Bipolar type one

Bipolar Type 1 is considered the most severe form of this illness.

According to the DSM 5, Bipolar I Disorder is characterized by one or more manic episode or mixed episodes (mixed episodes involve mania and depression) accompanied by episodes of depression alone (without mania or hypomania).

This is the most distinguishing, defining element of Bipolar I, (i.e. at least one truly manic episode).

A person may display psychotic symptoms such as delusions of grandeur or hallucinations.

In these cases, the condition is described as Bipolar Disorder I with psychotic features.

Bipolar I episodes of mania are so severe and debilitating that some experts use the term “raging Bipolar”.

A key point is “the symptoms are severe enough to disrupt the patient’s ability to work and socialize.”

Someone suffering from Bipolar I can have great difficulty functioning. You could have trouble holding down a job or maintaining a healthy relationship and typical, every day interactions with family and friends.1

Some symptoms you might experience during a manic episode include:

1. Decreased need for sleep.

2. Racing thoughts.

3. Pressured speech.

4. Excess energy or excessive hyperactivity.

5. Increased involvement in reckless or risky behavior.

6. Grandiosity or inflated self-esteem.

7. Becoming easily distracted or unable to finish one task or activity.

It is the tendency to become involved in risky or reckless behaviors that makes a manic episode the most dangerous to a patient. Driving carelessly, spending excessively and engaging in unsafe and reckless sex can have serious consequences that just do not matter to you at the time.

In a severe manic episode a person can lose all touch with reality. Left untreated a manic episode can last anywhere from a few days to several years of recurring episodes. Most of the time these symptoms will last for a few weeks or a few months.

The key difference between Bipolar I and Bipolar II is the presence of mania versus hypomania. It is important to understand this distinction in detail.

Bipolar I mania is often followed by a depressive episode. It can come within days or not pop up for several weeks or months.

During a depressive episode you may feel drained, in deep despair, guilty for no reason, worthless and irritable.

BP_Type_1

Activities you normally enjoy will hold no interest. You may experience sudden weight loss or weight gain and uncontrollable crying spells. At your lowest moment you may even have thoughts of suicide.

Again, possible consequences mean nothing to the afflicted person. These depressive episodes can last for years, which is why Bipolar I is often mistaken for chronic depression.

Many people with Bipolar I Disorder can enjoy periods where they don’t experience any symptoms in between episodes. These individuals are often able to go about their life, work, participate in family life, and socialize like anyone else. A minority of patients have rapid-cycling symptoms between mania and depression. In extreme cases symptoms of mania and depression can even alternate in the same day.2

Causes of Bipolar Disorder.

The exact cause of Bipolar Disorders is not precisely understood. It seems to be a combination of 3 things:

1. Genetics.

2. Chemical imbalances in the brain.

3. Stress and triggering events that somehow “activate” an inherited or genetic predisposition to the disorder.

Are Bipolar I and Bipolar II treated differently?

When you go for an assessment, just like with any other illness, you will be asked about family history. A close relative such as a parent with suspected or diagnosed bipolar disorder greatly increases the likelihood other family members also having the illness.

If you are concerned, take a Bipolar test.

So far, there does not seem to be any way to prevent the illness, but you can prevent some episodes of mania or depression once a doctor establishes that you do in fact have Bipolar I Disorder.

Bipolar I almost always requires the person to take medication for effective management. Don’t worry – stability and sanity is SO worth it!3

The key factor is stabilization. Regular therapy, a healthy diet, exercise and – MOST OF ALL – mood stabilizing medications such as
lithium can greatly reduce the frequency and severity of Bipolar I episodes.

Schizophrenia

Key facts

  • Schizophrenia is a chronic and severe mental disorder affecting 20 million people worldwide (1).
  • Schizophrenia is characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour. Common experiences include hallucinations (hearing voices or seeing things that are not there) and delusions (fixed, false beliefs).
  • Worldwide, schizophrenia is associated with considerable disability and may affect educational and occupational performance.
  • People with schizophrenia are 2-3 times more likely to die early than the general population (2). This is often due to preventable physical diseases, such as cardiovascular disease, metabolic disease and infections.
  • Stigma, discrimination and violation of human rights of people with schizophrenia is common.
  • Schizophrenia is treatable. Treatment with medicines and psychosocial support is effective.
  • Facilitation of assisted living, supported housing and supported employment are effective management strategies for people with schizophrenia.

