The Relationship Between ADHD and Bipolar Disorder

Research shows that up to 20 percent of adults living with bipolar disorder (BD) also have a diagnosis of attention deficit hyperactivity disorder (ADHD).

 

ADHD and bipolar disorder have similar symptoms—so much so that they’re often confused with one another. Symptoms such as impulsivity and inattention can overlap. This makes it difficult to tell the two disorders apart.

 

A 2018 Danish study found that BD was almost 11 times more likely in people with a prior diagnosis of ADHD, compared with people who had no prior diagnosis of ADHD or anxiety. It is not clear why ADHD and bipolar disorder so frequently occur together. Genetic and biological factors are believed to be partially responsible.

 

It is common for ADHD to be diagnosed first since symptoms usually begin to present in childhood. Approximately two-thirds of ADHD patients continue to have symptoms into adulthood.

 

Bipolar disorder is often not diagnosed before individuals are in their 20s. According to the National Alliance of Mental Illness, more than half of all cases begin between ages 15–25. 

 

“The main difference between the two is that ADHD creates more consistent patterns of behavior, while bipolar disorder can occur in cycles, with a manic episode mimicking many of the symptoms of ADHD,” wrote Hilary Lebow in December on PsychCentral.

 

Lebow offered a tabular overview of the differences and similarities.

 

ADHDBipolar Disorder
Often diagnosed in childhoodOften diagnosed in adulthood
Impact on attention and behaviorImpact on mood and behavior
Chronic or persistentEpisodic (occurs in cycles)
Increased energyIncreased energy during mania
Easily distractedEasily distracted during the manic phase
Talking too much or too fastPressured speech during mania
ImpulsivityImpulsivity during the manic phase
Motor hyperactivity or agitation (fidgeting)Motor hyperactivity during mania
Lower self-esteemIncreased self-esteem during mania
Consistent sleep disturbancesDecreased need for sleep during mania
Difficulty with memoryDifficulty with memory

 

Bipolar disorder is a serious mental illness—especially with co-occurring ADHD. BD is characterized by psychosis, a severe condition in which the person’s ability to recognize reality and emotional responses, thinking processes, judgment, and ability to communicate are so affected that functioning is seriously impaired. Colorado Recovery offers residential treatment for people with psychosis and our bipolar treatment program is highly regarded.

 

“Research shows that those who live with both ADHD and bipolar disorder have an increased chance of suicidal ideation and substance use disorder (SUD), particularly around alcohol,” warned Lebow in her article.

 

ADHD is routinely treated with medications that stimulate the central nervous system. Bipolar disorder, on the other hand, is often treated with antidepressants, mood stabilizers, or benzodiazepines. People with both conditions require thorough assessments and careful calibration of their medications as stimulants for ADHD can cause manic episodes if a co-occurring bipolar disorder is present.

 

“Medications are an important part of treatment but they are only part of the answer,” wrote the late Colorado Recovery founder Richard Warner, MD, in 2000. The mental health professionals at Colorado Recovery utilize a holistic treatment approach to help adults with serious mental health issues stabilize their illness, minimize symptoms, improve functioning, and enhance each person’s social inclusion, quality of life, and sense of meaning in life.

 

If you have questions about our services to treat schizophrenia, bipolar disorder, and similar mental illnesses, call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

 

The Importance of Social Recovery in Mental Healthcare

Recovery is a term frequently used by people with mental health issues to describe their efforts to live meaningful and satisfying lives. Colorado Recovery approaches mental healthcare based on a path of self-reliance through developed practiced skills. This non-institutionalized social recovery offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation.

Shulamit Ramon is mental health research lead at the University of Hertfordshire in Britain. In a 2018 article for the International Journal of Environmental Research and Public Health, Professor Ramon looked at the place of social recovery in mental health and social care services, alongside personal recovery.

“As distinct from personal recovery, yet inter-related to it, social recovery includes the components of interdependence with others, connectedness, recovery capital, and social capital, as well as the impact of collective culture and the structural elements of our socio-economic-political system,” wrote Ramon. “To add to the complexity, the impact of each element on one’s identity, in interaction with how one is seen by others, needs to be taken into account.”

