- Depression, Bipolar Disorder, Schizophrenia, SAD -
This page was last updated on Friday, January 11, 2013
Anyone who has recurrent thoughts of death or suicide, delusions, or hallucinations must get help now. Call 911 or an emergency room.
This section briefly describes mood disorders of Depression, Bipolar Disorder, Schizophrenia, and Seasonal Affective Disorder. The very limited material presented in this section and it only describes the relationship between these disorders, their symptoms, and the possibility of abuse. This section is not a diagnostic tool. However, I have cited a few references at the end of this section. These more provide more information about these afflictions including delusions and hallucinations.
Delusions may accompany depression or mania. Delusions are false personal beliefs. For an example, some persons had the delusion that they are Napoleon Bonaparte. Recently (March 2004), a man thought he was destined to become the state's next Governor and went to the State Capital to accept the reins of government. Those who have paranoid delusions feel that others have conspired against them. Others believe that cosmic aliens are controlling them. At other times, delusions of guilt, worthlessness, and ruination may appear during depression.
Hallucinations reflect the sensation (hearing, seeing, tasting, smelling or feeling) of a stimulus that is not there. A common hallucination is hearing spoken voices. Command hallucinations, where voices tell a person to hurt themselves or others, are extremely serious presentations that no one should ignore. Some command hallucinations can be extremely difficult to resist and may lead to violence.
Depression affects more than 8 percent of the American adult population. In this disorder, a person's mood state switches between normal state and depression. Depression is more than having a bad day or experiencing brief bouts of grief or sadness. Depression affects the way a person lives, feels, and acts. Women have a greater risk of depression than men.
Depression includes these symptoms:
Five or more of these symptoms that last most of the day, nearly every day for two weeks or longer indicates depression.
(1) These symptoms are regarded as the first signs of
(2) Increased irritability, hallucinations, and delusions may lead to violence.
(3) Women do attempt suicide, leading to self-inflicted injuries, far more often than men. But men's suicide rates are far higher then women's, especially as men grow older. Recurrent thoughts of death or suicide and suicide attempts are extremely serious and must not be ignored.
This drawing represents the mood states of depression. I did not scale these drawings to represent the extent of discreet mood states. Boundary lines appearing between mood states simply represent fuzzy or transitional zones.
Bipolar Disorder is probably the most difficult psychiatric disorder to diagnose and manage because a person's mood switches between depression, normal state, and mania. In Bipolar Disorder, Dr. Frank Mondimore described bipolar disorder as "the chameleon of psychiatric disorders." He wrote that bipolar disorder changes in "symptom presentation from one patient to the next, and from one episode to the next even in the same patient." Persons with bipolar disorder are sometimes mistakenly diagnosed as having schizophrenia.
Mania includes these symptoms:
Three or more of these symptoms that last most of the day, nearly every day for a week or longer indicates mania. If one of the symptoms is irritability then three to four additional symptoms must present.
(1) These symptoms are regarded as the first signs of mania.
(2) Excessive irritability, hallucinations, or delusions may lead to violence.
(3) The symptoms of erratic thinking and poor judgment are a part of mania. Since abnormal euphoria is also a symptom of mania, some people become addicted to their manic mood and stop taking their medication. Untreated hypomania can become severe mania in some people.
(4) Abuse of certain drugs, alcohol, or sleeping medications can induce the appearance of mania.
Three types of Bipolar Disorder exist. Bipolar I consist of recurrent episodes of mania and depression. Bipolar II consists of recurrent episodes of hypomania and depression. Rapid Cycling Bipolar Disorder presents the symptoms of four or more bipolar events within a 12-month period while some individuals experience multiple bipolar events within a 7-day period and sometimes within a 24-hour period. Some authors write that they can mistake Rapid Cycling Bipolar Disorder for Borderline Personality Disorder (BPD). The consensus is that those who have BPD frequently suffer from anxiety and severe depression. Proper psychotherapy combined with antidepressants and other medications may significantly alleviate these symptoms with positive changes in the patient's behavior.
The following drawing represents the mood states of bipolar disorder and the mood states of depression. I did not scale these drawings to represent the extent of discreet mood states. Boundary lines appearing between mood states simply represent fuzzy or transitional zones of varying gradients.
Mild Mania (Hypomania)
Schizophrenia is not split personality as in Robert Louis Stevenson’s fictional tale about Doctor Jekyll and Mr. Hyde. Multiple identity (dissociative identity) syndrome is a separate and very rare mental disorder exhibiting the existence of two or more distinct and independent personalities in an individual. Reservedly, each personality has its own identity, a set of behaviors and memories, and is not aware of the other personalities and their experiences.
