Smoking and mental health - NCSCT

Mental disorders 1
In addition to schizophrenia, other psychotic disorders include bipolar disorder
(see below), psychotic depression, schizoaffective disorder and delusional
disorders. Recent evidence suggests that between 2 and 3% of the population will
experience a psychotic disorder at some point in their lifetime. 2
1.5.2 Bipolar disorder
Bipolar disorder (formerly known as manic–depressive illness) is characterised
by two or more episodes of intense emotional states in which mood and activity
are substantially disturbed. On some occasions mood is elevated, and energy and
activity increased (known as hypomania), or, when psychotic features are
present, the illness is described as a manic episode. On other occasions mood is
lowered, and energy and activity decreased (depression). Repeated episodes of
mania or hypomania are classified as bipolar disorder I and II respectively.
Lifetime prevalence estimates are 1.0% for bipolar disorder I and 1.1% for
bipolar disorder II. 39 Bipolar disorder is equally prevalent among men and
women, with the exception of rapid cycling, which is a severe and difficult-totreat
variant of the disorder in which four or more episodes occur during 12
months, and arises mostly in women. 40
Bipolar disorder is a chronic disorder characterised by relapses. Up to 20% of
individuals with bipolar disorder take their own life, and nearly a third of
patients admit to at least one suicide attempt. 40 However, mood stabilisers can be
very effective in preventing relapse. Risk factors include genetic vulnerability, 41
black and minority ethnicity, 42 and psychosocial stressors such as childhood
abuse or neglect, which can also predict poor outcome. 43
1.6 Personality disorder
The concept of personality disorder refers to personalities associated with
functional impairment. The term therefore refers to characteristic, enduring and
pervasive patterns of inner experience and behaviour that deviate markedly as a
whole from the culturally expected and accepted range (or ‘norm’). However, as
with other areas of psychiatric classification, the categorical nature of diagnosis
simplifies the dimensional nature of the underlying personality features. There
are several different types of personality disorder, which are classified in the ICD-
10 as paranoid, schizoid, dissocial, emotionally unstable (with subtypes of
impulsive and borderline), histrionic, anxious, dependent and anankastic. 1 Many
people have features of more than one type.
Personality disorders are common, with a community prevalence in the UK of
4.4%. 44 By definition, they significantly impair personal and social functioning,
with considerable cost to the health service, the criminal justice system and the
individual. 45 Personality disorders are associated with medical service use and
© Royal College of Physicians 2013 7