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(Sample of article for The Dalhousie Psychiatry Monitor, a magazine for Dalhousie University's psychiatry community.)

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In Search Of Answers
Dr. Martina Ruzickova wants to know why so many people with bipolar disorder
develop diabetes

"I have always been anxious to know more about the human mind, the brain - this amazing organ we still know so little about: how it works, its connection to other systems in the human body, its relationship to all kinds of diseases, somatic and psychiatric," says Martina Ruzickova. "Already in high school I'd decided to become a psychiatrist." She found mood disorders particularly compelling, even then: "I wanted to understand, searched for explanations: Why do people suffer from these disorders? Why do some people experience such extremes in moods? Why do psychiatic illnesses run in families?"

Only 27 years old today, Martina has already completed her MD in her home city of Prague in the Czech Republic, and is presently a clinical research fellow at Dalhousie. "When I decided to come to Canada in 2001, I didn't know anyone here. I came to learn how to do good clinical research," she says. Since then, she's acquired a very full life, with friends, hobbies, and meaningful work.

As the principal and co-principal investigator of a series of studies which investigates relationships between the bipolar disorder and diabetes, she is fascinated by the combination health problems and genetics to psychiatric illnesses. "Genetics and somatic co-morbidities in psychiatry are definitely my favorite areas. Both approaches can give us a more complex idea about what is going on. I think that the connection between somatic and psychiatic disorders is still, to a considerable extent, underestimated, and it is definitely partly due to that fact that we do not know much about the mechanisms that are involved."

People with the bipolar disorder have about three times greater risk of developing diabetes mellitus, type two in particular."There are many possible mechanisms that can underlie the link between the two disorders, such as treatment and lifestyle, hormones - specifically, the HPA axis processes inside the cell and, possibly genetic links." The HPA axis is the hypothalamo-pituitary-adrenocortical axis, which regulates how much cortisol the adrenal gland releases during stress.

Could the bipolar disorder have caused this rise in diabetes? "Treatment by itself, specifically antipsychotics, could not explain the increased risk of diabetes in our sample," she says. She recently completed a research project on this, and presented the results of her preliminary study at the American Psychiatric Association meeting in San Francisco this year, the International Conference on Bipolar Disorder in Pittsburgh, and the Dalhousie department of psychiatry research day. "A paper on this study is already in press," she says. "We are now working on a more detailed study that explores differences in clinical characteristics for bipolar patients with and without diabetes mellitus as well as on genetic studies." Given that patients possessing both disorders are much more likely to experience more frequent and severe psychiatric episodes, Martina's interest is not just academic, but eminently practical. "Mental health professionals would be interested in this type of information," she says.

She is recruiting participants for this newer study, through mouth of word, collaboration with diverse local facilities and with the Maritime Bipolar Registry itself. "It will take us some time before we have sufficient number of patients for the whole project," she says.

Asked why she came to Canada, she pointed to Professor Martin Alda's research group, of which she, along with other researchers in Ontario and Quebec, is a member. World-class leaders in bipolar disorder research, with Dr. Alda sharing his considerable expertise in bipolar issues, these researchers also collaborate with several outstanding research groups in numerous centers in Europe.

Sidebar: In her personal time, she enjoys quiet reading, watching movies with friends, playing squash, and exploring Nova Scotia's many trails, and has tried her hand at sea kayaking and canoeing.

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