Bipolar Disorder Diagnosable By a 15-minute Electrocardiogram, Study Finds

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Credit to flickr.com user speedoglyn1. Used with permission under a Creative Commons license.

A groundbreaking Loyola Medicine study suggests that a simple 15-minute electrocardiogram could help a physician determine whether a patient has major depression or bipolar disorder.

Bipolar disorder often is misdiagnosed as major depression. But while the symptoms of the depressive phase of bipolar disorder are similar to that of major depression, the treatments are different and often challenging for the physician.

In bipolar disorder, formerly called manic depression, a patient swings between an emotional high (manic episode) and severe depression. Treatment for the depressed phase includes an antidepressant along with a safeguard such as a mood stabilizer or antipsychotic drug to prevent a switch to a manic episode. A physician who misdiagnoses bipolar disorder as major depression could inadvertently trigger a manic episode by prescribing an antidepressant without a safeguard mood stabilizing drug.

The study found that heart rate variability, as measured by an electrocardiogram, indicated whether subjects had major depression or bipolar disorder. (Heart rate variability is a variation in the time interval between heartbeats.) The study, by senior author Angelos Halaris, MD, PhD and colleagues, was published in the World Journal of Biological Psychiatry.

“Having a noninvasive, easy-to-use and affordable test to differentiate between major depression and bipolar disorder would be a major breakthrough in both psychiatric and primary care practices,” Dr. Halaris said. Dr. Halaris said further research is needed to confirm the study’s findings and determine their clinical significance.

Dr. Halaris is a professor in Loyola’s department of psychiatry and behavioral neurosciences and medical director of adult psychiatry.

Major depression is among the most common and severe health problems in the world. In the United States, at least 8 to 10 percent of the population suffers from major depression at any given time. While less common than major depression, bipolar disorder is a significant mental health problem, affecting an estimated 50 million people worldwide.

The Loyola study enrolled 64 adults with major depression and 37 adults with bipolar disorder.

All subjects underwent electrocardiograms at the start of the study. Each participant rested comfortably on an exam table while a three-lead electrocardiogram was attached to the chest. After the patient rested for 15 minutes, the electrocardiographic data were collected for 15 minutes.

Using a special software package, researchers converted the electrocardiographic data into the components of heart rate variability. These data were further corrected with specialized software programs developed by study co-author Stephen W. Porges, PhD, of Indiana University’s Kinsey Institute.

In measuring heart rate variability, researchers computed what is known to cardiologists as respiratory sinus arrhythmia (RSA). At the baseline (beginning of the study), the subjects with major depression had significantly higher RSA than those with bipolar disorder.

In a secondary finding, researchers found that patients with bipolar disorder had higher blood levels of inflammation biomarkers than patients with major depression. Inflammation occurs when the immune system revs up in response to a stressful condition such as bipolar disorder.

Text provided by Loyola University Health System.

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The Future of the Bipolar Parent: What Are You Interested In?

As a blogger, I’m interested in what my readers want. I’d like to cater to your interests. I’m curious to see which direction you think the Bipolar Parent should take, so I’ve created a poll to try and narrow down which posts you’re personally looking for. Please take the time to answer the poll, and, if you’re feeling inspired, leave a comment to explain your choice. The poll will be open forever. Thank you!

ETA: I just noticed that the poll code didn’t work, so I’ve replaced the code with something that hopefully will. Thanks for your patience with our technical difficulties!

ETA2: I apologize, but I’ve found I cannot make a poll without JavaScript, which WordPress does not support in free accounts. Looks like this experiment was a bust! If you’re interested, please comment on what you’d like to see out of the Bipolar Parent: Scientific Articles, Personal Experience, Advice, Guest Posts, or All of the Above. I’d love to hear your thoughts!

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Book Review: Rock Steady: Brilliant Advice From My Bipolar Life

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Ellen Forney’s book, Rock Steady: Brilliant Advice From My Bipolar Life.

Ellen Forney’s self-help book, Rock Steady: Brilliant Advice From My Bipolar Life is everything this blog aspires to be. With clean-lined, funny art pieces and truly brilliant advice, Forney’s book is easy to read and will be one of the staples in my repertoire. I highly recommend reading it.

