Quote of the day

Uncertainty paralyzed her every day, and whatever ailment she had progressed on a daily basis.

–DMK

Linkpost– Mental health in developing countries

Linkpost— Schizophrenia

Linkpost— Schizophrenia across different cultures

Advertisement

Bipolar disorder

Bipolar disorder, formerly known as manic depression, is characterized by significant mood fluctuations that include emotional highs (mania or hypomania) and lows (depression). Bipolar disorder is a type of mental illness that results in drastic changes in a person’s mood, energy level, and ability to think rationally. People suffering from bipolar experience extremes of emotion referred to as mania and depression, which are distinct from the ordinary ups and downs that most people experience. When you are depressed, you may have feelings of sadness or hopelessness and lose interest or pleasure in the majority of activities. When your mood swings into mania or hypomania (a milder form of mania), you may experience feelings of euphoria, increased energy, or extraordinary irritability. These mood swings can have an impact on one’s sleep, energy, activity, judgment, behavior, and capacity to think effectively.

Mood swings might occur infrequently or repeatedly throughout the year. Between bouts, most people will have some emotional symptoms, but some may not. According to the WHO, over 45 million individuals worldwide are affected by this illness. The typical age of occurrence is around 25, however, it can develop in the teens or even in childhood. Males and females are equally affected by the illness. A person with bipolar disorder can also have manic phases without experiencing depressive episodes.

Bipolar disorder and associated disorders come in a variety of forms. They may include manic or hypomanic episodes, as well as depression.

  • Bipolar I Disorder is characterized by manic episodes lasting at least seven days or by manic symptoms severe enough to require immediate hospitalization. 
  • In contrast to Bipolar I Disorder, Bipolar II Disorder is marked by a pattern of depressed and hypomanic episodes, but not full-blown manic episodes.
  • Cyclothymic Disorder (also known as Cyclothymia) – characterized by episodes of hypomania and depression symptoms lasting at least two years (1 year in children and adolescents). 

Occasionally, a person may exhibit bipolar disorder symptoms that may not fall into one of the three categories given below, which is referred to as “other specified and unspecified bipolar and related diseases.” Bipolar II disorder is not a subtype of bipolar I disorder; rather, it is a distinct diagnosis. While manic episodes in bipolar I disease can be intense and frightening, those with bipolar II condition may experience prolonged depression, resulting in major impairment.

Causes and risks

Bipolar disorder has no recognized etiology, however, several factors may play a role. They include environment, biological differences in brain structure, and function, and genetics. Bipolar disorder is more likely in first-degree relatives, such as siblings or parents. Researchers are searching for genes linked to bipolar disease.

Signs and Symptoms

Bipolar symptoms might vary. But they entail mood episodes: Symptoms of mania episode include: elated or ecstatic Feeling jittery or energized, Having a short fuse or appearing impatient, Thoughts rushing and speech frantic, Sleeping less, thinking you’re special, talented, or powerful. Spending a lot of money, drinking excessively, or engaging in dangerous sex, all of which reveal a lack of judgment.

Symptoms of depression episodes include sadness, hopelessness, and worthlessness. Loneliness or social isolation Slowly speaking, feeling speechless, or forgetting a lot Lacking energy, Oversleeping, Overeating or undereating. Inability to complete simple tasks and lack of enthusiasm in routine activities; Suicide or death thoughts.

A mixed episode is characterized by the coexistence of manic and depressed symptoms. For instance, you may feel incredibly depressed, empty, or hopeless while also feeling extremely invigorated. Certain individuals with bipolar illness may experience lesser symptoms. For instance, you may suffer from hypomania rather than mania. With hypomania, you may feel quite terrific and find that you are able to accomplish a great deal. You may have the impression that nothing is wrong. It’s possible, however, that you’ll be noticed by those closest to you. They may notice that your action is out of character for you. Following hypomania, you may have extreme depression.

Individuals diagnosed with bipolar illness may also suffer from co-occurring disorders such as anxiety, attention-deficit hyperactivity disorder (ADHD), posttraumatic stress disorder (PTSD), and substance use disorders/dual diagnosis. Bipolar patients with psychotic symptoms may be misdiagnosed with schizophrenia. Bipolar disorder is also frequently mistaken for Borderline Personality Disorder (BPD).

