schizophrenia is a group of serious brain disorders in which reality is interpreted abnormally.doc

7/27/2019 Schizophrenia is a group of serious brain disorders in which reality is interpreted abnormally.doc

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C h a p t e r IC h a p t e r I

INTRODUCTION

1.1 Background

Schizophrenia is a group of psychotic disorders that interfere with thinking

and mental or emotional responsiveness. It is a disease of the brain. The term

schizophrenia, which means "split mind," was first used in 1911 by Swiss

psychiatrist Eugen Bleuler to categorize patients whose thought processes

and emotional responses seemed disconnected. Despite its name, the

condition does not cause a split personality.Beck Cognitive Insight Scale

(BCIS) has been designed for assessment of self-reflection on patients'

anomalous experiences and interpretations of own beliefs. The scale has

been developed and validated for patients with schizophrenia. We wanted to

study the utility of the scale for patients with bipolar disorder. The

relationship between the BCIS as a measure of cognitive insight and

established methods for assessment of insight of illness was explored in both

diagnostic groups. Schizophrenia and bipolar disorder together affect

approximately 2.5% of the world population, and their etiologies are thought

to involve multiple genetic variants and environmental influences. The

analysis of gene expression patterns in brain may provide a characteristic

signature for each disorder. RNA samples from the dorsolateral prefrontalcortex (Brodmann area 46) consisting of individuals with schizophrenia (SZ),

bipolar disorder (BPD), and control subjects were tested on the Codelink

Human 20K Bioarray platform. Selected transcripts were validated by

quantitative real-time polymerase chain reaction (PCR)

1.2 Methods of Writing

This topic is approached through a selective literaturereview. This study used

the database assembled by the NIH/National Institute of Mental Health in 1th

July 2009 a stratified representative sample comprising in adults.

1
http://www.nimh.nih.gov/http://www.nimh.nih.gov/


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1.3 Limitation of Problems

What is Schizophrenia ?

Why does Schizophrenia happen?

What are the causes of Schizophrenia?

What is Bipolar disorder disease?

How does Bipolar disorder disease work?

Why does Bipolar disorder disease happen?

1.4 Objectives

To give information about Schizophrenia.

To explain about the etiology of Schizophrenia.

To explain about the causes of Schizophrenia.

To give information about Bipolar disorder disease.

To explain about how Bipolar disorder works.

To explain about why Bipolar disorder happens.

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1.5 Frame of Writing

CHAPTER I INTRODUCTION

1.1. Background

1.2. Limitation of Problems

1.3. Objective

1.4. Method of Writing

1.5. Frame of Writing

CHAPTER II Schizophrenia

Definition of Schizophrenia

Symptoms and Sign of Schizophrenia

Etiology of Schizophrenia

Risk Factor of Schizophrenia

Tests and Diagnosis of Schizophrenia

Complications of Schizophrenia

Treatment and Drugs of Schizophrenia

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Medication of Schizophrenia

CHAPTER III Bipolar disorder

Definition of Bipolar disorder

Symptoms and Sign of Bipolar disorder

Etiology of Bipolar disorder

Risk Factor of Bipolar disorder

Tests and Diagnosis of Bipolar disorder

Complication of Bipolar disorder

Therapy of Bipolar disorder

Treatment of Bipolar disorder

CHAPTER IV THE CORRELATION BETWEEN

SCHIZOPHRENIA AND BIPOLAR

DISORDER ON ADULTS IN JAKARTA YEAR

2007 - 2009

CHAPTER V CONCLUSION

BIBLIOGRAPHY

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C h a p t e r I IC h a p t e r I I

Definition of Schizophrenia

Schizophrenia is a group of serious brain disorders in which reality is

interpreted abnormally. Schizophrenia results in hallucinations, delusions,

and disordered thinking and behavior. People with schizophrenia withdraw

from the people and activities in the world around them, retreating into an

inner world marked by psychosis.

Contrary to popular belief, schizophrenia isn't the same as a split personality

or multiple personality. While the word "schizophrenia" does means "split-

mind," it refers to a disruption of the usual balance of emotions and thinking.

Schizophrenia is a chronic condition, requiring lifelong treatment. But thanks

to new medications, schizophrenia symptoms can often be successfully

managed, allowing people with the condition to lead productive, enjoyablelives.

Symptomps

There are several types of schizophrenia, so signs and symptoms vary. In

general, schizophrenia symptoms include:

Beliefs not based on reality (delusions), such as the belief that there's

a conspiracy against you

Seeing or hearing things that don't exist (hallucinations), especially

voices

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Incoherent speech

Neglect of personal hygiene

Lack of emotions

Emotions inappropriate to the situation

Angry outbursts

Catatonic behavior

A persistent feeling of being watched

Trouble functioning at school and work

Social isolation

Clumsy, uncoordinated movements

Schizophrenia ranges from mild to severe. Some people may be able to

function well in daily life, while others need specialized, intensive care. In

some cases, schizophrenia symptoms seem to appear suddenly. Other times,

schizophrenia symptoms seem to develop gradually over months, and they

may not be noticeable at first.

