Chapter 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 prefrontal cortex (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 literature review. 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.

1.3

Limitation of Problems

1.4

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?

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.

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

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 AND

BETWEEN BIPOLAR

SCHIZOPHRENIA 2007 - 2009

DISORDER ON ADULTS IN JAKARTA YEAR

CHAPTER V

CONCLUSION

BIBLIOGRAPHY

Chapter II
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 "splitmind," 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, enjoyable lives.

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

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: 6

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:

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 show differences 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.

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 a battery 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 9

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

10

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, even during periods when you feel better and your symptoms have subsided. Treatment with medications and psychosocial therapy can help you take control of your condition and become an active and informed participant in your own care. During crisis periods or times of severe symptoms, hospitalization may be necessary for your safety and to make sure you're getting proper nutrition, sleep and hygiene. 11

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.

12

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.

13

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-thecounter 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 communications skills, 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 help you 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.

14

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 may need 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.

Chapter III
15

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 manicdepressive 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 bipolar disorder 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.

16

Bipolar disorder symptoms reflect a range of moods. 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

17

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 disorder Signs and symptoms

the depressive phase of bipolar disorder may include:

Sadness Hopelessness Suicidal thoughts or behavior Anxiety Guilt Sleep problems

18

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

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 19

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 of psychosis 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. 20

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 the disorder, 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 with the 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

21

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 bipolar disorder 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

22

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.

23

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

24

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 or having 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: 25

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,

26

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, moodstabilizing 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.

Psychotherapy Psychotherapy 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

27

family. It can help your family improve its communication style and problemsolving 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.

CHAPTER IV The Correlation Between Schizoph

reniaand Bipolar Disorder on Adults in Jakarta Year 20052009

A trio of genome-wide studies collectively the largest to date has pinpointed a vast array of genetic variation that cumulatively may account

28

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 a suspect 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. 29

"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."

(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 30

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, or unique to, schizophrenia and bipolar disorder, the researchers say. Source: NIH/National Institute of Mental Health

CHAPTER V Conclusion

31

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 G72/G30, matter examples are are susceptibility in in genes for neuregulin-1 and which involved resulting neurodevelopment, the observed glutamatergic emotional

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

32

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