October 10 is World Mental Health Day, which aims to draw attention to the problems of mental well-being and recall the importance of preventing and treating mental disorders. We prepared this material together with the pharmaceutical company Gedeon Richter. For several years, Gedeon Richter has been initiating social projects aimed at changing the attitude of society towards patients with mental illness, in particular, schizophrenia and bipolar disorder.
How common are bipolar disorder and schizophrenia and why do they occur?
Friends or relatives who have experienced schizophrenia there is every fifth inhabitant of the country, and almost every tenth participant in the survey of VTsIOM and the pharmaceutical company “Gedeon Richter” informedthat someone in his environment has been diagnosed with Bipolar Affective Disorder (BAD).
Among the possible reasons for the development BAR and schizophrenia – heredity, as well as features of the structure and functioning of the brain. But even if a person has relatives diagnosed with mental disorders, this does not mean that such diseases will necessarily manifest themselves in him. Only a specialist can assess the risks, make a diagnosis and recommend drug therapy.
Lifehacker spoke with an expert and learned how mental disorders can affect the lives of people who have experienced them.
1. Bipolar affective disorder and schizophrenia are common diseases in the world or are they rare?
It is estimated that 1% of the population experiences schizophrenia, and about 1-4% have bipolar disorder. These figures vary in different countries due to the peculiarities of diagnostic approaches.
Patients with bipolar disorder and schizophrenia make up about a quarter of the total number of people who visit mental health specialists. These are chronic diseases, so often a person stays in contact with a specialist for years, unlike people with more common anxiety-depressive disorders, which patients can resolve relatively quickly.
2. Why do such disorders occur and at what age do they most often debut?
Genetic and environmental factors influence the likelihood of developing bipolar affective disorder or schizophrenia, but neither provides a 100% risk of developing the disease. A stressful state can only provoke the development of schizophrenia or bipolar disorder, but not cause them by itself. This makes diagnosis difficult. If traumatic events have occurred in the patient’s life, the specialist may associate the resulting depression with them, and not with bipolar disorder. In this case, therapy may not work.
There is now increasing evidence that adverse childhood events (such as various types of abuse) may increase the likelihood of developing schizophrenia and bipolar disorder. Another significant risk factor is the use of alcohol and psychoactive substances: many patients experience a first psychosis even after a single drug use. A person may feel the initial signs of a disorder, but if he tries to drown out anxiety with alcohol or stimulate himself with drugs, then in the end he worsens the course of the disease.
The average age of onset of schizophrenia in men is 18–25 years, in women it is 25–30 years. Previously, the average age of onset of bipolar disorder was 20 years old, now they say that the disorder can first appear at 15-16 years old, but it often takes years to establish the correct diagnosis.
3. What should a person who suspects a mental disorder do? What are the “rings” you need to pay attention to?
“Calls” often come not in the form of subjective sensations, but from long-term acquaintances, relatives or colleagues who say that a person has changed for no clear reason. For example, an always calm and economical homebody starts spending money right and left, makes grandiose and unrealistic plans, falls in love abruptly or often changes the object of sympathy, although he always believed that love was one and for life. Or the person suddenly withdraws, shows no interest in what he used to like, refuses to leave the house, says he has no strength for anything, or does not explain his behavior in any way, but looks scared and anxious. It is necessary to pay attention to statements about unwillingness to live, even if a person denies the intention to commit suicide.
Usually, a change in mental state is accompanied by sleep disorders: a person can sleep for 3 hours a day or, conversely, doze off almost all day. Appetite also suffers – most often it decreases. If at the same time it is difficult to cope with work, and the usual load has become overwhelming, you should seek help.
In the event that a person suspects any mental disorder, he should consult a mental health specialist – or two independent specialists if in doubt.
To test your hypothesis, you can use questionnaires that are available on the Internet (for example, the Beck Depression Scale, Altman Scale, HCL questionnaires), but only a specialist can confirm or refute guesses.
