Depression, Schizophrenia, and Bipolar Disorder

Depression, Schizophrenia, and Bipolar Disorder
Rena Petersen

What is Depression? Depression is a disorder that affects a person’s ability to eat, sleep, feel pleasure, and function in everyday life. The affected feel an overwhelming sadness most of the time. Depression affects the body and mind. “Depression” 17 Feb 2006 National Institute of Mental Health. 21 March < WHAT IS A DEPRESSIVE DISORDER? A depressive disorder is an illness that involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression. TYPES OF DEPRESSION Depressive disorders come in different forms, just as is the case with other illnesses such as heart disease. This pamphlet briefly describes three of the most common types of depressive disorders. However, within these types there are variations in the number of symptoms, their severity, and persistence. Major depression is manifested by a combination of symptoms (see symptom list) that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime. A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Depression and the Brain
People that suffer from depression have been proven to have less gray matter and weaker connections in the brain. “Depression Gene May Weaken Mood-regulating Circuit.” Nation Institute Of Mental Health. 10 May April < serotonin/brain-scan.jpg> Nation Institute Of Mental Health. “Depression Gene May Weaken Mood-regulating Circuit” Image. National Institute of Mental Health. 16 April < serotonin/brain-scan.jpg> Source: NIH/National Institute Of Mental Health Date: 10 May 2005 Depression Gene May Weaken Mood-regulating Circuit Areas in the cingulate (right) and amygdala (left) that differed in gray matter volume between subjects with the short and long version version of the serotonin transporter gene. Short version carriers showed the greatest reductions in the red area, which previous studies have linked to depression. (Image courtesy of National Institute of Mental Health) A brain scan study suggests that a suspect gene may increase susceptibility to anxiety and depression* by weakening a circuit for processing negative emotion. People with the depression-linked gene variant showed less gray matter and weaker connections in the mood-regulating circuit. How well the circuit was connected accounted for nearly 30 percent of their anxious temperament, researchers at the National Institute of Health's (NIH) National Institute of Mental Health (NIMH) found. Dr. Daniel Weinberger and colleagues report on their brain imaging genetics study in the May 8, 2005 online edition of Nature Neuroscience. "We discovered the mood-regulating circuit by using the gene to interrogate the imaging data," explained Weinberger. "The brain handles information much like an orchestra. So we asked questions akin to 'Are the violin and the clarinet playing the same tune and to what extent might this gene account for it?'" In this case, it turned out that the amygdala, a fear processing hub deep in the brain and the cingulate, an emotion-dampening center located near the front of the brain, were playing a duet under the baton of the depression-linked gene. The gene codes for the serotonin transporter, the protein in brain cells that recycles the chemical messenger after it's been secreted into the synapse, the gulf between cells. Since the most widely prescribed class of antidepressants act by blocking this protein, researchers have focused on possible functional consequences of a slight variation in its DNA sequence across individuals. Everyone inherits two copies of the gene, one from each parent, which comes in two common versions: short and long. The short version makes less protein, resulting in less recycling, increased levels of serotonin in the synapse, and more serotonin-triggered cellular activity. Previous NIMH-supported studies had shown that inheriting the short variant more than doubles risk of depression following life stresses,** boosts amygdala activity while viewing scary faces,*** and has been linked to anxious temperament. Yet, how it works at the level of brain circuitry remained a mystery. The NIMH research team first scanned 114 healthy subjects using magnetic resonance imaging (MRI). Those with at least one copy of the short variant had less gray matter, neurons and their connections, in the amygdala-cingulate circuit than those with two copies of the long variant. Next, using functional magnetic resonance imaging (fMRI), the researchers monitored the brain activity of 94 healthy participants while they were looking at scary faces, which activates fear circuitry. Those with the short variant showed less functional connectivity, in the same circuit. Nearly 30 percent of subjects' scores on a standard scale of "harm avoidance," an inherited temperament trait associated with depression and anxiety, was explained by how well the mood-regulating circuit was connected. "Until now, it's been hard to relate amygdala activity to temperament and genetic risk for depression," said Dr. Andreas Meyer-Lindenberg, a lead author. "This study suggests that the cingulate's ability to put the brakes on a runaway amygdala fear response depends upon the degree of connectivity in this circuit, which is influenced by the serotonin transporter gene." Since serotonin activity plays a key role in wiring the brain's emotion processing circuitry during early development, the researchers propose that the short variant leads to stunted coupling in the circuit, a poorly regulated amygdala response and impaired emotional reactivity -- resulting in increased vulnerability to persistent bad moods and eventually depression as life's stresses take their toll. Other members of the NIMH team were: Dr. Lukas Pezawas, Dr. Bhaskar Kolachana, Dr. Michael Egan, Dr. Venakata Mattay, Emily Drabant, Beth Verchinski, and Karen Munoz. Dr. Ahmad Hariri, University of Pittsburgh, also participated in the study.

What is Bipolar Disorder?
A mental illness also known as manic-depressive disorder. Characterized by severe high and low mood changes. Manic episodes and depressive episodes can last for hours, months, or even years. Different types of bipolar disorder are characterized by how long a manic episode may last. “Bipolar Disorder: What is Bipolar Disorder?” WebMD. March March < Bipolar Disorder: What Is Bipolar Disorder? Bipolar disorder is also known as manic depression. It’s a serious illness, one that can lead to risky behavior, damaged relationships and careers, even suicidal tendencies -- if it’s not treated. Bipolar disorder is characterized by extreme changes in mood (poles) -- from mania to depression. Between these mood swings, a person with Bipolar disorder may experience normal moods. "Manic" describes an increasingly restless, energetic, talkative, reckless, powerful, euphoric period. Lavish spending sprees or impulsive risky sex can be irresistible. Then, at some point, this high-flying mood can spiral into something darker -- irritation, confusion, anger, feeling trapped. "Depression" describes the opposite mood -- sadness, crying, sense of worthlessness, loss of energy, loss of pleasure, sleep problems. But because the pattern of highs and lows varies for each person, bipolar disorder is a complex disease to diagnose. For some people, mania or depression can last for weeks or months, even for years. For other people, bipolar disorder takes the form of frequent and dramatic mood shifts. “There’s a whole spectrum of symptoms and mood changes that have been found in bipolar disorder,” says Michael Aronson, MD, a clinical psychiatrist and consultant for WebMD. “It’s not always dramatic mood swings. In fact, some people seem to get along just fine. The manic periods can be very, very productive. They think things are going great.” The danger comes, he says, when the mania grows much worse. “The change can be very dramatic, with catastrophic results. People can get involved in reckless behavior, spend a lot of money, there may be sexual promiscuity, sexual risks.” The depressed phases can be equally dangerous: A person may have frequent thoughts of suicide. If you or someone you know has thoughts of death or suicide, contact a health-care professional, loved one, friend, or call 911 immediately.Bipolar disorder is equally difficult for families of those affected. The condition is the most difficult mental illness for families to accept, Aronson tells WebMD. “Families can more easily accept schizophrenia, to understand that it is an illness. But when a person is sometimes very productive, then becomes unreasonable or irrational, it wreaks more havoc on the family. It seems more like bad behavior, like they won’t straighten up.” If this rings true -- either for you or a loved one -- the first step in tackling the problem is to see a psychiatrist. Whether it's bipolar disorder or another mood-related problem, effective treatments are available. What’s most important is that you recognize the problem, and start looking for help. Next: Who Gets Bipolar Disorder? View the full table of contents of the Bipolar Disorder Guide. Edited by Charlotte E. Grayson, MD, WebMD, March 2005. SOURCES: WebMD Medical Reference with The Cleveland Clinic: "Bipolar Disorder (Manic Depressive Disorder)." WebMD Assess Plus: Bipolar Disorder Assessment. National Institute for Mental Health: "Step-BD Womens Studies." Massachusetts General Hospital Bipolar Clinic & Research Program. MedicineNet.com: "Bipolar Disorder (Mania)." WebMD Medical Reference with The Cleveland Clinic: "Effects of Untreated Depression." American Psychiatric Association: "Practice Guideline for the Treatment of Patients With Bipolar Disorder."

Bipolar Disorder and the Brain
Global Friends of Scotland. “Tracking Mental Illness Head On” Image. July April < psychiatry.jpg>

Manic Episodes A manic episode can include feeling euphoric, talkative, powerful, reckless, energetic, irritation, anger, and confusion. “Bipolar Disorder: What is Bipolar Disorder?” WebMD. March March < Braininspect.com “bipolaractive85percent” Image. Brain Spect Imaging, Inc. 16 April <braininspect.com/.../ bipolaractive85percent.jpg> Bipolar Disorder: What Is Bipolar Disorder? Bipolar disorder is also known as manic depression. It’s a serious illness, one that can lead to risky behavior, damaged relationships and careers, even suicidal tendencies -- if it’s not treated. Bipolar disorder is characterized by extreme changes in mood (poles) -- from mania to depression. Between these mood swings, a person with Bipolar disorder may experience normal moods. "Manic" describes an increasingly restless, energetic, talkative, reckless, powerful, euphoric period. Lavish spending sprees or impulsive risky sex can be irresistible. Then, at some point, this high-flying mood can spiral into something darker -- irritation, confusion, anger, feeling trapped. "Depression" describes the opposite mood -- sadness, crying, sense of worthlessness, loss of energy, loss of pleasure, sleep problems. But because the pattern of highs and lows varies for each person, bipolar disorder is a complex disease to diagnose. For some people, mania or depression can last for weeks or months, even for years. For other people, bipolar disorder takes the form of frequent and dramatic mood shifts. “There’s a whole spectrum of symptoms and mood changes that have been found in bipolar disorder,” says Michael Aronson, MD, a clinical psychiatrist and consultant for WebMD. “It’s not always dramatic mood swings. In fact, some people seem to get along just fine. The manic periods can be very, very productive. They think things are going great.” The danger comes, he says, when the mania grows much worse. “The change can be very dramatic, with catastrophic results. People can get involved in reckless behavior, spend a lot of money, there may be sexual promiscuity, sexual risks.” The depressed phases can be equally dangerous: A person may have frequent thoughts of suicide. If you or someone you know has thoughts of death or suicide, contact a health-care professional, loved one, friend, or call 911 immediately.Bipolar disorder is equally difficult for families of those affected. The condition is the most difficult mental illness for families to accept, Aronson tells WebMD. “Families can more easily accept schizophrenia, to understand that it is an illness. But when a person is sometimes very productive, then becomes unreasonable or irrational, it wreaks more havoc on the family. It seems more like bad behavior, like they won’t straighten up.” If this rings true -- either for you or a loved one -- the first step in tackling the problem is to see a psychiatrist. Whether it's bipolar disorder or another mood-related problem, effective treatments are available. What’s most important is that you recognize the problem, and start looking for help. Next: Who Gets Bipolar Disorder? View the full table of contents of the Bipolar Disorder Guide. Edited by Charlotte E. Grayson, MD, WebMD, March 2005. SOURCES: WebMD Medical Reference with The Cleveland Clinic: "Bipolar Disorder (Manic Depressive Disorder)." WebMD Assess Plus: Bipolar Disorder Assessment. National Institute for Mental Health: "Step-BD Womens Studies." Massachusetts General Hospital Bipolar Clinic & Research Program. MedicineNet.com: "Bipolar Disorder (Mania)." WebMD Medical Reference with The Cleveland Clinic: "Effects of Untreated Depression." American Psychiatric Association: "Practice Guideline for the Treatment of Patients With Bipolar Disorder."