Forney’s primary goal is to encourage and instruct people who suffer from bipolar disorder to obtain and then maintain stability. She clearly loves people, and wants them to succeed. Her best advice comes in the form of an acryonym: SMEDMERTS, which stands for Sleep, Meds, Eat, Doctor, Meditation*Mindfulness, Exercise, Routine, Tools, and Support. Using this acronym as a basis, Forney explains which doctors are out there and how to pay for one, how to get to sleep and stay asleep, and how to manage your meds. She also offers an entire chapter of coping tools, as well as a chapter on “the danger zone,” where she offers advice about how to recognize your warning signs when sliding into an episode.

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Forney’s acronym, SMEDMERTS, which stands for Sleep, Meds, Eat, Doctor, Meditation*Mindfulness, Exercise, Routine, Tools, and Support. Taken by Cassandra Stout and protected under a Creative Commons license.

Forney’s real talent lies in the unassuming artwork. This book is so much more than a list of to-dos. The art makes reading fun, and the information easy to digest. Each picture is clearly crafted to elicit a smile from the reader. The cover (pictured above) features the title in large, bold text, and an overwhelmed smiley face with a tongue sticking out. My toddler delighted in mimicking the emoticon, complete with sound effects.

Overall, I would rate Rock Steady a ten out of ten.

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22 Easy Meals to Make While Depressed

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Credit to flickr.com user Rool Paap. Used with permission under a Creative Commons license.

It’s an unfairness of the universe that, even while depressed, you still have to eat. Cooking is a useful skill to have, but who has the energy to cook when you don’t even have it to shower? Here’s some tips and a list of  22 meals to try when depressed.

Basic Tips

  • First, I recommend purchasing paper bowls and plates. You won’t feel like washing dishes when you’re down in the dumps.
  • Next, if it’s not overwhelming, print out this entry and stick it to the fridge so you have a list to refer to when you’re zoning out and can’t figure out what to eat.
  • Now is the time to decide whether ordering groceries online for delivery is worth it.
  • Think about setting alarms on your phone for when it’s time to eat. I recommend 9am, 12pm, and 5:30pm.
  • Assess whether meeting weight loss goals is doable, and consider letting them go temporarily, until you feel better.
  • And consider locking up your alcohol. It does no one good when depressed.

Hopefully, this list of meals will help make cooking easier.

Baked Chicken Breasts

Baked chicken can be the foundation of many meals. And the preparation is incredibly easy: simply place the chicken breasts in a casserole dish and bake for 55 minutes at 350 degrees Fahrenheit. Top with the condiments of your choice and serve with microwave veggies for a quick meal. Other options are to add chopped chicken to pasta, a bowl of spinach, eggs, tortillas, or rice.

Tortellini Soup

Tortellini Soup is one of the easiest recipes out there. It takes three ingredients, one of which is optional. I often make this meal for my family when I don’t feel like cooking.

Ingredients:

  • cheese-filled tortellini
  • 4 cups chicken broth
  • cheese (optional)

1. Bring chicken broth to a boil.
2. Add tortellini. Reduce heat to medium-high and boil for seven minutes.
3. Top with cheese, if desired. Serve with microwave vegetables or salad.

Mexican Rice

This is an easy meal which only involves one pot, if you don’t use a rice cooker.

Ingredients:

  • 2 cups long grain rice
  • 4 cups water
  • 1 can black beans, drained
  • 1 can corn, drained
  • 1 jar of salsa
  • cheese, optional
  • sour cream, optional

1. Bring water to a boil. Add rice and reduce heat to medium-low. Cover and steam rice for twenty minutes without removing the lid. Fluff with a fork.
2. Add other ingredients and stir. Heat on medium-high.
3. Top with cheese and sour cream if desired.

Everyday Cassoulet

Everyday Cassoulet is a French bean stew which is tasty and hearty. It takes about twenty minutes cook time and very little brain power to prepare. The longer you cook it, the better it tastes. Make this recipe when you’re feeling slightly ambitious.