How bipolar disorder and schizophrenia can affect the life of the patient and his loved ones
For bipolar affective disorder characteristic unusually sudden mood swings. Periods of mania with an abundance of energy alternate with episodes of depression, when there is not enough strength even for simple household rituals like preparing breakfast or going to the shower. In schizophrenia, they can arise hallucinations and strange ideas – for example, a person seems to be haunted or controlled by thoughts from outside. It is important for people who are faced with mental disorders to follow the advice of a specialist and regularly take the drugs recommended by him. And sometimes you have to make adjustments to the existing lifestyle.
1. How do bipolar disorder and schizophrenia affect daily life?
Schizophrenia and bipolar disorder are whole groups of diseases with different causes, course features and prognosis. Therefore, patients with the same diagnosis can vary greatly. If in one case we will talk about the minimal impact of the disorder on life, then in the other – about disability. But thanks to growing knowledge about mental disorders and advances in treatment, specialists now rarely encounter severe forms.
It would be dishonest to say that the lives of people with schizophrenia and bipolar disorder are no different from those of completely healthy people. But it is not much different from the lives of people with other chronic diseases, such as diabetes or hypertension. Long-term, often lifelong, medications are needed. It is important to strictly observe the regime of work and rest, exclude lack of sleep and work with night shifts, stop drinking alcohol and psychoactive substances, and conduct regular physical activity. It is clear that the last recommendations are useful to everyone, but if an ordinary person, in case of non-compliance with them, gets off with the usual malaise, a patient with bipolar disorder or schizophrenia may face psychosis.
2. How to help a loved one if they have problems with mental well-being?
First of all, it is important to keep in mind that in a painful state a person can change a lot. The fact that he is passive, fenced off, embittered, says offensive things or considers everyone around him enemies is not his whim, but manifestations of the disease. He can’t be blamed for this. During a depressive episode, it is important to involve a person in at least some kind of activity, without prodding and accusations, but persistently. Let it be washing two dishes or a 15-minute walk. It is important to point out any positive changes in the state, because depressed patients may discount their achievements. It is necessary to remind a person that loved ones love him in any state, even if it seems that he has to speak “into the void”.
In the case of the first psychosis in schizophrenia or the first episode of mania, it is very difficult to negotiate with the patient. The main task is to bring it to a specialist. If a person has already had psychosis or mania, then it is worth relying on previous experience and pointing out the similarity of manifestations. When the patient is in remission, you can ask him to write down what signs should be considered wake-up calls – for example, reduced sleep, a decision to change jobs, the appearance of hallucinations. If the condition worsens, it is worth appealing to this list and offering to talk with a specialist.
3. What are the challenges that partners, parents and friends of people who have been diagnosed with bipolar disorder and schizophrenia may face?
The most important and difficult thing in such a situation is to try to accept that after the development of the disease, the life of a loved one and those who are close to him will be different. Not bad, just different. There will be a lot of uncertainty in it: even with the ideal implementation of the competent recommendations of a specialist and a calm atmosphere at home and at work, there is a risk of aggravation. You can’t blame anyone for this, it’s a given disease. At first, patients, as a rule, are very worried, so they can break down on loved ones and catastrophize their situation, and it is difficult for others to resist such a mood. It is important to be patient and prepare for unexpected behavior.
It will be easier if there is a plan of action in a given situation. Such a plan is good to discuss with the specialist and the patient when he is in a stable condition. It is worth talking openly about the presence of the disease and the difficulties that have arisen, support and encourage a loved one in following the recommendations of a specialist.
The hackneyed phrase about the need to put on an oxygen mask first on yourself, and then on the one in need of help is very fair.
Those caring for loved ones with mental disabilities do not need to forego activities and social activities that energize them. You can seek help and support from other relatives, friends, people with similar problems. And it’s also worth realistically assessing your capabilities and not being shy about contacting a psychologist – for this you don’t have to wait for burnout to begin.
4. If such disorders are diagnosed in a person with children, is it necessary to explain to them what is happening?
Children should communicate information that they are able to perceive, taking into account their age, and answer clearly the questions they ask. For example, to the question “why is mom not at home”, a child of five years old should answer that mom is sick and is now being treated, and when she recovers, she will return. It is very important to explain, for example, that the mother is sad, crying and cannot play with him because she is sick. Small children, due to the peculiarities of the psyche, may believe that the poor condition of the parent is due to the fact that the child did something wrong. Adolescents can be given more complete information and discussed with them about the possible consequences of a parent’s illness for them.