Ramon points out that social recovery was initially defined by the late Colorado Recovery founder Richard Warner in Recovery from Schizophrenia as economic and residential independence with low social disruption but has since been expanded to refer to people’s ability to lead meaningful and contributing lives as active citizens.

People with mental health disorders are no longer just the recipients of treatment but are encouraged to participate in joint decision-making. “Existing research demonstrates that most people experiencing mental illness are able to make decisions and have the mental capacity to do so most of the time, including many of those who are in an acute admission ward,” wrote Professor Ramon. “This is hardly surprising to those of us coming from the recovery perspective, given that the intellectual and social capacities of many members of this group have been demonstrated by the strengths approach, the valued contribution of peer support workers, and the impressive contribution of service users [patients] who have championed recovery.”

Social recovery is a “co-production” of therapists and patients who “have not only strengths to share in a joint project, but that co-production can enhance the power they have within such an undertaking and with it their social standing and identity, as well as enriching any given project.”

This kind of empowerment is central to the Warner Model utilized at Colorado Recovery. It includes a residential treatment program, a transitional program, and an intensive outpatient program, and a “clubhouse” community mental health service model. “Treatment should include social rehabilitation,” wrote Dr. Warner in The Environment of Schizophrenia. “People with schizophrenia usually need help to improve their functioning in the community. This can include training in basic living skills; assistance with a host of day-to-day tasks; and job training, job placement, and work support.” The treatment team at Colorado Recovery recognizes that their clients share with them a need for a sense of community, meaning in life, and self-respect.

Professor Ramon also listed active citizenship and employment as important aspects of social recovery. “The emerging focus on co-production and active citizenship to overcome social exclusion and to foster social inclusion of people experiencing mental ill health is encouraging, and hopefully will also enhance the implementation of shared decision making at all levels. The message of social recovery lies in the need to include the social context in understanding, analyzing, and responding to people’s mental health difficulties. This author, for one, shares Warner’s optimism while being aware of the obstacles to achieving social recovery for all who need it.”

At Colorado Recovery it is our mission to help adults with serious mental health issues stabilize their illness, minimize symptoms, improve functioning and enhance each person’s social inclusion, quality of life, and sense of meaning in life.

If you have questions about our recovery model or our services to treat schizophrenia, bipolar disorder, and similar mental illnesses, call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

The Recovery Model of Mental Healthcare

The recovery model is a holistic, patient-centered approach to mental healthcare. This model has gained momentum in recent years and is based on the simple premise that it is possible to recover from a mental health condition.

That may not sound too surprising two decades into the 21st century but not that long ago, schizophrenia, bipolar disorder, and similar severe mental health conditions were considered chronic and beyond the reach of any meaningful recovery.

“As the name of the model implies, its hallmark principle is the belief that people can recover from mental illness to lead full, satisfying lives,” wrote Sarah Lyon in 2020 on Verywellmind.com. “Until the mid-seventies, many practitioners believed that patients with mental health conditions were doomed to live with their illness forever and would not be able to contribute to society.”

In the 1980s, the late Colorado Recovery founder Richard Warner used empirical evidence to strongly challenge the then-prevailing view of schizophrenia, which suggested that psychosis was strongly characterized by poor clinical and social outcomes. Since then, epidemiological, sociological, psychological, and biological research has made many aspects of that outdated model unsustainable.

“A central tenet of the recovery model is that empowerment of the user is important in achieving a good outcome in serious mental illness,” wrote Dr. Warner in 2010. “To understand why this may be so, it is important to appreciate that people with mental illness may feel disempowered, not only as a result of involuntary confinement or paternalistic treatment but also by their own acceptance of the stereotype of a person with mental illness. People who accept that they have mental illness may feel driven to conform to an image of incapacity and worthlessness, becoming more socially withdrawn and adopting a disabled role. As a result, their symptoms may persist and they may become dependent on treatment providers and others.” 

The recovery model counteracts those feelings of disempowerment and worthlessness. Its key tenets—”optimism about recovery from schizophrenia, the importance of access to employment, and the value of empowerment of user/consumers in the recovery process—are supported by scientific research,” wrote Warner in 2009. “Attempts to reduce the internalized stigma of mental illness should enhance the recovery process.”