Depressive Episodes Being depressed can make you feel worthless and you may have no energy, not be able to feel pleasure, and have sleeping problems. “Bipolar Disorder: What is Bipolar Disorder?” WebMD. March March < Bipolar Disorder: What Is Bipolar Disorder? Bipolar disorder is also known as manic depression. It’s a serious illness, one that can lead to risky behavior, damaged relationships and careers, even suicidal tendencies -- if it’s not treated. Bipolar disorder is characterized by extreme changes in mood (poles) -- from mania to depression. Between these mood swings, a person with Bipolar disorder may experience normal moods. "Manic" describes an increasingly restless, energetic, talkative, reckless, powerful, euphoric period. Lavish spending sprees or impulsive risky sex can be irresistible. Then, at some point, this high-flying mood can spiral into something darker -- irritation, confusion, anger, feeling trapped. "Depression" describes the opposite mood -- sadness, crying, sense of worthlessness, loss of energy, loss of pleasure, sleep problems. But because the pattern of highs and lows varies for each person, bipolar disorder is a complex disease to diagnose. For some people, mania or depression can last for weeks or months, even for years. For other people, bipolar disorder takes the form of frequent and dramatic mood shifts. “There’s a whole spectrum of symptoms and mood changes that have been found in bipolar disorder,” says Michael Aronson, MD, a clinical psychiatrist and consultant for WebMD. “It’s not always dramatic mood swings. In fact, some people seem to get along just fine. The manic periods can be very, very productive. They think things are going great.” The danger comes, he says, when the mania grows much worse. “The change can be very dramatic, with catastrophic results. People can get involved in reckless behavior, spend a lot of money, there may be sexual promiscuity, sexual risks.” The depressed phases can be equally dangerous: A person may have frequent thoughts of suicide. If you or someone you know has thoughts of death or suicide, contact a health-care professional, loved one, friend, or call 911 immediately.Bipolar disorder is equally difficult for families of those affected. The condition is the most difficult mental illness for families to accept, Aronson tells WebMD. “Families can more easily accept schizophrenia, to understand that it is an illness. But when a person is sometimes very productive, then becomes unreasonable or irrational, it wreaks more havoc on the family. It seems more like bad behavior, like they won’t straighten up.” If this rings true -- either for you or a loved one -- the first step in tackling the problem is to see a psychiatrist. Whether it's bipolar disorder or another mood-related problem, effective treatments are available. What’s most important is that you recognize the problem, and start looking for help. Next: Who Gets Bipolar Disorder? View the full table of contents of the Bipolar Disorder Guide. Edited by Charlotte E. Grayson, MD, WebMD, March 2005. SOURCES: WebMD Medical Reference with The Cleveland Clinic: "Bipolar Disorder (Manic Depressive Disorder)." WebMD Assess Plus: Bipolar Disorder Assessment. National Institute for Mental Health: "Step-BD Womens Studies." Massachusetts General Hospital Bipolar Clinic & Research Program. MedicineNet.com: "Bipolar Disorder (Mania)." WebMD Medical Reference with The Cleveland Clinic: "Effects of Untreated Depression." American Psychiatric Association: "Practice Guideline for the Treatment of Patients With Bipolar Disorder."

Manic-Depressive Episodes
“Biological Clocks and Bipolar Disorder” Image. PsychoEducation.org. 16 April < depression/clock.6.gif>

What is Schizophrenia? A mental illness that usually consumes the sufferer to the point where they can no longer function in society without treatment. Some symptoms include: delusions, hallucinations, disorganized thinking, and catatonic behavior. ”Signs and Symptoms” Schizophrenia Fellowship. 16 March < Signs and symptoms "The consumer who lives with schizophrenia is more than a complex presentation of signs and symptoms. Not only does this person experience the internal effects of the illness, they also feel the interaction between their internal physical and psychological experience, and the external social world" (Paul, a Mental Health Professional). There are a number of signs and symptoms that are characteristic of schizophrenia, however, the expression of these symptoms varies greatly from one individual to another. No one symptom is common to all people. As such, diagnosis and treatment must always be tailored to the individual's unique experience of schizophrenia. The symptoms of schizophrenia are often divided into two groups: Positive symptoms, for example, hallucinations and delusions Negative symptoms, for example, flat affect, apathy and poverty of speech It has also been proposed that disorganised symptoms (for example, disorganised speech and disorganised behaviour) constitute a third group, separate from the positive/negative groups. Positive symptoms The positive symptoms of schizophrenia (also referred to as 'psychotic' or 'active' symptoms) reflect an excess or distortion of normal functioning and include the following: Delusions Delusions are false personal beliefs held with extraordinary conviction in spite of what others believe and in spite of obvious proof or evidence to the contrary. They may revolve around persecutory, religious, grandiose, somatic or referential themes. For example, a person experiencing delusions may believe they are being spied on, tormented, followed or tricked (persecutory). Or they may believe gestures, comments, passages from books, television and other environmental cues are directed specifically at them (referential). Delusions may be bizarre (believing your thoughts have been removed by an outside force) or realistic (believing you are being followed by the police). Delusions will occur during some stage of the disorder in ninety percent of people who experience schizophrenia. Hallucinations Hallucinations can occur in any of the five senses but the most common are auditory. These are usually experienced as voices which are perceived as distinct from the person's own thoughts. For example, the person may hear voices repeating or mimicking their thoughts, arguing, commenting on their actions (often in a critical manner) or telling them what to do (command hallucinations). Hallucinations of any form occur in over 70 per cent of people who experience psychotic illnesses. Auditory hallucinations occur in approximately 50 per cent of people with schizophrenia, while visual hallucinations occur in 15 per cent. Disorganised Thinking This is usually expressed through abnormal spoken language. For example, the person's conversation jumps erratically from one topic to another, new words may be created, the grammatical structure of language breaks down and speech may greatly speed up or slow down. Disorganised Behaviour This can be manifested in a variety of ways and is the result of the underlying brain dysfunction. A person with schizophrenia may, for example, aimlessly wander, display child-like silliness or become unpredictable agitated. Or they may display behaviour that is considered inappropriate according to usual social norms, such as wearing many layers on a hot day, muttering aloud in public or inappropriately shouting or swearing. Disorganised behaviour can lead to problems in conducting the activities of daily living such as organising meals and maintaining hygiene. It may be difficult to link disorganised behaviour in adolescents as being a sign of early psychosis as teenagers are often intrinsically disorganised. Catatonic Behaviour This refers to states of muscular rigidity and immobility, stupor and negativism, or to states of wild excitement. The person may hold fixed or bizarre bodily postures for extended periods of time and resist any effort to be moved. The incidence of catatonic behaviour is very rare in developed countries (Cutting, 1996). Negative symptoms The negative symptoms of schizophrenia (also referred to as 'deficit' symptoms) reflect a loss of normal functioning and include the following: Withdrawal, Loss of Motivation and Ambivalence (Avolition) This may involve lack of energy, apathy or seeming absence of interest in what were usually routine activities. People experiencing avolition may be inattentive to grooming, personal hygiene, have difficulty making decisions and have difficulty persisting at work, school or household chores. Loss of Feeling or an Inability to Experience Pleasure (Anhedonia) This may manifest itself through having a lack of interest in social or recreational activities or through failure to develop close relationships. It may mean that the simple pleasures of life, like appreciating a beautiful sunset, being no longer enjoyed. Poverty of Speech (Alogia) The person's amount of speech is greatly reduced and tends to be vague or repetitious. People showing signs of alogia may be slow in responding to questions or not respond at all. Flat Presentation (Affective Flattening) This can be indicated by unchanging facial expressions, poor or no eye contact, reduced body language and decreased spontaneous movements. A person experiencing affective flattening may stare vacantly into space and speak in a flat, toneless voice. Flat affect refers to the outward expression of emotion and not the inner experience. Some people with schizophrenia experience negative symptoms prior to and after and acute episode of the illness. However, the negative symptoms are difficult to assess because they may be caused by a variety of other factors such as medication side effects, mood disorders or the demoralisation often felt as a consequence of a mental illness. It is also possible a person may have schizophrenia but be symptom-free. The symptoms may only emerge during an acute episode. Cognitive impairments Although not part of diagnostic criteria, cognitive dysfunction is often present in people with schizophrenia. A large body of research demonstrates schizophrenia is associated with cognitive impairments including problems with attention, concentration and memory. Are there any early warning signs? Yes. Usually before a person develops psychosis or schizophrenia, there is a period where 'something is not quite right'. During this time they may withdraw from their family and friends, have changes in their appetite and sleep patterns, find it difficult to concentrate and consequently have difficulties at school or work. The person may find this period very disturbing, even frightening, and may not want to talk about what is happening to them. This period is referred to in medical language as the ‘prodrome’. The prodrome is the period of disturbance or mild symptoms that occurs before the onset of an illness. The prodrome for schizophrenia can be anything from a month to several years. New research is suggesting that if early interventions are begun during this period, the prospects for recovery or a milder course of illness are increased. Some early warning signs and symptoms of psychosis are: Changes in thinking: Difficulty in concentrating, poor memory, preoccupation with odd ideas, increased suspiciousness. Changes in mood: Lack of emotional response, rapid mood changes, inappropriate moods. Changes in behaviour: Odd or unusual behaviour. Physical changes: Sleep disturbances or excessive sleep and loss of energy. Social changes: Withdrawal and isolation from family and friends. Changes in functioning: Decline in school or work performance. Remember: none of these symptoms by themselves indicate the presence of schizophrenia or another mental illness. But if they are severe, persistent or recurrent, professional help should be sought as soon as possible.