Prevention and treatment

There is no foolproof method of preventing bipolar disorder. It is important to get treatment as soon as a mental health illness is detected. Preventing modest symptoms from becoming major mania or depression: Take note of warning indications. Managing and monitoring symptoms early can help prevent worsening episodes.  Involving family or friends in spotting red flags. Avoid using drugs or alcohol– consumption of alcoholic beverages or recreational substances can exacerbate your symptoms and increase their likelihood of recurrence.

There are numerous strategies to treat and manage bipolar disorder: Psychotherapy–including cognitive behavioral therapy and family-focused therapy–can assist you in identifying and altering troublesome emotions, ideas, and behaviors. It can provide you and your family with assistance, information, skills, and coping mechanisms. Consult your physician about drugs such as mood stabilizers, antipsychotic medications, and, to a lesser extent, antidepressants.

Bear in mind that while bipolar disorder is a chronic illness, long-term, consistent therapy can help reduce symptoms– enabling you to maintain and live a healthy lifestyle.

References

Mental Disorders. (2019, November 28). Mental disorders. https://www.who.int/news-room/fact-sheets/detail/mental-disorders.

Bipolar Disorder: MedlinePlus. (2021, September 22). Bipolar Disorder: MedlinePlus. https://medlineplus.gov/bipolardisorder.html.

NIMH » Bipolar Disorder. (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/bipolar-disorder.

Bipolar Disorder – Symptoms And Causes. (2021, February 16). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955.

Bipolar Disorder | NAMI: National Alliance On Mental Illness. (n.d.). Bipolar disorder | NAMI: National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder.

Is schizophrenia over-diagnosed?

Researchers at Johns Hopkins Medicine conducted a short study of individuals referred to the Early Psychosis Intervention Clinic (EPIC) and found that around half of the participants referred to the clinic with a schizophrenia diagnosis did not have schizophrenia. Schizophrenia is a persistent, severe, and disabling condition characterized by abnormal thoughts, feelings, and behavior. Hearing voices or experiencing anxiety were two of the most common reasons for people to be misdiagnosed. “Because we’ve focused attention in recent years on emerging and early indicators of psychosis, diagnosis of schizophrenia is like a new trend,” says Krista Baker, L.C.P.C., manager of adult outpatient schizophrenia services at Johns Hopkins Medicine. “Diagnostic errors can be disastrous for individuals, particularly when a mental disease is misdiagnosed,” she says.[1]

What exactly is over-diagnosis? Overdiagnosis refers to the diagnosis of a medical illness that would never have generated any symptoms or difficulties in the first place. Psychological stress and excessive therapies might result from this type of diagnosis, which can be damaging.’ The consequences of overdiagnosis can be harmful to patients since they can result in overtreatment with potential side effects, diagnosis-related anxiety or despair, and labeling, as well as financial hardship.

Several studies conducted over several decades have revealed that Black individuals are diagnosed with schizophrenia at a higher incidence than white counterparts. Researchers discovered that Black individuals are 2.4 times more likely than white folks to be diagnosed with schizophrenia in a 2018 study of data from 52 distinct studies. According to other research, black people are diagnosed at a rate that is three to four times higher than that of white individuals. A number of studies have demonstrated the existence of the phenomena, according to William Lawson, M.D., Ph.D., chairperson of the Department of Psychiatry and Behavioral Sciences at Howard University Health Sciences. The overdiagnosis of schizophrenia is by far the most prevalent among black individuals. This phenomenon has been documented despite the paucity of genetic evidence demonstrating a true increase in incidence in this population. [2]

African Americans continued to have significantly higher rates of clinical diagnoses of schizophrenia after controlling for age, gender, income, location, and education, as well as the presence or absence of serious affective disorder, as determined by experts who were blinded to race and ethnicity, according to a study published in the journal JAMA Psychiatry in June 2012. After controlling for confounders such as major affective illness, Lawson and colleagues discovered that African Americans had considerably higher rates of clinical schizophrenia diagnoses than non-Latino white respondents. In addition, the researchers discovered that, despite these diagnostic disparities, African-American and white individuals did not differ significantly in blinded expert judgments of affective symptoms, but that African-American subjects did obtain greater ratings of psychosis than white respondents. Researchers found that “these data show that psychotic symptoms in African-American subjects may be overestimated by clinicians, skewing diagnoses toward schizophrenia-spectrum illnesses, even though affective symptoms are comparable to those in white subjects.”[3]