Dr. Warner distinguished between “complete recovery” and “social recovery.” He defined the former as loss of psychiatric symptoms and return to a pre-illness level of functioning, whereas he defined social recovery in functional terms; economic and residential independence with low social disruption, an important component of which is employment. His findings were recently confirmed by British research. 

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery from mental disorders as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” SAMHSA emphasizes four aspects of recovery:

 

  • Health: Overcoming or managing one’s disease(s) or symptoms and making informed, healthy choices that support physical and emotional wellbeing. 
  • Home: A stable and safe place to live.
  • Purpose: Meaningful daily activities, such as a job, school, volunteerism, family caretaking, creative endeavors, etc., and the resources to participate in society. 
  • Community: Relationships and social networks that provide support, friendship, love, and hope.

All four are important pillars of the Warner model utilized at Colorado Recovery. Our psychiatrists evaluate clients with bipolar, schizophrenia, and other serious mental illness as often as necessary to prescribe an effective medication regimen—a regimen that may vary from day to day depending on the current state of their disorder. Finding stable and safe housing for clients is another important aspect of the Warner treatment model. Transitional living is available to qualifying clients at an enhanced outpatient level of care.

At Colorado Recovery, treatment professionals empower their patients by giving them roads to be productive, to help them perceive a positive meaning in life and a sense of belonging that can significantly improve treatment outcomes. We offer a variety of vocational services to help clients with their short-term and long-term career goals, including job-seeking skills, career exploration, and resume creation.

“The recovery model stresses the importance of connectedness and social supports,” wrote Lyon. “When people have supportive relationships that offer unconditional love, they are better able to cope with the symptoms of their illness and work toward recovery.”

At Colorado Recovery it is our mission to help adults with serious mental health issues stabilize their illness, minimize symptoms, improve functioning and enhance each person’s social inclusion, quality of life, and sense of meaning in life.

If you have questions about our recovery model or our services to treat schizophrenia, bipolar disorder, and similar mental illnesses, call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

How Transitional Living Paves the Road to Independence

 

For people with a mental health condition, the basic necessity of a stable home can be hard to come by. “The lack of safe and affordable housing is one of the most powerful barriers to recovery,” according to the National Alliance on Mental Illness. “When this basic need isn’t met, people cycle in and out of homelessness, jails, shelters, and hospitals. Having a safe, appropriate place to live can provide stability to allow you to achieve your goals.”

Finding stable and safe housing for clients is an important aspect of the treatment model pioneered by the late Colorado Recovery founder Richard Warner. “We offer a Transitional Living Program to our patients with schizophrenia, bipolar disorder, and schizoaffective disorder,” says Ginger Robitaille, Director of Operations at Colorado Recovery.

The program includes:

  • Room and funds to buy groceries to prepare meals
  • A safe and healthy living environment
  • Oversight by live-in therapeutic housemates
  • Shopping, cooking, and dining as a group
  • Learning how to manage an independent household
  • Weekly house meetings
  • Life skills coaching
  • Individual therapy sessions
  • Vocational counseling
  • Recreational, therapeutic and psychoeducational groups
  • Fully furnished townhomes

The program has been offered to clients progressing from residential care or intensive outpatient treatment but Colorado Recovery is now also admitting directly into transitional living clients who are ready to begin this phase of their recovery.

Key to direct admission is a careful assessment of the new client by the outpatient team that typically takes several days. “It is important to make sure that clients are ready for a transitional-living environment in an unlocked, co-ed facility,” says Robitaille. “It’s also important to remember that transitional living at Colorado Recovery means sober living.”

“Unfortunately, we cannot admit patients into this program who are still struggling with a full-force addiction,” says June Bianchi, Transitional Living Program Manager for Colorado Recovery. “Patients should be stable in their recovery, have a good idea what medications work for them, and should able to rely on their support system.” If clients do have substance use issues, the Colorado Recovery team will help address them and help engage that support system to avoid jeopardizing their recovery.

