Schizophrenia and Bipolar in Psychiatric Researches - Research Paper Example

? Schizophrenia And Bipolar Critical Discussion Schizophrenia and Bipolar are two different and diverse terms in psychiatric research as suggested by different researches and studies. This assumption is however not justified or seen practical through the traditional methods of medical procedures and techniques. In this paper the argument that both these terms are different, is supported through a series of evidences from different researches, studies, books, and other online resources. Key Term: Schizophrenia, Bipolar disorder, psychotic / mental disease, P300. Introduction The modern medical diagnostic practices revolve around different theories and assumption which helps the overall process of treatment / diagnosis. Different assumptions regarding different diseases and its entities exist in the traditional medical practices of today’s world. If the traditional medical practices in the field of psychiatric research are observed critically then it will come into knowledge that these modern diagnostic practices are based on the assumption that schizophrenia and bipolar disorders are separate entities of a disease. This paper aims to critically discuss the argument suggesting that Schizophrenia and Bipolar are totally different expressions in the same spectrum of disorder. The argument will be supported in reference to different research articles and studies on the same topic. Background The question whether psychiatric research study should be categorized into schizophrenic and bipolar disorders as two different entities disturbs many doctors and researchers from the very beginning. However, different factors have been found which emphasizes on the fact that they both are different entities of a same disease. The dialogue is still under debate and that researchers are yet to find if the statement is balanced or not, however, as per the recent researches, factors, and studies it is suggested that Schizophrenia and Bipolar are two different bodies of a same disorder (Wagemaker, 1996). Body Talking about mental disorders than Schizophrenia and Bipolar are disorders of mental diseases. Both the disorders differ from each other in a variety of ways and factors which are very obvious. The reason why these disorders are sometimes related with each other and confuses the researchers and doctors is due to this fact that both of them shares very similar symptoms, therefore the differentiation between the two becomes quite difficult. If the disorders are studied critically and specifically, then it becomes easy for the psychiatrist to diagnose them in the right manne (Noll, 2009)r. The disorders can be studied in a variety of ways and can be differentiated easily. Following is the list of differences through which we can compare and differentiate that these two are different entities of a mental disorder with the help of various medical terms, phenomenon, and findings (Noll, 2009). Differences: Differentiating through the P300 endophenotype for Bipolar and Schizophrenia: In the study The P300 as a possible endophenotype for schizophrenia and bipolar disorder: Evidence from twin and patient studies conducted by Bestelmeyer, Phillips, Crombi, Benson and St.Clair highlights the differentiation of the two on the basis of the P300 component. The symptoms of this component are potential and that it has some genetic influence on the patient. This may include the psychological abnormalities in Schizorphenia with decreased amplitude of suggested possible constituent of P300 (Bestelmeyer, Phillips, Crombie, Benson, & St.Clair, 2009). The differentiation on the basis of the P300 component was done on the basis of studying patients and twins with Schizophrenia and Bipolar, setting the boundaries on the set of auditory and visual tasks (Torrey, 1995). The results showed that only the P300 component for Schizophrenia serves as an endophenotype while for bipolar it is not genetic. Furthermore, it was also concluded that P300 might act as a marker for the functional psychosis at whole but if talking about Schizophrenia in general then it might become difficult as the results also showed that only the auditory and not the visual P300 amplitude was found to be influenced genetically. Moreover, at midline sites the Schizophrenia and Bipolar patients cannot be differentiated through these measures (Bestelmeyer, Phillips, Crombie, Benson, & St.Clair, 2009). In another research ‘the visual P3a in schizophrenia and bipolar disorder: Effects of target and distracter stimuli on the P300’ by Bestelmeyer the similar topic was investigated which involves P300 and Schizophrenia and bipolar disorder. Due to the increased similarities of the two disorders, it has become quite difficult to observe the differences between them (as discussed above). This research further modifies and simplifies the confusion (Bestelmeyer, The visual P3a in schizophrenia and bipolar disorder: Effects of target and distractor stimuli on the P300, 2012). In this research the results were not very clear but somehow cleared the confusion between the two as it was concluded that patients