Psychiatric illnesses are diseases of the brain, but so are neurological illnesses and delirium. Before we talk about what mental illness is, let’s briefly discuss what it isn’t. As with much in medicine, the lines between the categories of diseases are often gray and hazy, and this is particularly true when classifying diseases as “neurologic” or “psychiatric.” Generally speaking, a neurologic illness is a brain disorder that is caused by an identifiable cause like an ischemic stroke (a plague blocking an artery that supplies the brain causing that part of the brain to die), an intracranial bleed, or a mass lesion like a tumor. There are also a plethora of diseases that historically have fallen under the realm of neurology even though the causative process isn’t as obvious as a dead portion of the brain, a giant blood clot in your noggin, or a tumor lunching on your noodle. These diseases include epilepsy, multiple sclerosis, and the dementias—the slow decline of cognitive abilities—the best known of which is Alzheimer’s disease. Finally, delirium—a rapid decline in mental status—is also exempted from the realm of psychiatry because most of the causes of delirium are readily identifiable and reversible (e.g. being intoxicated on a bunch of drugs, or being so sick with severe pneumonia that your brain checks out for a few days).
So that’s what mental illness isn’t. Now let’s briefly review the main categories of psychiatric disease and, hopefully, dispel some common misconceptions about them along the way.
Psychosis is a chronic disturbance of reality that often presents with auditory hallucinations (hearing voices) and with delusions—fixed false beliefs that persist even when the patient is presented with overwhelming evidence to the contrary. Delirium can present with hallucinations too, but the difference is that people with delirium become this way rapidly and then snap out of it once whatever is causing the delirium is fixed. Delirious people tend to be totally out of it—not oriented to person, place, or time. In contrast, psychosis is usually chronic, developing over time and presenting with someone who is alert and, relatively speaking, “with it.” Schizophrenia is the best known psychotic disorder and John Nash, the mathematician from the excellent movie, A Beautiful Mind, is an extremely high functioning schizophrenic.
Schizophrenia can be treated with antipsychotic medications; unfortunately, these medications tend to have really horrible side effects, including causing Parkinson’s Disease type movement disorders (shuffling gait, rigidity, “pill-rolling” tremors of the hands) and an involuntary movement disorder of the face that is called tardive dyskinesia. Interestingly, all antipsychotics exert their antipsychotic effects by blocking dopamine—people with Parkinson’s Disease have the opposite problem, not enough dopamine, and one of the primary treatments for that disease is with a dopaminergic medication called levodopa.
Bipolar Disorder is not “split” or “multiple personalities!” Bipolar disorder is a disease that is characterized by alternating between severe depression and mania. Mania is an extremely elevated mood that is closely akin to how people feel/look when they are high on cocaine or methamphetamine. Mania is characterized by the mnemonic “DIG FAST”—Distractibility; Irresponsible behaviors; delusions of Grandeur; Flight of ideas; increased Activity; decreased need for Sleep; and Talkativeness. A manic person is like Woody Woodpecker, bouncing all over the place and talking a million miles per hour! Mania causes people to do really stupid things, like blowing all their savings in one day or having sex with a dozen people that they’ve just met over the course of a week. In bipolar disorder, depression follows mania and the depression is often severe. These patients have a very high risk of committing suicide, as evidenced by Kurt Cobain, the lead singer of Nirvana, who suffered from bipolar disorder. Another famous person with bipolar disorder was Leonardo DaVinci, who lived into old age and died from natural causes with the King of France holding his hand in a gesture of support and respect for the great man.
Tomorrow we’ll discuss depression and the anxiety disorders. Thanks for visiting!
Dr. Leonardo Noto
Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis.
Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in private practice. Dr. Noto is the author of four full-length works and he also writes for a medical education corporation that assists medical students, interns, and residents as they prepare for the medical board examinations. Dr. Noto is the proud father of an extremely spoiled 11-month-old American bulldog who enjoys slobbering and tearing up things that he is not supposed to. Dr. Noto is an amateur practitioner of muay Thai and Brazilian jiu jitsu and he is currently learning to play the guitar (but he is currently a quite terrible musician, as his neighbors will readily attest).
Remember to discuss all health concerns with your personal physician (I don’t count!). This blog is intended to present general medical information for entertainment purposes and not as a specific guideline to any medical treatment. The author has made every effort to present accurate information; however, due to the ever-changing nature of medicine and the intrinsic caveats that are inherent in any particular case, no medical decisions should ever be made based on information gleaned from the internet. The internet and self-education are great, but they don’t replace your doc!