Over time, it becomes difficult to function in daily life. You may not be able to

go to work or school. You may have troubled relationships, partly because of

difficulty reading social cues or others' emotions. You may lose interest in

activities you once enjoyed. You may be distressed or agitated or fall into a

trance-like state, becoming unresponsive to others.

In addition to the general schizophrenia symptoms, symptoms are often

categorized in three ways to help with diagnosis and treatment:

Negative signs and symptoms

Negative signs and symptoms represent a loss or decrease in emotions or

behavioral abilities. They may include:

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Loss of interest in everyday activities

Appearing to lack emotion

Reduced ability to plan or carry out activities

Neglecting hygiene

Social withdrawal

Loss of motivation

Positive signs and symptoms

Positive signs and symptoms are unusual thoughts and perceptions that often

involve a loss of contact with reality. These symptoms may come and go.They may include:

Hallucinations, or sensing things that aren't real. In schizophrenia,

hearing voices is a common hallucination. These voices may seem to give

you instructions on how to act, and they sometimes may include harming

others.

Delusions, or beliefs that have no basis in reality. For example, you

may believe that the television is directing your behavior or that outside

forces are controlling your thoughts.

Thought disorders, or difficulty speaking and organizing thoughts, such

as stopping in midsentence or jumbling together meaningless words,

sometimes known as "word salad."

Movement disorders, such as repeating movements, clumsiness or

involuntary movements.

Cognitive signs and symptoms

Cognitive symptoms involve problems with memory and attention. These

symptoms may be the most disabling in schizophrenia because they interfere

with the ability to perform routine daily tasks. They include:

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Problems making sense of information

Difficulty paying attention

Memory problems

Etiology

It's not known what causes schizophrenia. However, researchers

believe that an interaction of genetics and environment may cause

schizophrenia. Problems with certain naturally occurring brain

chemicals, including the neurotransmitters dopamine and glutamate,

also may contribute to schizophrenia. Neuroimaging studies showdifferences in the brain structure and central nervous system of people

with schizophrenia. While researchers aren't fully certain about the

significance of these changes, they support evidence that

schizophrenia is a brain disease.

Risk Factor

Schizophrenia affects about 1 percent of the general population. In people

who have close relatives with schizophrenia, the illness is much more

common about 10 percent. In men, schizophrenia symptoms typically start

in the teens or 20s. In women, schizophrenia symptoms typically begin in the

20s or early 30s.

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Although the precise cause of schizophrenia isn't known, researchers have

identified certain factors that seem to increase the risk of developing or

triggering schizophrenia, including:

Having a family history of schizophrenia

Exposure to viruses while in the womb

Malnutrition while in the womb

Stressful life circumstances

Older paternal age

Taking psychoactive drugs during adolescence

Tests and diagnosis

When doctors suspect someone has schizophrenia, they typically run abattery of medical and psychological tests and exams. These can help rule

out other problems that could be causing your symptoms, pinpoint a

diagnosis and also check for any related complications. These exams and

tests generally include:

Physical exam. This may include measuring height and weight;

checking vital signs, such as heart rate, blood pressure and temperature;

listening to the heart and lungs; and examining the abdomen.

Laboratory tests. These may include a complete blood count (CBC),

screening for alcohol and drugs, and imaging studies, such as an MRI or CT

scan.

Psychological evaluation. A doctor or mental health provider will

talk to you about your thoughts, feelings and behavior patterns. He or she will

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ask about delusions or hallucinations and check for signs of psychosis. You

may also fill out psychological self-assessments and questionnaires. You may

be asked about substance or alcohol abuse. And with your permission, family

members or close friends may be asked to provide information about your

symptoms.

Diagnostic criteria for schizophrenia

To be diagnosed with schizophrenia, you must meet the criteria spelled out in

the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual

is published by the American Psychiatric Association and is used by mental

health providers to diagnose mental conditions and by insurance companies

to reimburse for treatment.