Individuals who have schizophrenia often suffer from terrifying hallucinations and delusions. Those who have these symptoms may become fearful and confused and may have difficulty expressing their thoughts in a logical and coherent way. Some individuals who exhibit the symptoms of schizophrenia may also experience prolonged episodes of depression or elation similar to bipolar disorder. This is why it is sometimes difficult to decide whether a person has schizophrenia or bipolar disorder or severe depression.
When a psychiatric professional cannot clearly determine a patient’s symptoms, they sometimes diagnose the patient as having schizoaffective disorder. Persons with schizoaffective disorder are more likely to return to an almost normal level of function than those with schizophrenia. These disorders may require long term treatment with mixed results. I have always thought that each individual has their own chemistry despite genetic inheritance and current research shows this.
Schizophrenia poses some puzzling presentations. One part of the puzzle is that this disorder affects men and women in nearly equal frequency but the onset of schizophrenia often occurs earlier in males than in females. These symptoms appear in males who are between the ages of seventeen through twenty-three. In females, they appear between the ages of twenty through thirty-three but the first symptoms of this disorder can appear after age forty-five.
In theory, identical twins are genetically identical. So if one identical twin has schizophrenia, the other twin should have this disorder, this is not so. The other twin has more than a 50 percent chance of having this disorder. Then again, 10 percent of lineal first degree lineal relatives develop this disorder though they share about 50 percent of the genes from the affected individual.
Childhood-onset schizophrenia begins after five years of age and, often, after normal development. Childhood schizophrenia is rare and can be difficult to differentiate from other pervasive developmental disorders of childhood, such as autism. The difficulty is that Autism is a disorder affecting communication development. It generally appears in the first three years of life and the symptoms may continue throughout life. No one knows why autism appears in males four times more often than in females and no one knows why one sibling has autism while another does not.
Prevailing literature recognizes five types of schizophrenia: catatonic, disorganized, paranoid, residual, and undifferentiated. The practitioner tries to decide the type of schizophrenia from the patient’s symptoms. Current papers define symptoms as positive, cognitive, and negative.
The positive symptoms of schizophrenia include severe agitation and confusion resulting from hallucinations, and paranoid delusions. These symptoms mark the acute or psychotic phase of schizophrenia. Some individuals have only one psychotic episode while others have many episodes during their lifetime but retain a high degree of normalcy between episodes. Many afflicted individuals need long term treatment. The problem is that some patients may stop using their medication because of side effects or loss of medical coverage. While others may have become addicted to abnormal elation that they had underwent during psychotic episodes.
These are some of the cognitive and negative symptoms of schizophrenia:
When any person has thoughts of suicide or threatens or tries to commit suicide, immediately seek professional help. No one can predict who of those with schizophrenia will commit suicide but we do know that younger adult males are at greater risk.
Seasonal Affective Disorder (SAD)
Seasonal Affective Disorder (SAD) is a form of depression that affects some persons and typically occurs during fall or winter and usually improves during spring or summer. So avoid being a shut-in with nothing to do. It's time for winter frolics and finding useful things to do.
The fall and winter seasons are characterized by declining temperatures, decreasing sunlight, and increased precipitation. Spring and Summer months are characterized by increasing temperatures, increasing sunlight, and decreased precipitation. Many of us have heard the lament ‘rain, rain, go away, come again some other day’. Sunlight causes the production of Vitamin D in humans. Ultraviolet therapy could be a solution. Another solution is adding up to 4000 International Units (IU) of Vitamin D3 (cholecalciferol) to the 400 (IU) recommended daily allowance of Vitamin D and your physician may want to adjust your dosage according to your needs.
When I first recommended increasing the dosage of Vitamin D some years ago, perhaps 2003, I knew 400 (IU) of vitamin D was only used to suppress rickets. Rickets is a disease that affects young children in their formative years of skeletal growth and is evident by soft and deformed bones caused by the body’s failure to assimilate calcium and phosphorous. This is associated with inadequate sunlight or vitamin D.
Today, many practitioners are prescribing far more than 4000 (IU) of Vitamin D3. Current dosages now range between 2,000 and 10,000 (IU) and some researchers and practitioners are recommending higher dosages. Please consult with your physician or practitioner before altering or increasing your dosage. The reason for this admonishment is that each person's body has its own limitations and requirements so what could be good for one person may not be good for another. However 4000 IU seems to be about the right amount.
From Other Publications
Bipolar disorder - Wikipedia, the free encyclopedia
NIMH · Bipolar Disorder - NIMH - National Institutes of Health
Bipolar disorder - MayoClinic.com
Bipolar Disorder Center: Symptoms, Types, Tests, and Treatments
Bipolar Disorder, Francis Mark Mondimore, M.D.
Decoding Schizophrenia, Daniel C. Javitt and Joseph T. Coyle, Scientific American (Jan 2004)