Ingredients:

  • kielbasa sausage
  • one can of black beans, undrained
  • one can of great northern beans, undrained
  • one can of red kidney beans, undrained
  • 3 tsp of thyme
  • one can of tomato sauce
  • 2 tbsp of brown sugar
  • cheese (optional)
  • sour cream (optional)

1. Chop the kielbasa sausage. Add to pot.
2. Add other ingredients. Bring to a boil, stirring occasionally. Reduce heat and simmer for twenty minutes.
3. Top with cheese and sour cream, if desired.

Five-Minute Meals

Here’s a quick and dirty list of meals found around the web that require only five minutes of prep time. These are level 0 meals, when you’ve just dragged yourself out of bed and are tempted to go back.

  • Peanut butter + banana + toast. Yes, that counts as a whole meal.
  • Scrambled eggs + salsa + cheese. Add chopped pepper if you’re feeling up to it. Serve with toast to round out the meal.
  • Guacamole + salsa + cheese + tortilla. Premade guac is more expensive but can be worth it.
  • Ensure meal replacement shake.
  • Cheese + crackers.
  • Cashews + dried fruit + chocolate.
  • Toast + hummus + avocado.
  • Microwave bags of vegetables.
  • Premade salad kit.
  • Microwave sweet potato (five minutes on each side) + one can of black beans + salsa + cheese.
  • Can of tuna + mayo + toast.
  • Peanut butter + jelly + toast.
  • Toast + mayo + turkey + cheese.
  • Cottage cheese + toast.
  • Greek yogurt.
  • Hummus + baby carrots.
  • Instant oatmeal.
  • Blend Greek yogurt + frozen fruit + milk for a delicious smoothie high in protein.

I hope this list of tips and meals helps you when you find yourself in the middle of a flare up. Remember to be kind to yourself. Depression is no joke, and self-care is critical, especially eating–even when you’d rather do anything else.

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Dealing With Mental Illness Privilege Guilt

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Credit to flickr.com user Derera Toujours. Used with permission under a Creative Commons license.

I am doing well.

Very well.

My mental illness–bipolar I, with pronounced manic, depressive, and mixed episodes–has been in remission for several years. My psychiatrist has found a cocktail of medications that actually works, and I only see him twice a year for refills. I no longer need my therapist. I am content, productive, and on top of the day-to-day demands of my life.

So why do I feel so guilty? And how do I deal with these feelings?

I think I’m dealing with guilt because I don’t feel I deserve to do so well when others are suffering with their mental illnesses. Medication rarely works as well as it has in my case, and for so long. My husband’s health insurance covers whatever I need. I am educated about my mental illness. I am white. I get to stay at home with my children, and I am happy with my choice, providing me an avenue of self-fulfillment not available to most parents today.

In short, I’m very privileged, and I recognize and own that. But it fosters guilt in me. I’ve written on this topic before, but clearly I need to revisit it if I’m feeling this way.

I also feel like an imposter. That, because I’m doing well and not suffering from my mental illness, I shouldn’t be writing a blog about the topic. I know that this is irrational, and that I still have something to offer the community, but I can’t help feeling this way.

One way to deal with these feelings is to put my money where my mouth is. I can and will donate to the National Alliance on Mental Illness (NAMI), as well as other charities which concentrate on helping the mentally ill. I can volunteer my time to help people. And I can ultimately go back to school–when my children are older–with the intent to become a counselor, which was my plan from the beginning.

But… guilt isn’t a very good motivator. I don’t want to help people because I feel guilty, rather than an altruistic nature. So I’ve got to examine myself and figure out why I feel this way. I must learn to forgive myself for doing well, and acknowledge the privilege that got me here.

Wish me luck.

Do you ever suffer from guilt from doing well?

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Left-handed People Require Different Mental Health Treatments, Study Finds

According to a radical new model of emotion in the brain, a current treatment for the most common mental health problems could be ineffective or even detrimental to about 50 percent of the population.

Since the 1970s, hundreds of studies have suggested that each hemisphere of the brain is home to a specific type of emotion. The neural system for emotions linked to approaching and engaging with the world – like happiness, pride and anger – lives in the left side of the brain, while emotions associated with avoidance – like disgust and fear – are housed in the right.

