The tragic shooting of Rigoberto Alpizar on Dec. 7 at the Miami International Airport by U.S. Marshals who thought he had a bomb offers an opportunity to discuss bipolar disorder and the need for law enforcement officials to understand mental illness.
Media reports stated that Mr. Alpizar may have had bipolar disorder, which has also been known in the past as manic depression. Although his specific diagnosis is still uncertain, the University of Michigan Depression Center offers this information:

• Bipolar disorder is estimated to affect 2.7 million Americans, or about 1 percent of the population, although the severity of the condition varies widely between individuals. Bipolar disorder is a top reason for disability in the United States, according to a recent U.S. Surgeon General’s report.

• The disorder is characterized by extreme variations in mood, from mania, euphoria and irritability to depression. Alterations in mood are commonly referred to as “mood swings” and can occur suddenly, prompting the start of manic or depressive “episodes.”

• Manic episodes can be especially distressing because they are often associated with high-risk behaviors like substance abuse, sexual promiscuity, immoderate spending, violent behavior, and disregard for danger. However, violent action during manic episodes tends to be self-injurious or suicidal, not aimed at injuring others.

• Bipolar disorder can be successfully treated with medications that can prevent episodes of depression or mania. These “mood stabilizing” medications include lithium and anticonvulsant medications. “Talk therapy” alone has not been shown to work in bipolar disorder.

• Medications should be taken regularly to prevent manic or depressive episodes from returning or worsening in severity. Also important are regular patterns of activity and of sleep, anticipation of stressful events or triggers, and early identification and treatment of new episodes.

• The Alpizar tragedy should spotlight the importance of training for law enforcement officials and others in recognizing and dealing with the outward signs of mental illness.

• Research has shown that bipolar disorder involves abnormalities in brain biochemistry and in the structure and/or activity of certain brain circuits. However, the causes of those abnormalities are still being investigated through studies involving brain scanning and other techniques.

• Bipolar disorder can run in families, and scientists at the University of Michigan and elsewhere are pursuing the genetic causes of bipolar disorder. U-M recently launched the U-M Prechter Bipolar Genes Project, funded by a gift from Waltraud Prechter, whose husband Heinz fell victim to suicide in 2001 after battling intermittent bouts of bipolar disorder for most of his adult life. The project is collecting samples from 1,000 bipolar patients, particularly adolescents with early onset of the disease, and 1,000 matched control participants. The University of Michigan will house the genetic repository, and the research also will involve investigators from Stanford University and Cornell University.

More information on bipolar disorder is available from the U-M Depression Center. Information on the Prechter Bipolar Genes Project is available at www.hcpfmd.org.