Hold on, don’t we all have prejudices? As a matter of fact, we all carry some sort of prejudice, whether we are aware of it or not. Others have a high level of self-awareness and will readily catch judgment before it exits its abode; nonetheless, our facial expressions or perhaps non-verbal signals can occasionally betray our true feelings and intentions. The thing is, by the time you misdiagnose someone based on their skin color, you’ve gone too far. Isn’t it, in some ways, a death sentence? Isn’t the goal of the healthcare sector to aid people, not to condemn them to an early grave? Perhaps not for people of color, but for everyone else—I’m so perplexed; aren’t we all human? I simply cannot fathom the fact that individuals are either overtreated, undertreated, or not treated at all based on their skin color.

My mind is spinning at the moment. Let’s meet on a patio and talk about this absurdity while sitting as comfortably as possible. We may be here for a while, so get a cup of coffee. This is a racial issue—I’m not going to sugarcoat it. This wilderness has no beginning, middle, or end, but we can nonetheless get started someplace. Consider the evidence that reveals that persons of color are less likely to seek and receive professional mental health care. I suppose they’re afraid for their own safety. Isn’t that so? I mean– If a black person goes to see a mental health professional because they are depressed or anxious, they may be diagnosed with schizophrenia. There is so much prejudice and discrimination that it scares people away from seeking professional treatment.

For some strange reason, all diagnoses — genuine or fraudulent — disappear when there is a court issue and requests for documentation of mental disorders with black people for a pass in jail and go to a mental facility. You are a robot without emotions in this arena (court and jail), and the court will lean toward the worst penalty imaginable, regardless of whether you deserve it or not. However, in the real world, you are portrayed as a mental case, whether or not that is the case. Either way, you have been tacitly sentenced to death. On the other hand,  You’re more likely to be mentally impaired if you’re a white person who’s on a trial or if you’re facing possible jail time hence sent to a mental facility despite the lethality of the crime.  And, in the normal world, you have the option and the ability to dictate what you believe is more fitting. To be continued…

Data shows that doctors utilize different symptom criteria when diagnosing schizophrenia among Black people[4] and that the use of a structured clinical interview does not alleviate this problem[5]. Additional research indicates that elevated diagnosis appears to be equally common among African Americans and white practitioners. [6] Patients with Black African ancestry appear to be perceived by clinicians as more paranoid and suspicious in general, which may contribute to the higher than average likelihood of psychotic diagnoses. Actually, much of contemporary popular literature has focused on how schizophrenia became known as a “black” diagnosis, in part because of cultural mistrust and perceived obstinance on the part of white people[7].

How about we make a point of agreeing to disagree? If there are overdiagnoses of African Americans in the normal world, why not apply the same standard while facing possible jail time? At the very least, there will be an opportunity to flee midway between prejudice and a probable death sentence…right? oh no, I forgot that if you’re sent to a mental facility, they’ll put you in such a drug-induced stupor that you’ll forget your name and pronoun. Please make some suggestions for possible actions, as that is by far the intended definition of “fucked” for a predominantly black man living in America.

So, what’s the deal, folks? Should individuals of color seek mental health care despite the high likelihood and risk of misdiagnosis, overdiagnosis, and underdiagnosis? Or should they remain put and perhaps devise a means of regaining a semblance of normalcy?

There are opportunities for cultural education and competence, for increasing the representation of persons of color in mental health professions, and so on. Even so, how soon will these measures become effective? The reality is that everyone needs equitable access to, at the very least, health care services. Everyone has the right to visit the doctor, and they shall be treated with dignity and respect as fellow people. Everyone deserves a chance at life, free from the threat of an implicit death sentence. Everyone, after all, is a human being!

References

[1] “Study Suggests Overdiagnosis of Schizophrenia.” Johns Hopkins Medicine Newsroom, 22 Apr. 2019, https://www.hopkinsmedicine.org/news/newsroom/news-releases/study-suggests-overdiagnosis-of-schizophrenia.