But those studies were done almost exclusively on right-handed people. That simple fact has given us a skewed understanding of how emotion works in the brain, according to Daniel Casasanto, associate professor of human development and of psychology.

That long-standing model is, in fact, reversed in left-handed people, whose emotions like alertness and determination are housed in the right side of their brains, Casasanto suggests in a new study. Even more radical: The location of a person’s neural systems for emotion depends on whether they are left-handed, right-handed or somewhere in between, the research shows.

“The old model suggests that each hemisphere is specialized for one type of emotion, but that’s not true,” Casasanto said. “Approach emotions are smeared over both hemispheres according to the direction and degree of your handedness … . The big theoretical shift is, we’re saying emotion in the brain isn’t its own system. Emotion in the cerebral cortex is built upon neural systems for motor action.”

The study, “Approach motivation in human cerebral cortex,” appeared June 18 in Philosophical Transactions of the Royal Society B: Biological Sciences. The paper’s first author, Geoffrey Brookshire, was a doctoral candidate in Casasanto’s lab at the University of Chicago and a visiting doctoral student in Casasanto’s lab at Cornell.

The idea for the researchers’ theory, called the “sword and shield” hypothesis, stems from Casasanto’s observation that we use our dominant hands for approach-oriented actions, while nondominant hands are used for avoidance movements.

“You would wield the sword in your dominant hand to make approach-related actions like stabbing your enemy, and use the shield in your nondominant hand to fend off attack,” he said. “Your dominant hand gets the thing you want and your nondominant hand pushes away the thing you don’t.”

The researchers theorized that approach and avoidance emotions are built on neural systems for approach and avoidance actions.

“If this sword and shield hypothesis is correct,” he said, “then three things should follow: Approach motivation should be mediated by the left hemisphere in strong right-handers, as it has been in tons of previous studies. But it should completely reverse in strong left-handers. For everyone in the middle of the handedness spectrum, approach emotions should depend on both hemispheres.”

Casasanto and Brookshire tested this idea by stimulating the two hemispheres of the brains of 25 healthy participants with a pain-free electrical current. The goal was to see if they could cause the participants to experience approach-related emotions – including enthusiasm, interest, strength, excitement, determination and alertness – depending on which hemisphere of the brain was stimulated and whether they were righties or lefties or somewhere in between. The study participants got zapped for 20 minutes a day for five days, and reported before and after the five days how strongly they were feeling emotions like pride and happiness.

The experiment worked – and corroborated the researchers’ first test of the sword and shield hypothesis using brain imaging. Strong righties who were zapped in the left hemisphere experienced a boost in positive emotions. So did strong lefties zapped in the right hemisphere. But when lefties are zapped in the left hemisphere – or righties in the right – “you see either no change or a detriment in the experience of these emotions,” Casasanto said.

The work has implications for a current treatment for recalcitrant anxiety and depression called neural therapy. Similar to the technique used in the study and approved by the Food and Drug Administration, it involves a mild electrical stimulation or a magnetic stimulation to the left side of the brain, to encourage approach-related emotions.

But Casasanto’s work suggests the treatment could be damaging for left-handed patients. Stimulation on the left would decrease life-affirming approach emotions. “If you give left-handers the standard treatment, you’re probably going to make them worse,” Casasanto said.

“And because many people are neither strongly right- nor left-handed, the stimulation won’t make any difference for them, because their approach emotions are distributed across both hemispheres,” he said.

hand

Credit to flickr.com user spazbot29. Used with permission under a Creative Commons license.

“This suggests strong righties should get the normal treatment, but they make up only 50 percent of the population. Strong lefties should get the opposite treatment, and people in the middle shouldn’t get the treatment at all.”

However, Casasanto cautions that this research studied only healthy participants and more work is needed to extend these findings to a clinical setting.

Text provided by Cornell University.

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Gene Breakthrough on Lithium Treatment for Bipolar Disorder

genes

Credit to flickr.com user Berkeley Lab. Used with permission under a Creative Commons license.

Genes linked to schizophrenia in psychiatric patients suffering from bipolar disorder are the reason why such patients don’t respond to the “gold standard” treatment for bipolar – the drug lithium – according to international research led by the University of Adelaide.

