Schizophrenia And Other Psychoses
Schizophrenia is a severe mental disorder, affecting 20 million people worldwide1. Psychoses, including schizophrenia, are characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour. Common psychotic experiences include hallucinations and delusions . The disorder can make it difficult for people affected to work or study normally.
Stigma and discrimination can result in a lack of access to health and social services. Furthermore, people with psychosis are at high risk of exposure to human rights violations, such as long-term confinement in institutions.
Schizophrenia typically begins in late adolescence or early adulthood. Treatment with medicines and psychosocial support is effective. With appropriate treatment and social support, affected people can lead a productive life and be integrated in society. Facilitation of assisted living, supported housing and supported employment can act as a base from which people with severe mental disorders, including schizophrenia, can achieve numerous recovery goals as they often face difficulty in obtaining or retaining a place to live and normal employment.
What If Im Not Happy With My Treatment
If you arent happy with your treatment you can:
- talk to your doctor about your treatment options,
- ask for a second opinion,
- get an advocate to help you speak to your doctor,
- contact Patient Advice and Liaison Service , or
- make a complaint.
There is more information about these options below.
How can I speak to my doctor about my treatment options?
You can speak to your doctor about your treatment. Explain why you arent happy with it. You could ask what other treatments you could try.
Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you arent given this treatment, ask your doctor to explain why it isnt suitable for you.
Whats a second opinion?
A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis.
You dont have a right to a second opinion. But your doctor should listen to your reason for wanting a second opinion.
What is advocacy?
An advocate is independent from the mental health service. They are free to use. They can be useful if you find it difficult to get your views heard.
There are different types of advocates available. Community advocates can support you to get a health professional to listen to your concerns. And help you to get the treatment that you would like. NHS complaints advocates can help you if you want to complain about the NHS.
Suicide In Bipolar Disorder
Being among the top 10 leading causes of death in the United States and the world, suicide is considered a major public health issue and a complex multifactorial human behavior. Studies suggest that the great majority of suicide cases occur among subjects with major mental illness, mainly mood disorders, with the risk of suicide death being 10-30 times higher in patients with bipolar disorder than in the general population. Specifically, it is estimated that 20-60% of patients with bipolar disorder attempt suicide at least once in their lifetime.
All in all, clinicians are trained to assess suicide risk by identifying many of these risk factors and performing comprehensive examinations of the mental state in patients. However, not all patients with bipolar disorder that present identifiable risk factors will engage in suicidal behaviors, and many patients who express suicidal ideation may attempt to commit suicide. At the same time, many patients who eventually commit suicide may do it without communicating any suicidal ideation . This suggests the need for the identification of biological markers that can be used concomitantly to clinical assessments for an improved suicide risk prediction and management in patients.
Malhi GS, Outhred T, Das P, Morris G, Hamilton A, Mannie Z. Modeling suicide in bipolar disorders. Bipolar Disorders, 20:334-348, 2018.
Dome P, Rihmer Z, Gonda X. Suicide risk in bipolar disorder: a brief review. Medicina, 55:403,
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Risk Factors For Mental Health
The determinants, onset and severity of mental health disorders are complex they can rarely be attributed to a single factor. Identifying potential risk factors form an important element of health research, potential prevention and in some cases, appropriate treatment nonetheless, many risk factors remain only correlates of observed patterns in mental health. They therefore need to be interpreted carefully.
The World Health Organization synthesize the potential contributors to mental health and wellbeing into three categories:29
- individual attributes and behaviours: these can be particular genetic factors or personality traits
- social and economic circumstances
- environmental factors.
In the table we see the WHOs breakdown of potential adverse and protective factors for mental health within these three categories. These factors often interact, compound or negate one another and should therefore not be considered as individual traits or exposures. For example, particular individual traits may make a given person more vulnerable to mental health disorders with the onset of a particular economic or social scenario the instance of one does not necessarily result in a mental health disorder, but combined there is a significantly higher vulnerability.
|Exposure to war or disaster||Physical security & safety|
Risk factors through the life-course
Pre-conception and pre-natal period
Infancy and early childhood
Could I Have Bipolar Disorder
Since bipolar disorder is made up of two parts, depression and mania, the symptoms are very different depending on whether you are in a manic or depressive period. The depression you experience if you have bipolar disorder is very similar to clinical depression.