Transitional-living clients benefit from an enhanced outpatient level of care. “They will be seeing a Colorado Recovery therapist and a Colorado Recovery psychiatrist,” says Bianchi. “The outpatient nurses help out with the medication schedules. That really helps keeping patients stable. It’s a pretty intensive level of care, comparable to an intensive outpatient program.”

Six Stages to Success

Colorado Recovery utilizes six stages in its transitional living process. The first is orientation, a time to adjust to the program. “Clients identify their strengths and areas they want to work on,” explains Robitaille. “They are getting comfortable with independent transportation, time management, food shopping, preparing meals, and other life skills.”

In the community stage, clients get to engage with their transitional living peers and the wider community. They begin to help with meetings and meals for the transitional living program and start exploring activities and groups outside the program. “They are spending quite a bit of time with life skills coaches and vocational trainers,” says Robitaille.

In the third stage, it’s time to focus on goals. After working toward employment, volunteering, or continuing education, it’s now time to focus on some short and long-term goals. Clients get to check in with their treatment team to discuss the best options for moving forward. They can also rely on Colorado Recovery’s local community partners to help make those goals a reality.

The fourth stage is all about maintaining a routine surrounding all of the healthy habits clients are learning. This helps increase structure and stability.

The fifth stage allows clients time to reflect on how far they have come and where they are headed as they prepare to leave the transitional living program. In the final stage, clients work through logistical preparation while they enjoy lots of access to support. They work on packing, making purchases, and organizing their new home. They are now well prepared for success!

“Our mission is to help people become more independent,” says Bianchi.

If you have questions about our transitional-living program or our other services to treat schizophrenia, bipolar disorder, and similar mental illnesses, call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

The Difference Between Unipolar and Bipolar Depression

Bipolar disorder and major depression share some similarities. They are sometimes confused because both can include depressive episodes, but there are some key differences. 

The main difference between the two is that depression is unipolar, meaning that there are no periods of abnormally elevated mood, while bipolar disorder includes symptoms of mania.

In a recent article for PsychCentral, Sonya Matejko explored the distinction between the two conditions. “To put it simply, unipolar depression is another name for major depressive disorder (MDD), also known as clinical depression,” she wrote. “This mood disorder is characterized by a persistent feeling of sadness or a lack of interest in things that you used to enjoy.”

According to the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) used by psychiatrists to diagnose mental health conditions patients must experience the following to receive an MDD (unipolar depression) diagnosis:

  • symptoms for two weeks or longer
  • episodes of depression or significant loss of interest, or both
  • a change in the way you previously functioned

Diagnostic criteria include experiencing five or more of the following symptoms in a two-week period:

  • feeling sad or irritable
  • trouble falling asleep
  • feeling worthless or guilty
  • intense feelings of restlessness
  • change in appetite or sudden weight loss
  • lack of energy or unusual sense of tiredness
  • loss of interest in activities you once enjoyed
  • difficulty with decision making or concentrating
  • having thoughts about self-harming

In unipolar depression, there is one prolonged mood episode—a major depressive episode, i.e. a period characterized by symptoms of major depressive disorder. “This is in comparison with other mental health conditions, like bipolar disorder, which may lead you to experience changes in your mood, from depression to mania, an elevated mood state,” wrote Matejko. 

Bipolar depression, on the other hand, is a term used to describe depression within bipolar disorder. It’s not so much a condition by itself but rather a symptom of depression for someone living with bipolar disorder.

According to the American Psychiatric Association, “people with bipolar disorder experience intense emotional states that typically occur during distinct periods of days to weeks, called mood episodes. These mood episodes are categorized as manic/hypomanic (abnormally happy or irritable mood) or depressive (sad mood). People with bipolar disorder generally have periods of neutral mood as well.”

The National Institute of Mental Health lists three types of bipolar disorder: 

Bipolar I disorder is defined by manic episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospitalization. Usually, depressive episodes occur as well, typically lasting at least two weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible.

Bipolar II disorder is defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of bipolar I disorder.

Cyclothymic disorder (also called cyclothymia) is defined by periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least two years in adults. However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, irritable, or energized behavior (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

It is primarily the alternation between mood episodes that differentiates bipolar depression from unipolar or clinical depression. The most significant difference is that the latter does not include episodes of mania as a major symptom.

