenic impotence exists, therefore you must have it. The poodle has never been the same.> There could be a physiological reaciton to the biological depression that you are experiencing.
What is a "reaction"? How does that differ from an integral symptom?
It is not a *reaction* to having a bipolar diathesis that produces sway and other physical incoordinations. It is most likely the diathesis itself. That's why it can be detected by measurement devices in the absence of overt mood dysregulation. Maybe you are not at all overtly clumsy or otherwise incoordinated. Maybe you really don't have bipolar disorder. Psychodynamic therapy might cure your pseudo-bipolar conversion reaction.
You launched an assault against my reality with insufficient information. I doubt it was your intention to insult me, but I felt very much insulted. You make me feel feeble-minded. You don't think I can bump into walls and other objects without it being some sort of reaction? Reaction to what?
Impairments of physical coordination occurs with me. Obviously, they do not occur with you as you self-report. Maybe you are unaccustomed to self-reporting and have yet to learn the skill. Or perhaps this is a good starting place to investigate a poorly quantified phenomenon.
For what it's worth, prior to de novo treatment, I observed myself sway when walking and bumping into objects during my depressed phase of an ultra-rapid cycle. I was able to compare my ability to coordinate movements when depressed against my normothymic phase. (I was first diagnosed as unipolar because I had never displayed classic manic symptoms until then). Of course, one could easily explain my irritable or agitated temperament when I was younger as being a presentation of a mixed state. This is one explanation currently being studied.
Just as you don't feel like justifying your diagnosis of bipolar disorder to me, I don't feel like justifying my various bipolar physical incoordinations to you. I find it fruitful to have an open mind and simply listen to people when they describe themselves.
By the way, drugs can produce impairments in physical coordination as side effects. I know you knew that. However, what is often lost here is that if a drug can do it, why can't a sick brain do it on its own?
I don't know, Morgan. I just don't know. I am not sure of much except for the nature of the beast as I experience it.
- Scott
Posted by SLS on July 7, 2011, at 3:58:41
In reply to Re: Bipolar Disorder and Imaired Balance / Posture., posted by morgan miller on July 7, 2011, at 2:58:03
It was an egg of the pro-chicken that contained the first genetic mutation(s) to produce the chicken phenotype. This would be consistent with what we know about sexual reproduction and evolution.
In any event, it is nice to see that science validates my experience with bipolar disorder.
- Scott
Posted by SLS on July 7, 2011, at 4:12:03
In reply to Re: Bipolar Disorder and Imaired Balance / Posture. » SLS, posted by morgan miller on July 7, 2011, at 3:10:01
> Hold on, were you questioning me being bipolar as a way to make a point,
No. It was an interrogative meant for me to have a better understanding of your illness. I must have missed the posts of yours that described your experience with bipolar disorder. I didn't know you have it - or at least that you have been diagnosed as such.
> I'm just having a hard time figuring out why you would even ask me the question in the first place. I think you're being very immature here Scott.
No comment need be placed here by me.
> I can't realy blame you though, after suffering as many years as you have the way you have, I would be immature, angry, and unreasonable at times also.
I truly appreciate your consideration of my uncontrollable fits of rage and juvenile reactions to your disaffirmations of my life's experiences.
- Scott
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