Schizophrenia and the Brain
The Treatment Advocacy Center. “Schizophrenia in Identical Twins” Image. 16 April < schizophrenia_graphi...>

Causes There are receptor sites for the chemical messengers in our brains. Serotonin is the chemical messenger linked to depression. Depression is caused by a deficiency of serotonin and its receptor sites. “Decoding Mental Illness” Science. 302:5653 (19 Dec 2003) Academic Abstract. College of the Sequoias Library. 28 Feb 2006. Find The Light. “Bain Chemistry Basics.” Illustration. 25 Feb Find The Light. Find The Light. 15 March < images/serotonin.jpg> This year's discoveries illuminated realms as small as a single molecule and as large as a gamma ray burst. #2 Schizophrenia, depression, and bipolar disorder often run in families, but only recently have researchers identified particular genes that reliably increase one's risk of disease. Now they're unraveling how these genes can distort the brain's information processing and nudge someone into mental illness. The chemical messenger serotonin relays its signal through a receptor that's a target of antidepressant drugs. The gene for this receptor comes in two common flavors, or alleles, one of which had been tenuously linked to an increased risk of depression. This year, researchers revealed why the link had been so elusive: The allele increases the risk of depression only when combined with stress. Among people who had suffered bereavement, romantic rejection, or job loss in their early 20s, those who carried the vulnerability gene were more likely to be depressed than those with the other gene variant. People with the high-risk allele have unusually heightened activity in a fear-focused brain region called the amygdala when viewing scary pictures. Together, these studies suggest that the gene variant biases people to perceive the world as highly menacing, which amplifies life stresses to the point of inducing depression. A different brain area, the prefrontal cortex, is regulated in part by a gene called COMT, one of the handful associated with risk of schizophrenia. It encodes an enzyme that breaks down neurotransmitters such as dopamine. Two years ago, one version of this gene was shown to muddle the prefrontal cortex, which is necessary for planning and problem-solving skills that are impaired by schizophrenia. Even healthy people who carry the schizophrenia risk allele have extra activity in the prefrontal cortex even when doing relatively simple tasks. The nonschizophrenia allele, which allows more efficient activity in the prefrontal cortex, appears to increase the risk of anxiety, suggesting that the two diseases lie at opposite ends of a spectrum. Late in 2002, an allele of a gene for brain-derived neurotrophic factor (BDNF) was implicated in bipolar disorder, once known as manic depression. This year the allele was found to curb activity in the hippocampus, a structure necessary for memory that is shrunken in people with mood disorders. BDNF encourages the birth of new neurons in the hippocampus; other work this year showed that antidepressants require this neurogenesis to be effective. Through these and similar insights, researchers hope to understand brain biases underlying mental illnesses well enough to correct them. PHOTO (COLOR): Agony antecedents. New work links genes, brain activity biases, and mental illness. Copyright of Science is the property of American Association for the Advancement of Science and its content may not be copied without the publisher's express written permission except for the print or download capabilities of the retrieval software used for access. This content is intended solely for the use of the individual user. Copyright of Science is the property of American Association for the Advancement of Science and its content may not be copied or ed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or articles for individual use.

Causes Someone with a family history of mental illnesses would be more susceptible to develop bipolar disorder, schizophrenia, and depression. “Decoding Mental Illness” Science. 302:5653 (19 Dec 2003) Academic Abstract. College of the Sequoias Library. 28 Feb 2006. “Family” national Statistics. Graphic. 16 April 2006 < images/families.gif> This year's discoveries illuminated realms as small as a single molecule and as large as a gamma ray burst. #2 Schizophrenia, depression, and bipolar disorder often run in families, but only recently have researchers identified particular genes that reliably increase one's risk of disease. Now they're unraveling how these genes can distort the brain's information processing and nudge someone into mental illness. The chemical messenger serotonin relays its signal through a receptor that's a target of antidepressant drugs. The gene for this receptor comes in two common flavors, or alleles, one of which had been tenuously linked to an increased risk of depression. This year, researchers revealed why the link had been so elusive: The allele increases the risk of depression only when combined with stress. Among people who had suffered bereavement, romantic rejection, or job loss in their early 20s, those who carried the vulnerability gene were more likely to be depressed than those with the other gene variant. People with the high-risk allele have unusually heightened activity in a fear-focused brain region called the amygdala when viewing scary pictures. Together, these studies suggest that the gene variant biases people to perceive the world as highly menacing, which amplifies life stresses to the point of inducing depression. A different brain area, the prefrontal cortex, is regulated in part by a gene called COMT, one of the handful associated with risk of schizophrenia. It encodes an enzyme that breaks down neurotransmitters such as dopamine. Two years ago, one version of this gene was shown to muddle the prefrontal cortex, which is necessary for planning and problem-solving skills that are impaired by schizophrenia. Even healthy people who carry the schizophrenia risk allele have extra activity in the prefrontal cortex even when doing relatively simple tasks. The nonschizophrenia allele, which allows more efficient activity in the prefrontal cortex, appears to increase the risk of anxiety, suggesting that the two diseases lie at opposite ends of a spectrum. Late in 2002, an allele of a gene for brain-derived neurotrophic factor (BDNF) was implicated in bipolar disorder, once known as manic depression. This year the allele was found to curb activity in the hippocampus, a structure necessary for memory that is shrunken in people with mood disorders. BDNF encourages the birth of new neurons in the hippocampus; other work this year showed that antidepressants require this neurogenesis to be effective. Through these and similar insights, researchers hope to understand brain biases underlying mental illnesses well enough to correct them. PHOTO (COLOR): Agony antecedents. New work links genes, brain activity biases, and mental illness. Copyright of Science is the property of American Association for the Advancement of Science and its content may not be copied without the publisher's express written permission except for the print or download capabilities of the retrieval software used for access. This content is intended solely for the use of the individual user. Copyright of Science is the property of American Association for the Advancement of Science and its content may not be copied or ed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or articles for individual use.

Chromosomal Causes The 22nd chromosome has been a proven link between Schizophrenia, Bipolar disorder, and Depression. Genome News Network. “Chromosome 22” Image. 16 April < Bipolar1.gif> Winstead, Edward R. “Region of Chromosome 22 linked to bipolar disorder, again.” Genome News Network. 2 Feb April < Region of chromosome 22 linked to bipolar disorder, againSame region may contain susceptibility gene(s) for schizophrenia By Edward R. Winstead February 2, 2001 A genome-wide search for susceptibility genes in bipolar disorder has yielded a potential hotspot on chromosome 22. In addition to the chromosome 22 region, researchers found evidence of susceptibility genes for bipolar disorder on chromosomes 3, 5, 10, 13 and 21. The regions of chromosomes 22, 13, and 10 implicated here may also contain susceptibility genes for schizophrenia, according to published data. Proof that bipolar disorder, or manic depression, and schizophrenia have susceptibility genes in common will require the identification of specific genes. But the researchers, led by John R. Kelsoe, of University of California, San Diego, are intrigued that the disorders might share risk factors—and that different mutations in the same gene might have different disease outcomes. Writing in Proceedings of the National Academies of Science, they cite data suggesting some degree of overlap between the disorders. The new scans, they note, raise the possibility that "the relationship between these two disorders may be more complex than previously thought." The researchers analyzed the genomes of 164 subjects from 20 families that had been recruited in San Diego and Vancouver, British Columbia. The researchers used 443 DNA markers to track the inheritance of chromosome regions among affected and unaffected individuals, and a statistical analysis of the scan data yielded the potential hotspots. The strongest statistical evidence implicated chromosome 22. Kelsoe and colleagues first reported a possible risk factor for bipolar disorder on chromosome 22 in That study involved 13 of the 20 families reported in the current study, which used more individuals and more DNA markers. To gain some independent confirmation of the findings, Kelsoe's group compared its data to scans involving 57 families from the Bipolar Disorder Genetics Initiative (from the US National Institutes of Mental Health). The findings were consistent with the current study, according to the researchers. Different hypotheses about the role of genes in the development of bipolar disorder have been proposed. One theory says the risk for bipolar disorder is due to a few susceptibility genes; another says that many susceptibility genes contribute modestly to the risk for disease.

