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Schizophrenia, bipolar disorder, obsessive–compulsive disorder, and personality disorder 

Schizophrenia, bipolar disorder, obsessive–compulsive disorder, and personality disorder

Schizophrenia, bipolar disorder, obsessive–compulsive disorder, and personality disorder

Stephen Lawrie

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date: 28 April 2017

Schizophrenia—is characterized by phenomena that qualitatively differ from everyday experience. These may be ‘positive symptoms’, commonly auditory hallucinations and/or bizarre delusions, or ‘negative symptoms’, commonly including a loss of emotion (flat affect), apathy, self-neglect, and social withdrawal. Acute positive symptoms generally respond well to any antipsychotic drug, but prognosis is often poor, with most suffering chronic symptoms, numerous relapses, unemployment, and social isolation.

Bipolar disorder (‘manic depression’)—the key features are episodic increases or decreases in mood, thoughts, and activity. Patients who are hypomanic feel ‘high’, report rapid thoughts, have limitless energy, require little sleep, and are disinhibited—problems that become uncontrollable if they become manic. If depressed, mood is low. Hypomania generally responds well to antipsychotic drugs. Lithium is also effective and remains the mainstay of treatment. Carbamazepine and sodium valproate are alternative mood stabilizers. Recurrence is the norm.

Obsessive–compulsive disorder—is characterized by recurrent, unwanted ideas or images that are recognized by the patient as their own, and repeated behaviours or mental acts (rituals) to relieve tension. Patients are commonly ill for years before they come to psychiatric attention. Both drugs (the tricyclic antidepressant clomipramine, and selective serotonin reuptake inhibitors (SSRIs)) and psychotherapy are effective. A chronic waxing and waning course is typical.

Personality disorders—people with personality disorders are common, disabled, and often regarded as ‘problem patients’. They are defined by having culturally abnormal experience or behaviour, with onset in early adulthood, which is pervasive and inflexible, leading to distress or impairment. Few treatments have been evaluated: cognitive therapy may reduce the frequency of deliberate self-harm; dysthymia responds to antidepressants; paranoid, schizotypal, and borderline patients may benefit from antipsychotic drugs; and those with obsessional personality disorder may respond to SSRIs.

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