Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-19T12:04:53.365Z Has data issue: false hasContentIssue false
  • English
  • Français

Update on the Etiology and Treatment of Schizophrenia and Bipolar Disorder

Published online by Cambridge University Press:  07 November 2014

Peter F. Buckley
Peter F. Buckley*
Affiliation:
Peter F. Buckley, MD, is professor and chairman in the Department of Psychiatry and Health Behavior at the Medical College of Georgia in Augusta
Get access Rights & Permissions [Opens in a new window]

Abstract

Schizophrenia and bipolar disorder are two debilitating mental health disorders, both of which manifest early in adulthood and are associated with severe impairment as well as increased suicide risk. In addition, factors affecting disease severity, such as substance abuse, are often prevalent in these patient populations. In the United States, the prevalence of bipolar disorder is believed to be ~3.5%, while the rate for schizophrenia is ~1%. Although each disorder presents with its own symptom profile, the approaches to treatment are similar and include early diagnosis and use of psychosocial therapy. Research initiatives, such as genetic studies, are used in both disorders as well. For schizophrenia, treatment typically includes the combination of an antipsychotic and psychosocial intervention. For bipolar disorder, clinicians commonly prescribe mood-stabilizing drugs (eg, lithium, valproic acid) as first-line treatment. Many of the second-generation antipsychotics have been approved by the US Food and Drug Administration for bipolar disorder treatment in the manic phase. Patients who are affected by either disorder also face the challenges of treatment nonadherence, which can be affected by substance abuse and can hinder symptom remission as well as spur unnecessary medication switches due to nonresponse. Family members play a key role in the treatment of either disorder.

This expert review supplement focuses on treatment options and research strategies being utilized for the management and advanced understanding of schizophrenia and bipolar disorder. Research examining the pharmacology of commonly used medications for the treatment of both disorders is also presented.