Depression Statistics
Major Depressive disorder affects approximately 14.8 million American adults, or about 6.7% of the U.S. population that are 18 or older in a year. Major Depression is more prevalent in women than in men. The median onset age of major depression is 35. “The Numbers Count: Mental Disorders in America” 17 Feb National Institute of Mental Health. 16 March < Mental Disorders in America Mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages and older — about one in four adults — suffer from a diagnosable mental disorder in a given year.1 When applied to the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translates to 57.7 million people.2Even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 — who suffer from a serious mental illness.1 In addition, mental disorders are the leading cause of disability in the U.S. and Canada for ages Many people suffer from more than one mental disorder at a given time. Nearly half (45 percent) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity.1 In the U.S., mental disorders are diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).4 Mood Disorders Mood disorders include major depressive disorder, dysthymic disorder, and bipolar disorder. Approximately 20.9 million American adults, or about 9.5 percent of the U.S. population age 18 and older in a given year, have a mood disorder.1 The median age of onset for mood disorders is 30 years.5 Depressive disorders often co-occur with anxiety disorders and substance abuse.5 Major Depressive Disorder Major Depressive Disorder is the leading cause of disability in the U.S. for ages Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.1 While major depressive disorder can develop at any age, the median age at onset is 32.5 Major depressive disorder is more prevalent in women than in men.6 Dysthymic Disorder Symptoms of dysthymic disorder (chronic, mild depression) must persist for at least two years in adults (one year in children) to meet criteria for the diagnosis. Dysthymic disorder affects approximately 1.5 percent of the U.S. population age 18 and older in a given year.1 This figure translates to about 3.3 million American adults.2 The median age of onset of dysthymic disorder is 31.1 Bipolar Disorder Bipolar disorder affects approximately 5.7 million American adults, or about 2.6 percent of the U.S. population age 18 and older in a given year.1 The median age of onset for bipolar disorders is 25 years.5 Suicide In 2002, 31,655 (approximately 11 per 100,000) people died by suicide in the U.S.7,8 More than 90 percent of people who kill themselves have a diagnosable mental disorder, most commonly a depressive disorder or a substance abuse disorder.9 The highest suicide rates in the U.S. are found in white men over age 85.8 Four times as many men as women die by suicide8; however, women attempt suicide two to three times as often as men.10 Schizophrenia Approximately 2.4 million American adults, or about 1.1 percent of the population age 18 and older in a given year,11 have schizophrenia. Schizophrenia affects men and women with equal frequency.12 Schizophrenia often first appears in men in their late teens or early twenties. In contrast, women are generally affected in their twenties or early thirties.12 Anxiety Disorders Anxiety disorders include panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and phobias (social phobia, agoraphobia, and specific phobia). Approximately 40 million American adults ages 18 and older, or about 18.1 percent of people in this age group in a given year, have an anxiety disorder.1 Anxiety disorders frequently co-occur with depressive disorders or substance abuse.1 Most people with one anxiety disorder also have another anxiety disorder. Nearly three-quarters of those with an anxiety disorder will have their first episode by age Panic Disorder Approximately 6 million American adults ages 18 and older, or about 2.7 percent of people in this age group in a given year, have panic disorder.1 Panic disorder typically develops in early adulthood (median age of onset is 24), but the age of onset extends throughout adulthood.5 About one in three people with panic disorder develops agoraphobia, a condition in which the individual becomes afraid of being in any place or situation where escape might be difficult or help unavailable in the event of a panic attack.12 Obsessive-Compulsive Disorder (OCD) Approximately 2.2 million American adults age 18 and older, or about 1.0 percent of people in this age group in a given year, have OCD.1 The first symptoms of OCD often begin during childhood or adolescence, however, the median age of onset is 19.5 Post-Traumatic Stress Disorder (PTSD) Approximately 7.7 million American adults age 18 and older, or about 3.5 percent of people in this age group in a given year, have PTSD.1 PTSD can develop at any age, including childhood, but research shows that the median age of onset is 23 years.5 About 30 percent of Vietnam veterans experienced PTSD at some point after the war.13 The disorder also frequently occurs after violent personal assaults such as rape, mugging, or domestic violence; terrorism; natural or human-caused disasters; and accidents. Generalized Anxiety Disorder (GAD) Approximately 6.8 million American adults, or about 3.1 percent of people age 18 and over, have GAD in a given year.1 GAD can begin across the life cycle, though the median age of onset is 31 years old.5 Social Phobia Approximately 15 million American adults age 18 and over, or about 6.8 percent of people in this age group in a given year, have social phobia.1 Social phobia begins in childhood or adolescence, typically around 13 years of age.5 Agoraphobia Agoraphobia involves intense fear and anxiety of any place or situation where escape might be difficult, leading to avoidance of situations such as being alone outside of the home; traveling in a car, bus, or airplane; or being in a crowded area.5 Approximately 1.8 million American adults age 18 and over, or about 0.8 percent of people in this age group in a given year, have agoraphobia without a history of panic disorder.1 The median age of onset of agoraphobia is 20 years of age.5 Specific Phobia Specific phobia involves marked and persistent fear and avoidance of a specific object or situation. Approximately 19.2 million American adults age 18 and over, or about 8.7 percent of people in this age group in a given year, have some type of specific phobia.1 Specific phobia typically begins in childhood; the median age of onset is seven years.5 Eating Disorders The three main types of eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder. Females are much more likely than males to develop an eating disorder. Only an estimated 5 to 15 percent of people with anorexia or bulimia14 and an estimated 35 percent of those with binge-eating disorder15 are male. In their lifetime, an estimated 0.5 percent to 3.7 percent of females suffer from anorexia, and an estimated 1.1 percent to 4.2 percent suffer from bulimia.16 Community surveys have estimated that between 2 percent and 5 percent of Americans experience binge-eating disorder in a 6-month period.15,17 The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages in the general population.18 Attention Deficit Hyperactivity Disorder (ADHD) ADHD, one of the most common mental disorders in children and adolescents, also affects an estimated 4.1 percent of adults, ages 18-44, in a given year.1 ADHD usually becomes evident in preschool or early elementary years. The median age of onset of ADHD is seven years, although the disorder can persist into adolescence and occasionally into adulthood.5 Autism Autism is part of a group of disorders called autism spectrum disorders (ASDs), also known as pervasive developmental disorders. ASDs range in severity, with autism being the most debilitating form while other disorders, such as Asperger syndrome, produce milder symptoms. Estimating the prevalence of autism is difficult and controversial due to differences in the ways that cases are identified and defined, differences in study methods, and changes in diagnostic criteria. A recent study reported the prevalence of autism in 3-10 year-olds to be about 3.4 cases per 1000 children.19 Autism and other ASDs develop in childhood and generally are diagnosed by age three.20 Autism is about four times more common in boys than girls. Girls with the disorder, however, tend to have more severe symptoms and greater cognitive impairment.19,20 Alzheimer's Disease AD affects an estimated 4.5 million Americans. The number of Americans with AD has more than doubled since AD is the most common cause of dementia among people age 65 and older.22 Increasing age is the greatest risk factor for Alzheimer’s. In most people with AD, symptoms first appear after age 65. One in 10 individuals over 65 and nearly half of those over 85 are affected.23 Rare, inherited forms of Alzheimer’s disease can strike individuals as early as their 30s and 40s.24 From the time of diagnosis, people with AD survive about half as long as those of similar age without dementia.25 For More Information Mental Health Information and Organizations from NLM's MedlinePlus (en Español). References 1. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6): 2. U.S. Census Bureau Population Estimates by Demographic Characteristics. Table 2: Annual Estimates of the Population by Selected Age Groups and Sex for the United States: April 1, 2000 to July 1, 2004 (NC-EST ) Source: Population Division, U.S. Census Bureau Release Date: June 9, 3. The World Health Organization. The World Health Report 2004: Changing History, Annex Table 3: Burden of disease in DALYs by cause, sex, and mortality stratum in WHO regions, estimates for Geneva: WHO, 2004. 4. American Psychiatric Association. Diagnostic and Statistical Manual on Mental Disorders, fourth edition (DSM-IV). Washington, DC: American Psychiatric Press, 1994. 5. Kessler RC, Berglund PA, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry Jun;62(6): 6. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association, 2003; Jun 18;289(23): 7. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (producer). Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2004). Available online from: URL: [2004 June 21 accessed]. 8. Kochanek KD, Murphy SL, Anderson RN, Scott C. Deaths: final data for National Vital Statistics Reports Oct 12;53 (5):1-115. 9. Conwell Y, Brent D. Suicide and aging I: patterns of psychiatric diagnosis. International Psychogeriatrics, 1995; 7(2): 10. Weissman MM, Bland RC, Canino GJ, et al. Prevalence of suicide ideation and suicide attempts in nine countries. Psychological Medicine, 1999; 29(1): 9-17. 11. Regier DA, Narrow WE, Rae DS, Manderscheid RW, Locke BZ, Goodwin FK. The de facto mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry Feb;50(2):85-94. 12. Robins LN, Regier DA, eds. Psychiatric disorders in America: the Epidemiologic Catchment Area Study. New York: The Free Press, 1991. 13. Kulka RA, Schlenger WE, Fairbank JA, Hough RL, Jordan BK, Marmar CR, Weiss DS. Contractual report of findings from the National Vietnam veterans readjustment study. Research Triangle Park, NC: Research Triangle Institute, 1988. 14. Andersen AE. Eating disorders in males. In: Brownell KD, Fairburn CG, eds. Eating disorders and obesity: a comprehensive handbook. New York: Guilford Press, 1995; 15. Spitzer RL, Yanovski S, Wadden T, Wing R, Marcus MD, Stunkard A, Devlin M, Mitchell J, Hasin D, Horne RL. Binge eating disorder: its further validation in a multisite study. International Journal of Eating Disorders Mar;13(2): 16. American Psychiatric Association Work Group on Eating Disorders. Practice guideline for the treatment of patients with eating disorders (revision). American Journal of Psychiatry Jan;157(1 Suppl):1-39.. 17. Bruce B, Agras WS. Binge eating in females: a population-based investigation. International Journal of Eating Disorders. 1992;12: 18. Sullivan PF. Mortality in anorexia nervosa. American Journal of Psychiatry Jul;152(7): 19. Yeargin-Allsopp M, Rice C, Karapurkar T, Doernberg N, Boyle C, Murphy C. Prevalence of Autism in a US Metropolitan Area. The Journal of the American Medical Association Jan 1;289(1):49-55. 20. Fombonne E. Epidemiology of autism and related conditions. In: Volkmar FR, ed. Autism and pervasive developmental disorders. Cambridge, England: Cambridge University Press, 1998; 21. Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA. Alzheimer disease in the US population: prevalence estimates using the 2000 census. Archives of Neurology Aug;60(8): 22. National Institute on Aging, Progress Report on Alzheimer’s disease NIH Publication No Bethesda, MD: National Institute on Aging, Available from 23. Evans DA, Funkenstein HH, Albert MS, Scherr PA, Cook NR, Chown MJ, Hebert LE, Hennekens CH, Taylor JO. Prevalence of Alzheimer's disease in a community population of older persons: Higher than previously reported. The Journal of the American Medical Association Nov 10;262(18): 24. Bird TD, Sumi SM, Nemens EJ, Nochlin D, Schellenberg G, Lampe TH, Sadovnick A, Chui H, Miner GW, Tinklenberg J. Phenotypic heterogeneity in familial Alzheimer's disease: a study of 24 kindreds. Annals of Neurology Jan;25(1):12-25. 25. Larson EB, Shadlen MF, Wang L, McCormick WC, Bowen JD, Teri L, Kukull WA. Survival after initial diagnosis of Alzheimer disease. Annals of Internal Medicine Apr 6;140(7):501-9.