Symptoms of depression
- I have overwhelming feelings of sadness or grief
- Ive lost interest in taking part in activities I used to enjoy
- I find myself avoiding other people
- Im sleeping more or less than usual
- Im eating more or less than usual
- Im having difficulty concentrating or making decisions
- Im feeling extremely irritable and angry
- Im feeling guilty all the time
- Ive lost my energy Im feeling very tired
- Ive lost my desire for sex
- Im feeling worthless, helpless or hopeless
- Ive had thoughts of death or suicide
Symptoms of mania
- Ive been in an excessively high or elevated mood
- I feel extremely irritable or angry
- Im optimistic about everything, even when others arent
- Im making quick decisions often without thinking them through
- Im spending money more quickly or my sexual habits have changed
- My thoughts are racing I have a lot of plans
- Im really energetic I cant seem to stay still
- Im talking all the time
- Im talking more quickly than usual and people seem to have a hard time understanding me
- Im feeling little need for sleep
- I have an extremely short attention span
- Im seeing or hearing things that other people arent experiencing
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Seven Classes And The Key Findings That Shaped Them
The seven phenoclasses, as the U-M team has dubbed them, include standard measures doctors already use to diagnose and track the progress of bipolar disorder.
Changes in cognition, which includes thinking, reasoning and emotion processing
Psychological dimensions such as personality and temperament
Measures of behaviors related to substance use or abuse called motivated behaviors
Aspects of the persons life involving family, intimate relationships and traumas
Patterns of sleep and circadian rhythms
Measures of how patients symptoms change over time and respond to treatment
Some of the key findings the U-M team made in the Prechter cohort include:
Although bipolar disorder tends to run in families, the long-term study revealed no one gene explains it, says McInnis, who is the Woodworth Professor of Bipolar Disorder and Depression in the U-M Medical Schools Department of Psychiatry.
If there was a gene with a strong effect like what we see in breast cancer, for instance, we would have found it, he explains. We hope this new framework will provide a new approach to understand this disorder, and other complex diseases, by developing models that can guide a management strategy for clinicians and patients and give researchers consistent variables to measure and assess.
Brain Chemistry And Biology
Bipolar disorder also has a neurological component.
Neurotransmitters are chemical messengers in the brain. They help relay messages between nerve cells throughout the body. These chemicals play an essential role in healthy brain function. Some of them even help regulate mood and behavior.
Older links three main neurotransmitters to bipolar disorder:
Imbalances of these brain chemicals may prompt manic, depressive, or hypomanic mood episodes. This is particularly the case when environmental triggers or other factors come into play.
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Data Availability On Mental Health
The majority of data presented in this entry is based on estimates from the IHMEs Global Burden of Disease . This is currently one of the only sources which produces global level estimates across most countries on the prevalence and disease burden of mental health and substance use disorders.
Nonetheless, the GBD acknowledges the clear data gaps which exist on mental health prevalence across the world. Despite being the 5th largest disease burden at a global level , detailed data is often lacking. This is particularly true of lower-income countries. The Global Burden of Disease note that the range of epidemiological studies they draw upon for global and national estimates are unequally distributed across disorders, age groups, countries and epidemiological parameters.46 Using these studies to provide full coverage of these disorders is challenging.
To overcome these methodological challenges the authors note:
Statistics Related To Mental Health Disorders
The following are the latest statistics available from the National Institute of Mental Health Disorders, part of the National Institutes of Health:
Mental health disorders account for several of the top causes of disability in established market economies, such as the U.S., worldwide, and include: major depression , manic depression , schizophrenia, and obsessive-compulsive disorder.
An estimated 26% of Americans ages 18 and older — about 1 in 4 adults — suffers from a diagnosable mental disorder in a given year.
Many people suffer from more than one mental disorder at a given time. In particular, depressive illnesses tend to co-occur with substance abuse and anxiety disorders.
Approximately 9.5% of American adults ages 18 and over, will suffer from a depressive illness each year.
- Women are nearly twice as likely to suffer from major depression than men. However, men and women are equally likely to develop bipolar disorder.
- While major depression can develop at any age, the average age at onset is the mid-20s.
- With bipolar disorder, which affects approximately 2.6% of Americans age 18 and older in a given year — the average age at onset for a first manic episode is during the early 20s.
Most people who commit suicide have a diagnosable mental disorder — most commonly a depressive disorder or a substance abuse disorder.
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Conditions That Can Co
Many people with bipolar disorder also may have other mental health disorders or conditions such as:
- Psychosis. Sometimes people who have severe episodes of mania or depression also have psychotic symptoms, such as hallucinations or delusions. The psychotic symptoms tend to match the persons extreme mood. For example:
- Someone having psychotic symptoms during a manic episode may falsely believe that he or she is famous, has a lot of money, or has special powers.
- Someone having psychotic symptoms during a depressive episode may believe he or she is financially ruined and penniless or has committed a crime.
