How do you view people with mental illness? Do you view it like any other illness, or do you just consider them to be crazy?

Jack, this is a good question. Being a medical student, I always get really ticked when people refer to people with mental illnesses and psychos or crazies. IMO, it just reveals their ignorance about mental illness. For example, my sister in law has a friend that lives down the street from her that has bipolar disorder....poorly treated, I suppose, because she's constantly having mood swings. My sister-in-law always refers to her as the crazy lady. I personally think this is so wrong. Again, it simply displays her ignorance on the issue. The lady is not crazy, and she's not psycho. She simply has a malfunctioning brain, due to an improper balance of brain chemicals. Bipolar disorder is commonly caused by a hyperfucntioning dopaminergic system, which is completely biological. Only was to treat it is with a mood stabilizer like Lithium, an anticonvulsant like Depakote or Lamictal, or an atypical antipsychotic like Zyprexa or Risperdal.
Bipolar is almost 100% genetic.

Isn't bipolar when you brain has a decrease in dopamine (sp?). And then parkinsins (sp?) disease is when you have too much dopamine in your brain.
Sorry for the spelling.

On Topic - Of course society places a stigma on people who have mental illnesses. It can go either way. People can treat you like you are just crazy or they can treat you like you are normal because they can't "see" your illness with their eyes like physical illnesses.

Patrick, you are absolutely right. No coroner has ever done an autopsy and found a "mind." There is only the brain and the brain is a physical organ just like the kidneys, the lungs, etc. Mental illness has been misunderstood for as long as there have been people. Insurance companies continue to treat it differently, which helps to further the problem. One day, things will change. But you are spot-on.

Isn't bipolar when you brain has a decrease in dopamine (sp?). And then parkinsins (sp?) disease is when you have too much dopamine in your brain.
Sorry for the spelling.

Well, you're probably thinking more of the difference between Parkinson's and Schizophrenia. In Parkinson's you have diminished dopaminergic activity in the brain, due to loss of dopaminergic neurons, which leads to the movement disorders, cognitive slowing, etc. associated with Parkinson's.

In Schizophrenia you have increased dopaminergic activity in the striatum.

Thus, we give dopaminergic agents to treat Parkinson's, and drugs that block dopamine receptors (specifically D2) to treat Schizophrenia.

Bipolar is a whole different ballgame. During a state of mania, you have increased release of feel good chemicals like dopamine, norepinephrine, and serotonin. During depression, you have the opposite. During a mixed state, you have increased dopamine and a decrease of the others. Bipolar is a weird animal.

Patrick, you are absolutely right. No coroner has ever done an autopsy and found a "mind." There is only the brain and the brain is a physical organ just like the kidneys, the lungs, etc. Mental illness has been misunderstood for as long as there have been people. Insurance companies continue to treat it differently, which helps to further the problem. One day, things will change. But you are spot-on.

Things are changing, slowly but surely. We're slowly perfecting the use of PET scans and SPECT scans to observe function in different regions of the brain. Obviously, in different disorders, certain areas of the brain are overactive, while others are underactive.

I truly believe that in the future, we'll be able to give a person a PET scan and be able to diagnose exactly what's going on with someone's brain.

You might do a Google search for the Amen Clinic. Daniel Amen is doing some awesome work in the area of SPECT scans to diagnose mental illness.

By the way, I do believe that environment plays a role in some mental illness, especially reactive depression, PTSD, etc. But, what's causing the symptoms? Obviously, the environmental issue has caused the brain to become sick.

I don't see why we treat it differently from regular illness. You have a bacterial infection, you take an antibiotic to fight it. You have a mental illness, you take a medicine to correct the imbalance.

By the way, don't take this the wrong way. I think counseling is crucial as well, but usually counseling is better at changing thought patterns to help prevent a mental illness from returning, not treating an already existing mental illness.

Also, some disorders like schizophrenia, Bipolar disorder, etc. are completely biologically based.

http://www.amenclinic.com/

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Well, you're probably thinking more of the difference between Parkinson's and Schizophrenia. In Parkinson's you have diminished dopaminergic activity in the brain, due to loss of dopaminergic neurons, which leads to the movement disorders, cognitive slowing, etc. associated with Parkinson's.

In Schizophrenia you have increased dopaminergic activity in the striatum.

Thus, we give dopaminergic agents to treat Parkinson's, and drugs that block dopamine receptors (specifically D2) to treat Schizophrenia.

Bipolar is a whole different ballgame. During a state of mania, you have increased release of feel good chemicals like dopamine, norepinephrine, and serotonin. During depression, you have the opposite. During a mixed state, you have increased dopamine and a decrease of the others. Bipolar is a weird animal.


You are right. I was speaking of schizophrenia vs. parkinson's. Sometimes people who take medication for schizophrenia has side effects similiar to Parkinson's symptoms ( like jerking uncontrollable movements).

Yeah, that's especially common with the older antipsychotics. They blocked dopamine receptors which really helped with schizophrenia, but unfortunately, they caused extrapyramidal side effects like tremors, tardive dyskinesia, and other movement disorders. Unfortunately, many of these were permanent after long term use.

Fortunately, we now have newer antipsychotics, which we call atypical antipsychotics...drugs like Zyprexa, Risperdal, Abilify, Seroquel, Clozaril, and Geodon...I think that covers all of them. Anyways, they work more on blocking a specific serotonin receptor (5-HT2) and less on dopamine receptors, so we really don't have the problem with them.

What's interesting is trying to treat someone with both Parkinson's and Schizophrenia. That's hard to do. Can't give them antipsychotics because that will make Parkinson's worse. Can't give them dopaminergic drugs, because that makes Parkinson's worse. Only option we really have is to give them anticholinergic drugs, which help reduce some of the movement problems.

By the way, atypical antipsychotics are very interesting in the way they work.....they block dopamine receptors in the striatum which reduces the positive symptoms like hallucinations, but they increase dopamine in the frontal cortex which helps the negative symptoms (the more depression like symptoms). The latter involved their affects on serotonin receptors.

By the way, atypical antipsychotics are now also useful in bipolar disorder (most are now FDA approved for that) and treatment-resistant depression. Unfortunately, the name antipsychotic is even more of a stigma, because these drugs are now used for these other uses. I've seen them really help a depressed person when an SSRI like Paxil just wasn't working.