Manic Depressive Illness
(also known as Bipolar
Disorder)
Individuals diagnosed
with manic-depressive illness, or bipolar disorder, have mood swings that alternate from periods of severe highs (mania) to
extreme lows (depression). These mood swings, which are out of proportion or totally unrelated to events in a person's life,
affect thoughts, feelings, physical health, behavior, and functioning.
Manic-depressive illness
is a neurobiological brain disorder that affects approximately 1.3 million Americans today, 0.5 percent of the population.
While manic-depressive illness usually begins in adolescence or early adulthood, it can sometimes start in early childhood
or as late as age 40 or 50.
Generally, people with
manic-depressive illness consult between three to four doctors and spend more than eight years seeking treatment before they
receive a correct diagnosis.
The average person
has four episodes of mania or depression during the first 10 years of the illness. Men are more likely to start with a manic
episode, and women are more likely to begin with a depressive episode.
Symptoms of Manic
Depressive Illness
While no single pattern
of symptoms fits every individual with manic-depressive illness, there are four distinct types of mood episodes that can occur
over the course of the illness, including:
Mania (manic episode) often begins with a pleasurable sense of heightened
energy, creativity, and social ease; feelings that without proper medical treatment can quickly escalate out of control into
a full-blown manic episode. People experiencing mania typically lack self-awareness, deny anything is wrong, and angrily blame
anyone who points out a problem. In addition to feeling unusually "high," euphoric or irritable, the person also may exhibit
symptoms such as:
•
Needing little sleep yet having great amounts of energy;
•
Talking so fast that others can't follow the person's thinking;
•
Having racing thoughts;
•
Being so easily distracted that the individual's attention shifts between many topics in just a few minutes; and
•
Having an inflated feeling of power, greatness or importance; and doing reckless things without concern about possible bad
consequences, such as spending too much money, inappropriate sexual activity, making foolish business investments.
Hypomania (hypomanic episode) is a milder form of mania with similar
yet less severe symptoms and less overall impairment. In hypomania, for example, the individual may have an elevated mood,
feel better than usual, and be more productive. These episodes often feel good, and the quest for hypomania may even cause
people to stop taking their medication.
Depression (major depressive episode) takes away the capacity to experience
pleasure, and causes profound sadness and irritability, changes in sleep patterns, a decrease in appetite, an inability to
concentrate, low self-esteem, and thoughts of suicide. Severe depressions also may include hallucinations or delusions.
Mixed Episode is perhaps the most disabling since an individual can experience
both mania and depression simultaneously or at different times throughout the day.
Treating Manic-Depressive
Illness
While there is no cure
for manic-depressive illness, it is a highly treatable disease. In fact, according to the National Advisory Mental Health
Council, the treatment success rate for manic-depressive illness is a remarkable 80 percent.
It is important to
diagnose and treat manic-depressive illness as early as possible to help people avoid or reduce frequent relapses and re-hospitalizations.
Several promising, large-scale studies suggest early intervention may forestall the worst long-term outcomes of this devastating
brain disorder.
Individuals experiencing
mania often lack self-awareness and do not recognize that they are ill and require treatment in the hospital to prevent self-destructive,
impulsive, or aggressive behavior. Hospital stays can be as brief as two weeks and as long as six months.
The two most important
types of medication used to control the symptoms of manic-depressive illness are mood stabilizers and antidepressants.
Mood Stabilizers, the
mainstay of long-term preventive treatment for both mania and depression, are used to improve symptoms during acute manic,
hypomanic, and mixed episodes; they also may reduce symptoms of depression. The most widely used mood stabilizers include
lithium (ESKALITH, LITHOBID, LITHONATE, and other brands), valproate (used as divalproex or DEPAKOTE), and carbamazepine (TEGRETOL).
About one in three
people will be completely free of symptoms by taking mood stabilizing medications for life.
{This is the same as for those receiving a placebo, for about one-third will without drugs recover from a depression
episode—jk.}
In conjunction with
the mood stabilizers, antianxiety medications such as lorazepam (ATIVAN) and clonazepam (KLONOPIN) and antipsychotic drugs
such as haloperidol (HALDOL) and perphenazine (TRILAFON) are used for insomnia, agitation, or other symptoms, during a manic
phase.
Antidepressants are
given together with mood stabilizers to prevent an "overshoot" from occurring in the patient, for if used on their own in
the treatment of bipolar disorder, antidepressants can push moods up too high causing hypomania, mania, or rapid cycling.
Most experts consider the following two types of antidepressants to be the most effective for bipolar patients: bupropion
(WELLBUTRIN) or selective serotonin reuptake inhibitors such as: fluoxetine (PROZAC); fluvoxamine (LUVOX); paroxetine (PAXIL),
and sertraline (ZOLOFT). There are many other choices if these do not work, or if they cause unpleasant adverse effects, including:
mirtazapine (REMERON), monoamine oxidase inhibitors such as phenelzine (NARDIL) and tranylcypromine (PARNATE); nefazodone
(SERZONE); tricyclic antidepressants such as amitriptyline (ELAVIL), desipramine (NORPRAMIN), imipramine (TOFRANIL), nortriptyline
(PAMELOR); and venlafaxine (EFFEXOR).