Type
Research Article
Information
CNS Spectrums , Volume 13 , Issue S1 , January 2008 , pp. 1 - 12
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Murray, CJL, Lopez, AD, eds. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. 1st ed. Cambridge: Harvard School of Public Health on behalf of the World Health Organization and the World Bank; 1996.Google Scholar
2.Baldessarini, RJ, Pompili, M, Tondo, L. Suicide in bipolar disorder: risks and management. CNS Spectr. 2006;11(6):465–471.CrossRefGoogle ScholarPubMed
3.Goodwin, FK, Jamison, KR. Manic-Depressive Illness. New York, NY: Oxford University Press; 1990.Google Scholar
4.Jamison, KR. Suicide and bipolar disorder. J Clin Psychiatry. 2000;61(suppl 9):47–51.Google ScholarPubMed
5.Dalton, EJ, Cate-Carter, TD, Mundo, E, Parikh, SV, Kennedy, JL. Suicide risk in bipolar patients: the role of co-morbid substance use disorders. Bipolar Disord. 2003;5(1):58–61.CrossRefGoogle Scholar
6.Hawton, K, Sutton, L, Haw, C, et al.Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors. J Clin Psychiatry. 2005;66(6):693–704.CrossRefGoogle ScholarPubMed
7.Palmer, BA, Pankratz, VS, Bostwick, JM. The lifetime risk of suicide in schizophrenia: a reexamination. Arch Gen Psychiatry. 2005;62(3):247–253.CrossRefGoogle ScholarPubMed
8.Buckley, P. Considerations of Medical Comorbidity in Schizophrenia. Available at: www.medscape.com/infosite/schizophrenia-)management/article-4. Accessed December 18, 2007.Google Scholar
9.Newcomer, JW. Medical risk in patients with bipolar disorder and schizophrenia. J Clin Psychiatry. 2006;67(suppl 9):25–30.CrossRefGoogle ScholarPubMed
10.Krishnan, KR. Psychiatric and medical comorbidities of bipolar disorder. Psychosom Med. 2005;67(1):1–8.CrossRefGoogle ScholarPubMed
11.Regier, DA, Farmer, ME, Rae, DS, et al.Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA. 1990;264(19):2511–2518.CrossRefGoogle ScholarPubMed
12.Caspi, A, Moffitt, TE, Cannon, M, et al.Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-O-methyltransferase gene: longitudinal evidence of a gene X environment interaction. Biol Psychiatry. 2005;57(10):1117–1127.CrossRefGoogle ScholarPubMed
13.Merikangas, KR, Akiskal, HS, Angst, J, et al.Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2007;64(5):543–552.CrossRefGoogle ScholarPubMed
14.Kessler, RC, Chiu, WT, Demler, O, et al.Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiatry. 2005;62(6):617–627.CrossRefGoogle Scholar
15.Regier, DA, Narrow, WE, Rae, DS, et al.The de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Arch Gen Psychiatry. 1993;50(2):85–94.CrossRefGoogle Scholar
16.Celten, JP, Sijben, N. First admission rates for schizophrenia in immigrants to the Netherlands: The Dutch National Register. Soc Psychiatry Psychiatr Epidemiol. 1994;29(2):71–77.CrossRefGoogle Scholar
17.Grove, W, Clayton, PJ, Endicott, J, et al.Immigration and major affective disorder. Acta Psychiatr Scand. 1986;74(6):548–552.CrossRefGoogle ScholarPubMed
18.Kendler, KS. Twin studies of psychiatric illness. Current status and future directions. Arch Gen Psychiatry. 1993;50(11):905–915.CrossRefGoogle ScholarPubMed
19.Kendler, KS. Genetic epidemiology in psychiatry. Taking both genes and environment seriously. Arch Gen Psychiatry. 1995;52(11):895–899.CrossRefGoogle ScholarPubMed
20.Craddock, N, O'Donovan, MC, Owen, MJ. The genetics of schizophrenia and bipolar disorder: dissecting psychosis. J Med Genet. 2005;42(3):193–204.CrossRefGoogle ScholarPubMed
21.Cannon, M, Jones, PB, Murray, RM. Obstetric complications and schizophrenia: historical and meta-analytic review. Am J Psychiatry. 2002;159(7):1080–1092.CrossRefGoogle ScholarPubMed
22.O'Callaghan, E, Gibson, T, Colohan, HA, et al.Season of birth in schizophrenia. Evidence for confinement of an excess of winter births to patients without a family history of mental disorder. Br J Psychiatry. 1991;158:764–769.CrossRefGoogle ScholarPubMed
23.Cammit, S, Allebeck, P, Dalman, C. Paternal age and risk for schizophrenia. Br J Psychiatry. 2003;183:405–408.Google Scholar
24.Gorwood, P, Leboyer, M, Jay, M, et al.Gender and age at onset in schizophrenia: impact of family history. Am J Psychiatry. 1995;152(2):208–212.Google ScholarPubMed
25.Correll, CU, Penzner, JB, Frederickson, AM, et al.Differentiation in the preonset phases of schizophrenia and mood disorders: evidence in support of a bipolar mania prodrome. Schizophr Bull. 2007;33(3):703–714.CrossRefGoogle ScholarPubMed
26.Cddington, J. The diagnosis and assessment of individuals prodromal for schizophrenia psychosis. CNS Spectr. 2004;9(8):588–594.CrossRefGoogle Scholar
27.Peralta, V, Cuesta, MJ, Martinez-Larrea, A, et al.Duration of untreated psychotic illness: the role of premorbid social support networks. Soc Psychiatry Psychiatr Epidemiol. 2005;40(5):345–349.CrossRefGoogle ScholarPubMed