[2] Schwartz, Robert C, and David M Blankenship. “Racial Disparities in Psychotic Disorder Diagnosis: A Review of Empirical Literature.” World Journal of Psychiatry, Baishideng Publishing Group Inc, 22 Dec. 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274585/v.

[3] Moran, Mark, and Search for more papers by this author. “Overdiagnosis of Schizophenia Said to Be Persistent among Black Patients.” Psychiatric News, 29 Dec. 2014, https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2015.1a17.

[4]Neighbors HW, Trierweiler SJ, Ford BC, et al. Racial differences in DSM diagnosis using a semi-structured instrument: the importance of clinical judgment in the diagnosis of African Americans. Journal of Health and Social Behavior. 2003;44:237–256.  

[5]Neighbors HW, Trierweiler SJ, Munday C, et al. Psychiatric diagnosis of African Americans: diagnostic divergence in clinician-structured and semistructured interviewing conditions. Journal of the National Medical Association. 1999;91:601–612. 

[6]Trierweiler SJ, Neighbors HW, Thompson EE, et al. Differences in Patterns of Symptom Attribution in Diagnosing Schizophrenia Between African American and Non-African American Clinicians. American Journal of Orthopsychiatry. 2006;76:154–160. 

[7]Whaley AL. Cultural mistrust and the clinical diagnosis of paranoid schizophrenia in African American patients. Journal of Psychopathology and Behavioral Assessment. 2001;23:93–100. 

Schizophrenia across different cultures

Kraepelin was the first to raise the topic of whether schizophrenia is a universal condition in 1960. Is it possible for it to happen to anyone or even different populations, cohorts, and cultures? According to the findings of the World Health Organization’s research conducted in 20 nations, Schizophrenia can affect anyone, regardless of their age, ethnicity, gender, or geographic location. [1] Even though the outcome of schizophrenia appears to be better in developing countries compared to developed countries, the reasons for this are not fully understood; however, it can be safely assumed that culturally determined processes, whether social or environmental in nature, are at least partially responsible. [2]

The pattern for most diseases is clear: the richer and more developed the country, the better the patient outcome. Schizophrenia appears to be different. This paradox first came to light 40 years ago. For further research, in the 1960s, the World Health Organization (WHO) launched the first of the following three landmark international studies: the International Pilot Study of Schizophrenia (IPSS); the Determinants of Outcomes of Severe Mental Disorders (DOSMeD); and the International Study of Schizophrenia (ISoS).

The IPSS included 1,202 patients from nine countries, three developing (Colombia, India, and Nigeria) and six developed (Denmark, Taiwan, the United Kingdom, the United States, the Soviet Union, and Czechoslovakia). The patients’ outcomes were rated from one (best) to seven (worst) based on three factors: time with psychotic symptoms, remission after each episode, and social impairment (worst). After five years, India had the most success, with 42% of cases reporting the “best” outcomes, followed by Nigeria with 33%. However, only 17% of cases in the US and less than 10% in other wealthy countries had the best outcomes.

In the early 1980s, DoSMeD began studying schizophrenia in 12 centers in 10 countries. From a single psychotic episode to a chronic illness, its 1379 patients fell into nine categories. The study found that 37% of underdeveloped countries had complete recovery compared to 15% of developed countries. Chronic illness rates were 11.1% in the developing world and 17.4% in the developed. Patients in developing countries had longer periods of normal social functioning despite taking fewer antipsychotics. The researchers discovered that a powerful element called ‘culture’ can influence gene-environment interactions that cause disease. The present study does not answer the question but simply states that it exists. To see if the prior studies’ better outcomes persisted, the ISoS trial added two more groups of IPSS and DOSMeD patients after 15 and 25 years. It found that half of the patients had positive outcomes.[3]

According to a 2009 assessment by psychiatrist Parmanand Kulhara of the Postgraduate Institute of Medical Education and Research in Chandigarh, India, 58 schizophrenia papers were examined in order to compare outcomes across industrialized and developing countries. The explanation doesn’t make any more sense. As Kulhara points out, “patients appear to be doing better in impoverished nations, even while resources such as health facilities and medical infrastructure are severely constrained,” including treatment facilities and treatment facilities. This could be attributed to the fact that developing countries have a different socio-cultural environment, with a larger reliance on family members for care and assistance, as well as stronger social support and social networking.[4]

If you ever found yourself on the verge of going insane, a supportive network like this would do everything possible to help you regain your composure. 