Bipolar Disorder Statistics
Affects approximately 5.7 million American adults, or about 2.6% of the U.S. population age 18 or older in a given year. The median onset age of Bipolar disorder for American adults in 25. “Decoding Mental Illness” Science. 302:5653 (19 Dec 2003) Academic Abstract. College of the Sequoias Library. 28 Feb 2006. This year's discoveries illuminated realms as small as a single molecule and as large as a gamma ray burst. #2 Schizophrenia, depression, and bipolar disorder often run in families, but only recently have researchers identified particular genes that reliably increase one's risk of disease. Now they're unraveling how these genes can distort the brain's information processing and nudge someone into mental illness. The chemical messenger serotonin relays its signal through a receptor that's a target of antidepressant drugs. The gene for this receptor comes in two common flavors, or alleles, one of which had been tenuously linked to an increased risk of depression. This year, researchers revealed why the link had been so elusive: The allele increases the risk of depression only when combined with stress. Among people who had suffered bereavement, romantic rejection, or job loss in their early 20s, those who carried the vulnerability gene were more likely to be depressed than those with the other gene variant. People with the high-risk allele have unusually heightened activity in a fear-focused brain region called the amygdala when viewing scary pictures. Together, these studies suggest that the gene variant biases people to perceive the world as highly menacing, which amplifies life stresses to the point of inducing depression. A different brain area, the prefrontal cortex, is regulated in part by a gene called COMT, one of the handful associated with risk of schizophrenia. It encodes an enzyme that breaks down neurotransmitters such as dopamine. Two years ago, one version of this gene was shown to muddle the prefrontal cortex, which is necessary for planning and problem-solving skills that are impaired by schizophrenia. Even healthy people who carry the schizophrenia risk allele have extra activity in the prefrontal cortex even when doing relatively simple tasks. The nonschizophrenia allele, which allows more efficient activity in the prefrontal cortex, appears to increase the risk of anxiety, suggesting that the two diseases lie at opposite ends of a spectrum. Late in 2002, an allele of a gene for brain-derived neurotrophic factor (BDNF) was implicated in bipolar disorder, once known as manic depression. This year the allele was found to curb activity in the hippocampus, a structure necessary for memory that is shrunken in people with mood disorders. BDNF encourages the birth of new neurons in the hippocampus; other work this year showed that antidepressants require this neurogenesis to be effective. Through these and similar insights, researchers hope to understand brain biases underlying mental illnesses well enough to correct them. PHOTO (COLOR): Agony antecedents. New work links genes, brain activity biases, and mental illness. Copyright of Science is the property of American Association for the Advancement of Science and its content may not be copied without the publisher's express written permission except for the print or download capabilities of the retrieval software used for access. This content is intended solely for the use of the individual user. Copyright of Science is the property of American Association for the Advancement of Science and its content may not be copied or ed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or articles for individual use.

Schizophrenia Statistics
Prevalence of Schizophrenia in Americans: Approximately 2.2 million adults. Estimated 1.3% of adults. Approximately 1 in 123 American adults suffer from Schizophrenia. “Statistics by Country for Schizophrenia” 1 July Wrong Diagnosis. 16 March < Prevalance of Schizophrenia: Approximately 2.2 million American adults (NIMH); estimated 1.3% adults (USSG); more than 2 million Americans Prevalance of Schizophrenia: Approximately 2.2 million American adults (NIMH); estimated 1.3% adults (USSG); more than 2 million Americans Prevalance Rate for Schizophrenia: approx 1 in 123 or 0.81% or 2.2 million people in USA [about data] Extrapolation of Prevalence Rate of Schizophrenia to Countries and Regions: The following table attempts to extrapolate the above prevalence rate for Schizophrenia to the populations of various countries and regions. As discussed above, these prevalence extrapolations for Schizophrenia are only estimates and may have limited relevance to the actual prevalence of Schizophrenia in any region: Country/Region Extrapolated Prevalence Population Estimated Used Schizophrenia in North America (Extrapolated Statistics) USA 2,375,154 293,655,4051 Canada 262,931 32,507,8742 Mexico 848,937 104,959,5942 Schizophrenia in Central America (Extrapolated Statistics) Belize 2,207 272,9452 Guatemala 115,504 14,280,5962 Nicaragua43,350 5,359,7592 Schizophrenia in Caribbean (Extrapolated Statistics) Puerto Rico 31,527 3,897,9602 Schizophrenia in South America (Extrapolated Statistics) Brazil 1,489,053 184,101,1092 Chile 127,987 15,823,9572 Colombia 342,219 42,310,7752 Paraguay 50,077 6,191,3682 Peru 222,784 27,544,3052 Venezuela 202,346 25,017,3872 Schizophrenia in Northern Europe (Extrapolated Statistics) Denmark 43,784 5,413,3922 Finland 42,176 5,214,5122 Iceland 2,377 293,9662 Sweden 72,684 8,986,4002 Schizophrenia in Western Europe (Extrapolated Statistics) Britain (United Kingdom) 487,483 60,270,708 for UK2 Belgium 83,699 10,348,2762 France 488,725 60,424,2132 Ireland 32,106 3,969,5582 Luxembourg 3,742 462,6902 Monaco 261 32,2702 Netherlands (Holland) 131,985 16,318,1992 United Kingdom 60,270,7082 Wales 23,601 2,918,0002 Schizophrenia in Central Europe (Extrapolated Statistics) Austria 66,119 8,174,7622 Czech Republic 10,079 1,0246,1782 Germany 666,669 82,424,6092 Hungary 81,144 10,032,3752 Liechtenstein 270 33,4362 Poland 312,418 38,626,3492 Slovakia 43,867 5,423,5672 Slovenia 16,269 2,011,473 2 Switzerland 60,264 7,450,8672 Schizophrenia in Eastern Europe (Extrapolated Statistics) Belarus 83,393 10,310,5202 Estonia 10,851 1,341,6642 Latvia 18,653 2,306,3062 Lithuania 29,181 3,607,8992 Russia 1,164,496 143,974,0592 Ukraine 386,068 47,732,0792 Schizophrenia in the Southwestern Europe (Extrapolated Statistics) Azerbaijan 63,641 7,868,3852 Georgia 37,965 4,693,8922 Portugal 85,121 10,524,1452 Spain 325,800 40,280,7802 Schizophrenia in Southern Europe (Extrapolated Statistics) Greece 86,119 10,647,5292 Italy 469,582 58,057,4772 Schizophrenia in the Southeastern Europe (Extrapolated Statistics) Albania28,671 3,544,8082 Bosnia and Herzegovina 3,296 407,6082 Bulgaria 60,807 7,517,9732 Croatia 36,371 4,496,8692 Macedonia 16,500 2,040,0852 Romania 180,816 22,355,5512 Serbia and Montenegro 87,562 10,825,9002 Schizophrenia in Northern Asia (Extrapolated Statistics) Mongolia 22,253 2,751,3142 Schizophrenia in Central Asia (Extrapolated Statistics) Kazakhstan 122,485 15,143,7042 Tajikistan 56,711 7,011,556 2 Uzbekistan 213,613 26,410,4162 Schizophrenia in Eastern Asia (Extrapolated Statistics) China 10,505,385 1,298,847,6242 Hong Kong s.a.r. 55,445 6,855,1252 Japan 1,029,899 127,333,0022 Macau s.a.r. 3,601 445,2862 North Korea 183,583 22,697,5532 South Korea 390,125 48,233,7602 Taiwan 184,006 22,749,8382 Schizophrenia in Southwestern Asia (Extrapolated Statistics) Turkey 557,230 68,893,9182 Schizophrenia in Southern Asia (Extrapolated Statistics) Afghanistan 230,625 28,513,6772 Bangladesh 1,143,195 141,340,4762 Bhutan 17,677 2,185,5692 India 8,614,541 1,065,070,6072 Pakistan 1,287,617 159,196,3362 Sri Lanka 160,997 19,905,1652 Schizophrenia in Southeastern Asia (Extrapolated Statistics) East Timor 8,243 1,019,2522 Indonesia 1,928,663 238,452,9522 Laos 49,080 6,068,1172 Malaysia 190,255 23,522,4822 Philippines 697,543 86,241,6972 Singapore 35,215 4,353,8932 Thailand 524,647 64,865,5232 Vietnam668,596 82,662,8002 Schizophrenia in the Middle East (Extrapolated Statistics) Gaza strip 10,716 1,324,9912 Iran 545,981 67,503,2052 Iraq 205,236 25,374,6912 Israel 50,139 6,199,0082 Jordan 45,384 5,611,2022 Kuwait 18,259 2,257,5492 Lebanon 30,551 3,777,2182 Saudi Arabia 208,643 25,795,9382 Syria 145,724 18,016,8742 United Arab Emirates 20,414 2,523,9152 West Bank 18,693 2,311,2042 Yemen 161,965 20,024,8672 Schizophrenia in Northern Africa (Extrapolated Statistics) Egypt 615,655 76,117,4212 Libya 45,549 5,631,5852 Sudan 316,639 39,148,1622 Schizophrenia in Western Africa (Extrapolated Statistics) Congo Brazzaville 24,248 2,998,0402 Ghana 167,887 20,757,0322 Liberia 27,424 3,390,6352 Niger 91,886 11,360,5382 Nigeria 143,569 12,5750,3562 Senegal 87,774 10,852,1472 Sierra leone 47,590 5,883,8892 Schizophrenia in Central Africa (Extrapolated Statistics) Central African Republic 30,270 3,742,4822 Chad 77,149 9,538,5442 Congo kinshasa 471,681 58,317,0302 Rwanda 66,636 8,238,6732 Schizophrenia in Eastern Africa (Extrapolated Statistics) Ethiopia 576,986 71,336,5712 Kenya 266,767 32,982,1092 Somalia 67,169 8,304,6012 Tanzania 291,749 36,070,7992 Uganda 213,450 26,390,2582 Schizophrenia in Southern Africa (Extrapolated Statistics) Angola 88,797 10,978,5522 Botswana 13,258 1,639,2312 South Africa359,509 44,448,4702 Swaziland 9,457 1,169,2412 Zambia 89,178 11,025,6902 Zimbabwe 29,698 1,2671,8602 Schizophrenia in Oceania (Extrapolated Statistics) Australia 161,062 19,913,1442 New Zealand 32,302 3,993,8172 Papua New Guinea 43,840 5,420,2802 Footnotes: 1. US Census Bureau, Population Estimates, US Census Bureau, International Data Base, Last revision: July 1, 2003

Treatments While there is no cure for depression, bipolar disorder, or schizophrenia medication and therapy have proven to be the most effective in managing the symptoms.

