User:Sfatima 12/Comparison of bipolar disorder and schizophrenia

Article Draft
Both Schizophrenia is a primary psychotic disorder, and whereas, B ipolar disorder is a primary mood disorder which can also involve psychosis. Both S chizophrenia and  B ipolar disorder are characterized as critical psychiatric disorders in the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5). There are several prime causes of disability worldwide that are linked to Schizophrenia and Bipolar disorder. Moreover, Both disorders are heritable and have significant genetic components. Evidently, because of some similar symptoms, differentiating between the two can sometimes be difficult; indeed, there is an intermediate diagnosis termed schizoaffective disorder. Simply stated, people who exhibit the symptoms of both mood (Bipolar disorder) and psychotic (Schizophrenia) disorder are diagnosed with Schizoaffective disorder (SAD).

While reported and observed symptoms are a main way to diagnose either disorder, recent studies use the advanced technology like magnetic resonance imaging (MRI) scans to try to understand the biology of mood and psychotic disorders. Through MRIs, psychiatrists can see specific structural differences in the brains of people with schizophrenia and Bipolar disorder. These differences include volume of gray matter, neuropathological size differences variations and cortical thickness, which are associated with cognitive differences on tests. These differences may sometimes be seen throughout the lifespan of the diseases and often occur soon after the initial episode. In treating the Bipolar disorder and Schizophrenia, there are several paths that psychiatrists and psychologists take, some are similar and others are different. However, there are a few conflicts regarding the medical and therapeutic treatments considering the long-term affects and relapse issues in treating both disorders.

Causes and Epidemiology
Both bipolar disorder and schizophrenia appear to result from gene–environment interaction. Evidence from numerous family and twin studies indicates a shared genetic etiology between schizophrenia and bipolar disorder. Researchers found a combined heritability for bipolar disorder and schizophrenia of approximately 60%, with environmental factors accounting for the remainder. Genetic contributions to schizoaffective disorder appear to be entirely shared with those contributing to schizophrenia and mania.

Bipolar I disorder and schizophrenia each occur in approximately 1% of the population; schizoaffective disorder is estimated to occur in less than 1% of the population.

(I am keeping the information as it is in the existing article because I believe it is doing a job of comparing the two disorders. Below, I went into further details of causes and epidemiology of these disorders individually.)

Schizophrenia:
Schizophrenia is caused by a combination of genetic and environmental factors. Research illustrates that schizophrenia is hereditary and is more likely to strike those who carry particular genes. It is believed that those who are susceptible to the disorder are affected by something in their environment. According to research, alteration in the concentrations of specific chemicals in the brain may also contribute to Schizophrenia. Among the 1% of the population affected by this disorder, it is recorded that men are more susceptible than women to being impacted. The disorder typically shows symptoms during adolescence.

(Edited the causes presented initially in the article with an elaboration of each. Also, added other causes researched associated with the disorder).

Bipolar Disorder:
There is no conclusive evidence as to what triggers it, but genetic and environmental factors are both being considered as probable causes. It is believed that genetic factors contribute a role in its development. However, not everyone with a family history of bipolar disorder develops the disorder. According to research, people with specific genes are more likely to develop the disorder (Jann, 2014). Stress, for example, can also precipitate the onset of bipolar disorder.

Furthermore, certain environmental factors, such as virus exposure or malnutrition, may increase the risk. Studies using Magnetic Resonance Imaging (MRI) have shown that people with schizophrenia have amygdala volumes that are significantly lower than those of people with bipolar disorder and healthy controls.

(Elaborated on the information of the disorder with other sources material. Detailed description for the specific disorder).

Signs and Symptoms
During severe episodes of mania or depression people with bipolar disorder may have psychotic symptoms, such as hallucinations or delusions. When experiencing hallucinations or delusions, people with schizophrenia often seem to "lose touch" with reality. "Voices" are the most common type of hallucination in schizophrenia. In bipolar disorder, the psychotic symptoms tend to reflect the person's extreme depressed or elated mood (mood congruence). People with either disorder may have delusions of grandeur in which they believe they are a famous person or historical figure. When psychotic symptoms are present, bipolar disorder is sometimes misdiagnosed as schizophrenia.

