SIMPLE tasks can “rewire” the brain in patients at a high genetic risk of developing bipolar disorder, according to research presented in Edinburgh.
The pilot study in New York offers hope of a low-cost early intervention which could prevent the onset of bipolar disease – also known as manic depression – potentially saving the health service money and allowing patients to avoid mood-stabilising drugs known for their unpleasant side effects.
On average, one per cent of the population will require treatment for bipolar disorder but a person’s risk of developing the disease is significantly higher if a parent or sibling already has it.
However, not all members of a family will fall ill and scientists want to understand what makes some people “resilient” despite their genetic predisposition.
Researchers in New York used a type of brain scan known as functional magnetic resonance imaging (MRI) to map activity in the brains of three groups: patients with bipolar disorder, their siblings who did not develop the illness, and unrelated healthy individuals.
They found that both the bipolar patients and their siblings had similar abnormalities in the areas of the brain involved in processing emotion, but that this appeared to change in siblings during the study.
Participants were asked to perform repetitive tasks on the computer for around two to three minutes every day, designed to tap into the parts of the brain compromised in bipolar disease – such the ability to regulate emotion, impulsivity, ambiguity and inhibitions.
Speaking at the Royal College of Psychiatrists International Congress in Edinburgh, Sophia Frangou, Professor of psychiatry at the Ichan Medical Institute, said: “This is an area of work I think you will see more and more. The pilot study gives patients simple task to do regularly at home.
“If they engage in these for about two minutes per day we do see a restructuring of the brain in a way that could be useful. It may actually be therapeutic and is actually cost effective.”
“The tasks do not challenge them in the way that cognitive behavioural therapy [CBT] does, for example.
“That’s not to dismiss CBT, but this is a very repetitive task. They have to train themselves to do it every day, but it involves very basic affective stimuli that has no significance to them.
“We know that if they do it for about three weeks there’s a change, but we don’t know how long that lasts. It will probably require booster sessions but we don’t know how often these may be required. You have to think of it like going to the gym – you don’t go to the gym for three weeks and expect the effects to last.”
The study was discussed as part of a wider presentation into the potential to predict who is likely to develop depression, bipolar and schizophrenia based on brain scans.
Imagemend, a major EU-led brain imaging project has shown evidence of being able to distinguish healthy people from those at risk of schizophrenia.
However, there were warnings that the tool could be a “minefield”. One audience member, a US-based psychiatrist, said: “If suddenly my doctor’s saying ‘you have got a biomarker for severe depression’, I’m in trouble in terms of health coverage, life insurance and so on. What do we do about that?”
Dr Emanuel Schwarz, co-leader of Imagemend, said: “It’s a very important issue. There isn’t really a clear consensus yet. There’s a risk the insurance companies would ask patients to undergo these tests before taking out insurance.
“But I hope for psychiatry that there can be a benefit clinically without compromising patients’ rights.”
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