Selective Serotonin Reuptake Inhibitors (SSRIs)
Treating Depression Medications help keep the symptoms of Depression manageable. Selective Serotonin Reuptake Inhibitors (SSRI’s) have proven to be very helpful. SSRI’s target the receptor sites in the brain helping the serotonin deficiency. “Selective Serotonin Reuptake Inhibitors (SSRI’s)” HealthyPlace.com April < BBC News. “SSRI’s” Photo. 10 Oct bbc.co.uk 16 April <newsimg.bbc.co.uk/.../ jpg/_ _drug203.jpg> Selective Serotonin Reuptake Inhibitors (SSRIs) General information about the SSRIs, their relative merits, and their side effects. Prime Candidates The SSRIs are particularly helpful in heading off depression in the early stages, before it becomes deeply rooted. Some studies suggest that SSRIs are ideal for those people with minor depressive illness -- much better than tricyclics, such as imipramine, or the complication-prone MAOIs. The SSRIs are effective for major depression, too. "Before taking Zoloft, I had a bad case of the blahs. Everything just seemed colorless. But now, sometimes I'll just lie in bed and rub the blanket between my fingers," says Sharon, 38. "It's not sexual, but my sensitivity is heightened. The feel-goodness goes right down into my bones." Research seems to suggest that you can head off serious full-blown illness by taking an SSRI during the early stages of depression. This doesn't mean that SSRIs are the only worthwhile antidepressant, of course. There is still a place for the older drugs. Research has shown that the older tablets (Tricyclics) are just as effective as the newer ones (SSRIs) but, on the whole, the newer ones seem to have fewer side-effects. A major advantage of the SSRIs is that they are not so dangerous if someone takes an overdose. Researchers also note that the SSRIs don't work for 20 percent to 40 percent of depressed or anxious people who try them -- the same failure rate as for the older antidepressants. Which SSRI Is Best? Most experts agree that no single SSRI is better than the rest, despite Prozac's image as a miracle drug that not only cures depression but can make many healthy people "better than well". Each drug has a certain profile of its own particular side effects; some have markedly similar side effects, while others vary widely. For example, Zoloft and Paxil don't last as long in the body as Prozac; the half-life of Zoloft is about 26 hours, and the half-life of Paxil is about 21 hours. ("Half-life" is the time it takes for a drug in the blood to decrease by half of its original dose.) It's important to understand that all the SSRIs may cause nausea, headache, anxiety, dry mouth, insomnia, and a variety of sexual dysfunctions. But as mentioned, what makes Prozac less desirable is that it lingers in the body much longer than other SSRIs; up to six weeks after you stop taking the drug, traces of Prozac and its metabolites can still be found in your body. If you have a bad reaction to Zoloft or Paxil, symptoms last for a week or two. But side effects while taking Prozac can last for up to six weeks before all traces of the drug leave your body. Of course, none of the SSRIs are any sort of wonder drug. They all have some side effects, although they are less severe than those of other antidepressants. One of the biggest problems with these drugs is their cost. All of them are much more expensive than the generic versions of older drugs like MAOIs or tricyclics. Generic versions of the older drugs are available because their patents have expired. No matter how wonderful a drug may be, if you can't afford it, it's not going to do you much good. The high cost of the SSRIs can be a real hardship for someone with no insurance, or whose insurance doesn't cover drugs. At about $2 to $3 per pill, the pharmacy bill can be overwhelming. It's a problem for Mary, 28, whose health insurance covers all drugs except medications for mental health problems. "My psychiatrist is very aware of this problem," Mary explains. "He doesn't give me Zoloft alone because it would be too expensive. So he prescribes a smaller amount of Zoloft with desipramine (a less-expensive tricyclic)." The desipramine boosts the effects of Zoloft, and the combination costs less than a full dose of Zoloft alone. SSRI Antidepressants, Suicidal Feelings and Young People There is evidence of increased suicidal thoughts and behaviors and other side effects in young people taking antidepressants. So SSRI antidepressants, with the exception of Prozac, are not approved by the FDA for use in people under 18. In fact, in 2004, the FDA ordered the strongest safety warning possible: Antidepressants increase the risk of suicidal thinking and behavior (suicidality) in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of [Drug Name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need. The complete black box warning and additional details on antidepressant use in children and adolescents can be found here. There is no clear evidence of an increased risk of self-harm and suicidal thoughts in adults - age 18 years or over. But, individuals mature at different rates. Young adults are more likely to commit suicide than older adults, so a young adult should be particularly closely monitored if he or she takes an SSRI antidepressant. Medical Cautions Severe kidney or liver disease could result in higher-than-normal blood levels of the SSRIs. In addition, the SSRIs may not be the best choice in the treatment of patients with mania, or in those with a history of seizures. Side Effects The side effects of SSRIs are usually mild and manageable, although once in a while a sensitive person gets a severe reaction. Like most antidepressants, SSRIs may cause nausea, dizziness, or dry mouth, not to mention a range of sexual-function side effects, including decreased sexual interest (in men), increased sexual interest (in women), ejaculation problems, impotence, or menstrual changes. During the first couple of weeks of taking them, you may feel sick and more anxious. Some of these tablets can produce nasty indigestion, but you can usually stop this by taking them with food. More seriously, as noted above, they may interfere with your sexual function. There have been reports of episodes of aggression, although these are rare. The list of side effects looks worrying - there is even more information about these on the leaflets that come with the medication. However, most people get a small number of mild side-effects (if any). The side effects usually wear off over a couple of weeks as your body gets used to the medication. It is important to have this whole list, though, so you can recognize side effects if they happen. You can then talk them over with your doctor. The more serious ones - problems with urinating, difficulty in remembering, falls, confusion - are uncommon in healthy, younger or middle-aged people. The most common side effects with Zoloft, launched in 1991, and Paxil, introduced in 1993, are insomnia, diarrhea, tremor, and drowsiness. If you get side effects while taking either of these, your doctor may switch you to Wellbutrin, as long as you don't have any of the conditions that might make you vulnerable to seizures with this drug (such as previous severe head injury or epilepsy). And like Prozac, Zoloft, Paxil, Celexa, Lexapro and other SSRIs, it can produce mild mania in some people with a genetic tendency in that direction. Sexual dysfunction may occur in SSRI users from one to five percent according to the drug companies (although actual incidence of the problem may be much higher, critics charge -- as high as 40 percent). It is common, if you are depressed, to think of harming or killing yourself. Tell your doctor - suicidal thoughts should pass once the depression starts to lift. Drug Interactions Given together, tryptophan and any of the SSRIs may cause headache, nausea, sweating, and dizziness. Taking an SSRI within two weeks of an MAOI (such as Marplan or Parnate) may cause serious side effects; you should wait at least two weeks between stopping MAOIs and starting an SSRI, or at least five weeks after stopping an SSRI and starting an MAOI. advertisement Combining Paxil and warfarin may cause excess bleeding. If you're taking cimetidine, which can cause an increase in the blood levels of Paxil, your dosage of Paxil should be adjusted.Research suggests that Zoloft, unlike MAOIs or tricyclics, doesn't necessarily appear to cause problems when mixed with alcohol. However, Zoloft's manufacturers don't recommend the combination. There are no known dangerous reactions between nonprescription drugs and Zoloft, but because it's theoretically possible, be sure to talk to your doctor about any other drugs you take. Combining Zoloft with either digitoxin (Crystodigin) or warfarin (Coumadin) may cause unwanted side effects. Pregnancy and Breast-Feeding It is always best to take as little as possible in the way of medication during pregnancy, especially during the first 3 months. However, some mothers do have to take antidepressants during pregnancy. The evidence so far is that their babies don't show any harmful effects from this. Most SSRIs, however, haven't been studied in nursing mothers or pregnant women. Animal studies have suggested that Zoloft may cause developmental problems or decrease survival of offspring. Animal studies with Paxil haven't revealed any birth defects. Postpartum Depression After giving birth, it is not uncommon for a woman to experience some level of depression - this is called post-natal depression or postpartum depression. It usually gets better with counseling and practical support. However, if you are unlucky enough to get it badly, it can exhaust you, stop you from breast-feeding, upset your relationship with your baby and even hold back your baby's development. In this case, antidepressants can be helpful. What about the baby? He or she will get only a small amount of antidepressant from mother's milk. Babies older than a few weeks have very effective kidneys and livers. They are able to break down and get rid of medicines just as adults do, so the risk to the baby is very small. Some antidepressants are better than others in this regard and it is worth discussing this with your doctor or pharmacist. On balance, bearing in mind all the advantages of breast-feeding, it seems best to carry on with it while taking antidepressants. Other Disorders The SSRIs may be an effective treatment for other disorders besides depression. Some have been approved for treating various anxiety disorders including panic attacks, obessive-compulsive disorder, ptsd and social anxiety disorder. Some are used to treat eating disorders and chronic pain. Antidepressant Withdrawal Antidepressant drugs don't cause the addictions that you get with tranquilizers, alcohol or nicotine, in the sense that: You don't need to keep increasing the dose to get the same effect You won't find yourself craving them if you stop taking them However, there is a debate about this. In spite of not having the symptoms of addiction described above, up to a third of people who stop SSRIs and SNRIs have withdrawal symptoms. These include: Stomach upsets Flu like symptoms Anxiety Dizziness Vivid dreams at night Sensations in the body that feel like electric shocks In most people these withdrawal effects are mild, but for a small number of people they can be quite severe. They seem to be most likely to happen with Paxil and Effexor. It is generally best to taper off the dose of an antidepressant rather than stop it suddenly. Some people have reported that, after taking an SSRI for several months, they have had difficulty managing once the drug has been stopped and so feel they are addicted to it. Most doctors would say that it is more likely that the original condition has returned. The Committee of Safety of Medicines in the UK reviewed the evidence in 2004 and concluded "There is no clear evidence that the SSRIs and related antidepressants have a significant dependence liability or show development of a dependence syndrome according to internationally accepted criteria." Last updated: Jan. 2005 Sources: "From Making the Prozac Decision: A Guide to Antidepressants," by arrangement with RGA Publishing, Inc." Antidepressant discontinuation reactions. British Medical Journal 1998; 316: (11 April) Depression in primary care, Vol 2. "Treatment of Major Depression," US Department of Health and Human Services, 1993 (Clinical practice guidelines No. 5). "Antidepressants," Royal College of Psychiatrists, Dec. 2004