Colorado Recovery provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Providing Fulfilling Employment For People With Schizophrenia

“Can people with schizophrenia work?” journalist Gina Ryder recently asked on PsychCentral.com. The Answer: Absolutely! The real question is what kind of job works best for individual people.

Meaningful employment is an important aspect of the treatment model originated by Colorado Recovery founder, Richard Warner. “Work is central to the development of self-esteem and in shaping the social role of the mentally ill person,” Dr. Warner wrote in The Environment of Schizophrenia. Finding suitable employment for clients thus becomes an important part of the treatment approach.

“Outpatient clinical services are transitioning from a medical model with an illness focus to a patient-centered model with a holistic emphasis on well-being and functioning,” wrote Cohen, Hamilton, et al. in a 2016 study. “Recovery from serious mental illness has various operational definitions, but there is consensus around definitions that emphasize the ability to live a fulfilling and productive life in spite of symptoms.”

Central to that fulfilling and productive life is the ability to contribute in a meaningful way. “Treatment should include social rehabilitation,” wrote Dr. Warner. “People with schizophrenia usually need help to improve their functioning in the community. This can include training in basic living skills; assistance with a host of day-to-day tasks; and job training, job placement, and work support.”

Gina Ryder provided a list of widely accepted strategies helpful for people with schizophrenia who are trying to fulfill career goals:

  • Staying away from nonprescription drugs, alcohol, stressful situations, and other triggers
  • Reaching out for social support from allies
  • Taking medications as directed (medication compliance)
  • Practicing strategies learned from cognitive behavioral therapy (CBT)
  • Creating a soothing and simplified environment, such as clearing clutter or playing music
  • Engaging in spirituality
  • Focusing on well-being through exercise and diet
  • Continuing education

She then offered three additional strategies that may help people with schizophrenia take action toward their career goals:

  • Explore careers that work for you
  • Maintain routine care
  • Heal from negative past job experiences

These are the main pillars in the vocational program at Colorado Recovery. We offer a variety of vocational services to help clients with bipolar and schizophrenia with their short-term and long-term career goals, including job seeking and retention skills, career exploration, and resume creation.

To stay motivated, it is important to leave previous negative job experiences behind.

“If you’ve experienced past work struggles, such as encountering stereotypes, low performance reviews, or unfair termination, you may have internalized some discouraging beliefs that can keep you from getting back out there,” Ryder wrote.

“Defeatist beliefs and amotivation are prominent obstacles in vocational rehabilitation for people with serious mental illnesses,” wrote Mervis, Fiszdon, et al. in 2016. Defeatist beliefs are often driven by stigma and stereotypes people with mental illness still encounter on an almost daily basis.

At Colorado Recovery, treatment professionals empower their patients by giving them roads to be productive, to help them perceive a positive meaning in life, a sense of belonging and community that can significantly improve treatment outcomes.

People with mental illness can thrive in the work environment if the job is compatible with their condition. As a member of the Employment Alliance that works with the Boulder Independent Business Association, Colorado Recovery works proactively to provide employment to people with psychiatric disabilities.

The vocational workers from the participating mental health agencies provide support to the employer and the newly placed employees. On-site job coaching is provided, when needed, to ensure the success of the placement.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Bipolar Disorder Linked to Increased Risk for Cardiac Disease

Bipolar disorder (BD) is a serious mental illness. According to the American Psychiatric Association, “people with bipolar disorder experience intense emotional states that typically occur during distinct periods of days to weeks, called mood episodes. These mood episodes are categorized as manic/hypomanic (abnormally happy or irritable mood) or depressive (sad mood). People with bipolar disorder generally have periods of neutral mood as well. When treated, people with bipolar disorder can lead full and productive lives.”

Unfortunately, people with BD face elevated medical health risks as well. According to a study published in Psychosomatic Medicine, they are more likely to experience a major adverse cardiac event or MACE.

“Researchers analyzed data from the Rochester Epidemiology Project (REP) provided by clinicians in Olmsted County, Minnesota, of individuals older than 30 years who sought primary care between 1998 and 2003,” reported Mary Stroka on Psychiatry Advisor. “They excluded patients with a known history of coronary artery disease, stroke, atrial fibrillation, or heart failure.”