Other symptoms of schizophrenia, including lack of pleasure, difficulty making decisions, and difficulty focusing, are similar to some symptoms of depression seen in bipolar disorder. Jumping from one idea to another and being unusually distracted during a manic episode may resemble the disorganized thinking that is characteristic of schizophrenia.

Substance abuse is a complicating factor for both conditions, making symptoms more difficult to recognize as a mental illness and interfering with treatment efficacy and adherence.

Unlike schizophrenia, bipolar disorder has very little differences for gray matter volume. Overall, there is no difference in brain tissue volumes between bipolar patients and healthy control patients.

Biological
Patients with schizophrenia have some gray matter volume loss in both hemispheres of the brain. Patients with Schizophrenia have abnormal brain activities which include changes in brain structure or function and abnormal levels of neurotransmitters. These changes may be associated with abnormal social or emotional functioning.

(Added biologically specific symptoms of the disorder)

Grey Matter
To be exact, patients with Schizophrenia lose the volume of the grey matter in both hemispheres of the brain specifically in the left thalamus and the right caudate. Furthermore, the grey matter loss extends in to the cerebrum, Parahippocampal gyrus and hippocampus. However, the gray matter increases in the temporal and parietal lobes along with the anterior cerebellum. When patients with schizophrenia are compared to healthy participants, there is a decrease in gray matter volume in prefrontal and temporal regions. The only region in which the volume increases for gray matter is within the right cerebellum, an area that contributes to the cognitive, affective, perceptual, and other deficits seen in Schizophrenia.

Neuropathological:
Magnetic resonance imaging studies found that schizophrenia is associated with significantly smaller amygdala volume compared to both healthy controls and participants with bipolar disorder. Although there was no significant difference in amygdala volume between individuals with bipolar disorder and controls, amygdala size in the group with bipolar disorder was positively correlated with treatment using mood stabilizer medications This is important to consider as mood stabilizers like lithium appear to have protective and growth-stimulating effects in multiple regions of the brain, including the amygdala. Thus, it is possible that the size differences of the amygdala are due to medication rather than disease. Even so, the amygdala might still be a place of partially shared pathophysiology between these disorders.

Besides the amygdala, there are other neuropathological areas of degeneration as well; the overall brain volume can also be measured. Research shows that the overall brain volume is not statistically significantly different between patients with bipolar disorder and patients with schizophrenia, except when making comparisons in the intracranial volume. A larger intracranial volume is present in the brains in bipolar disorder, but no variation occurs in the brains of people with schizophrenia.

Behavioral
Includes withdrawal from social interaction, disorganized speech or behavior, and abnormal motor behaviors. Disorganized speech can include rambling, incoherence, or abruptly switching between topics. People who have schizophrenia may also have delusions or hallucinations. Delusions are false beliefs not supported by evidence—for example, believing that you are being followed or watched or possessing special abilities or powers. Hallucinations are the perception of seeing, hearing, or feeling things that are not present.

(Provided more description and examples of specific behavioral signs and symptoms of the disorder.)

Biological
Unlike schizophrenia, bipolar disorder has very little differences for gray matter volume. Overall, there is no difference in brain tissue volumes between bipolar patients and healthy control patients.

However, some research has observed that patients with Bipolar disorder had abnormalities including cortical tissue and subcortical regions of brain. Left anterior lesions, whether cortical or subcortical predicts high level of depression in patients suffering from mood disorders. Both the left cortical and subcortical showed a significant relationship between the severity of depression and the location of the lesion in regard to the frontal lobe.

