Schizophrenia and Bipolar Disorder (manic depression)

While mental illness frequently has residual features that can disrupt a person’s functioning over the longer term, there are several specialized treatments available that can help minimize disruptions, and improve self-management of symptoms and overall quality of life.

What is Bipolar Disorder?

Bipolar Disorder (BD), previously known as depressive psychosis, describes a condition where individuals suffer mood swings between the extreme of elation and, for most, severe depression. This condition affects approximately 1-2 percent of general population. Mood swings vary from mild to severe. Extreme elation is termed mania.

Symptoms of BD include

• elevated mood, in which the person feels extremely happy and on top of the world;
• reduced sleep;
• irritability; and
• rapid thought and speech, which is often difficult for other to follow.

In addition, poor judgment is quite common and may involve risky behavior or grandiose plans or beliefs. For example, sufferers may believe they possess extraordinary talent and, quite commonly, lack insight that these beliefs are unrealistic. Most people with BD also experience episodes of depression:

overwhelming sadness,

poor concentration, loss of appetite and weight and feelings of hopelessness or excessive guilt. During the depressed stage of the illness, some sufferers show increased risk of suicide. Between BD episodes, many individuals manage to live normal lives. Many sufferers alternate, over time, between these extreme highs and lows.

What causes Bipolar Disorder?

The main factors thought to contribute to BD include genetic vulnerability, a history of this disorder in the family, minor changes in brain chemistry and stress that is difficult to cope with in everyday life. Some evidence also suggests that the expression of this disorder may vary with the seasons, with mania being more common in spring and depression in winter.

The average age of onset for BD is during early adulthood, with men and women equally at risk of developing the disorder. Without appropriate medication, the number of episodes suffered on average is four in 10 years, with up to 15 percent of sufferers having multiple episodes within a given year. Although most individuals function well between episodes, 20-30 percent still suffer mood difficulties or problems with social and vocational activities between active episodes.

Treatment and Management

As with Schizophrenia, the most effective treatment for BD involves a combination of interventions as well as treatment with mood-stabilizing medication, generally coordinated by a GP or psychiatrist. Since the 1950s, the drug Lithium has been shown to be effective in treating BD and there is also a range of other mood-stabilizing medications available.

In recent years, it has been recognized that optimal treatment should also include systematic psychological intervention using cognitive behavior techniques. This treatment is usually delivered by a skilled professional, most commonly a clinical psychologist, and focuses on changing maladaptive thinking patterns and behaviors. As with Schizophrenia, cognitive behavioral therapy may also help to increase medication compliance.

Case management may also be required, depending on the severity of the symptoms. For example, if an individual is displaying poor judgment and risky behavior, an overall coordinated management strategy may be beneficial. This may include the treatments already described, as well as rehabilitative intervention to promote maximum potential in everyday living skills.

Psychoeducational family therapy, a specialized family intervention, can also be very useful with BD as well as Schizophrenia.