Suicide is the number
one cause of premature death among people with manic-depressive illness, with 15 percent to 17 percent taking their own lives
as a result of negative symptoms that come from untreated illness. The extreme depression and psychoses that can result due
to lack of treatment are the usual culprits in these sad cases. These suicides rates can be compared to that of the general
population, which is somewhere around one percent.
Schizophrenia Facts
Schizophrenia interferes
with a person’s ability to think clearly, manage emotions, make decisions, and relate to others. Specific abnormalities
that can be noted in individuals with schizophrenia include:
•
delusions and hallucinations;
•
alterations of the senses;
•
an inability to sort and interpret incoming sensations, and an inability therefore to respond appropriately;
•
an altered sense of self; and changes in emotions, movements and behavior.
Schizophrenia is a
neurological brain disorder that affects 2.2 million Americans today, or almost one percent of the population. Schizophrenia
can affect anyone at any age, but most cases develop between ages 16 and 30.
Symptoms of Schizophrenia
In healthy people,
the brain functions in such a way that incoming stimuli are sorted and interpreted, followed by a logical response (e.g.,
saying "thank you" after a gift is given, realizing the potential outcome of arriving late to work, etc.). Conversely, the
inability of patients with schizophrenia to sort and interpret stimuli and select appropriate responses is one of the hallmarks
of the disease.
The symptoms of schizophrenia
are generally divided into three categories, including positive, disorganized, and negative symptoms.
Positive, or "psychotic"
symptoms, include delusions, and hallucinations which occur because the patient has lost touch with reality in certain important
ways. Delusions cause the patient to believe that people are reading their minds or plotting against them, that others are
secretly monitoring and threatening them, or that they can control other people’s thoughts. Hallucinations cause people
to hear or see things that are not there. Approximately three-fourths of individuals with schizophrenia will hear voices (auditory
hallucinations) at some time during their illness.
Disorganized thinking,
speech, and behavior affect most people with this illness. For example, people with schizophrenia sometimes have trouble communicating
in coherent sentences or carrying on conversations with others; move more slowly, repeat rhythmic gestures or make movements
such as walking in circles or pacing; and have difficulty making sense of everyday sights, sounds and feelings.
Negative symptoms include
emotional flatness or lack of expression, an inability to start and follow through with activities, speech that is brief and
lacks content, and a lack of pleasure or interest in life. "Negative" does not, therefore, refer to a person’s attitude,
but to a lack of certain characteristics that should be there.
Diagnosing Schizophrenia
To be diagnosed with
schizophrenia, a patient must have psychotic, "loss-of-reality" symptoms for at least six months and show increasing difficulty
in functioning normally. Before the six-month period is reached, the person is diagnosed as having a schizophreniform disorder.
Prior to a medical
diagnosis, it is critically important that a doctor rule out other problems that may mimic schizophrenia, such as psychotic
symptoms caused by the use of drugs or other medical illnesses; major depressive episode or manic episode with psychotic features;
delusional disorder (no hallucinations, disorganized speech or thought or "flattened" emotions) and autistic disorder or personality
disorders (especially schizotypal, schizoid, or paranoid personality disorders). Schizoaffective disorder is a diagnosis used
to indicate that the person has an illness with a mix of symptoms of both schizophrenia and bipolar disorder.
Although the cause
of schizophrenia has not yet been identified, recent research suggests that schizophrenia is linked to abnormalities of brain
chemistry and brain structure. Genes play some role, but the magnitude of that role remains to be ascertained. Abnormalities
of neurotransmitters (e.g., dopamine, serotonin) and viruses also are under investigation. The brain changes in some cases
are suspected to date to childhood. Brain-imaging technology has demonstrated that schizophrenia is as much an organic brain
disorder, as is Multiple Sclerosis, Parkinson’s or Alzheimer’s disease.
Treating Schizophrenia
While there is no cure
for schizophrenia, it is a highly treatable disorder. In fact, according to the National Advisory Mental Health Council, the
treatment success rate for schizophrenia is comparable to the treatment success rate for heart disease.
It is important to
diagnose and treat schizophrenia as early as possible to help people avoid or reduce frequent relapses and re-hospitalizations.
Several promising, large-scale studies suggest early intervention may forestall the worst long-term outcomes of this devastating
brain disorder.
People who experience
acute symptoms of schizophrenia may require intensive treatment, sometimes including hospitalization. Hospitalization is necessary
to treat severe delusions or hallucinations, serious suicidal inclinations, severe problems with drugs or alcohol and the
inability to care for oneself.
It is critical that
people with schizophrenia stay in treatment even after recovering from an acute episode. About 80 percent of those who stop
taking their medications after an acute episode will have a relapse within one year, whereas only 30 percent of those who
continue their medications will experience a relapse in the same time period.