Some bipolar disorder symptoms are like those of other illnesses, which can lead to misdiagnosis. For example, some people with bipolar disorder who also have psychotic symptoms can be misdiagnosed with schizophrenia. Some physical health conditions, such as thyroid disease, can mimic the moods and other symptoms of bipolar disorder. Street drugs sometimes can mimic, provoke, or worsen mood symptoms.
What Can I Do About It
Some common treatments for bipolar disorder, used on their own or in combination, include:
Medication: There are many different types of effective medication for bipolar disorder, and different kinds work in different ways. Medication can help keep your mood more stable. Mania can make you feel so good that you stop taking your medications. This is very dangerous because symptoms that return after stopping treatment are often much harder to treat properly. Talk to your doctor to find out if medication is right for you and if so, how to use it properly.
Counselling: There are two types of counselling that work best for people with bipolar disorder.
- Cognitive-behavioural therapy : A health professional who uses this approach can teach you skills to help change your view of the world around you. They do this by coaching you to break the negative patterns of depression or the destructive patterns of mania including the thoughts and actions that can keep the moods going.
- Interpersonal therapy : Often when you are depressed or in mania, your relationships with other people suffer. A health professional who uses IPT can teach you skills to improve how you interact with other people.
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Myth: There Is Only One Type Of Bipolar Disorder
There are actually a few different types of the disease. These include:
Bipolar I disorder. You have manic episodes that last at least 7 days or that send you to the hospital for care. You may also go through periods of depression that last 2 weeks or more. You may have episodes that involve only mania or have mania and depression at the same time.
Bipolar II disorder. You go through stretches of depression and boosted mood, but your highs aren’t as severe as in bipolar I.
Cyclothymic disorder. You get highs and lows, but they tend to be mild.
How Do Doctors Treat It
Although there’s no cure for bipolar disorder, treatment can help stabilize moods and help the person manage and control symptoms. Like other teens with long-lasting medical conditions , teens with bipolar disorder need to work closely with their doctors and other medical professionals to treat it.
This team of medical professionals, together with the teen and family, develop what is called a treatment plan. Teens with bipolar disorder will probably receive medication, such as a mood stabilizer, from a psychiatrist or other medical doctor. A psychologist or other type of counselor will provide counseling or psychotherapy for the teen and his or her family. Doctors will watch the symptoms closely and offer additional treatment advice if necessary.
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Causes & Risk Factors
The precise causes of bipolar disorder are unknown. However, there is strong evidence that biological factors, including genetics, play an important role. Stress or difficult family relationships do not cause the illness. However, these factors may trigger an episode in someone who already has the illness.
Tips For Coping And Support
If youve noticed symptoms of bipolar disorder, a good first step involves reaching out to a doctor or therapist as soon as possible.
Similarly, if its a friend or loved one who has symptoms, consider encouraging them to connect with a therapist as soon as possible. It never hurts to remind them that they have your understanding and support, either.
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How Do Medications Factor In
Treating bipolar disorder with medication can be something of a delicate balance. Antidepressants that help ease depressive episodes can sometimes trigger manic episodes.
If your healthcare provider recommends medication, they might prescribe an antimanic medication such as lithium along with an antidepressant. These medications can help prevent a manic episode.
As you work to develop a treatment plan with your care provider, let them know about any medications you take. Some medications can make both depressive and manic episodes more severe.
Also tell your care provider about any substance use, including alcohol and caffeine, since they can sometimes lead to mood episodes.
Some substances, including cocaine, ecstasy, and amphetamines, can produce a high that resembles a manic episode. Medications that might have a similar effect include:
- high doses of appetite suppressants and cold medications
- prednisone and other steroids
- thyroid medication
If you believe youre experiencing a mood episode or other symptoms of bipolar disorder, its always a good idea to connect with your healthcare provider as soon as possible.
Prevalence Of Bipolar Disorder Among Adolescents
- Based on diagnostic interview data from National Comorbidity Survey Adolescent Supplement , Figure 3 shows lifetime prevalence of bipolar disorder among U.S. adolescents aged 13-18.4
- An estimated 2.9% of adolescents had bipolar disorder, and 2.6% had severe impairment. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria were used to determine impairment.
- The prevalence of bipolar disorder among adolescents was higher for females than for males .
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Women And Bipolar Disorder
- Women and people with bipolar II disorder are significantly more likely to experience periods of rapid cycling than men with the same condition. . Depression, anxiety and perceived stress in women with and without PCOS: A community-based study. Psychological Medicine, 49)
- Other research findings indicate that women with bipolar disorder may have more depressive episodes and more mixed episodes than do men with the illness.