How BAD and Schizophrenia Affect Relationships with Others
Mental disorders can lead to difficulties in relationships and work – for example, it can be difficult for colleagues to understand why a person who, in an episode of mania, worked for days on end, during a depressive period, is unable to solve the simplest task. But subject to the recommendations of a specialist and medical support, people with bipolar disorder and schizophrenia lead ordinary lives, start relationships and succeed in their careers. So, about mental well-being problems openly spoke Catherine Zeta-Jones, Selena Gomez and Kanye West. Their example proves that mental illness is not a reason to withdraw into oneself and refuse help.
1. What problems do people with bipolar disorder and schizophrenia face in relationships?
Patients with bipolar disorder between manic and depressive episodes are no different from other people. Often they are good friends and partners, responsible and productive at work, which is why bosses and colleagues, even knowing about their illness, often hold on to them. In the depressive phase, patients with bipolar disorder may feel that they are treated badly or that they do not deserve good treatment, in the manic phase, that others do not understand and underestimate them. If loved ones are aware of the essence of the disease and its limitations, the relationship remains good. More often, patients are faced with prejudiced judgments of people who know nothing about the disease and are guided by old stereotypes.
In patients with schizophrenia during remission, residual symptoms may persist in the form of low emotionality, isolation, and a tendency to apathy. It can be difficult even for relatives to accept such changes, they expect that a person “will be as before”, but this does not happen, which is why conflicts occur.
The diagnosis of BAD is now even somewhat romanticized and arouses more interest than fear. “Schizophrenic” in the view of the layman is still a stigma, meaning that a person is “crazy and dangerous”, you need to stay away from him, so patients often hide their diagnosis. In fact, people with schizophrenia are much more likely to be victims of crime than perpetrators.
2. Do people with bipolar disorder and schizophrenia have difficulty finding a job? Do I need to tell my employer or colleagues about my diagnosis?
There is a statutory list of professions to which people with bipolar disorder or schizophrenia are not allowed. For example, these are professions that involve access to weapons or work with children. If a patient has a mental disability, they are entitled to special working conditions that they cannot expect unless they report it.
When the work does not provide for any health restrictions, a person has every right not to tell anyone about his diagnosis.
If you have a long sick leave or a sparing regimen is needed to avoid aggravation, it is worth starting a conversation as problems arise. The response of management will depend on the nature and education of the management and how the patient has performed. Of course, you can encounter negativity and stereotypical prejudice. But in my practice, I have repeatedly met with the fact that the bosses were looking for the best option to help their employees and even paid for their treatment.
3. How can a person with a mental disorder tell new acquaintances about his illness and is it worth it at all?
It depends on what kind of acquaintance, whether the interlocutor inspires confidence and how personal a person considers the topic of health in general. There are people who openly declare their mental disorder – in doing so, they make a huge contribution to the destigmatization of such diseases and may receive more support, but also risk facing a negative reaction. There are people who communicate this information to a select circle or no one, because it is more comfortable and safer for them. This is a choice of a person who should be respected.
4. What do you do if people around you make hurtful comments about mental health issues or offer unsolicited advice?
You need to accept that there will be such reactions, and understand that the opinions of others do not say anything about a person with a mental disorder. People tend to be afraid, to show curiosity about the new and unusual, to try to cope with these feelings, giving unsolicited advice or trying to provide unnecessary patronage.
You can react like this: “No one is immune from mental illness, I’m glad that this didn’t affect you. I understand that you do not quite know what you are talking about, since you have no experience of living with a mental disorder. Your comments are unpleasant to me, I ask you to refrain from them”, “Thank you for your interest, but I discuss the treatment plan only with a specialist” or “Yes, I have a mental disorder, but now I feel good. I would not like to discuss the topic of my health unnecessarily, I consider it personal.