The investigators found that individuals with bipolar disorder were also more likely to present with other risk factors such as “higher body mass index (BMI), hypertension, diabetes, chronic kidney disease, current smoking, alcohol use disorder (AUD), and substance use disorders (SUD). They had lower diastolic blood pressure values and high-density lipoprotein (HDL) cholesterol levels.”

“The hazard ratio for MACE was higher for all risk factors, AUD, bipolar disorder, and major depressive disorder (MDD),” Stroka wrote. “An inverse relationship was reported for MACE and HDL.”

After adjusting for age and sex, the investigators reported an association between bipolar disorder and MACE. That association remained significant after adjusting for smoking, diabetes, hypertension, HDL, BMI, age, and sex, as well as adjusting for AUD, SUD, and MDD.

“Our findings also underscore the importance of the future development of medical and lifestyle interventions to more effectively address the burden of [cardiovascular disease] in patients with [bipolar disorder],” the investigators said. “Such interventions may need to be tailored to the unique challenges presented in [bipolar disorder] and will require interdisciplinary collaborations between psychiatry, psychology, cardiology, physical medicine and rehabilitation, case management, occupational and physical therapy, and likely several other disciplines.”

The study illustrates that effective treatment of bipolar disorder requires a holistic approach. The late founder of Colorado Recovery Richard Warner believed that recovery from mental illness should involve much more than getting rid of symptoms and staying out of the hospital. “It is about regaining a sense of identity, belonging, and meaning in life,” he said.

Dr. Warner’s system at Colorado Recovery includes a residential treatment program, a transitional program, and an intensive outpatient program, and a “clubhouse” community mental health service model. The Warner model is based on a warmer and more human familial setting, comprehensive levels of care that result in a path of self-reliance, and community engagement for connection and a feeling of contribution.

Having a productive role in life is an important part of mitigating the effects of mental illness. This in turn can help reduce secondary health risks such as cardiac events, substance use disorder, and depression.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

The Role of Synaptic Dysfunction in Schizophrenia

“Schizophrenia is an often misunderstood chronic mental illness that causes psychosis,” wrote Anna Guildford in a recent article for Medical News Today

It is a “debilitating, complicated mental disorder that affects 20 million people globally.

In his book, The Environment of Schizophrenia, Colorado Recovery founder Richard Warner also described psychosis as a primary feature of schizophrenia, calling it “a severe mental disorder in which the person’s emotions, thinking, judgment, and grasp of reality are so disturbed that his or her functioning is seriously impaired.”

“People with schizophrenia have a unique combination of symptoms or experiences,” explained Guildford. They may include feeling disconnected, hallucinations, hearing voices, delusions, and confused thinking or speech.

“There is no single organic defect or infectious agent which causes schizophrenia,” wrote Dr. Warner and it remains unclear what biological mechanisms are involved. Researchers have long suspected differences in brain chemistry to be the cause of schizophrenia. People with the condition typically have differences in their neurotransmitters, i.e. chemicals that control communication within the brain.

“Growing evidence implicates synaptic proteins in the pathogenesis of neuropsychiatric disorders such as autism spectrum disorder (ASD), intellectual disability (ID), and schizophrenia,” wrote Caldeira, Peça, and Carvalho in their 2019 study on synaptic dysfunction in neuropsychiatric disorders.

According to a new study by Adams, Pinotsis, Tsirlis, et.al., the imbalance of nerve cell activity responsible for the condition and its associated symptoms may result from the body trying to rebalance excitatory and inhibitory functions. Dr. Rick Adams, a Research Fellow at the Centre for Medical Image Computing at University College London, UK, explained to Medical News Today that “there is an enormous amount of indirect evidence that synaptic gain decreases in schizophrenia. This means that excitatory neurons have a reduced ability to stimulate one another.”

Dr. Adams and his colleagues used computational modeling of electroencephalography (EEG) to record brain activity and measure overall synaptic gain. They collected EEG data from 272 participants, which comprised 107 with diagnosed schizophrenia, 57 of their relatives, and 108 control participants. Each participant underwent three EEGs and a resting functional magnetic resonance imaging (fMRI).

