key: cord-0685471-03fky8h4
authors: Balaban, Özlem Devrim; Yildizhan, Eren; Atbaşoğlu, E. Cem
title: Two Faces of Chronic Mental Disorders in a Changing World: Schizophrenia and Bipolar Disorder
date: 2021-09-20
journal: Noro Psikiyatr Ars
DOI: 10.29399/npa.28015
sha: ccacca51f4b107b6a8d76776cba90ccf88a3e00d
doc_id: 685471
cord_uid: 03fky8h4

nan

Schizophrenia is a neurodevelopmental disorder that starts in adolescence or young adulthood and is brought about by the interplay of several pathophysiological mechanisms. Genetic factors underlying the biological and clinical features are heterogenous, and a high degree of pleiotropy is involved (1) . The lifetime prevalence is roughly 1%. The likelihood of being employed with a regular income is estimated to be as low as 10-15% (2). Bipolar disorder is a relapsing psychiatric disorder with the core features of fluctuations in mood and energy. Similar to schizophrenia, genetic and environmental factors act together in etiology and clinical course. The prevalence is about 2%, although this figure increases to as high as 5% when milder forms on the bipolar spectrum are included (3) . The World Health Organization surveys identify bipolar disorder as the second most common cause of absenteeism. The burden of bipolar disorder on the health care system has been increasing, paralleling the increase in the incidence and the associated disability-adjusted life years (4).

The burden of severe mental disorders has grown with the increase in the world population and higher life expectancy. Furthermore, the recent COVID-19 pandemic has swirled the world into a period of "mental pandemic" for the last two years. We have been witnessing a higher incidence of psychiatric disorders and symptom exacerbations, resulting in an increased demand for mental support, further expanding the burden on health system. Mitigating the negative effect of COVID-19 pandemic on mental health was recently announced as a public health priority (5).

In a changing and transforming world, access to treatment and public acceptance of those currently disadvantaged groups have come to be even more difficult. Stigmatization, obstacles on physical and mental health engagement, low income, negative factors associated with life style and poor social support have contributed to the adverse impact of the pandemic. Social isolation, quarantine and lockdown regulations have added to the stress factors, increasing the frequency of relapses (6).

A common feature of schizophrenia and bipolar is that they constitute the major diagnostic entities of what are collectively called as severe mental disorders. In addition to this, there is considerable overlap between the genetic, pathophysiologic and psychopathologic features of these disorders. Above all, we are currently far behind our expectations regarding their treatment. The prevailing view centralizes pharmacotherapy as the major treatment modality for both schizophrenia and bipolar disorder, however psychotherapeutic management including individual psychotherapy and other psychosocial methods (i.e., family interventions and rehabilitation) are also essential components of treatment (7) .

In this supplemental issue we intended to present an up to date referential source for clinicians, inviting authors whose clinical and academic specialty is schizophrenia or bipolar disorder. Arch Neuropsychiatry 2021; 58: (Supplement 1): S1−S2

We opted against linguistic restrictions for the sake of adopting a common terminology. The reader will therefore find varying terminology for similar constructs, as in the examples of "episode" and "attack", or "treatment" and "therapy". We do value the use of original Turkish language in scientific writing. Nonetheless, experts of the field chose to use the original English term when they felt that the exact equivalent of the expression would be lost in an effort of translation.

We hope the reader will find a comprehensive review of the several approaches in the life-time treatment of schizophrenia and bipolar disorder in this issue.

What it will take to make coordinated specialty care available to anyone experiencing early schizophrenia: getting over the hump

Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative

Trends in the incidence and DALYs of bipolar disorder at global, regional, and national levels: results from the global burden of Disease Study

Impact of COVID-19 pandemic on mental health in the general population: a systematic review

Management of patients with severe mental illness during the coronavirus disease 2019 pandemic

Psychosocial therapies in severe mental illness: update on evidence and recommendations

Financial Support: Dr. Özlem Devrim Balaban has been a speaker at the meetings organized by Abdi İbrahim Otsuka, Nobel and Janssen companies in the last three years.