Medication appears
to improve the long-term prognosis for many people with schizophrenia. Studies show that after 10 years of treatment, one-fourth
of those with schizophrenia have recovered completely, one-fourth have improved considerably, and one-fourth have improved
modestly. Fifteen percent have not improved, and 10 percent are dead. {The one-fourth,
cure rate is about equal to those who are not treated—jk}
Individuals with schizophrenia
die at a younger age than do healthy people. Males have a 5.1 times greater than expected early mortality rate than the general
population, and females have a 5.6 times greater risk of early death. Suicide is the single largest contributor to this excess
mortality rate, which is 10 to 13 percent higher in schizophrenia than the general population.
Suicide is, in fact,
the number one cause of premature death among people with schizophrenia, with an estimated 10 to 13 percent killing themselves.
The extreme depression and psychoses that can result due to lack of treatment are the usual culprits in these sad cases. These
suicides rates can be compared to that of the general population, which is somewhere around one percent. Other contributors
to excess mortality include:
Accidents: Although individuals with schizophrenia do not drive as much
as other people, studies have shown that they have double the rate of motor vehicle accidents per mile driven. A significant
but unknown number of individuals with schizophrenia also are killed as pedestrians by motor vehicles.
Diseases: There is some evidence that individuals with schizophrenia have
more infections, heart disease, type II (adult onset) diabetes, and female breast cancer, all of which might increase their
mortality rate. Individuals with schizophrenia who become sick are less able to explain their symptoms to medical personnel,
and medical personnel are more likely to disregard their complaints and assume that they are simply part of the mental illness.
There also is evidence that some persons with schizophrenia have an elevated pain threshold so they may not complain of symptoms
until the disease has progressed too far to be treatable.
Homelessness: Although it has not been well studied to date, it appears
that homelessness increases the mortality rate of individuals with schizophrenia by making them even more susceptible to accidents
and diseases.
Antipsychotic Medications
Antipsychotic drugs
are used in the treatment of schizophrenia. These medications help relieve the delusions, hallucinations, and thinking problems
associated with this devastating disorder. Scientists believe the drugs work by correcting imbalances in the chemicals that
help brain cells communicate with one another. As with drug treatments for other physical illnesses, many patients with severe
mental illnesses may need to try several different antipsychotic medications before they find the one, or the combination
of medications, that works best for them.
Older conventional
or standard antipsychotics include: chlorpromazine (THORAZINE); fluphenazine (PROLIXIN); haloperidol (HALDOL); thiothixene
(NAVANE); trifluoperazine (STELAZINE); perphenazine (TRILAFON) and thioridazine (MELLARIL).
Atypical antipsychotics
are newer drugs and include: risperidone (RISPERDAL); clozapine (CLOZARIL) and olanzapine (ZYPREXA).
Since these medications
do not work immediately, experts recommend that doctors give the antipsychotic time to take effect before switching to another
antipsychotic, adjusting the dose, or adding another medication.
Antipsychotic drugs
are usually taken daily in tablet or liquid form. Fluphenazine (PROLIXIN) and haloperidol (HALDOL), for example, also can
be given in long-acting injections (called "depot formulations") at one- to four-week intervals. With depot formulations,
medication is stored in the body and slowly released. This can be especially helpful for patients who have a hard time taking
pills on a daily basis.
Adverse Effects of
Antipsychotic Medication
|
Most common adverse effects: dry mouth, constipation, blurred
vision, and drowsiness.
Less common adverse effects: decreased sexual desire, menstrual
changes, and stiff muscles on one side of the neck and jaw.
More serious adverse effects: restlessness, muscle stiffness,
slurred speech, tremors of the hands or feet. Agranulocytosis, a decrease in the production of white blood cells, which occurs
to any significant degree only when taking clozapine, requires monitoring of the blood.
Tardive Dyskinesia is an unpleasant and serious adverse effect
of antipsychotic drugs causing involuntary facial movements and sometimes jerking or twisting movements of other parts of
the body. This condition usually develops in older patients, affecting 15 to 20 percent of those who have taken older antipsychotic
drugs for years. In the majority of cases, the tardive dyskinesia slowly goes away when the medication is stopped.
All drugs have the potential to cause adverse reactions. Some
of these are inconvenient or unpleasant, but are not serious, while others are potentially life-threatening. The true risk
of various adverse drug reactions is largely unknown. The approved product labeling or "package insert" for a drug lists the
percentage of patients who experienced various adverse reactions in the clinical trials conducted before the drug was approved.
These percentages are a measure of the short-term risk associated with a drug in a relatively small carefully defined population
of patients who are closely monitored by trained researchers.
Once a drug is approved it can be prescribed to tens of thousands
of patients in the general population who may be different than the patients included in the pre-approval clinical trials.
For example, they may have other medical conditions or must take other medications and the risks of adverse reactions may,
or may not, be increased.
There is no requirement that adverse drug reactions be reported
by health professionals after a drug is approved – reporting is voluntary. In a voluntary system, many adverse reactions
are not reported. The Food and Drug Administration (FDA) has estimated that for every report of a serious reaction it receives,
ten adverse events go unreported. Because we do not know the true number of adverse reactions and can only estimate the number
of patients that have received a drug the risk of a particular adverse reaction cannot be estimated. |
