Bipolar Thought Deficits: What We Can Learn From Schizophrenia Research
A few weeks ago, in the Ask feature here at BipolarConnect, Nathan wrote:
"Is bipolar the same as schizophrenia? I know a person who has bipolar and another friend of mine says it's just a fancy name people use for schizophrenia. Is this true?"
My quick reply: "Absolutely not true. Bipolar is a MOOD disorder. Schizophrenia is a THOUGHT disorder. There is some overlap, but we can save that discussion for another time."
Now is a good time for that discussion. This week I attended the International Congress on Schizophrenia Research, held in San Diego. As an illustration of the brain power at this conference, at one of the sessions, sitting in the same row as me, was Nobel Laureate Arvid Carlsson.
I was there because schizophrenia research sheds tremendous light on bipolar. Yes, bipolar and schizophrenia are very different illnesses, but there is a lot of overlap between the two, and the same principles of brain science apply to both.
My first insight into this came in 2001 from a review article by Carrie Bearden, now of UCLA, which clearly showed there was a lot more to mood disorders than just mood. A lot of us experience difficulty thinking clearly, even when we're not depressed or manic or on meds. After reading Dr Bearden's article, I started paying a lot closer attention to "the other stuff" that was going on in our brains.
I got a chance to meet Dr Bearden very briefly in 2006 at a bipolar conference in Edinburgh, and had a chance to talk with her more in depth here at the schizophrenia conference. Since she is one of the few researchers studying both illnesses, it is worth quoting from a recent essay of hers:
"Current classification schemas are based on particular clusters of symptoms and clinical course descriptors that do not necessarily describe homogeneous conditions, but rather reflect final common pathways of various pathophysiological processes."
In other words, if we really want to learn what is going wrong inside our brains, we need to be thinking outside the DSM box. Symptoms are merely the end result of what is going on inside the brain, and there are numerous pathways to any particular symptom.
In short, sometimes it pays not to think in terms of make or model, schizophrenia or bipolar. Instead, open up the hood of the brain and take a close look inside. A defective carburetor is a defective carburetor whether it's a Chevy or a Ford.
When it comes to looking under the hood, the schizophrenia researchers have at least a 20-year head start over their counterparts in bipolar. They are much better funded and publish a lot more articles. Let's put it this way: by attending a schizophrenia conference, I stand to gain a lot of insight into bipolar, more so, in fact, than some of the bipolar conferences I have attended.
Psychosis gets all the attention in schizophrenia, but the researchers here were more focused on other cognitive deficits, such as how the brain processes information and performs basic tasks. In other words, schizophrenia is not just about hallucinations and delusions. We have medications that can stop psychosis dead in its tracks, but then we're still left with the problem of non-psychotic patients smoking in day rooms, unable to make a go of it in the real world.
If I were attending this conference say six or eight years ago, I asked the people there, would I be seeing this same emphasis on cognitive deficits? Or would psychosis be far more on display?
Far greater focus on psychosis, was their unequivocally unanimous response.
Our current thinking about bipolar is where schizophrenia used to be. The emphasis is on depression and mania. Very little thought goes into thought. Thanks to researchers like Dr Bearden and others, that is changing. Granted, in bipolar, our thought deficits are not nearly so malignant as those in schizophrenia. But clearly, they hold us back in our recovery.
Again, there are parallels to schizophrenia: Obviously, in schizophrenia you need to knock out the psychosis. Nothing else is going to work until you get that aspect of the illness under control. Similarly, with mood disorders first we need to get a handle on the depression and mania. Working on improving our cognitive function is a non-starter when our moods are in charge of our brain.
So now that you know that your brain is far more messed up than you thought it was, here is the good news:
The brain is plastic. Every minute of every day it is laying down new roadwork, and you have a large say in remapping all that roadwork. Think of learning something new, such as swinging a golf club. The same principles of "practice makes perfect" apply to improving our more basic cognitive functions, such as holding a thought in our working memory long enough to lay down that roadwork.
No surprise, the schizophrenia people are on the case. They are working with patients using specially-developed computer games to improve these basic skills, with lasting positive results. All this is new, and you will be hearing much more about it in weeks and years to come. Clearly, a lot of it will be adapted to bipolar.
In the meantime: crossword puzzles, sudoku, challenging hobbies, socializing with others. You get the picture ...
On one hand, by owning up to our cognitive weaknesses, we are acknowledging that our illness may be worse than we once thought. On the other, knowing that we can do something about it holds out the prospect of getting better than we ever imagined.
Clearly, we have a lot to learn from schizophrenia. Clearly, I will be attending many more schizophrenia conferences ...