Diagnostic criteria for schizophrenia are:

Presence of at least two of these: delusions, hallucinations,

disorganized speech, disorganized or catatonic behavior, or presence of

negative symptoms

Significant impairment in the ability to work, attend school or perform

normal daily tasks

Signs last for at least six months

Other mental health disorders have been ruled out

You may be diagnosed with one of the five subtypes of schizophrenia,

although not all people easily fit into a specific category. The five subtypes

are:

Paranoid

Catatonic

Disorganized

Undifferentiated

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Residual

Complications

Left untreated, schizophrenia can result in severe emotional, behavioral,

health, and even legal and financial problems that affect every area of your

life. Complications that schizophrenia may cause or be associated with

include:

Suicide

Self-destructive behavior, such as self-injury

Depression

Abuse of alcohol, drugs or prescription medications

Poverty

Homelessness

Family conflicts

Inability to work or attend school

Health problems from antipsychotic medications

Being a victim or perpetrator of violent crime

Heart disease, often related to heavy smoking

Treatments and drugs

Schizophrenia is a chronic condition that requires lifelong treatment, evenduring periods when you feel better and your symptoms have subsided.

Treatment with medications and psychosocial therapy can help you takecontrol of your condition and become an active and informed participant inyour own care. During crisis periods or times of severe symptoms,hospitalization may be necessary for your safety and to make sure you'regetting proper nutrition, sleep and hygiene.

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Schizophrenia treatment is usually guided by a psychiatrist skilled in treating

the condition. But you may have others on your treatment team as well,

including psychologists, social workers and psychiatric nurses, because the

condition can affect so many areas of your life. You may also have a case

manager to make sure that you're getting all of the treatment you need and

that your care is coordinated among all of your health care providers.

Medications

Medications are the cornerstone of schizophrenia treatment. But because

medications for schizophrenia can cause serious but rare side effects, you

may be reluctant to take them. Work with your psychiatrist and other health

care providers to find a medication regimen that works for you, with the

fewest side effects.

Antipsychotic medications are the most commonly prescribed medications to

treat schizophrenia. They're thought to control symptoms by affecting the

brain neurotransmitters dopamine and serotonin. There are two main types of

antipsychotic medications:

Conventional, or typical, antipsychotics. These medications have

traditionally been very effective in managing the positive symptoms of

schizophrenia. These medications have frequent and potentially severe

neurological side effects, including the possibility of tardive dyskinesia, or

involuntary jerking movements. This group of medications includes:

Haloperidol (Haldol)

Thioridazine

Fluphenazine

These typical antipsychotics are often cheaper than newer counterparts,

especially the generic versions, which can be an important consideration

when long-term treatment is necessary.

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New generation, also called atypical antipsychotics. These

newer antipsychotic medications are effective at managing both positive and

negative symptoms. They include:

Clozapine (Clozaril)

Risperidone (Risperdal)

Olanzapine (Zyprexa)

Quetiapine (Seroquel)

Ziprasidone (Geodon)

Aripiprazole (Abilify)

Paliperidone (Invega)

Risperidone (Risperdal) is the only atypical antipsychotic medication that's

been approved by the Food and Drug Administration (FDA) to treat

schizophrenia in children ages 13 to 17. Atypical antipsychotic medications

pose a risk of metabolic side effects, including weight gain, diabetes and high

cholesterol.

Which medication is best for you depends on your own individual situation. It

can take several weeks after first starting a medication to notice an

improvement in your symptoms. In general, the goal of treatment with

antipsychotic medications is to effectively control signs and symptoms at the

lowest possible dosage. Other medications also may be helpful, such as

antidepressants or anti-anxiety medications.

If one medication doesn't work well for you or has intolerable side effects,

your doctor may recommend combining medications, switching to a different

medication or adjusting your dosage. Don't stop taking your medications

without talking to your doctor, even if you're feeling better. You may have a

relapse of psychotic symptoms if you stop taking your medication. In

addition, antipsychotic medication needs to be tapered off, rather than

stopped abruptly, to avoid withdrawal symptoms.

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Be aware that all antipsychotic medications have side effects and possible

health risks. Certain antipsychotic medications, for instance, may increase

the risk of diabetes, weight gain, high cholesterol and high blood pressure.

Clozaril can cause dangerous changes in your white blood cell count. Certain

antipsychotic medications can cause serious health problems in some older

adults and should be avoided.

Be sure to talk to your doctor about all of the possible side effects and being

monitored for health problems while you take these medications.

Antipsychotic medications can also have dangerous interactions with other

substances. Your doctors should know about all medications and over-the-

counter substances you take, including vitamins, minerals and herbal

supplements.

Psychosocialtreatments

Although medications are the cornerstone of schizophrenia treatment,

psychotherapy and other psychosocial treatments also are important. These

treatments may include:

Individual therapy. Psychotherapy with a skilled mental health

provider can help you learn ways to cope with the daily life challenges

brought on by schizophrenia. Therapy can help you improve communicationsskills, relationships, your ability to work and your motivation to stick to your

treatment plan. Learning about schizophrenia can help you understand it

better, cope with lingering symptoms, and understand the importance of

taking your medications. Therapy can also help you cope with stigma

surrounding schizophrenia.