with Schizophrenia were observed with decreased amplitude of P300 components towards targets, distracters and recurrent stimuli. Whereas, the results for the bipolar patients had only minor differences and did not show major conflict with any of the schizophrenia patient (Bestelmeyer, The visual P3a in schizophrenia and bipolar disorder: Effects of target and distractor stimuli on the P300, 2012). In ‘Auditory event-related potential abnormalities in bipolar disorder and schizophrenia’ by O’Donnell, Vohs, Hetrick, Caroll, and Shekhar also tried to differentiate the two entities on the basis of auditory P300 and Early Related Potential (ERP) components. Sample of 49 different patients were examined to study the difference. The patients were not identical in terms of their diseases, 13 were maniac or mixed bipolar patients while 12 patients were those with Schizophrenia and other 24 controlled subjects were examined (O’Donnell, Vohs, Hetrick, Carroll, & Shekhar, 2004). The results of this study showed that N100, P200, and N200 amplitudes among the Schizophrenia patients were noticed to be lower, whereas the case was not the same with the bipolar patients. The results also told that among both the bipolar and schizophrenia patients reduced amplitude of P300 and expanded latency of P300 were observed (O’Donnell, Vohs, Hetrick, Carroll, & Shekhar, 2004). Differentiation on the basis of FRS Just like the P300 component, there is another factor which is called as FRS. First Rank Symptoms are not only bound to Schizophrenia or Bipolar, they are noticed among both of them. Just like any other symptoms which may confuse the doctor or the patient FRS also is found with a little difference among these two entities. Through this research, it was however concluded that results shown that FRS appears more frequently, with greater intensity and were sever in patients with Schizophrenia, while it was not as severe and frequent among the bipolar patients as the Schizophrenia ones (Rosen, Grossman, Harrow, Bonner-Jackson, & Faull, 2011). Thus again with a small difference, the patients with Schizophrenia and FRS in their acute phases are more likely to observe poor long term results. These results were also found in alliance with the Diagnostic and Statistical Manual of Mental Disorders DSM, third edition (Rosen, Grossman, Harrow, Bonner-Jackson, & Faull, 2011). Differentiation through symptoms There should not be any conflict on the fact that Schizophrenia and Bipolar disorder are entities of mental disease and that they differ from each other. It is very simple to understand that Schizophrenia is a psychotic issue while the other one (bipolar) is a mood problem. If the psychiatrist or the doctor performs specific diagnosis of each of them, that will make the diagnosis more clear and understandable, highlighting the difference of the two (Acton, 2013). Both the Schizophrenia and Bipolar disorders show very common symptoms which puzzles and becomes problematic for the psychiatrists and doctors to appropriately diagnose the exact disease or sickness in the patient. If the symptoms are however studies very accurately and precisely then chances occur which can help in differentiating the two as different entity of a disease (Lake, 2012). Depression: depression is witnessed as the most common type of symptom that is common in both Schizophrenia and Bipolar patients. The patients undergo different kinds of depression. Being very specific, then the bipolar patients undergoes states of depression and mania while the schizophrenia patients show their level of depression through their acts and which are quite depressive in nature. Therefore, if we keenly observe the depressive patterns among the schizophrenia and bipolar patients we will be able to differentiate these two entities (Acton, 2013). Hallucination: Hallucination tends to occur only among the Schizophrenia patients. This difference can be found very helpful in the diagnosis between the two entities however; this may result in the failure of the diagnosis as well. Bipolar patients can also be seen experiencing hallucinations as there manic stage of patents is sometimes (minor cases) very incompetent and disorderly. Expressions in this case may serve as a catalyst to the diagnosis. The expressions of the patients can be examined critically and the psychiatrist can then have a clear approach towards whether it is Schizophrenia or Bipolar disorder (Yatham & Maj, 2011). Moreover, it is observed that the expressiveness of the bipolar patients is greater compared to the schizophrenia patients who are monotone in their nature of expression of hallucination. Furthermore, the manic stages in which these hallucinations occurs happens with increased frequency in bipolar patients then in schizophrenia ones. Due to the fact that bipolar patients do not at all experience hallucination, it is basically their jumpy and confused attitude to pick new tasks without completing any. Thus, this symptom can easily differentiate that the two are totally different (Lake, 2012). Gray Matter: for the purpose of sensory perception and muscle control there is a part of brain which performs