So does this imply that the greater the amount of support available, the more likely it is that someone suffering from schizophrenia will be able to improve? Perhaps. If you compare developing nations to developed nations, which are known for their individualistic cultures, developing countries are known for their collectivist cultures. To be clear, collectivist cultures place a higher value on the needs of a group or community than they do on the needs of an individual, whereas individual cultures are the polar opposite. As a result, a problem that affects one person affects everyone else.

Most developing countries have limited or no resources, as well as little or no awareness of mental health issues, but the good news is that they have each other. They are extremely supportive of one another, which is amusing because it is not necessarily because they want to, but rather because it is ingrained in cultural norms. And that is the most potent force they have; they either prosper or perish together. If you ever found yourself on the verge of going insane, a supportive network like this would do everything possible to help you regain your composure. Perhaps there is little time for one’s own thoughts because they are predominantly occupied by the group. A patient’s ability to maintain a satisfactory social support system is directly related to reduced hospitalization and re-admission to the hospital among those suffering from schizophrenia. Patients who have a larger network of people who care about them spend less time in the hospital and perform better on tests and assessments.

References

[1] Jablensky, A, and N Sartorius. “Is schizophrenia universal?.” Acta psychiatrica Scandinavica. Supplementum vol. 344 (1988): 65-70. doi:10.1111/j.1600-0447.1988.tb09003.x

[2] Kulhara, P, and S Chakrabarti. “Culture and schizophrenia and other psychotic disorders.” The Psychiatric clinics of North America vol. 24,3 (2001): 449-64. doi:10.1016/s0193-953x(05)70240-9

[3] Padma, T. V. “Developing Countries: The Outcomes Paradox.” Nature News, Nature Publishing Group, 2 Apr. 2014, http://www.nature.com/articles/508S14a.

[4] Parmanand Kulhara, Ruchita Shah, Sandeep Grover, Is the course and outcome of schizophrenia better in the ‘developing’ world?,Asian Journal of Psychiatry,Volume 2, Issue 2, 2009, Pages 55-62, ISSN 1876-2018, https://doi.org/10.1016/j.ajp.2009.04.003.
(https://www.sciencedirect.com/science/article/pii/S1876201809000306)

Schizophrenia

This wondrous soul once existed. She was a very remarkable individual. She had dimples on her cheeks that gave the impression of a smile. She was very stunning. She was a really brilliant student. Oh, she was a complete and utter genius. She had tenacity as well as academic ability. She was simply herself. She was a straight-laced woman. Her academic achievements were unwavering, and she broke records at every school where she was enrolled. Just before starting college, she began to detach at irregular intervals. She couldn’t hold a conversation and jumped from one topic to another without a clear beginning or end to what she was saying. The lovely young lady was slowly fading away. It got to the point where whatever was going on with her became so scary that those who were around her began to notice something odd. The crowd could hear her screams, watch her wilt, and feel her misery at not knowing what was going on. Whatever the case, they were at a loss for what to do next. When they took her to the doctor, they discovered that she did not have any physical issues. They tried to help her by giving her some drugs, but nothing appeared to help her condition. They took her church in the hopes of soliciting the assistance of an exorcist, but nothing changed. Trying to make it till the next sunrise, day after day, after year after year.

Individuals concerned about her were left wandering aimlessly in the wilderness, attempting to figure out what was wrong but only coming up with dead ends. Every day, she was paralyzed by fear, and the condition she was suffering from progressed on a daily basis. Later, the family made the decision to commit her to the only recognized mental facility in the country. Unfortunately, it was too late when the hospital called in a flurry to inform the family that she had passed suddenly. That lovely soul belonged to my cousin sister. I lived with her and witnessed her life slowly ebb away before my eyes every day, completely oblivious to what was going on. I’ll always wonder if we’d known or someone had known what was going on, whether things would have turned out differently–and whether she could still be alive.