Family therapy. Both you and your family may benefit from therapy

that provides support and education to families. Your symptoms have a

better chance of improving if your family members understand your illness,

can recognize stressful situations that might trigger a relapse, and can helpyou stick to your treatment plan. Family therapy can also help you and your

family communicate better with each other and understand family conflicts.

Family therapy can also help family members cope and reduce their distress

about your condition.

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Rehabilitation. Training in social and vocational skills to live

independently is an important part of recovery from schizophrenia. With the

help of a therapist, you can learn such skills as good hygiene, cooking and

better communication. Many communities have programs to help people with

schizophrenia with jobs, housing, self-help groups and crisis situations. If you

don't have a case manager to help you with these services, ask your doctors

about getting one. Today, fewer people with schizophrenia require long-term

hospitalization because effective treatments are available.

Treatment challenges

When you have appropriate treatment and stick to your treatment plan, you

have a good chance of leading a productive life and functioning well in daily

activities. But be prepared for challenges that can interfere with treatment.

For one thing, it's often difficult for people with schizophrenia to stick to their

treatment plans. You may believe that you don't need medications or other

treatment. Also, if you're not thinking clearly, you may forget to take your

medications or to go to therapy appointments. Talk to your doctors about tips

to stick to your treatment plan, such as taking a medication that's available in

a long-lasting injectable form. Even with good treatment, you may have a

relapse. Have a plan in place to deal with a relapse.

Many people with schizophrenia smoke, often heavily. If you smoke, you mayneed a higher dose of antipsychotic medication because nicotine interferes

with these medications.

Similarly, using alcohol and drugs can make schizophrenia symptoms worse.

If you have a problem with alcohol or substance abuse, you may benefit from

treatment programs that include care for both schizophrenia and substance

abuse.

C h a p t e r I I IC h a p t e r I I I

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Definition of Bipolar Disorder

From high to low. From mania to depression. From recklessness to

listlessness. These are the extremes associated with bipolar disorder, a

mental illness characterized by mood instability that can be serious and

disabling. Bipolar disorder is also known as manic-depression or manic-

depressive illness manic behavior is one extreme of this disorder, and

depression is the other.

The deep mood swings of bipolar disorder may last for weeks or months,

causing great disturbances in the lives of those affected, and those of family

and friends, too. Today, a growing volume of research suggests that bipolardisorder occurs across a spectrum of symptoms, and that many people aren't

correctly diagnosed. Left untreated, bipolar disorder generally worsens, and

the suicide rate is high among those with bipolar disorder. But with effective

treatment, you can live an enjoyable and productive life despite bipolar

disorder.

Symptoms

Bipolar disorder symptoms are characterized by an alternating pattern of

emotional highs (mania) and lows (depression). The intensity of signs and

symptoms can vary from mild to severe. There may even be periods when

your life doesn't seem affected at all.

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Bipolar disorder symptoms reflect a range ofmoods.

Manic phase of bipolar disorder

Signs and symptoms of the manic phase of bipolar disorder may include:

Euphoria

Extreme optimism

Inflated self-esteem

Poor judgment

Rapid speech

Racing thoughts

Aggressive behavior

Agitation

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Increased physical activity

Risky behavior

Spending sprees

Increased drive to perform or achieve goals

Increased sexual drive

Decreased need for sleep

Tendency to be easily distracted

Inability to concentrate

Drug abuse

Depressive phase of bipolar disorderSigns and symptoms

the depressive phase of bipolar disorder may include:

Sadness

Hopelessness

Suicidal thoughts or behavior

Anxiety

Guilt

Sleep problems

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Appetite problems

Fatigue

Loss of interest in daily activities

Problems concentrating

Irritability

Chronic pain without a known cause

Types of bipolar disorder

Bipolar disorder is divided into two main subtypes:

Bipolar I disorder. You've had at least one manic episode, with or

without previous episodes of depression.

Bipolar II disorder. You've had at least one episode of depression

and at least one hypomanic episode. A hypomanic episode is similar to a

manic episode but much briefer, lasting only a few days, and not as severe.

With hypomania, you may have an elevated mood, irritability and some

changes in your functioning, but generally you can carry on with your normal

daily routine and functioning, and you don't require hospitalization. In bipolar

II disorder, the periods of depression are typically much longer than the

periods of hypomania.

Cyclothymia. Cyclothymia is a mild form of bipolar disorder.

Cyclothymia includes mood swings but the highs and lows are not as severe

as those of full-blown bipolar disorder.

Other bipolar disorder symptoms

In addition, some people with bipolar disorder have rapid cycling bipolar

disorder. This is the occurrence of four or more mood swings within 12

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months. These moods shifts can occur rapidly, sometimes within just hours.