Treatments for Bipolar Disorder
Antidepressants and mood stabilizers are used for treating bipolar disorder. Some common medications used are Lithium, Tegrotol, and Seroquel “Medication for Bipolar Disorder” Psychology Information Online April < “Lithium” Photo. Coping with HIV. 16 April <mindprod.com/ images/lithium.jpg> Overview Three groups of antidepressant medications are most often used to treat depressive disorders: tricyclics, monoamine oxidase inhibitors (MAOIs), and lithium. Lithium was the treatment of choice for bipolar disorder and some forms of recurring, major depression. However, more recently doctors have also been using anticonvulsants for bipolar disorder. Your physician must consider your personal health history and response to medications in determining what is best for you. Sometimes different medications are tried, and sometimes the dosage must be increased to be effective. People often are tempted to stop medication too soon. It is important to keep taking medication until your doctor says to stop, even if you feel better beforehand. Some medications must be stopped gradually to give your body time to adjust. For individuals with bipolar disorder, medication may have to become part of everyday life to avoid disabling symptoms. That is, antimanic medications are designed to stop a manic episode in progress, but they are also preventative. Taking the medication helps prevent another manic episode. Depending on the frequency and severity of episodes, your physician may recommend ongoing treatment with antimanic medication to prevent future episodes. As is the case with any type of medication prescribed for more than a few days, antimanic medications have to be carefully monitored to see if you are getting the correct dosage. Your doctor will want to check the dosage and its effectiveness regularly. Never mix medications of any kind--prescribed, over-the counter, or borrowed--without consulting your doctor. Be sure to tell your dentist or any other medical specialist who prescribes a drug if you are taking antimanic medication. Some of the most benign drugs when taken alone can cause severe and dangerous side effects if taken with others. Be sure to call your doctor if you have a question about any drug or if you are having a problem you believe is drug related. Also, never take alcohol with medications of any kind, unless your physician has told you it is safe to do so. Alcohol interacts with many different medications. Bipolar meds - Topic List Other Psychology Links Symptom Relief, Not Cure Just as aspirin can reduce a fever without clearing up the infection that causes it, psychotherapeutic medications act by controlling symptoms. Like most drugs used in medicine, they correct or compensate for some malfunction in the body. Psychotherapeutic medications do not cure mental illness. In many cases, these medications can help a person get on with life despite some continuing difficulty coping with problems. In the case of bipolar disorder, the antimanic medications help control, or minimize the effects of a manic episode. However, the person still has to learn self-monitoring skills, to identify an episode as it is developing, and psychotherapy is helpful to learn to adjust to the limitations of the disorder, as well as focusing on depressive symptoms and issues. How long someone must take a psychotherapeutic medication depends on the disorder. Many depressed and anxious people may need medication for a single period perhaps for several months and then never have to take it again. But. for manic-depressive illness, medication may have to be take indefinitely or, perhaps, intermittently. Like any medication, psychotherapeutic medications do not produce the same effect in everyone. Some people may respond better to one medication than another. Some may need larger dosages than others do. Some experience annoying side effects, while others do not. Age, sex, body size, body chemistry, physical illnesses and their treatments, diet, and habits such as smoking, are some of the factors that can influence a medication's effect. Questions for Your Doctor To increase the likelihood that a medication will work well, patients and their families must actively participate with the doctor prescribing it. You must tell the doctor about your past medical history, other medications being taken, anticipated life changes such as planning to have a baby and, after some experience with a medication, whether it is causing side effects. When a medication is prescribed, you should ask the following questions, recommended by the US Food and Drug Administration (FDA): What is the name of the medication, and what is it supposed to do? How and when do I take it, and when do I stop taking it? What foods, drinks, other medications, or activities should I avoid while taking the prescribed medication? What are the side effects, and what should I do if they occur? Is there any written information available about the medication? Here, medications are described by their generic (chemical) names and by their trade names (brand names used by drug companies). This page describes antimanic medications. Treatment evaluation studies have established the efficacy of the medications described here; however, much remains to be learned about these medications. The National Institute of Mental Health, other Federal agencies, and private research groups are sponsoring studies of these medications. Scientists are hoping to improve their understanding of how and why these medications work, how to control or eliminate unwanted side effects, and how to make the medications more effective. Antimanic Medications Bipolar disorder (manic-depressive illness) is characterized by cycling mood changes: severe highs (mania) and lows (depression). Cycles may be predominantly manic or depressive with normal mood between cycles. Mood swings may follow each other very closely, within hours or days, or may be separated by months to years. These "highs" and "lows" may vary in intensity and severity. When someone is in a manic "high," s/he may be overactive, over talkative, and have a great deal of energy. S/he will switch quickly from one topic to another, as if s/he cannot get thoughts out fast enough; the attention span is often short, and s/he can easily be distracted. Sometimes, the "high" person is irritable or angry and has false or inflated ideas about his/her position or importance in the world. S/he may be very elated, full of grand schemes which might range from business deals to romantic sprees. Often, s/he shows poor judgment in these ventures. Mania, untreated, may worsen to a psychotic state. Depression will show in a "low" mood, with lack of energy, changes in eating and sleeping patterns, feelings of hopelessness, helplessness, sadness, worthlessness, and guilt, and sometimes thoughts of suicide. Lithium The medication used most often over the years to combat a manic "high" is lithium. It is unusual to find mania without a subsequent or preceding period of depression. Lithium evens out mood swings in both directions, so that it is used not just for acute manic attacks or flare-ups of the illness, but also as an ongoing treatment of bipolar disorder. Lithium will diminish severe manic symptoms in about 5 to 14 days, but it may be anywhere from days to several months until the condition is fully controlled. Antipsychotic medications are sometimes used in the first several days of treatment to control manic symptoms until the lithium begins to take effect. Likewise, antidepressants may be needed in addition to lithium during the depressive phase of bipolar disorder. Someone may have one episode of bipolar disorder and never have another, or be free of illness for several years. However, for those who have more than one episode, continuing (maintenance) treatment on lithium is usually given serious consideration. Some people respond well to maintenance treatment and have no further episodes, while others may have moderate mood swings that lessen as treatment continues. Some people may continue to have episodes that are diminished in frequency and severity. Unfortunately, some manic-depressive patients may not be helped at all. Response to treatment with lithium varies, and it cannot be determined beforehand who will or will not respond to treatment. Regular blood tests are an important part of treatment with lithium. A lithium level must be checked periodically to measure the amount of the drug in the body. If too little is taken, lithium will not be effective. If too much is taken, a variety of side effects may occur. The range between an effective dose and a toxic one is small. A lithium level is routinely checked at the beginning of treatment to determine the best lithium dosage for the patient. Once a person is stable and on maintenance dosage, a lithium level should be checked every few months. How much lithium a person needs to take may vary over time, depending on the severity of the bipolar disorder, body chemistry, and physical condition. Anything that lowers the level of sodium (table salt is sodium chloride) in the body may cause a lithium buildup and lead to toxicity. Reduced salt intake, heavy sweating, fever, vomiting, or diarrhea may do this. An unusual amount of exercise or a switch to a low-salt diet are examples. It's important to be aware of conditions that lower sodium and to share this information with the doctor. The lithium dosage may have to be adjusted. When a person first takes lithium, s/he may experience side effects, such as drowsiness, weakness, nausea, vomiting, fatigue, hand tremor, or increased thirst and urination. These usually disappear or subside quickly, although hand tremor may persist. Weight gain may also occur. Dieting will help, but crash diets should be avoided because they may affect the lithium level. Drinking low-calorie or no-calorie beverages will help keep weight down. Kidney changes, accompanied by increased thirst and urination, may develop during treatment. These conditions are generally manageable and are reduced by lowering the dosage. Because lithium may cause the thyroid gland to become underactive (hypothyroidism) or sometimes enlarged (goiter), thyroid function monitoring is a part of the therapy. To restore normal thyroid function, thyroid hormone is given along with lithium. Because of possible complications, lithium may either not be recommended or may be given with caution when a person has existing thyroid, kidney, or heart disorders, epilepsy, or brain damage. Women of childbearing age should be aware that lithium increases the risk of congenital malformations in babies born to women taking lithium. Special caution should be taken during the first 3 months of pregnancy. Lithium, when combined with certain other medications, can have unwanted effects. Some diuretics substances that remove water from the body increase the level of lithium and can cause toxicity. Other diuretics, like coffee and tea, can lower the level of lithium. Signs of lithium toxicity may include nausea, vomiting, drowsiness, mental dullness, slurred speech, confusion, dizziness, muscle twitching, irregular heart beat, and blurred vision. A serious lithium overdose can be life-threatening. If you are taking lithium, you should tell all your doctors, including dentists, about all the other medications you are taking. With regular monitoring, lithium is a safe and effective drug that enables many people, who otherwise would suffer from incapacitating mood swings, to lead normal lives. Anticonvulsants Not all patients with symptoms of mania benefit from lithium. Some have been found to respond to another type of medication, the anticonvulsant medications that are usually used to treat epilepsy. Carbamazepine (Tegretol) is the anticonvulsant that has been most widely used. Individuals with bipolar disorder who cycle rapidly, (changing from mania to depression and back again over the course of hours or days, rather than months) seem to respond particularly well to carbamazepine. Early side effects of carbamazepine, although generally mild, include drowsiness, dizziness, confusion, disturbed vision, perceptual distortions, memory impairment, and nausea. They are usually transient and often respond to temporary dosage reduction. Another common but generally mild adverse effect is the lowering of the white blood cell count which requires periodic blood tests to monitor against the rare possibility of more serious, even life-threatening, bone marrow depression. Also serious are the skin rashes that can occur in 15 to 20 percent of patients. These rashes are sometimes severe enough to require discontinuation of the medication. In 1995, the anticonvulsant divalproex sodium (Depakote) was approved by the Food and Drug Administration for manic-depressive illness. Clinical trials have shown it to have an effectiveness in controlling manic symptoms equivalent to that of lithium; it is effective in both rapid-cycling and non-rapid-cycling bipolar. Though divalproex can cause gastrointestinal side effects, the incidence is low. Other adverse effects occasionally reported are headache, double vision, dizziness, anxiety, or confusion. Because in some cases divalproex has caused liver dysfunction, liver function tests should be performed prior to therapy and at frequent intervals thereafter, particularly during the first six months of therapy. Medication precautions with children, the elderly and women Special Considerations Children, the elderly, and pregnant or nursing women have special concerns and needs when taking psychotherapeutic medications. Some effects of medications on the growing body, the aging body, and the childbearing body are known, but much remains to be learned. Research in these areas is ongoing. Children There are many treatments that can help children. This includes medication, but psychotherapy, behavioral therapy, social skills training, family therapy, and group therapy should be explored before deciding to prescribe medications for children. The therapy used for an individual child is based on the child's diagnosis and individual needs. When the decision is reached that a child should take medication, active monitoring by all caretakers (parents, teachers, others who have charge of the child) is essential. Children should be watched and questioned for side effects (many children, especially younger ones, do not volunteer information). They should also be monitored to see that they are actually taking the medication and taking the proper dosage. The long term effects of many psychotherapeutic medications on children is not known, especially in newly developed medications. The Elderly Persons over the age of 65 make up 12 percent of the population of the United States, yet they receive 30 percent of prescriptions filled. The elderly generally have more medical problems and often are taking medications for more than one of these problems. In addition, they tend to be more sensitive to medications. Even healthy older people eliminate some medications from the body more slowly than younger persons and therefore require a lower or less frequent dosage to maintain an effective level of medication. The elderly may sometimes accidentally take too much of a medication because they forget that they have taken a dose and take another dose. The use of a 7-day pill box is especially helpful to an elderly person. The elderly, and their friends, relatives, and caretakers, need to pay special attention and watch for adverse (negative) physical and psychological responses to medication. Because they often take more medications (including prescription drugs, over-the-counter preparations, and home or natural remedies) the possibility of negative drug interactions is higher. Pregnant, Nursing, or Childbearing-Age Women In general, during pregnancy, all medications (including psychotherapeutic medications) should be avoided where possible, and other methods of treatment should be tried. A woman who is taking a psychotherapeutic medication and plans to become pregnant should discuss her plans with her doctor; if she discovers that she is pregnant, she should contact her doctor immediately. During early pregnancy, there is a possible risk of birth defects with some of these medications, and for this reason: 1) Lithium is not recommended during the first 3 months of pregnancy. 2) Benzodiazepines are not recommended during the first 3 months of pregnancy. The decision to use a psychotherapeutic medication should be made only after a careful discussion with the doctor concerning the risks and benefits to the woman and her baby. Small amounts of medication pass into the breast milk. This is a consideration for mothers who are planning to breast-feed. A woman who is taking birth-control pills should be sure that her doctor is aware of this. The estrogen in these pills may alter the breakdown of other medications by the body. For more detailed information, talk to your doctor or mental health professional, consult your local public library, or write to the pharmaceutical company that produces the medication or contact: US Food and Drug Administration 5600 Fishers Lane Rockville, MD Index of Medications If a medication's trade name does not appear in this list, look it up by its generic name or ask your doctor or pharmacist for more information. As we gather more information on specific medications, links will take you from the medication name to additional information on that specific drug. Otherwise, more information is available through the references listed at the bottom of the page. GENERIC NAME TRADE NAME carbamazepine Tegretol divalproex sodium Depakote lithium carbonate Eskalith Lithane Lithobid lithium citrate Cibalith-S Bipolar meds - Topic List Other Psychology Links References AHFS Drug Information, 91. Gerald K. McEvoy, Editor. Bethesda, Maryland: American Society of Hospital Pharmacists, Inc., 1991. Bohn J. And Jefferson J.W., Lithium and Manic Depression: A Guide. Madison, Wisconsin: Lithium Information Center, rev. ed Goodwin F.K. and Jamison K.R. Manic-Depressive Illness. New York: Oxford University Press, 1990. Medenwald J.R., Greist J.H., and Jefferson J.W. Carbamazepine and Manic Depression: A Guide. Madison, Wisconsin: Lithium Information Center, rev. ed., 1990. Physicians' Desk Reference, 52nd edition. Montvale, New Jersey: Medical Economics Data Production Company, 1998. Acknowledgments Thanks and acknowledgment are extended to the National Institute of Mental Health, which was a primary resource for information on this page. More Information About Psychological Practice Topics: Top of Page and Navigation Bar Depression Home page Information about other Psychological Problems Psychology Information Online Links Psychology Information Online Home Page The National Directory of Psychologists Psychology Information Online was developed by Donald J. Franklin, Ph.D., Psychology Information Online provides information for Consumers , Psychologists , and Students The National Directory of Psychologists will help you locate a local psychologist. Our Self-Help Psychology Bookstore will help you locate books about psychological topics Students and Professionals like our Continuing Education and Graduate Training Programs, Mental Health Professionals use our Resource Listings (Books and Supplies) and Job Listings. copyright 1999, 2000, all rights reserved