28.Kapur, S, Mamo, D. Half a century of antipsychotics and still a central role for dopamine D2 receptors. Prog Neuropsychopharmacol Biol Psychiatry. 2003;27:1081–1090.CrossRefGoogle Scholar
29.Scott, JE, Dixon, LB. Psychological interventions for schizophrenia. Schizophr Bull. 1995;21(4):621–630.CrossRefGoogle ScholarPubMed
30.Dixon, LB, Lehman, AF. Family interventions for schizophrenia. Schizophr Bull. 1995;21(4):631–643.CrossRefGoogle ScholarPubMed
31. National Alliance on Mental Illness. About Mental Illness. Available at: www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=23037. Accessed on December 18, 2007.Google Scholar
32.McGurk, SR. Neurocognition as a determinant of employment status in schizophrenia. J Psychiatr Pract. 2000;6(1):190–196.CrossRefGoogle ScholarPubMed
33.Davis, LW, Lysaker, PH. Therapeutic alliance and improvements in work performance over time in patients with schizophrenia. J Nerv Ment Dis. 2007;195(4):353–357.CrossRefGoogle ScholarPubMed
34.Lehman, AF. Vocational rehabilitation in schizophrenia. Schizophr Bull. 1995;21(4):645–656.CrossRefGoogle ScholarPubMed
35.Killackey, EJ, Jackson, HJ, Gleeson, J, Hickie, IB, McGorry, PD. Exciting career opportunity beckons! Early intervention and vocational rehabilitation in first-episode psychosis: employing cautious optimism. Aust N Z J Psychiatry. 2006;40(11-12):951–962.CrossRefGoogle ScholarPubMed
36.Liu, KW, Hollis, V, Warren, S, Williamson, DL. Supported-employment program processes and outcomes: experiences of people with schizophrenia. Am J Occup Ther. 2007;61(5):543–554.CrossRefGoogle ScholarPubMed
37. Principles of the ACT Model. Available at: www.actassociation.org/actModel. Accessed on December 18, 2007.Google Scholar
38.Phillips, SD, Burns, BJ, Edgar, ER, et al.Moving assertive community treatment into standard practice. Psychiatr Serv. 2001;52(6):771–779.CrossRefGoogle ScholarPubMed
39.Holthausen, EA, Wiersma, D, Cahn, W, et al.Predictive value of cognition for different domains of outcome in recent-onset schizophrenia. Psychiatry Res. 2007;149(1-3):71–80.CrossRefGoogle ScholarPubMed
40.Bell, M, Fiszdon, J, Greig, T, Wexler, B, Bryson, G. Neurocognitive enhancement therapy with work therapy in schizophrenia: 6-month follow-up of neuropsychological performance. J Rehabil Res Dev. 2007;44(5):761–770.CrossRefGoogle ScholarPubMed
41.Granholm, E, McQuaid, JR, McClure, FS, et al.Randomized controlled trial of cognitive behavioral social skills training for older people with schizophrenia: 12-month follow-up. J Clin Psychiatry. 2007;68(5):730–737.CrossRefGoogle Scholar
42.Levin, ED, Rezvani, AH. Nicotinic interactions with antipsychotic drugs, models of schizophrenia and impacts on cognitive function. Biochem Pharmacol. 2007;74(8):1182–1191.CrossRefGoogle ScholarPubMed
43.Prochaska, JJ, Hall, SM, Bero, LA. Tobacco Use Among Individuals With Schizophrenia: What Role Has the Tobacco Industry Played?Schizophr Bull. 2007. In press.Google Scholar
44.Goldberg, TE, Goldman, RS, Burdick, KE, et al.Cognitive improvement after treatment with second-generation antipsychotic medications in first-episode schizophrenia: is it a practice effect? Arch Gen Psychiatry. 2007;64(10):1115–1122.CrossRefGoogle ScholarPubMed
45.Stys, PK, Lipton, SA. White matter NMDA receptors: an unexpected new therapeutic target? Trends Pharmacol Sci. 2007;28(11):561–566.CrossRefGoogle ScholarPubMed
46.Robbins, MJ, Starr, KR, Honey, A, et al.Evaluation of the mGlu8 receptor as a putative therapeutic target in schizophrenia. Brain Res. 2007;1152:215–227.CrossRefGoogle ScholarPubMed
47.Castner, SA, Williams, GV. Tuning the engine of cognition: a focus on NMDA/D1 receptor interactions in prefrontal cortex. Brain Cogn. 2007;63(2):94–122.CrossRefGoogle ScholarPubMed
48.Buchanan, RW, Davis, M, Goff, D, et al.A summary of the FD A-NIMH-MATRICS workshop on clinical trial design for neurocognitive drugs for schizophrenia. Schizophr Bull. 2005;31(1):5–19.CrossRefGoogle Scholar
49.Manschreck, TC, Boshes, RA. The CATIE schizophrenia trial: results, impact, controversy. Harv Rev Psychiatry. 2007;15(5):245–258.CrossRefGoogle ScholarPubMed
50.Glick, ID. Understanding the results of CATIE in the context of the field. CNS Spectr. 2006;11(suppl 7):40–47.CrossRefGoogle ScholarPubMed
51.Moore, TA, Buchanan, RW, Buckley, PF, et al.The Texas medication algorithm project antipsychotic algorithm for schizophrenia: 2006 update. J Clin Psychiatry. 2007;68:1751–1762.CrossRefGoogle ScholarPubMed
52.Kucukalic, A, Dzubur-Kulenovic, A, Mehmedika-Suljic, E. Relapse prevention in schizophrenia - new therapeutic challenges. Psychiatr Danub. 2007;19(4):362–366.Google ScholarPubMed