In mixed state bipolar disorder, symptoms of both mania and depression

occur at the same time.

Severe episodes of either mania or depression may result in psychosis, or a

detachment from reality. Symptoms ofpsychosis may include hearing or

seeing things that aren't there (hallucinations) and false but strongly held

beliefs (delusions).

Etiology

It's not known what causes bipolar disorder. But a variety of biochemical,

genetic and environmental factors seem to be involved in causing and

triggering bipolar episodes:

Biochemical. Some evidence from high-tech imaging studies indicates

that people with bipolar disorder have physical changes in their brains. The

significance of these changes is still uncertain but may eventually help

pinpoint causes. The naturally occurring brain chemicals called

neurotransmitters, which are tied to mood, also may play a role. Hormonal

imbalances also are thought to be a culprit.

Genes. Some studies show that bipolar disorder is more common in

people whose biological family members also have the condition.

Researchers are trying to find genes that may be involved in causing bipolar

disorder. Some studies also show links between bipolar disorder and

schizophrenia, pointing to a shared genetic cause.

Environment. Environment also is thought to play a causal role in

some way. Some studies of identical twins show that one twin has the

condition while the other doesn't which means genes alone aren't

responsible for bipolar disorder. Environmental causes may include problems

with self-esteem, significant loss or high stress.

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Risk factors

It's estimated that about 1 percent of the population has bipolar disorder.

However, some researchers suggest that bipolar disorder occurs on a

continuum, and that many more people may have other forms of thedisorder, pushing its prevalence as high as 6 percent of the population. In

addition, some people may go undiagnosed because they don't seek

treatment, because their condition is mistaken for depression or because

their symptoms don't meet current diagnostic criteria.

Bipolar I disorder affects about the same number of men and women, but

bipolar II, the rapid cycling form, is more common in women. In either case,

bipolar disorder usually starts between ages 15 and 30.

Factors that may increase the risk of developing bipolar disorder include:

Having other biological family members with bipolar disorder

Periods of high stress

Drug abuse

Major life changes, such as the death of a loved one

Medical Advice

If you have any symptoms of bipolar disorder, seek medical help as soon as

possible. Bipolar disorder doesn't get better on its own. Yet many people withthe disorder don't get treatment or are reluctant to get treatment. Despite

the mood extremes, people with bipolar disorder often don't recognize how

greatly it affects their lives and the lives of their loved ones. And if you're

like some people with bipolar disorder, you may enjoy the feelings of

euphoria and cycles of being more productive but they're bound to be

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followed by emotional crashes that can leave you depressed, worn out, and

perhaps in financial or legal trouble.

Getting treatment from a mental health provider with experience in bipolardisorder can help you learn ways to manage your symptoms. If you're

reluctant to seek treatment, try to work up the courage to confide in

someone, whether it's a friend or loved one, a health care professional, a

faith leader or someone else you trust. They can help you take the first steps

to successful treatment.

When you have suicidal thoughts

Suicidal thoughts and behavior are common among people with bipolar

disorder. Tragically, the suicide rate is higher in bipolar disorder than most

other mental illnesses. If you're considering suicide right now and have the

means available, talk to someone now. The best choice is to call 911 or your

local emergency services number. If you simply don't want to do that, for

whatever reason, you have other choices for reaching out to someone:

Contact a family member or friend

Contact a doctor, mental health provider or other health care

professional

Contact a minister, spiritual leader or someone in your faith community

Go to your local hospital emergency room

Call a crisis center or hot line

Helping a loved one with bipolar disorder symptoms

If you have a loved one you think may have symptoms of bipolar disorder,

have an open and honest discussion about your concerns. You may not be

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able to force someone to seek professional help, but you can offer

encouragement and support and help your loved one find a qualified doctor

or mental health provider. If you have a loved one who has harmed himself or

herself, or is seriously considering doing so, take them to the hospital or call

for emergency help.

Tests and diagnosis

When doctors suspect someone has bipolar disorder, they typically run a

battery of medical and psychological tests and exams. These can help rule

out other problems, pinpoint a diagnosis and also check for any related

complications.

These exams and tests generally include:

Physical exam. This may include measuring height and weight;

checking vital signs, such as heart rate, blood pressure and temperature;

listening to the heart and lungs; and examining the abdomen.

Laboratory tests. These may include a complete blood count (CBC)

as well as thyroid tests and other blood tests. You may also have a urinalysis.

Psychological evaluation. A doctor or mental health provider will

talk to you about your thoughts, feelings and behavior patterns. You may also

fill out psychological self-assessments and questionnaires. You may be asked

about substance or alcohol abuse. And with your permission, family members

or close friends may be asked to provide information about your symptoms

and possible episodes of mania or depression.