Behavioral
Behavioral symptoms of patients with Bipolar disorder include changes in mood, activity levels, and behavior. Bipolar disorder patients may be delighted during a manic episode and extremely sad during a depressive episode. They may also experience changes in their level of activity. They may be highly active during a manic episode and then extremely inactive during a depressive episode and exhibit behavioral changes. They may engage in behaviors they would not normally engage in during a manic episode, such as excessive spending.

(Described the specific behavioral symptoms and signs of which some are mentioned shallowly in the original article)

Treatment
While there is no cure for either condition, effective treatments can help people manage their symptoms and live productive lives.

Most treatments are designed to control symptoms and make them more tolerable due to low rates of complete remission for both disorders and poorly understood and under-researched change mechanisms. Treatments for these disorders include medication, psychotherapy, and others.

(Used the general term therapy instead of psychotherapy because therapies, in this case, are broad)

Medication
Medication is the cornerstone of treatment for both bipolar disorder and schizophrenia. Antipsychotic medications are the most commonly prescribed for both conditions. Antipsychotics work by helping to regulate the levels of certain chemicals in the brain that are involved in mood and thinking. Moreover, mood-stabilizers, such as lithium, are the primary medication treatment for bipolar disorder.

Furthermore, second generation antipsychotics (dopamine antagonist and serotonin antagonist) medications may also be used for bipolar disorder, often in combination with antidepressant medications (which typically increase serotonin availability). Antipsychotics (usually second generation but also first generation) are the major class of medications used to treat schizophrenia.

Side effects:
Common side effects of antipsychotic medications include dry mouth, weight gain, drowsiness, and constipation. Some antipsychotic medications can also cause a temporary worsening of symptoms known as akathisia.

Psychotherapy
Psychotherapy is a treatment for patients with both disorders. They guide the patients in their thoughts, and use communication or behavioral work as a means of healing. The most common and effective type of therapy is Cognitive behavioral therapy (CBT) that can help people manage their symptoms and improve their overall functioning. It aids people identify and change negative thinking and behavior patterns. CBT is used to treat both bipolar disorder and schizophrenia.

Families of the affected also benefit from this treatment, as they can sit on sessions and talk to the therapist as well. Other type of therapy that can be helpful for people with bipolar disorder and schizophrenia include family therapy, psycho-education, and support groups

Other
Rehabilitation is one of several psychosocial treatments for schizophrenia. It involves social and job-skills training to improve an individual's ability to function in society. Electroconvulsive therapy (ECT) may be used to treat bipolar disorder when other treatments are ineffective or when medication would be dangerous because of another medical condition.

Aford4706's review:

 * The edits made to the Lead clarify and update a lot of the language used. (Thanks.)
 * More information about the medication used could be added. (I am in a process of finding more information on the medications used to treat these two disorders and planning to use later in the article under the treatment section).
 * I'm not sure how much information would be found on it, but the article lacks information about marginalized demographics. This may be something worth looking into. (This is an interesting point and I looked into it, but unfortunately, could not find anything on the marginalized demographics).
 * You include information about the treatment of these 2 disorders in the Lead, though this information should be similarly transcribed in the Treatment heading. (Nice point! Noted and reworded psychological to therapeutic in the lead section).
 * I think that a new heading of Biological Factors could be created, with Gray Matter and Neuropathological being changed into subheading beneath it. (I am planning to talk about biological factors like gray matter and neuropathological factors for both disorders later in the article. I think, then, there will be no need for the new heading. But thanks for the suggestions.)

Hannachaise's review:

 * Great job on your contributions!  (Thanks!) 
 * The lead has been updated to reflect new content added, as well as added a strong and concise introductory sentence.  (Thanks). 
 * Content that has been added is extremely relevant to the topic.  (Certainly. I thought the original article needed more elaboration). 
 * None of the article seems biased in towards a specific position.  (Surely). 
 * No grammatical or spelling errors, information is also well organized into a specific section.  (Thanks). 
 * The article, so far, has great flow and is easy to follow.  (Thanks! I have added more information and still trying to compose information I found into this article). 
 * Only thing to notice would be the use of secondary literature instead of primary literature.  (Noted! I am trying to find all secondary information. Thanks for reminding me). 