this function; gray matter is a set of neural cells and is found in that part of the brain. Schizophrenia and bipolar patients are affected through there disorders with the decrease or increase in the number of the volume of these cells (Goodwin & Jamison, 2007). In both the hemispheres of the brain a certain loss of volume of the gray matter is observed among the schizophrenic patients. ‘Thalamus’ and ‘right caudate’ faces serious loss of these cells. This is not just it; the loss is further expanded to ‘cerebrum ’, ‘hippocampus’, and ‘parahippocampal gyrus’. Compared to normal healthy participants for research, a gradual decrease in the volume of the gray matter is observed in the prefrontal and temoral regions of the brain (Noll, 2009). Talking about the bipolar patients and gray matter, then very less loss of gray matter is observed which somehow resembles the bipolar patients with that of the healthy patients. Again an MRI scan can help the psychiatrist and the doctor to differentiate between the two (Noll, 2009). Where on one hand symptoms help the psychiatrist to study the differences, Magnetic Resonance Imaging (MRI) scans are being done by the doctors to get visible and definite results. It is with the help of this scan test that the psychiatrists are able to locate the specific differences between the brain structure and the diseases (Noll, 2009). Further Studies on the Topic According to the study, ‘Genes for Schizophrenia and Bipolar Disorder? Implication for Psychiatric Nosology’ by Carddock, O’Donovan, and Owen it was observed that traditionally, the modern diagnostic practices are based on the dichotomous classification of Emil Kraepelin’s ‘functional ‘ Psychosis. It assumes that schizophrenia and bipolar disorders are separate disease entities. Recently psychiatric researches show increasing trends of overlap of genetic susceptibility to a kind of overlap in genetic susceptibility to done in a kind of illness with mixed features of schizophrenia. Therefore it is important to consider other option for psychiatric research rather than depending on Krapelinian dichotomy. Most of the research done in the past focused only on one or the other disorder. Instances where Schizophrenia and bipolar features were mixed were either ignored or placed under some category of one of them (Craddock, O’Donovan, & Owen, 2006). Family studies/twin studies/ linkage studies Several studies have shown that schizophrenia and bipolar disorder run in the family. More over, it has also been observed that schizophrenic disorder occurs at increased rates in the families with case of schizophrenic and bipolar disorder and both these disorders occur at increased rate in family containing schizoaffective disorder (Craddock, O’Donovan, & Owen, 2006). When studying twins, it was discovered that there was an overlap of schizophrenic and mania showing the existence of some genes specific to schizophrenia and some specific bi polar disorder. There are few linkages studies that were carried out between families that had predominant aspects of schizophrenic members and families with predominant bipolar members (Craddock, O’Donovan, & Owen, 2006). When studies of individual genes were conducted it was discovered that most of the studies were done on influence of genes of schizophrenia.Existence of NRG in schizophrenia was first found in the study of Icelandic population. It has been discovered that a variation in NRGI gene increases the risk of schizophrenia. But its influence on bipolar disorder has not been established. DAOA and schizophrenia has been seen to be closely linked by the studies conducted on people from Germany, China, USA and South Africa (Craddock, O’Donovan, & Owen, 2006). Variation of DAOA/G30 has been shown to influence bipolar disorder. Studies conducted on 2831 individuals showed 709 has schizophrenia, 706 had bipolar 1 disorder while 1416 were ethnically matched. Bipolar disorder was associated with DAO/G3 but association with schizophrenia could not be established (Craddock, O’Donovan, & Owen, 2006). This research also highlights the fact that there are only minor differences between schizophrenia and bipolar disorders which are hard to find and creates obstacles for the psychiatrist and doctors to conduct diagnosis of their patients. The author of this article has tried to identify whether these entities have some genetic influence / relationship between them and whether or not they are different from each other. It was however concluded as the result of this study that the variation / change in the DTNBP1 influence to schizophrenia in a predominant manner. Moreover it probably forms sickness which is characterized with the help of very obvious negative symptoms. This ultimately affects the bipolar disorder (confined only to those patients who are suffering from prominent psychotic problems). Mood disorder syndrome was greatly noticed in relevance with the schizophrenia disorder, as most of the cases showed results reflecting this problem (Craddock, O’Donovan, & Owen, 2006). ‘Genetics and intermediate phenotypes of the schizophrenia—bipolar disorder boundary’ is another study which also defines