It should be noted that, according to the World Health Organization, more than 69 percent of persons with schizophrenia do not receive sufficient care. Ninety percent of patients with untreated schizophrenia live in low- and middle-income nations. When the illness impacts the body, it can be toxic to the brain, which is one of the ways it manifests itself. A person with schizophrenia can suffer brain damage if they do not receive treatment, though specialists disagree on the methods by which this occurs. It is possible that their mental health will deteriorate. Non-only can the signs and symptoms of schizophrenia worsen, but they can also acquire other mental health conditions, such as obsessive-compulsive disorder (OCD), depression, and Anxiety Disorders.

What is Schizophrenia?

Schizophrenia is a chronic brain disorder that manifests itself in various ways. In this case, the patient is suffering from psychosis, which is a type of mental illness characterized by distortions in thinking, perception, emotions, language, self-perception, and behavior. Despite the fact that schizophrenia affects approximately 20 million people around the world, it is far less common than many other mental disorders. Men are more likely than women to develop the disease earlier, and it is associated with significant disability, as well as the potential to impair educational and occupational performance. People suffering from schizophrenia are two to three times more likely than the general population to die prematurely. 

The symptoms and experiences associated with schizophrenia include hallucinations, which are the perception of things that are not there; delusions, which are fixed false beliefs or suspicions that are not shared by others in the person’s culture and that are firmly held even when there is evidence to the contrary; and paranoia, which is the fear of something happening that is not happening. Disordered behavior patterns include wandering aimlessly, mumbling or laughing to oneself, strange appearance, self-neglect or appearing unkempt; disorganized speech, which includes incoherent or irrelevant speech; and/or disturbances of emotions, which include marked apathy or disconnect between reported emotion and what is observed, such as a facial expression or body language.

What causes Schizophrenia?

There hasn’t been a single factor identified through research. It is hypothesized that schizophrenia is caused by a complex interaction between genes and a variety of environmental factors. Psychiatric disorders such as schizophrenia are thought to have a hereditary component. People who have a family member who has schizophrenia – particularly a first-degree relative – are at increased risk of developing the disorder themselves. While schizophrenia affects only one percent of the population, it affects ten percent of those who have a relative who has the condition. Many people who develop schizophrenia, on the other hand, do not come from a family with a history of the disorder. The development of schizophrenia, according to some scientists, may be influenced by prenatal exposure to toxins, maternal malnutrition, or viral infection during pregnancy. Additional research suggests that birth trauma may increase the likelihood of developing the disorder. Scientists have discovered that schizophrenia is caused by an imbalance in the interrelated, complex, and interconnected brain reactions involving dopamine and glutamate (both neurotransmitters), which are interconnected and interdependent on one another. People who have schizophrenia also have distinct brain structures, such as the ventricles, which are important in the functioning of their brain.

According to the World Health Organization, more than 69 per cent of persons with schizophrenia do not receive sufficient care. Ninety percent of patients with untreated schizophrenia live in low- and middle-income nations. 

When it comes to major mental illnesses, schizophrenia is the most chronic and debilitating of them all. People who suffer from schizophrenia often have difficulties functioning in their daily lives, in societal structure, at school, and in their social interactions. A person’s level of severity of schizophrenia will vary from one to another; some will experience only one psychotic break in their lifetime, whereas others will experience an overall slowing of their ability to function, with little relief between full-blown psychotic episodes. While schizophrenia is a chronic disorder that causes people who suffer to become fearful and withdrawn, it is treatable with the correct combination of medications and treatment approaches.

The lack of resources and access to mental health services, particularly in developing countries, is a significant problem. Furthermore, people suffering from schizophrenia are less likely than the general population to seek treatment. People suffering from schizophrenia are particularly vulnerable to human rights violations, both inside and outside of mental health institutions. The disorder has a high level of social stigma attached to it. This contributes to discrimination, which can in turn limit access to general health care, education, housing, and employment opportunities for people of color. We must continue to address the widespread stigma associated with schizophrenia, as well as with other mental illnesses, indefinitely. Furthermore, governments of countries that do not have mental health policies should make an effort to take it into consideration. There is no such thing as health without mental health.

References

“Schizophrenia.” World Health Organization, World Health Organization, https://www.who.int/news-room/fact-sheets/detail/schizophrenia.