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Diagnostic criteria for bipolar disorder

To be diagnosed with bipolar disorder, you must meet the criteria spelled out

in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This

manual is published by the American Psychiatric Association and is used by

mental health providers to diagnose mental conditions and by insurance

companies to reimburse for treatment.

Diagnostic criteria for bipolar disorder are based on the specific type of

bipolar disorder as well as the history and types of episodes, such as manic,

hypomanic or depressed. Talk to your doctor about which type of bipolar

disorder you have so that you can learn more about your specific situation

and its treatments.

Some researchers believe the current diagnostic criteria are too strict,

though. Indeed, a growing volume of evidence indicates that bipolar disorder

can be thought of more as a spectrum of disorders, with varying degrees of

symptoms. Some researchers believe that many people go undiagnosed or

misdiagnosed and thus don't get appropriate treatment because the

criteria don't account for less severe but still serious symptoms.

Complications

Left untreated, bipolar disorder can result in severe emotional and even legal

and financial problems that affect every area of your life.

Complications that bipolar disorder may cause or be associated with include:

Suicide

Substance and alcohol abuse

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Legal problems

Financial problems

Relationship troubles

Isolation

Poor work or school perform

Treatments and drugs

Bipolar disorder is a long-term condition that requires lifelong treatment,

even during periods when you feel better. Bipolar disorder treatment is

usually guided by a psychiatrist skilled in treating the condition. But you may

have others on your treatment team as well, including psychologists, social

workers and psychiatric nurses, because the condition can affect so many

areas of your life.

Effective and appropriate treatment is vital for reducing the frequency and

severity of manic and depressive episodes and allowing you to live a more

balanced and enjoyable life. Maintenance treatment continued treatment

during periods of remission also is important. People who skip

maintenance treatment are at high risk of a relapse of their symptoms orhaving minor episodes turn into full-blown mania or depression. If you have

problems with alcohol or substance abuse, you must get treatment for those,

too, since they can worsen bipolar symptoms.

Here are the core treatments for bipolar disorder:

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Medications

Medications are a vital part of bipolar treatment. Because medications for

bipolar disorder can cause serious but rare side effects, you may be reluctant

to take medications. But you can work with your psychiatrist and other health

care professionals to find a medication regimen that works for you.

Medication options include:

Mood stabilizers. Mood stabilizers are most the commonly prescribed

medications for bipolar disorder. These medications help regulate and

stabilize mood so that you don't swing between depression and mania.

Lithium (Eskalith, Lithobid) has been widely used as a mood stabilizer and is

generally the first line of treatment for manic episodes. Your doctor may

recommend that you take mood stabilizers for the rest of your life to prevent

and treat manic episodes.

Anti-seizure medications. The medications are used to prevent

mood swings, especially in people with rapid cycling bipolar disorder. These

medications, such as valproic acid (Depakene), divalproex (Depakote) and

lamotrigine (Lamictal), also are widely used as mood regulators. These

medications are also known as anticonvulsants.

Antidepressants. Use of antidepressants in bipolar disorder, although

once common, is now controversial. Antidepressants may not be advised at

all, depending on your situation. There's limited data indicating that

antidepressants are effective for bipolar disorder, and in some cases they can

trigger manic episodes. Before taking antidepressants, carefully weigh the

pros and cons with your doctor.

Other medications. Certain atypical antipsychotic medications, such

as olanzapine (Zyprexa) and risperidone (Risperdal), may help people who

don't gain benefits from anti-seizure medications. And anti-anxiety

medications, such as benzodiazepines, may help improve sleep. In addition,

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one medication, quetiapine (Seroquel), has been approved by the Food and

Drug Administration to treat both the manic and depressive episodes of

bipolar disorder.

Numerous medications are available to treat bipolar disorder. If one doesn't

work well for you, there are many others to explore. Your doctor may advise

combining certain medications for maximum effect. It can take several weeks

after first starting a medication to notice an improvement in your symptoms.

Be aware that all medications have side effects and possible health risks.

Certain antipsychotic medications, for instance, may increase the risk of

diabetes, obesity and high blood pressure. If you take these medications, talk

to your doctor about being monitored for health problems. Also, mood-

stabilizing medications may harm a developing fetus or nursing infant. So

women with bipolar disorder who want to become pregnant or do become

pregnant must fully explore with their health care providers their options and

the benefits and risks of medications.

PsychotherapyPsychotherapy is another vital part of bipolar disorder treatment. Several

types of therapy may be helpful.