Lithium has been widely used as a treatment for bipolar disorder since the 1950s because of its mood stabilising effect. It has unique protective properties against both manic and depressive episodes, and an ability to decrease the risk of suicide.

However, about 30% of patients are only partially responsive, more than a quarter show no clinical response at all, and others have significant side-effects to lithium.

Until now, researchers have not understood why these patients have not responded to the common treatment, while others have responded well to the drug.

Published in the journal JAMA Psychiatry>, an international consortium of researchers led by the University of Adelaide’s Professor Bernhard Baune reports a major discovery that could affect the future quality of treatment for people with this significant mental health condition.

Known as the international Consortium on Lithium Genetics, the group has studied the underlying genetics of more than 2500 patients treated with lithium for bipolar disorder.

“We found that patients clinically diagnosed with bipolar disorder who showed a poor response to lithium treatment all shared something in common: a high number of genes previously identified for schizophrenia,” says Professor Baune, Head of the Discipline of Psychiatry at the University of Adelaide and lead author on the paper.

“This doesn’t mean that the patient also had schizophrenia – but if a bipolar patient has a high ‘gene load’ of schizophrenia risk genes, our research shows they are less likely to respond to mood stabilisers such as lithium.

“In addition, we identified new genes within the immune system that may play an important biological role in the underlying pathways of lithium and its effect on treatment response,” Professor Baune says.

Understanding the underlying biology of people’s response to lithium treatment is a key area of research and urgent clinical need in mental health.

“These findings represent a significant step forward for the field of translational psychiatry,” Professor Baune says.

“In conjunction with other biomarkers and clinical variables, our findings will help to advance the highly needed ability to predict the response to treatment prior to an intervention. This research also provides new clues as to how patients with bipolar disorder and other psychiatric disorders should be treated in the future.”

Text provided by the University of Adelaide.

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Light Therapy Helps Bipolar Disorder Patients Function

light

Credit to flickr.com user Richard Leeming. Used with permission under a Creative Commons license.

Daily exposure to bright white light at midday significantly decreased symptoms of depression and increased functioning in people with bipolar disorder, a recent Northwestern Medicine study found.

 

Previous studies found morning bright light therapy reduced symptoms of depression in patients with Seasonal Affective Disorder (SAD). But patients with bipolar disorder can experience side effects such as mania or mixed symptoms from this type of depression treatment. This study implemented a novel midday light therapy intervention in an effort to provide relief for bipolar depression and avoid those side effects.

Compared to dim placebo light, study particpants assigned to bright white light between noon and 2:30 p.m. for six weeks experienced a significantly higher remission rate (minimal depression and return to normal functioning). More than 68 percent of patients who received midday bright light achieved a normal level of mood, compared to 22.2 percent of patients who received the placebo light.

The group receiving bright light therapy also had a much lower average depression score of 9.2 compared to 14.9 for the placebo group and significantly higher functioning, meaning they could go back to work or complete tasks around the house they hadn’t been able to finish prior to treatment.

The study was published Oct. 3, 2017 in the American Journal of Psychiatry.

“Effective treatments for bipolar depression are very limited,” said lead author Dr. Dorothy Sit, associate professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. “This gives us a new treatment option for bipolar patients that we know gets us a robust response within four to six weeks.”

Patients also experienced minimal side effects from the therapy. No one experienced mania or hypomania, a condition that includes a period of elation, euphoria, irritability, agitation, rapid speech, racing thoughts, a lack of focus and risk-taking behaviors.

“As clinicians, we need to find treatments that avoid these side effects and allow for a nice, stable response. Treatment with bright light at midday can provide this,” said Sit, also a Northwestern Medicine psychiatrist.

The study included 46 participants who had at least moderate depression, bipolar disorder and who were on a mood stabilizer. Patients were randomly assigned to either a 7,000 lux bright white light or a 50 lux placebo light. The light therapy patients were instructed to place the light box about one foot from their face for 15-minute sessions to start. Every week, they increased their exposure to the light therapy by 15-minute increments until they reached a dose of 60 minutes per day or experienced a significant change in their mood.