Symptoms

Schizophrenia is a psychosis, a type of mental illness characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour. Common experiences include:

  • hallucination: hearing, seeing or feeling things that are not there;
  • delusion: fixed false beliefs or suspicions not shared by others in the person’s culture and that are firmly held even when there is evidence to the contrary;
  • abnormal behaviour: disorganised behaviour such as wandering aimlessly, mumbling or laughing to self, strange appearance, self-neglect or appearing unkempt;
  • disorganised speech: incoherent or irrelevant speech; and/or
  • disturbances of emotions: marked apathy or disconnect between reported emotion and what is observed such as facial expression or body language.

Magnitude and impact

Schizophrenia affects 20 million people worldwide but is not as common as many other mental disorders. Schizophrenia also commonly starts earlier among men.

Schizophrenia is associated with considerable disability and may affect educational and occupational performance.

People with schizophrenia are 2 – 3 times more likely to die early than the general population (2). This is often due to physical illnesses, such as cardiovascular, metabolic and infectious diseases.

Stigma, discrimination and violation of human rights of people with schizophrenia is common.

Causes of schizophrenia

Research has not identified one single factor. It is thought that an interaction between genes and a range of environmental factors may cause schizophrenia.

Psychosocial factors may also contribute to schizophrenia.

Services

More than 69% of people with schizophrenia are not receiving appropriate care (3). Ninety per cent of people with untreated schizophrenia live in low- and middle- income countries. Lack of access to mental health services is an important issue. Furthermore, people with schizophrenia are less likely to seek care than the general population.

Management

Schizophrenia is treatable. Treatment with medicines and psychosocial support is effective. However, most people with chronic schizophrenia lack access to treatment.

There is clear evidence that old-style mental hospitals are not effective in providing the treatment that people with mental disorders need and violate basic human rights of persons with mental disorders. Efforts to transfer care from mental health institutions to the community need to be expanded and accelerated. The engagement of family members and the wider community in providing support is very important.

Programmes in several low- and middle- income countries (e.g. Ethiopia, Guinea-Bissau, India, Iran, Pakistan and United Republic of Tanzania) have demonstrated the feasibility of providing care to people with severe mental illness through the primary health-care system by:

  • training primary health-care personnel;
  • providing access to essential drugs;
  • supporting families in providing home care;
  • educating the public to decrease stigma and discrimination;
  • enhancing independent living skills through recovery-oriented psychosocial interventions (e.g. life skills training, social skills training) for people with schizophrenia and for their families and/or caregivers; and
  • facilitating independent living, if possible, or assisted living, supported housing and supported employment for people with schizophrenia. This can act as a base for people with schizophrenia to achieve recovery goals. People affected by schizophrenia often face difficulty in obtaining or retaining normal employment or housing opportunities.

Human rights violations

People with schizophrenia are prone to human rights violations both inside mental health institutions and in communities. Stigma of the disorder is high. This contributes to discrimination, which can in turn limit access to general health care, education, housing and employment.

WHO response

WHO’s Mental Health Gap Action Programme (mhGAP), launched in 2008, uses evidence-based technical guidance, tools and training packages to expand service in countries, especially in resource-poor settings. It focuses on a prioritized set of conditions, directing capacity building towards non-specialized health-care providers in an integrated approach that promotes mental health at all levels of care. Currently mhGAP is being implemented in more than 100 WHO Member States.

The WHO QualityRights Project involves improving the quality of care and human rights conditions in mental health and social care facilities and to empower organizations to advocate for the health of people with mental disorders.WHO’s Mental Health Action Plan 2013-2020, endorsed by the World Health Assembly in 2013, highlights the steps required to provide appropriate services for people with mental disorders including schizophrenia. A key recommendation of the Action Plan is to shift services from institutions to the community.