Bipolar teen’s case shows benefits of the synergies that come from working across disciplines
The brain and the mind are two very different things. When you think of the brain, you think of physical grey matter and the diagrams in science class that showed the hippocampus and the cortex. Meanwhile, the mind is responsible for mental processes, your unique way of thinking and behaving.
The brain can get damaged through stroke, trauma or cancer, while the mind can fall prey to disorders affecting mood, memory and understanding. When the physical brain is damaged, it can affect mental function.
Recognizing that disorders of the brain and mind overlap, Sunnybrook Health Sciences Centre created the Brain Sciences Program, which pulls together experts in psychiatry, neurology, geriatric medicine, family medicine, neuroimaging, neurosurgery, and neuropsychology.
“We’re ahead of the game,” says Dr. Ken Shulman, chief of the Brain Sciences Program at Sunnybrook. “When it matters most, we are improving the quality of people’s lives. The disorders we deal with cause the greatest burden on families, such as Alzheimer’s, Parkinson’s, stroke, and depression. Sunnybrook is inventing the future of health care by reorganizing itself to care for disorders of the brain and mind.”
Among the Brain Sciences Program’s innovative features are one of the most advanced stroke prevention and treatment programs in the country; an ongoing commitment to cutting-edge, world-class research; state-of-the-art brain imaging equipment and facilities; and a Family Navigation Project designed to help patients and their families access the support they need from Sunnybrook and elsewhere in the health care system, to name a few.
The Program also places psychiatry firmly in the mainstream of medicine. “Psychiatry is integrated instead of segregated. This is a major move to normalize mental illness,” says Dr. Shulman.
For young patient Parag Kapoor, nothing could be more important. Parag is an 18-year-old with bipolar disorder and a patient at Sunnybrook’s Centre for Youth Bipolar Disorder, part of the Brain Sciences Program. Parag, a high school senior, is heading to York University in Toronto in the fall to pursue a degree in business.
Parag describes his disorder: “One part is depression and the other part is mania. For a long time I was depressed. Then, during the mania phase you jump from topic to topic really fast. You have to teach yourself to fight the urge to keep on talking.” At Sunnybrook, Parag is learning to control bipolar disorder through a combination of medication, regular contact with health care professionals, an active lifestyle – he’s on a mountain bike relay team -- and keeping busy with school work, art projects and volunteering. “Keeping myself busy keeps me distracted and keeps me away from bipolar. It is like a battle, we are always struggling,” he says.
Parag’s physician, Dr. Benjamin Goldstein, is director of the Centre for Youth Bipolar Disorder and a scientist dedicated to helping young people like Parag. Dr. Goldstein, who has been recognized internationally for his research, has three innovative projects underway. The first is a study that aims to ultimately develop a blood test for bipolar disorder.
“Right now,” says Dr. Goldstein, “the only way to diagnose and treat the condition is to ask patients how they feel.” In the study, which is funded by the Canadian Institutes of Health Research, Dr. Goldstein will measure subjects’ mood and functioning, while also gauging certain proteins in their bloodstream. “The goal is to identify blood-based biomarkers that can help inform real-life diagnostic and treatment decisions among teens with bipolar disorder,” says Dr. Goldstein.
“We think mood disorders are systemic, and there are a lot of markers in the blood. The same things that are bad for mood are bad for blood vessels,” he says.
In another study, Dr. Goldstein is using Sunnybrook’s state-of-the-art brain imaging facilities to study the effect that regular cycling has on the efficiency of the brain. The hope is that the study will contribute to a growing body of research showing aerobic exercise aids young people with bipolar disorder.
A third, promising study is on curcumin, a natural chemical that gives yellow pigment to the Indian curry spice turmeric. He recently received approval for a pilot study looking at whether curcumin supplements are an effective treatment for the depressed phase of bipolar disorder in teens.
Parag has witnessed how bipolar disorder is misunderstood and is working to raise awareness of the illness. “I don’t like the way people with bipolar disorder are treated. It’s almost like a taboo,” he says. “I told one person at my co-op that I had bipolar and they said, ‘So if you don’t take your meds, you go crazy’? I told them, no, I just don’t sleep. And without sleep, it’s hard to function.”
“Parag is a demonstration of the fact that people can do well,” says Dr. Goldstein. “The hope is that in future people don’t have to walk such a difficult path.”
Whether patients are suffering from depression, dementia, stroke, mood and anxiety disorders, multiple sclerosis, or traumatic brain injury, they fit under the Brain Sciences umbrella. “Collaboration between different types of brain specialists is essential because diseases of the brain and mind don’t exist in isolation,” says Dr. Shulman.
Sunnybrook is committed to this collaborative approach and is encouraging medical schools and the Royal College of Physicians and Surgeons of Canada to teach medicine a different way – cultivating multi-disciplinary learning. “Working together across disciplines and professions is the future of Brain Sciences,” he says. “We can’t be bound by the traditional disciplines of medicine – because the complex disorders of the brain and mind don’t respect those artificial boundaries.”