HYPOTESIS OF BIPOLAR ORIGIN OF PSYCHIATRIC ILLNESS.
Classical psychiatrists endeavored to cluster various signs and symptoms into different disorders. Consequently coherent system of classification emerged which looked logical on paper. Nevertheless, practical realities don’t get neatly fit into this template. Most of time psychiatrists come across mix pictures of presentation. Anxiety disorder, affective disorders, thought disorders and etc are found mixed up. Currently co morbidities are attached frequently to describe the situation. This indicates that possibly different classes of psychiatric disorders despite being distinct entities have some common substrate .Schizophrenia, bipolar affective disorder and OCD are like primary colors spectrum of psychiatric illnesses .From these primary diseases complete range of signs and symptoms of psychiatric all psychiatric illnesses can be derived. Psychiatric studies have established that prevalence of co morbidities is much higher than what was conceived when classification of disease was initially made. When symptom of patient suffering diseases is studied symptoms presentation shows visible dichotomy. Some patients show symptoms which are found in classical diseases other shows a confusing mixture of diseases. This has led to propounding of hypotheses of bipolar origin of psychiatric illness. At one pole is pure form of disease and at other is conjoint pool of diseases which may be called unitary psychosis.
Record of signs and symptoms patients of bipolar ,schizophrenia and OCD was studied .Among neurosis OCD was selected as it inhere features found distributed in rest of the neurosis .Contents of obsessions ,compulsions, hallucination .and delusions, oddities of behaviors were studied. An electronic search was made at different database websites like Medline, science direct, psychiatrist.com to study status of co morbidities in three major illnesses.
Study of records shows that signs and symptoms of particular diseases were not same when it was having co morbidities with it. This review supports the hypothesis that important psychiatric illness can originate from than two different sources and can evolve with two different pathophysiological systems. Final picture of diseases is sum total of pathology of two poles. Disease exhibits changes in its presentation as it originate from it pole and progress along its course.
Study of co morbidities revealed substantial overlapping of OCD, schizophrenia and bipolar.
Mutual strong correlation among OCD, schizophrenia, and bipolar indicates that theses entities are not water tight chambers. They have some common origin or at some stage, same underlying mechanism. This shared pathophysiology of theses diseases is conjoint pool of diseases which has been termed as unitary psychosis. When conjoint pole dominates diseases process co morbidities become more palpabable. In some of the case all components of conjoint pool manifest in serial manner. In quest to understand and preempt disease before it becomes apparent prodromal symptoms of various diseases are being studied. These prodromal symptoms are mixture of schizophrenia, OCD and bipolar .Presence of symptoms in muddle forms point toward existence of some undifferentiated form of psychiatric diseases. Newer psychopharmacological agents like atypical antipsychotics have exhibited their efficacy in broader spectrum of disorders because wider range of affinity of receptors. More researches are required to understand this complex phenomenon of diseases with and with out co morbidities. This would help better understanding and management of psychiatric diseases.