Emiell490's review:

 * In the first sentence of the lead, the editor has changed it to be a comparison of bipolar and schizophrenia and their differences rather than how they relate. This provides a clear picture for what is to come later within the article.  (Certainly. I believe since the topic of the article is about comparing these two disorders, it is a good idea to give reader an insight on the comparison of these two disorders. However, I will be going deep into these disorders separately later in the article along with their comparison. This will help reader get better idea of these two disorder individually). 
 * "There are several prime causes of disability worldwide that are linked to Schizophrenia and Bipolar disorder" feels as if it is moving along to a different subject. Consider moving it elsewhere.  (That is a great point! Noted. I have eliminated this statement for now, but I will see if I can move it somewhere depending on if I can find further information on this topic). 
 * Other than these factors, the lead is clear and concise.  (Thanks for these nice suggestions). 
 * The content of this article is great, however it seems to be lacking. Consider adding in some other subjects. My suggestions are: history, treatments, and signs/symptoms of each separately. (This is a work in progress and I am still trying to find elaborated information on treatment and sign/symptoms of both separate and combined as comparison).
 * The tone of this article is neutral. There is nothing leaning towards a certain side.  (Certainly). 
 * All sources and references look correct. Links work correctly.  (Thanks for double checking). 
 * Organization of this article is great. It is set up in such a way that each topic is very clear and simple, and is not overwhelming to read through.  (I have added a few more headings to make the structure of the article more clear). 
 * Consider adding more images to this article related to the topic. There is only one image. I would suggest different brain scans of each disorder, or photos of medications used to treat these disorders.  (I have a few images that I found, and I will insert them once I move to the related section. Nice suggestion!). 
 * The article feels like a great start to comparing bipolar and schizophrenia. However, it feels small. Adding in some more scientific information, such as differences in brain scans/shapes, neurochemistry, and more could be a great addition.  (I also believed that the existing article is short and the information is very vague. I have added a little more information and I will be adding a lot more in the future. Thanks for noting and suggesting it). 

Mksearcy's review:

 * The edits you made are great! All of the grammatical errors you fixed make everything flow so much better. You’re doing great.  (Thanks!) 

Snqadri's review:
I would like you to know first of all, that I tried my very best to give you any helpful feedback I could come up with to the best of my ability. ''' (Any feedback is a good feedback and aids to improve work. So, thanks for your feedback!). ''' However, I think so far you have are right on track and honestly, probably exceeding with your revisions in comparison to what I've seen so far. ''' (Thanks). '''The information you have added to the first paragraph is a great lead into the topic as a whole and better ties together the two subjects than the existing article on it. ''' (My idea was not to jump from one idea to another but to give it a better flow and provide more information because I believed that the information was very limited as compared to what I have found while searching for the secondary sources to edit this article). ''' It is relevant, neutral, and helpful too with seeing how the two disorders are involved. ''' (Thanks). ''' The only critique I have so far is that I think you can edit the use of transitional words, particularly at the beginning of your sentences. I think without them, the information might not flow as well, but it will be more "matter of fact" and to the point which is important in scientific articles like these. ''' (This is a nice suggestion and I have added transition words in the content I added this week. However, I believe the lead section does not require additional transition words). '''

I think you did a great job with finding pertinent information to add, all of your links work, and the references themselves are credible and up to par with wikipedia guidelines.  (Thanks for double checking) . I did not note any biases and I like how you worded the final sentence to highlight that there are differing views considering the possible treatments, but you still kept it as neutral as possible. ''' (Thanks. I will go into further details on the treatments and how they conflict and I will keep this point in mind while adding or editing that information). '''

Reference
''Instructor feedback (you can delete once addressed): Please see above for some additional suggested edits. So far, you have done a nice job with edits. The article cited is an example of peer-reviewed primary literature and you will need to include (at minimum) two examples of peer-reviewed secondary literature.''