Schizophrenia

What is it?

Schizophrenia is a mental disorder often characterized by abnormal social behavior and failure to recognize what is real. It affects approximately 1% of the world’s population, equally between men and women, and is present in all cultures and countries. Schizophrenia can have “positive” symptoms, including delusions, hallucinations, and disorganised thought, speech or behaviour. It can also have “negative” symptoms, including a flattening in emotions, lack of drive, and social withdrawal. Diagnosis is based on observed behavior and the person’s reported experiences. Statistics show that 80% of patients will go off their medication at least once as they being to “feel better”. The risk of suicide is high at 10%, although 50% of patients will attempt suicide at least once.

Signs and symptoms?

Symptoms typically begin in young adulthood, with about 1% of people are affected during their lifetime. Schizophrenia is thought to mainly affect the ability to think, but can also contribute to chronic problems with behavior and emotion. People with schizophrenia are likely to develop additional conditions, including depression and anxiety disorders.

Individuals with “positive” symptoms of schizophrenia may experience hallucinations (most reported are hearing voices), delusions (often bizarre or persecutory in nature), and disorganized thinking and speech (ranging from loss of train of thought, to loosely connected sentences, to speech that is not understandable). Individuals with “negative” symptoms often experience social withdrawal, sloppiness of dress and hygiene, and loss of motivation and judgment. Impairment in social cognition is associated with schizophrenia, as are symptoms of paranoia, difficulties in long-term memory, attention, and speed of processing information. People with schizophrenia often find facial emotion perception to be difficult. About 30 to 50% of people with schizophrenia fail to accept that they have an illness or their recommended treatment, although treatment may have some effect on helping to gain insight.

Treatment options?

The primary treatment of schizophrenia is antipsychotic medications, often in combination with psychological and social support. Hospitalization may occur for severe episodes, but long-term hospitalization is uncommon. Community support services including drop-in centers, visits by members of a community mental health team, supported employment and support groups are common. Some evidence indicates that regular exercise has a positive effect on the physical and mental health of those with schizophrenia.


Bipolar Disorder

What is it? Bipolar Disorder is a mental disorder characterized by periods of elevated mood and periods of depression. There are 2 major forms of the illness: Bipolar 1 and Bipolar 2. Each has a separate diagnosis generally based on the severity of the patient’s episodes. The elevated mood is significant and is known as mania (Bipolar 1) or hypomania (Bipolar 2) depending on the severity or whether there is psychosis. During hypomania, an individual has a sustained, noticeably different mood that is elevated (heightened), expansive (grand, superior) or irritable. During mania, that mood is extremely abnormal, and is also combined with increased activity or energy that is also abnormal. During both mania and hypomania an individual feels or acts abnormally happy, energetic, or irritable; often making poorly thought out decisions with little regard to the consequences. The need for sleep is usually reduced. During periods of depression there may be crying, poor eye contact with others, and a negative outlook on life. Someone with Bipolar 1 Disorder may also have hypomanic episodes, but someone with Bipolar 2 cannot ever have had a manic episode. The risk of suicide among those with the disorder is high at greater than 6% over 20 years, while self-harm occurs in 30–40%. Other mental health issues such as anxiety disorder and drug misuse are commonly associated.

Signs and symptoms? Mania is the defining feature of bipolar disorder, and can occur with different levels of severity. With milder levels of mania, known as hypomania, individuals appear energetic, excitable, and may be highly productive. As mania worsens, individuals begin to exhibit erratic and impulsive behavior, often making poor decisions due to unrealistic ideas about the future, and very little sleep. At the most severe level, manic individuals can experience very distorted beliefs about the world known as psychosis. A depressive episode commonly follows an episode of mania, although the biological mechanisms responsible for this switching of state remains poorly understood.

Treatment options? There are a number of pharmacological and psychotherapeutic techniques used to treat bipolar disorder, with individuals often using self-help to pursue recovery.  Psychotherapy is aimed at alleviating core symptoms, recognizing episode triggers, reducing negative expressed emotions, recognizing symptoms before full-blown recurrence, and practicing the factors that lead to maintenance of remission.

Hospitalization may be required especially with the manic episodes present, but long-term inpatient stays are uncommon. Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team, supported employment and patient-led support groups or intensive outpatient programs.


Depression

What is it? Depression is a state of low mood and aversion to activity that can affect a person’s thoughts, behavior, feelings and sense of well-being.

Signs and symptoms? People with depressed mood can feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable or restless. They may lose interest in activities that were once pleasurable, experience loss of appetite or overeating, have problems concentrating, remembering details or making decisions, and may contemplate, attempt or commit suicide. Insomnia, excessive sleeping, fatigue, aches, pains, digestive problems or reduced energy may also be present.

Treatment options? Depressed mood may not require any professional treatment, and may be a normal reaction to certain life events, a symptom of some medical conditions, or a side effect of some drugs or medical treatments. A prolonged depressed mood, especially in combination with other symptoms, may lead to a diagnosis of a psychiatric or medical condition, which may benefit from treatment.  The UK National Institute for Health and Care Excellence (NICE) 2004 guidelines indicate that antidepressants should not be used for the initial treatment of mild depression, because the risk-benefit ratio is poor.


Anxiety

What is it? Anxiety disorders are characterized by feelings of anxiety and fear, where anxiety is a worry about future events and fear is a reaction to current events. These feelings may cause physical symptoms, such as a racing heart and shakiness. There are various forms of anxiety disorders, including generalized anxiety disorder, a specific phobia, social anxiety disorder, and panic disorder.

Signs and symptoms? Anxiety disorders are often severe chronic conditions, which can be present from an early age or begin suddenly after a triggering event. They are prone to flare up at times of high stress and are frequently accompanied by physiological symptoms such as headache, sweating, muscle spasms, palpitations, and hypertension; sometimes leading to fatigue or exhaustion.  Anxiety disorders often occur along with other mental disorders, particularly depression, which may occur in as many as 60% of people with anxiety disorders. The fact that there is considerable overlap between symptoms of anxiety and depression, and that the same environmental triggers can provoke symptoms in either condition, may help to explain this high rate of co-morbidity.

Treatment options? Treatment options available include lifestyle changes, therapy, and medications. Medication are only recommended if other measures are not effective. Stopping smoking has benefits in anxiety as large as or larger than those of medications.