Treating Schizophrenia
Antipsychotic medications have proven to be the most helpful in treating Schizophrenia. Some medications that are most commonly used for schizophrenia are: Seroquel, Haldol, Clozaril, and Zyprexa. Grohol, John M. “Medications for Schizophrenia” Psych Central. 13 Feb April < “Seroquel” Photo. Seroquel (quetiapin). 16 April 2006 < Seroquel-to-liten.jpg> Medications for Schizophrenia By NIMH 4 Nov Antipsychotic medications have been available since the mid-1950s. They have greatly improved the outlook for individual patients. These medications reduce the psychotic symptoms of schizophrenia and usually allow the patient to function more effectively and appropriately. Antipsychotic drugs are the best treatment now available, but they do not "cure" schizophrenia or ensure that there will be no further psychotic episodes. The choice and dosage of medication can be made only by a qualified physician who is well-trained in the medical treatment of mental disorders. The dosage of medication is individualized for each patient, since people may vary a great deal in the amount of drug needed to reduce symptoms without producing troublesome side effects. The large majority of people with schizophrenia show substantial improvement when treated with antipsychotic drugs. Some patients, however, are not helped very much by the medications and a few do not seem to need them. It is difficult to predict which patients will fall into these two groups and to distinguish them from the large majority of patients who do benefit from treatment with antipsychotic drugs. A number of new antipsychotic drugs (the so-called "atypical antipsychotics") have been introduced since The first of these, clozapine (Clozaril), has been shown to be more effective than other antipsychotics, although the possibility of severe side effects -- in particular, a condition called agranulocytosis (loss of the white blood cells that fight infection) -- requires that patients be monitored with blood tests every one or two weeks. Even newer antipsychotic drugs, such as risperidone (Risperdal) and olanzapine (Zyprexa), are safer than the older drugs or clozapine, and they also may be better tolerated. They may or may not treat the illness as well as clozapine, however. Several additional antipsychotics are currently under development. Antipsychotic drugs are often very effective in treating certain symptoms of schizophrenia, particularly hallucinations and delusions; unfortunately, the drugs may not be as helpful with other symptoms, such as reduced motivation and emotional expressiveness. Indeed, the older antipsychotics (which also went by the name of "neuroleptics"), medicines like haloperidol (Haldol) or chlorpromazine (Thorazine), may even produce side effects that resemble the more difficult to treat symptoms. Often, lowering the dose or switching to a different medicine may reduce these side effects; the newer medicines, including olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal), appear less likely to have this problem. Sometimes when people with schizophrenia become depressed, other symptoms can appear to worsen. The symptoms may improve with the addition of an antidepressant medication. Patients and families sometimes become worried about the antipsychotic medications used to treat schizophrenia. In addition to concern about side effects, they may worry that such drugs could lead to addiction. However, antipsychotic medications do not produce a "high" (euphoria) or addictive behavior in people who take them. Another misconception about antipsychotic drugs is that they act as a kind of mind control, or a "chemical straitjacket." Antipsychotic drugs used at the appropriate dosage do not "knock out" people or take away their free will. While these medications can be sedating, and while this effect can be useful when treatment is initiated particularly if an individual is quite agitated, the utility of the drugs is not due to sedation but to their ability to diminish the hallucinations, agitation, confusion, and delusions of a psychotic episode. Thus, antipsychotic medications should eventually help an individual with schizophrenia to deal with the world more rationally. Last reviewed: On 13 Feb By John M. Grohol, Psy.D.

Bibliography BBC News. “SSRI’s” Photo. 10 Oct bbc.co.uk 16 April <newsimg.bbc.co.uk/.../ jpg/_ _drug203.jpg> “Biological Clocks and Bipolar Disorder” Image. PsychoEducation.org. 16 April < depression/clock.6.gif> “Bipolar Disorder: What is Bipolar Disorder?” WebMD. March March < Braininspect.com “bipolaractive85percent” Image. Brain Spect Imaging, Inc. 16 April <braininspect.com/.../ bipolaractive85percent.jpg> “Decoding Mental Illness” Science. 302:5653 (19 Dec 2003) Academic Abstract. College of the Sequoias Library. 28 Feb 2006. “Depression” 17 Feb 2006 National Institute of Mental Health. 21 March “Depression Gene May Weaken Mood-regulating Circuit.” Nation Institute Of Mental Health. 10 May April serotonin/brain-scan.jpg “Family” national Statistics. Graphic. 16 April 2006 < images/families.gif>

Find The Light. “Bain Chemistry Basics. ” Illustration. 25 Feb 2006
Find The Light. “Bain Chemistry Basics.” Illustration. 25 Feb Find The Light. Find The Light. 15 March images/serotonin.jpg Genome News Network. “Chromosome 22” Image. 16 April < Bipolar1.gif> Global Friends of Scotland. “Tracking Mental Illness Head On” Image. July April < psychiatry.jpg> Grohol, John M. “Medications for Schizophrenia” Psych Central. 13 Feb April “Lithium” Photo. Coping with HIV. 16 April <mindprod.com/ images/lithium.jpg> “Medication for Bipolar Disorder” Psychology Information Online April Nation Institute Of Mental Health. “Depression Gene May Weaken Mood-regulating Circuit” Image. National Institute of Mental Health. 16 April < serotonin/brain-scan.jpg>

“Selective Serotonin Reuptake Inhibitors (SSRI’s)” HealthyPlace. com
“Selective Serotonin Reuptake Inhibitors (SSRI’s)” HealthyPlace.com April “Seroquel” Photo. Seroquel (quetiapin). 16 April 2006 < Seroquel-to-liten.jpg> ”Signs and Symptoms” Schizophrenia Fellowship. 16 March < “Statistics by Country for Schizophrenia” 1 July Wrong Diagnosis. 16 March < “The Numbers Count: Mental Disorders in America” 17 Feb National Institute of Mental Health. 16 March The Treatment Advocacy Center. “Schizophrenia in Identical Twins” Image. 16 April < schizophrenia_graphi...> Winstead, Edward R. “Region of Chromosome 22 linked to bipolar disorder, again.” Genome News Network. 2 Feb April <

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Depression, Schizophrenia, and Bipolar Disorder

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