Cognitive behavioral therapy. This is a common form of individual

therapy for bipolar disorder. The focus of cognitive behavioral therapy is

identifying unhealthy, negative beliefs and behaviors and replacing them with

healthy, positive ones. In addition, you can learn about bipolar disorder and

its treatment and what may trigger your bipolar episodes. You also learn

effective strategies to manage stress and to cope with upsetting situations.

Family therapy. Family therapy involves you and your family

members. Family therapy can help identify and reduce stressors within your

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family. It can help your family improve its communication style and problem-

solving skills and resolve conflicts.

Group therapy. Group therapy provides a forum to communicate with

and learn from others in a similar situation. It may also help build better

relationship skills.

Electroconvulsive therapy(ECT)

Electroconvulsive therapy is geared mainly for people who have episodes of

severe depression with suicidal tendencies or for people who haven't seen

improvements in their symptoms despite other treatment. Electroconvulsive

therapy is a procedure in which electrical currents are passed through your

brain to trigger a seizure. Researchers don't fully understand just how ECT

works. But it's thought that the seizure causes changes in brain chemistry

that may lead to improvements in your mood.

Hospitalization

In some cases, people with bipolar disorder may benefit from inpatient

hospitalization. Hospitalization for psychiatric treatment can help stabilize

your mood, whether you're in a full-blown manic episode or a deep

depression. Partial hospitalization or day treatment programs also are options

to consider.

C H A P T E RC H A P T E R II VV

T h e C o r r e l a t i o n B e t w e e n S c h i z o p hT h e C o r r e l a t i o n B e t w e e n S c h i z o p h

r e n i a a n d B i p o l a r D i s o r d e r o n A d u l t sr e n i a a n d B i p o l a r D i s o r d e r o n A d u l t s

i n J a k a r t a Y e a r 2 0 0 5 2 0 0 9i n J a k a r t a Y e a r 2 0 0 5 2 0 0 9

A trio of genome-wide studies collectively the largest to date has

pinpointed a vast array of genetic variation that cumulatively may account

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for at least one third of the genetic risk for schizophrenia. One of the studies

traced schizophrenia and bipolar disorder, in part, to the same chromosomal

neighborhoods.

"These new results recommend a fresh look at our diagnostic categories,"

said Thomas R. Insel, M.D., director of the National Institute of Mental Health

(NIMH), part of the National Institutes of Health. "If some of the same genetic

risks underlie schizophrenia and bipolar disorder, perhaps these disorders

originate from some common vulnerability in brain development."

Three schizophrenia genetics research consortia, each funded in part by

NIMH, report separately on their genome-wide association studies online July

1, 2009, in the journal Nature. However, the SGENE, International

Schizophrenia (ISC) and Molecular Genetics of Schizophrenia (MGS) consortia

shared their results making possible meta-analyses of a combined sample

totaling 8,014 cases and 19,090 controls.

All three studies implicate an area of Chromosome 6 (6p22.1), which is known

to harbor genes involved in immunity and controlling how and when genes

turn on and off. This hotspot of association might help to explain how

environmental factors affect risk for schizophrenia. For example, there are

hints of autoimmune involvement in schizophrenia, such as evidence that

offspring of mothers with influenza while pregnant have a higher risk of

developing the illness.

"Our study was unique in employing a new way of detecting the molecular

signatures of genetic variations with very small effects on potential

schizophrenia risk," explained Pamela Sklar, M.D., Ph.D., of Harvard

University and the Stanley Center for Psychiatric Research, who co-led the

ISC team with Harvard's Shaun Purcell, Ph.D.

"Individually, these common variants' effects do not all rise to statistical

significance, but cumulatively they play a major role, accounting for at least

one third and probably much more of disease risk," said Purcell.

Among sites showing the strongest associations with schizophrenia was asuspect area on Chromosome 22 and more than 450 variations in the suspect

area on Chromosome 6. Statistical simulations confirmed that the findings

could not have been accounted for by a handful of common gene variants

with large effect or just rare variants. This involvement of many common

gene variants suggests that schizophrenia in different people might

ultimately be traceable to distinct disease processes, say the researchers.

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(Photo Credit: Psychiatric and Neurodevelopmental Genetics Unit, Center for

Human Genetic Research, Harvard University.)

Still, most of the genetic contribution to schizophrenia, which is estimated to

be at least 70 percent heritable, remains unknown.

"Until this discovery, we could explain just a few percent of this contribution;

now we have more than 30 percent accounted for," said Thomas Lehner,

Ph.D., MPH, chief of NIMH's Genomics Research Branch. "The new findings tell

us that many of these secrets have been hidden in complex neural networks,

providing hints about where to look for the still elusive and substantial

remaining genetic contribution."