53.Perkins, DO, Johnson, JL, Hamer, RM, et al.Predictors of antipsychotic medication adherence in patients recovering from a first psychotic episode. Schizophr Res. 2006;83(1):53–63.CrossRefGoogle ScholarPubMed
54.Lacro, JP, Dunn, LB, Dolder, CR, Leckband, SG, Jeste, DV. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry. 2002;63(10):892–909.CrossRefGoogle ScholarPubMed
55.Buckley, PF, Wirshing, DA, Pierre, J, Bushen, P, Resnick, S, Wishing, SC. Lack of insight and treatment adherence in schizophrenia. CNS Drugs. 2007;21:129–141.CrossRefGoogle ScholarPubMed
56.Valenstein, M, Ganoczy, D, McCarthy, JF, Myra Kim, H, Lee, TA, Blow, FC. Antipsychotic adherence over time among patients receiving treatment for schizophrenia: a retrospective review. J Clin Psychiatry. 2006;67(10):1542–1550.CrossRefGoogle ScholarPubMed
57.Tunis, SL, Faries, DE, Stensland, MD, Hay, DP, Kinon, BJ. An examination of factors affecting persistence with initial antipsychotic treatment in patients with schizophrenia. Curr Med Res Opin. 2007;23(1):97–104.CrossRefGoogle ScholarPubMed
58.Tandon, R, Carpenter, WT, Davis, JM. First- and second-generation antipsychotics: learning from CUtLASS and CATIE. Arch Gen Psychiatry. 2007;64(8):977–978.CrossRefGoogle ScholarPubMed
59.Egan, MF, Straub, RE, Goldberg, TE, et al.Variation in GRM3 affects cognition, prefrontal glutamate, and risk for schizophrenia. Proc Natl Acad Sci U S A. 2004;101(34):12604–12609.CrossRefGoogle ScholarPubMed
60.Harrison, PJ, Weinberger, DR. Schizophrenia genes, gene expression, and neuropathology: on the matter of their convergence. Mol Psychiatry. 2005;10:40–68.CrossRefGoogle ScholarPubMed
61.Laruelle, M, Frankle, WG, Narendran, R, Kegeles, LS, Abi-Dargham, A. Mechanism of action of antipsychotic drugs: from dopamine D(2) receptor antagonism to glutamate NMDA facilitation. Clin Ther. 2005;27(suppl A):S16–S24.CrossRefGoogle ScholarPubMed
62.Huxley, NA, Parikh, SV, Baldessarini, RJ. Effectiveness of psychosocial treatments in bipolar disorder: state of the evidence. Harv Rev Psychiatry. 2000;8(3):126–140.CrossRefGoogle ScholarPubMed
63.Fountoulakis, KN, Vieta, E, Siamouli, M, et al.Treatment of bipolar disorder: a complex treatment for a multi-facet disorder. Ann Gen Psychiatry. 2007;6(1):27.CrossRefGoogle Scholar
64.Sachs, GS, Thase, ME. Bipolar disorder therapeutics: maintenance treatment. Biol Psychiatry. 2000;48(6):573–581.CrossRefGoogle ScholarPubMed
65.Perlis, R. Review: adding second generation antipsychotics to mood stabilizers reduces acute mania symptoms. Evid Based Ment Health. 2007;10:111.CrossRefGoogle ScholarPubMed
66.Surja, AA, Tamas, RL, El-Mallakh, RS. Antipsychotic medications in the treatment of bipolar disorder. Curr Drug Targets. 2006;1217–1224.Google Scholar
67.Miklowitz, DJ, Otto, MW, Frank, E, et al.Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program. Arch Gen Psychiatry. 2007;64(4):419–426.CrossRefGoogle ScholarPubMed
68. Depression Bipolar Support Alliance. Available at: www.dbsalliance.org. Accessed on January 18, 2008.Google Scholar
69.Justo, L, Soares, B, Calil, H. Family interventions for bipolar disorder. Cochrane Database Syst Rev. 2007;(4):CD005167.Google Scholar
70.Amann, B, Grunze, H, Vieta, E, Trimble, M. Antiepileptic drugs and mood stability. Clin EEG Neurosci. 2007;38(2):116–123.CrossRefGoogle ScholarPubMed
71.Perlis, RH, Ostacher, MJ, Patel, JK, et al.Predictors of recurrence in bipolar disorder: primary outcomes from the systematic treatment enhancement program for bipolar disorder (STEP-BD). Am J Psychiatry. 2006;163(2):217–224.CrossRefGoogle ScholarPubMed
72.Lieberman, JA, Stroup, TS, McEvoy, JP, et al, and the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353(12):1209–1223.CrossRefGoogle ScholarPubMed
73.Zaremba, PD, Bialek, M, Blaszczyk, B, Cioczek, P, Czuczwar, SJ. Non-epilepsy uses of antiepilepsy drugs. Pharmacol Rep. 2006;58(1):1–12.Google ScholarPubMed
74.Chiu, CC, Huang, SY, Chen, CC, Su, KP. Omega-3 fatty acids are more beneficial in the depressive phase than in the manic phase in patients with bipolar I disorder. J Clin Psychiatry. 2005;66(12):1613–1614.CrossRefGoogle ScholarPubMed
75.Yurgelun-Todd, DA, Silveri, MM, Gruber, SA, Rohan, ML, Pimentel, PJ. White matter abnormalities observed in bipolar disorder: a diffusion tensor imaging study. Bipolar Disord. 2007;9(5):504–512.CrossRefGoogle ScholarPubMed
76.Shaltiel, G, Chen, G, Manji, HK. Neurotrophic signaling cascades in the pathophysiology and treatment of bipolar disorder. Curr Opin Pharmacol. 2007;7(1):22–26.CrossRefGoogle ScholarPubMed
77.Buckley, PF, Mahadik, S, Pillai, A, Terry, A Jr.Neurotrophins and schizophrenia. Schizophr Res. 2007;94(1-3):1–11.CrossRefGoogle ScholarPubMed