“By starting at a lower dose and slowly marching that dose up over time, we were able to adjust for tolerability and make the treatment suitable for most patients,” Sit said.

Sit and her colleagues also observed a noticeable effect of bright light therapy by four weeks, which is similar to other studies that test light therapy for non-seasonal depression and depression during pregnancy.

Light therapy has conventionally been tested using morning light at awakening because previous research has suggested that morning light helps reset circadian rhythms and can be helpful in the treatment of SAD, Sit said. However, the mechanism of response is unclear in bipolar disorder. To understand the possible effects of midday bright light on circadian rhythms in patients with depression and bipolar disorder, Sit and colleagues are planning new studies to investigate.

Text provided by Northwestern University.

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Brain Protein Targeted to Develop New Bipolar Disorder Therapies

protein

Credit to flickr.com user HealthMindandKat. Used with permission under a Creative Commons license.

A new study by scientists from the Florida campus of The Scripps Research Institute (TSRI) has identified specific genetic variations closely associated with increased susceptibility to bipolar disorder and other conditions. The discovery may provide a target for new therapies.

 

In the new study, the researchers focused on a gene known as PDE10A, one of the many genes that has been linked to bipolar disorder, and the proteins this gene produces. These proteins help regulate intracellular levels of a messenger molecule called cAMP (cyclic adenosine monophosphate), which is involved in a variety of biological processes including learning and memory.

“We began with the idea that behavioral changes in bipolar subjects might be due to these genetic variations in the cAMP messenger pathway,” said Ron Davis, chair of TSRI’s Department of Neuroscience. “We did find that this was the case and, indeed, that these variations were in one specific gene for the cAMP messenger pathway called PDE10A. The variations that we found in the gene may alter the function of one form of PDE10A and lead to susceptibility to bipolar disorder.”

The research, published recently by the journal Translational Psychiatry, examined human brain tissue from patients with bipolar disorder, as well as brain tissue from individuals without the psychiatric disorder.

“The PDE10A19 protein is interesting because we previously didn’t know it even existed in the human brain and because it’s found only in other primates—not mice or rats,” said Research Assistant Courtney MacMullen, the first author of the study. “Once we understand how this protein helps neurons remain healthy, we might be able to develop medications to treat neurons when they function abnormally, such as in patients with bipolar disorder and schizophrenia.”

The results suggested abnormal variations in PDE10A19 might alter cAMP signaling by interacting with another protein known as PDE10A2, restricting its activity and disrupting the entire process.

Davis said that the complexity of gene expression in the human brain is greatly underestimated, and that future neurogenetic studies ought to begin with a deep study of each gene’s ability to code for proteins to avoid false conclusions, particularly when it comes to the development of potential therapies.

“We need to know much more about this large family of enzymes and the roles they play in disorders like bipolar disorder,” he said.

Text taken from the Scripps Research Institute.

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Pot Smoking in Teens Linked to Bipolar Symptoms

Researchers at Warwick University found that cannabis use in young adults is linked to future development of hypomania, a state in which people deal with feelings of euphoria, irritability, increased sexuality, and competitiveness-–but less than someone with full-blown mania.

Led by Dr Steven Marwaha, a clinical academic Psychiatrist, the research analysed data from the Avon Longitudinal Study of Parents and Children and found that teenage cannabis use at least 2–3 times weekly is directly associated with suffering from symptoms of hypomania in later years.

However, the relationship between cannabis use and hypomania was so direct that any use increased the risk of developing the bipolar symptom, but less powerfully.

The Warwick team is the first to examine the link between cannabis and bipolar symptoms while controlling for other factors such as psychosis.

Cannabis is one of the most commonly used substances of abuse in

cannabis

Credit to flickr.com user DJ Kettle. Used with permission under a Creative Commons license.

western countries. Problematic use in the general population is as high as 9.5% in the United States, while 2.6% of the UK population report having been cannabis dependent in the last year.

 

The research, Cannabis Use and Hypomania in Young People: A Prospective Analysis, is published by Schizophrenia Bulletin.

The Warwick researchers hope to use this study to encourage interventions for teenagers who are cannabis dependent.

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