Dynamic causal modeling of the EEG experiments and fMRI data showed changes in the group of people who had received a diagnosis of schizophrenia. “The altered brain waves in those with diagnosed schizophrenia occurred due to a loss of synaptic gain, or excitability,” reported Guildford. “The hallucinations and other symptoms of schizophrenia were, however, associated with loss of neural inhibition.”

“This might mean that the loss of excitation comes first, then the brain tries to compensate for this by reducing inhibition, but then this leads to hallucinations,” Adams told Medical News Today.

Despite a great deal of pharmaceutical investment, there is still not a targeted drug to treat schizophrenia by understanding the biology of the disease and identifying the receptors and processes involved. Adams believes “if future studies can establish this, it means we should be able to give treatments that change excitatory or inhibitory function at the right time and to the right people.”

Such a targeted drug to treat schizophrenia is not yet available, though, and pharmacological approaches can only be a partial solution.

“Medications are an important part of treatment but they are only part of the answer,” wrote the late Colorado Recovery founder Richard Warner, MD, in The Environment of Schizophrenia (2000). “They can reduce or eliminate positive symptoms but they have a negligible effect on negative symptoms.”

The empowerment of patients and vocational rehabilitation are equally important elements in the treatment approach at Colorado Recovery. Our program approaches mental healthcare with a focus on self-reliance through developed practiced skills. Our non-institutionalized philosophy offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

The Power of Engagement and Employment

Having a job, receiving a paycheck, and being able to support themselves can significantly improve the quality of life for people with mental illness. Meaningful employment is an important aspect of the treatment model originated by Colorado Recovery founder, Richard Warner. “Work is central to the development of self-esteem and in shaping the social role of the mentally ill person,” Dr. Warner wrote in The Environment of Schizophrenia. 

Finding suitable employment for clients thus becomes an important part of the treatment approach. “Patients can improve dramatically in a short period of time, even in an outpatient setting,” explained relocation counselor Dalma Farkas.

Colorado Recovery recently started admitting clients directly into the intensive outpatient program (IOP) and several of them quickly found employment appropriate for their condition and were able to enjoy new social connections as well.

“One client managed to transition from a stressful 12-hours-a-day job that made his condition worse to a much more appropriate employment,” said Farkas. “The IOP employment group put their heads together and found a much better job for that client who is doing much better now.”

People with mental illness can thrive in the work environment if the job is compatible with their condition. At Colorado Recovery they get all the help they need to find the right job, write a skillful application, and prepare for sometimes tough job interviews—in addition to individual and group therapy sessions.

Joining the Colorado Recovery IOP enabled several clients to find jobs quickly and thus strengthen their sense of belonging and purpose. The treatment program at Colorado Recovery aims to empower people with mental illness with an unrelenting optimism for recovery, purposeful involvement in the community, and an enhanced sense of meaning in life.

“Work helps people recover from schizophrenia,” wrote Dr. Warner in The Environment of Schizophrenia. “Productive activity is basic to a person’s sense of identity and worth.”

Having a steady income and engaging with people in the workplace and the wider community can have a strong therapeutic effect on people with a variety of mental illnesses. “One of our clients found a new job and was right away invited to a Halloween party by his new colleagues,” remembers Farkas. “He was pretty happy about that.”

 

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Antipsychotics and Cognition in the Treatment of Schizophrenia

“People with schizophrenia can be treated in a variety of settings,” wrote the late Colorado Recovery founder Richard Warner, MD, in The Environment of Schizophrenia (2000). “Medications are an important part of treatment but they are only part of the answer. They can reduce or eliminate positive symptoms but they have a negligible effect on negative symptoms.”

Antipsychotics, also known as neuroleptics have had a dramatic impact on the treatment of schizophrenia since they were first introduced in the 1950s. “Time after time, in many thousands of treatment settings, clinical experience has shown that the antipsychotic drugs can bring dramatic relief from psychotic symptoms in most schizophrenic patients,” Dr. Warner wrote in Recovery from Schizophrenia.

