Research

Central to our research interests is the role of genetic factors in the causation of bipolar disorder. The stable population of the Maritimes allows us to conduct some of the most informative and unique genetic investigations in the world.

Our group is conducting a number of genetic-focused investigations including gene-mapping projects, the study of children of parents living with mental illness, brain imaging studies and studies of the risk of suicide in people with mood disorders.

The Maritime Bipolar Registry, with a current enrolment of over 500 participants, is a voluntary, confidential registry established by the Mood Disorders Research Group to provide long-term information about the course and outcome of bipolar disorder.

Through the registry we have formed strong links with community psychiatrists, family physicians and other clinicians. In addition to research, the registry serves clinical (consultations, often provided locally) and educational purposes (seminars for health care professionals throughout the Maritimes).

We also publish a quarterly newsletter with articles written by researchers, clinicians and patients, reporting on various aspects of mood disorders. The newsletter currently has a mailing list of 620 and is sent to registry participants as well as health care professionals and mental health clinics throughout the region.

The registry represents a major clinical and academic resource fostering collaboration between researchers and clinicians at both primary and specialized levels of care. Opportunities for participatory research have recently expanded with the introduction of the Canadian Depression Research and Intervention Network (CDRIN) Maritimes Registry, which enrols people with all types of mood and anxiety disorders.

Properly selected long-term treatment can have a dramatic positive effect on mood disorder outcomes. Unfortunately, clinicians still rely on a trial-and-error approach to treatment selection, with each trial taking many months before indicating if it is effective.

Our group has been one of the leaders in developing tools to personalize long-term treatment of bipolar disorder. In particular, we have been investigating clinical and molecular predictors of response to lithium and other mood stabilizers in collaboration with a number of specialty clinics and research consortia around the world, including the International Consortium on Lithium Genetics (ConLiGen) and Pharmacogenomics of Bipolar Disorder (PGBD).

The longitudinal study of the children of parents living with mental illness is another active research area for the group. Family history is the strongest risk factor associated with the development of mood disorders and other types of mental illness.

The majority of young people who have a family history of mood disorders remain well. However, offspring of parents with bipolar disorder are at 10 times higher risk of developing bipolar disorder than offspring of parents without the disorder. They may also be at increased risk for developing other types of mental illness, such as major depression or psychosis.

With the help of families included in genetic databases, the research team members see children ages 1 to 25 as part of this study. For more information on the study of parents and children, see Families Overcoming Risks and Building Opportunities for Well-being.

Brain imaging holds potential to provide insight into brain structure, chemical composition and function in people with severe psychiatric disorders. Our aim is to better understand how structural and functional brain changes fit into a pathophysiological model of mood disorders. Are these associated with the genetic risk of developing the illness or do they develop progressively as a result of being ill?

Such distinction is crucial to further our understanding of the illness and also for clinical reasons. Whereas the primary changes may aid in diagnosis, the secondary ones may be a target for preventive measures. We are also examining whether early interventions may help healthy brain development in children of parents living with mental illness.

Anxiety is a common and impairing companion of bipolar disorder. Dr. Pavlova and others in our group are examining

• how common comorbid anxiety disorders are among people living with bipolar disorder
• how these disorders change with the phases of bipolar illness
• how comorbid anxiety can be most effectively treated

Dr. Pavlova is conducting the first study of cognitive behavioural therapy for social anxiety disorder in people with bipolar disorder.

Diabetes occurs at much higher rates in individuals with bipolar disorder. Dr. Calkin and others in our group have been studying diabetes and its affect on outcome in bipolar disorder.

We have found that diabetes and even pre-diabetes (insulin resistance) are associated with:

• a more chronic course of illness
• rapid cycling of mood episodes
• poor response to lithium (the principal mood stabilizing treatment for bipolar disorder)

Dr. Calkin recently received funding from the Stanley Medical Research Institute to study the effect of metformin (a drug used to treat diabetes) on bipolar disorder outcome in people with chronic bipolar depression and pre-diabetes. Participants in this study will have not responded to the usual treatments for bipolar disorder. This will be the first study to see whether treating pre-diabetes (a medical illness) can improve outcome in bipolar disorder (a psychiatric illness).