BIPOLAR DISORDER (MANIC DEPRESSION)
Onset is usually before the age of 30 but can occur at any time of life. Both men and women are equally at risk. Bipolar disorder tends to run in families, indicating a likely genetic involvement.
Bipolar Disorder causes severe mood swings from mania and elation, to depression. A manic or depressive state may last for weeks or months at a time. Feelings are extreme and incapacitating. When in the depressive state, a sufferer will feel intense depression and despair. At some point this will flip into the mania stage, in which there is extreme over-activity, grandiosity and happiness.
Sometimes both the depressive and manic states can co-exist with depression combined with extreme agitation and restlessness, characteristic of the manic state. People with bipolar disorder can have long periods of wellness – months or years at a time although a small proportion have frequent episodes that are very difficult to treat.
During the depressive phase of the illness, sufferers experience the classic symptoms of depression. During times of mania, the very first symptom is usually little or no sleep and can be accompanied by excessive talking and racing thoughts. Initially there may be a feeling of wellbeing which bipolar sufferers enjoy and are anxious to retain. Other symptoms include:
- Extreme happiness and excitement
- Feelings of grandiosity and importance
- Irritability with others not feeling the same
- Rapid succession of new and exciting ideas and plans.
- Inability to stay with and focus on one idea at a time
- Mania, excessive energy, unable or unwilling to rest or sleep
- Excessive sexual appetite
- Spontaneous, rapid, spur of the moment decision-making. Reckless spending of money.
If the manic or depressive episode remains untreated and becomes very intense, psychosis can develop. Manic psychosis may show itself as extreme grandiosity, with a belief in the possession of special powers and abilities.
Depressive psychosis leads to feelings of extreme guilt and worthlessness. Sometimes there may be hallucinations.
Between episodes of depression and mania, many people with bipolar are symptom free, but for most there may be difficulty in clear thinking and mild depression.
The most successful treatment involves a combination of medication, counselling and self-management.
The most commonly prescribed drug is lithium. While lithium can be effective in controlling episodes of mania, it also acts as an antidepressant and dampens mood swings. Side-effects make some bipolar patients reluctant to take the drug. Sodium valproate and carbemazepine are anti-convulsant drugs which can be prescribed to stabilise mood swings.
Other drug treatments include SSRI antidepressants and antipsychotic medication. Finding the right drug treatment can be challenging but rewarding.
Schizophrenia is an illness where there is a severe disturbance of brain function which disrupts the persons behaviour, ideas and moods. Schizophrenia affects one in every 100 people, with men and women affected equally. The most common age of diagnosis is between 15 and 35 years. About one-quarter of people with schizophrenia have only a few short episodes and make a full recovery whereas for others it is a lifelong affliction.
While it is not clear exactly what causes schizophrenia, it is thought likely to be a combination of:
- Genes – 10% of schizophrenics have an affected parent. If one identical twin is schizophrenic, there is a 50% likelihood of the other twin also being schizophrenic.
- Brain damage – Schizophrenics have some brain abnormalities which may be attributed to lack of oxygen during birth, or exposure to viral infections while in-utero.
- Marijuana – heavy use of marijuana can increase the risk of schizophrenia by up to 600%.
- Childhood deprivation and abuse increase the risk of schizophrenia in adulthood.
There is a wide range of symptoms, some or all of which may manifest in a person with schizophrenia. These include:
- Hallucinations – the person may hear, see, taste, smell or feel things that are not there. Hearing voices is the most common hallucination and these are often threatening or frightening.
- Delusions – the person may develop unusual and steadfast beliefs such as having special powers. Such delusions cannot be changed by logical argument.
- Paranoid delusions – strange ideas that lead to feelings of persecution, such as a belief that their partner is unfaithful, or a belief that they are being followed or spied on.
- Thought disorder – thinking becomes muddled and confused and it becomes impossible to focus or concentrate on things. Thoughts may jump rapidly from one topic to another.
- Feelings of being controlled – feelings that thoughts and body are being overtaken by some outside force, such as a television or radio, or God or the Devil.
- General apathy about life – difficulty doing basic jobs for self-care, and often a withdrawal from all social contact.
- Depression – around 50% of untreated schizophrenics will suffer from depression.
While some schizophrenics with mild symptoms may not require any treatment or special assistance, it is important that schizophrenia is diagnosed early, and treatment provided if needed. Treatment may include antipsychotic medication although side-effects are common and it may be necessary to try a number of different medications to find the right one. Medication must be combined with an education programme and ongoing support with housing and finances. Monitoring and follow-up is essential for those at risk of repeated relapse.
BORDERLINE PERSONALITY DISORDER
Borderline Personality Disorder (BPD) is a mental illness characterised by extreme instability of moods. There is difficulty in interpersonal relationships, self-image and behaviour. BPD sufferers can cycle through many moods in a matter of hours. They may swing wildly from anger to depression to anxiety all within the space of one day. BPD can affect anyone but by far the most commonly affected group is young women. Psychiatric hospitalisations are common, and there is a high incidence of self-injury including suicide attempts. Impulsive and harmful behaviours such as unsafe sex, and drug and alcohol abuse are also common amongst BPD sufferers.
BPD is characterised by a poor sense of self worth. Sufferers often feel guilty and loathsome about themselves. They also often feel hard done by, bored, empty and lacking in self-identity. They tend to idealise others in the early stages of relationship, but can quickly turn to anger and loathing of the other if they feel isolated or rejected in any way. As a result of their condition, BPD sufferers often have lives that seem unstable, with frequent changes of job, country and partner.
CAUSE AND TREATMENT
The cause of BPD is not clear, although sufferers often report a history of childhood abuse and neglect, and studies show that between 40–70% of BPD patients have been sexually abused in childhood. Brain studies also show that there is impaired regulation of the neural circuits’ emotional regulation, especially of sadness, anger, anxiety and irritability.
Treatment may include a combination of drugs that enhance serotonin levels in the brain, to improve emotional symptoms; and psychological therapy such as cognitive behavioural therapy.
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