In a recent presentation for Psych Congress Network, Leslie Citrome, MD, MPH, clinical professor of psychiatry and behavioral sciences at New York Medical College, Valhalla, NY, examined neurobiological targets, the current research regarding antipsychotics, and other schizophrenia treatment options. “As we are working towards improvement in the pharmacological approaches to schizophrenia, greater attention has been paid to cognition.”

“The neurobiology of cognitive impairment in schizophrenia is complex and does involve the interplay of a number of neurotransmitter systems. They include our favorite players here, dopamine, but also glutamate and acetylcholine,” said Dr. Citrome.

“The role of dopamine has long been of interest to schizophrenia researchers because drugs such as amphetamines that increase dopamine’s effects can cause psychoses that resemble schizophrenia, and drugs that block or decrease dopamine’s effect are useful for the treatment of psychoses,” wrote Dr. Warner in The Environment of Schizophrenia.   

The current focus is on “the dorsolateral prefrontal cortex or DLPFC, and its interactions with other brain regions,” explained Citrome. “Now, in the DLPFC, dopaminergic transmission is mainly mediated through dopamine D1 receptors, not D2.”

“Chronic low levels of dopamine in the DLPFC in people with schizophrenia have been demonstrated,” Citrome said. “This is very different from our understanding of the positive symptoms of schizophrenia, which are thought to be due to excess amounts of dopamine in the ventral striatum, and where the dopamine D2 receptor is the target of antipsychotic medications.”

So, it seems to be D1 versus D2—a case of “not enough dopamine” versus “too much dopamine.” 

“Actually, what we have in the brain is too much dopamine in one place and too little in the other,” said Citrome. How can this be remedied? “Second-generation antipsychotics also possess strong antagonism at presynaptic serotonin 5-HT2A receptors on the dopaminergic neuron. This facilitates the release of dopamine and theoretically boosts the dopamine levels in the DLPFC. However, attempts to measure this effect have resulted in disappointment,” Dr. Citrome said.

Many studies have been done with second-generation antipsychotics comparing them generally with the classic first generation antipsychotic Haloperidol. As it turned out, “there were only small improvements compared to Haloperidol and very little difference amongst the second-generation antipsychotics themselves.”

Citrome suggested that we have to look at other neurobiological targets. “Of increasing interest is the glutamate system, with its connections with dopamine circuitry. Glutamate is widely distributed in the brain, and it’s the primary excitatory neurotransmitter” in the human central nervous system.

“Experimentally, glutamate has shown to be involved in neuroplasticity and higher cognitive functioning, such as memory,” Citrome said. “In the DLPFC, NMDA glutamate receptors are involved in high-level processes, such as executive functioning.”

The final common pathway, though, is dopamine. “Glutamate neurons regulate the dopamine neurons, either directly, boosting dopamine, or indirectly, acting as a brake, decreasing dopamine. Depending on where we look, we see either effect,” explained Dr. Citrome.

The NMDA receptor has been a target of significant interest in terms of improving its functioning. One theory of schizophrenia is the hypo-functioning NMDA receptor hypothesis. “We can’t give glutamate, but if we give medicines or other interventions that boost signaling in the NMDA receptor” we can boost its functioning.

One option is to increase glycine at the NMDA receptor. Glycine is required for the NMDA receptor to function and theoretically, hypo-functioning NMDA receptors can be boosted by providing more glycine.

“We can do that with a glycine transporter inhibitor, GlyT1 inhibition,” said Dr. Citrome. “You’re going to hear about this. There is a medicine currently being evaluated for this purpose.”

Concluding his presentation, Citrome said that “cognition is an important determinant of function, and cognitive impairment is very common in people with schizophrenia. The effect of medications on cognition is actually independent of how well they work on the positive symptoms. We know we can treat the positive symptoms quite well, but our second-generation antipsychotics don’t quite do the job with cognition. One strategy is to improve on that.” 

“In the meantime, we have vocational rehabilitation. We have cognitive remediation, and we should use those to the hilt while waiting for a more definitive intervention,” Dr. Citrome said.

Vocational rehabilitation is an important element in the treatment approach at Colorado Recovery. Our program approaches mental healthcare with a focus on self-reliance through developed practiced skills. Our non-institutionalized philosophy offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation. 

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.