the relationship between the schizophrenia and bipolar issues. The study is conducted by Ivleva, Morris, Moates, Suppes, Thaker and Tamminga. Through this research the authors have again emphasized on the closely bounded similarities and relationship between schizophrenia and bipolar. The author believes that it is an ongoing debate which needs clarification (Ivlevaa, et al., 2010). It was concluded with the help of this study that the previous concepts regarding the issues are not justified and that contemporary genetic and neurophysiological theories does not support the ‘dichotomous concept of psychosis’. The studies further informed that schizophrenia and bipolar disorder are entities of disorders which rarely and partially show overlapping symptoms and only presents a clinical continuum. The authors have however also emphasized on the fact that more researches on the topic should be conducted as the topic needs to be addressed on a broader and wider perspective and research (Ivlevaa, et al., 2010) ‘The Genetic Variation of RELN Expression in Schizophrenia and Bipolar Disorder’ is one of the many studies that have been presented to date on the similar topic of schizophrenia and bipolar disorders. The research is presented by Ovadia and Shifman. After going through this research, it can be analyzed that Reelin gene plays a vital role in the functioning of the brain and its development. Reelin gene is linked with various neuropsychiatric diseases. The factors that have an influence on the Reelin gene were analyzed and investigated in this research. Samples of patients with bipolar and schizophrenia disorder were studied (Ovadia & Shifman, 2011). In the bipolar disorder, the C-terminal of the disease was missing due to the prominent decrease in the proportion of the RELN isoform. Similarly in the case of schizophrenia, an imbalance in the allelic expression of RELN was noticed (Ovadia & Shifman, 2011). Keeping in view the increased similarities between the two entities, psychiatrists and researchers were very much inclined towards the fact that there should be some system for the doctors and the nurses to recognize and diagnose the patient in the appropriate manner. A research on this topic was therefore conducted by different authors to train and guide the nurses regarding the medications and the correct usage of drugs among the patients of schizophrenia and bipolar disorders. The research “On the Meaning of ‘Drug Seeking’” which has been conducted by McCaffery, Grimm, Pasero, Ferell, and Uman gives a complete insight on the topic (McCaffery, Grimm, Pasero, Ferrel, & Uman, 2005). Drug seeking is a term commonly used by nurses in their practicing fields’ referring to the patients who are addicted to using opioids. But this term was removed by The American Society for Pain Management Nurses (ASPN, 2002) because it in their it showed prejudice, biasness towards the people who demanded help in this area. There were various definitions of this ter. As per Goldman (1999) he defined it as individuals who seek drugs to sell them in the streets. He put the drug seekers into three categories 1. People who had dependency on this drug 2. Those who seek drugs to sell in the streets 3. those who are hired by drug dealers to sell these drugs by getting prescriptions (McCaffery, Grimm, Pasero, Ferrel, & Uman, 2005) There were numerous other definitions of drug seeking but in general terms it refers to the person who makes attempts to seek opioids. A survey was conducted for this purpose between nurses in different sectors and compared with medical practitioners who had more experience in these fields. Different nursing resources were used to carry out this survey. They were then sent for further studies to pain management programs and were discussed with members who participated in this survey. The data was analyzed and their perception of drug seeking behaviors was studied using contingency table analysis and the chi-square statistics. The data which was obtained contained three group categories; general nurses, emergency nurses, pain management (McCaffery, Grimm, Pasero, Ferrel, & Uman, 2005). Summary: It was noticed that Shizophrenia and Bipolar disorders are very much alike in their nature. These entities show very common and alike symptoms which cause difficulties and problems for the psychiatrists to diagnose and detect the definite disease and problem of the patient. Both the entities are psychotic problems. However, different studies and researches on the topic have been presented by many psychiatrist, doctors, and researchers to overcome the complexities of the issue. It was evidenced through different research articles that both these entities are however found very much alike in their nature actually differ from each other and that both of them and different expression in the same spectrum of disorders. The argument was supported in reference to various scholarly articles. Thus with the help of different elements and symptoms, the argument was addressed and it can be concluded that both of them does differ from each other in their expressions. 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