Written by: Dr. Joseph Leong Jern-Yi
Understanding Bipolar & Schizophrenia
Both bipolar disorder and schizophrenia were considered severe mental illnesses with no recovery in the past. This is not true in modern psychiatry as we have developed more effective treatments such as medications (psycho-pharmacology) and psycho-social interventions (psycho-therapy and psycho-social rehabilitation) which help patients improve their quality of life as well as reduce symptoms and restore function.
Bipolar disorder and schizophrenia may have similar symptoms which are disturbances in thinking, feelings and behaviour. The major difference is that bipolar disorder is classified as a mood disorder whereas schizophrenia is classified as a psychotic disorder. Mental healthcare professionals make diagnoses based on reports of patients, caregivers, or other information sources as well as observations made during the assessment interview.
Experts have also formulated that schizophrenia and bipolar disorder may be a spectrum disorder with schizophrenia on one end and bipolar disorder on the other end with schizoaffective disorder in the middle of the spectrum.
What is more important however is not the exact diagnosis alone but rather the identification of symptoms so that treatment can be effectively targeted at the relief of the symptoms, restoring function and improving quality of life. This targeted symptom approach has proven to be one of the most effective ways of helping persons recover from these brain conditions.
Let’s discuss some of the common symptoms –
Delusions, which are untrue, unshakable, and unshared beliefs which can exist in both brain conditions.
For example, delusions of persecution which are beliefs of being targeted, being followed, being sabotaged (persecutory) are common in schizophrenia while delusions of grandiosity such as believing that they are particularly important persons and have special powers or ability to save the world (grandiose delusions) are more common in bipolar disorder. For persons with schizoaffective disorder, they might have both persecutory and grandiose delusions at the same time. It also has an underlying co-occurring mood disorder.
Hallucinations which are perceptual disturbances such as hearing voices which are not heard by others, seeing, smelling, tasting or feeling things which are not present are more likely to happen in schizophrenia.
Severe mood swings and manic episodes where the person has fast speech and high energy levels are associated with abnormal spending, socialising, exercising, or expanding businesses with the need for very little sleep over a few days and weeks are more likely to happen in bipolar disorder.
More than half a century ago, most persons suffering from these brain conditions were isolated and confined to asylums as there were no effective treatments until the discovery of medications that can change brain chemistry. Neurotransmitters which are chemicals responsible for brain and other bodily functions were discovered. Noradrenaline, serotonin, and dopamine disturbances were more likely causes in bipolar disorder while dopamine imbalance was a more probable cause of schizophrenia. See https://dana.org/article/neurotransmitters/
The Help Of Modern Medicine
Modern psychopharmacology offers an array of medications which can act on various neurotransmitter sites in the brain. Several medications and several rounds of adjustment and fine-tuning may often be needed to achieve stabilisation with medications with relief of symptoms. This is best done collaboratively with the patient, psychiatrist, and caregiver at the consultation with all the medications brought in for review.
Adjusting to a new medication through an effective therapeutic trial may take at least 2 weeks, starting with the lowest dose and increasing dosing to a maximised symptom relief dose over 2 months.
Medications need to be taken daily to be effective, and this is best done using a pill box and with supervision from a loved one. Medications are served by nurses in the inpatient hospital setting who ensure that the correct dose is directly observed to be taken by the patient – however, this is often lacking in the outpatient setting leading to the return of the symptoms causing distress and dysfunction.
Bipolar & Schizophrenia Treatment Methods
Comparing bipolar disorder and schizophrenia to other brain conditions may be helpful in understanding how one can better achieve remission and recovery.
Epilepsy is a brain condition where there are electrical firing of neurons causing disturbances in thinking, feeling and behaviour. To stay in control of oneself, the doctor may recommend various combinations of anti-epileptic medications to prevent another seizure. In fact, the model of kindling in epilepsy has been used to understand mental health treatment in this highly readable resource essay – https://aeon.co/essays/should-the-kindling-concept-direct-mental-health-treatment
If you speak to someone with experience with epilepsy, they will tell you about ‘warning signs’ and the ‘confusional state’ after a breakthrough seizure.
Similarly, for those struggling with bipolar disorder and schizophrenia, one becomes more aware of ‘warning signs’, and ‘confusional states’ through direct feedback from loved ones who are observant and psycho-educated by healthcare professionals. Charting, monitoring and sharing your experience are key to success in achieving remission and recovery. Use this mood chart and share it with your mental healthcare professionals for more in-depth analysis – https://loricalabresemd.com/wp-content/uploads/2017/12/Personalized-Mood_Chart.pdf
Symptoms management starts with monitoring your symptoms and the response to the treatment – what makes it better, what makes it worse, whether it is mild, moderate or severe. The frequency, intensity and severity can be charted so that effective treatment of psycho-pharmacology (active use of medications) and psycho-social interventions (psycho-therapy and psycho-social rehabilitation) can be targeted to achieve the best outcome for you.
Recovery Is Possible
Your mental healthcare professional can coach and pace you so that it will not be overwhelming. Recovery starts with taking it one day at a time. Be gentle with yourself. Learn to trust and entrust your healing to people who care about you. Learning from feedback as well as charting, monitoring and sharing your experience with loved ones – trusted family or friends or co-workers greatly enhance effectiveness.
Atomic habits by James Clear is an excellent book which illustrates the importance of charting, monitoring and shaping your habits, on the premise of improving 1% daily leading to more than 365% improvement in one year. This is Youtube illustrates how that can happen – “How to become 37.78 times better at anything”.
There are many services available at Promises Healthcare and Community Partners which can help reduce symptoms, restore function, and improve quality of life. Recovery is possible and becomes a reality with appropriate support and adequate skill training. With the right help and support, persons in recovery can live meaningful and satisfying lives.
Here are some real stories that illustrate many facets of mental health and recovery:
- Total WEllness Village : On The Red Dot – it takes a village
- She helps spot those with undiagnosed mental illness
- Recovery from Bipolar Disorder and winning the Healthcare Humanity Award
- Bipolar Disorder: You Too Can Walk In Recovery
- Bipolar survivor motivates others to recover – WTPulse
- S’pore woman reflects on ‘gritty reality’ of schizophrenia & living life again after treatment
- More pain than happiness during therapy, but I hung on, says one youth. Here’s why you should too
- Silent Cry | Living with Schizophrenia for 27 Years
- Mending What Was Broken: Schizophrenia And A Mother’s Love | CNA Insider
- What’s It Like Living With Schizophrenia in Singapore?
- Meet Charmaine Wee: She’s on a journey to defeat schizophrenia and does it by keeping the faith
- Distinguished Professor of Psychiatry Robert Paul Liberman talking about his Bipolar Disorder diagnosis and treatment and his life work on psycho-social rehabilitation