The MGS consortium pinpointed an association between schizophrenia and

genes in the Chromosome 6 region that code for cellular components that

control when genes turn on and off. For example, one of the strongest

associations was seen in the vicinity of genes for proteins called histones that

slap a molecular clamp on a gene's turning on in response to the

environment. Genetically rooted variation in the functioning of such

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"There was substantial overlap in the genetic risk for schizophrenia and

bipolar disorder that was specific to mental disorders," added Sklar. "We

saw no association between the suspect gene variants and half a dozen

common non-psychiatric disorders."


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regulatory mechanisms could help to explain the environmental component

repeatedly implicated in schizophrenia risk.

The MGS study also found an association between schizophrenia and a

genetic variation on Chromosome 1 (1p22.1) which has been implicated in

multiple sclerosis, an autoimmune disorder.

The SGENE consortium study pinpointed a site of variation in the suspect

Chromosome 6 region that could implicate processes related to immunity and

infection. It also found significant evidence of association with variation on

Chromosomes 11 and 18 that could help account for the thinking and

memory deficits of schizophrenia.

The new findings could eventually lead to multi-gene signatures or

biomarkers for severe mental disorders. As more is learned about the

implicated gene pathways, it may be possible to sort out what's shared by, orunique to, schizophrenia and bipolar disorder, the researchers say.

Source: NIH/National Institute of Mental Health

C H A P T E R VC H A P T E R V

C o n c l u s i o nC o n c l u s i o n

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Evidence suggesting that schizophrenia has etiological factors and

pathophysiological pathways in common with bipolar disorder is now

increasing; overlapping clinical features might be a consequence. Well

documented examples are susceptibility genes for neuregulin-1 and

G72/G30, which are involved in neurodevelopment, glutamatergic

transmission, or both; disturbed connectivity that is apparent from white

matter abnormalities resulting in the observed cognitive, emotional

symptoms, or both already in the prodromal phase. On a clinical level

depression is a precursor in the majority of cases in both disorders. Beyond

these commonalities, disease-specific features (as different risk factors and

neuropathological features) are also apparent. It can be concluded that the

relationship between both disorders does not fit into a 'nosological'

dichotomy as originally conceived. Currently, several lines of evidence

suggest that patients with psychotic features in bipolar disorder are very

similar to patients with schizophrenia in genetic and neurobiological respects.

Remodeling of the complex relationship between both disorders will become

possible once the relationship between an exhaustive set of specific

susceptibility genes with structure and function of brain systems as well as

with each of the two disorders and their symptoms is elucidated.

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B i b l i o g r a p h y

1 http://www.sciencecodex.com/schizophrenia_and_bipolar_disorder_share_genetic_roots

2 http://www.medscape.com/viewarticle/574866

3 http://www.mayoclinic.com/health/bipolar-

disorder/DS00356/DSECTION=treatments-and-drugs

4 http://www.springer.com/medicine/psychiatry/book/978-1-4419-0912-1

5 Mortensen PB, Pedersen CB, Melbye M, et al. Individual and familial risk

factors for bipolar affective disorders in Denmark. Arch Gen Psychiatry

2003; 60:1209-1215.

6 Krabbendam L, Myin-Germeys I, Hanssen M, et al. Hallucinatoryexperiences and onset of psychotic disorder: evidence that the risk ismediated by delusion formation. Acta Psychiatr Scand 2004; 110:264-272.

7 * Angst J, Sellaro R, Stassen HH, Gamma A. Diagnostic conversion fromdepression to bipolar disorders: results of a long-term prospective studyof hospital admissions. J Affect Disord 2005; 84:149-157.

8 http://www.schizophrenia.com/stanfordtalks/diffdiag.html
http://www.sciencecodex.com/schizophrenia_and_bipolar_disorder_share_genetic_rootshttp://www.sciencecodex.com/schizophrenia_and_bipolar_disorder_share_genetic_rootshttp://www.medscape.com/viewarticle/574866http://www.mayoclinic.com/health/bipolar-disorder/DS00356/DSECTION=treatments-and-drugshttp://www.mayoclinic.com/health/bipolar-disorder/DS00356/DSECTION=treatments-and-drugshttp://www.springer.com/medicine/psychiatry/book/978-1-4419-0912-1http://www.sciencecodex.com/schizophrenia_and_bipolar_disorder_share_genetic_rootshttp://www.sciencecodex.com/schizophrenia_and_bipolar_disorder_share_genetic_rootshttp://www.medscape.com/viewarticle/574866http://www.mayoclinic.com/health/bipolar-disorder/DS00356/DSECTION=treatments-and-drugshttp://www.mayoclinic.com/health/bipolar-disorder/DS00356/DSECTION=treatments-and-drugshttp://www.springer.com/medicine/psychiatry/book/978-1-4419-0912-1

schizophrenia is a group of serious brain disorders in which reality is interpreted abnormally.doc

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