A New Study Explores Why Multiple Diagnoses Are Common With Mental Illness

Much research has been invested in identifying susceptibility genes for schizophrenia and bipolar disorder. Several well-established linkages have emerged in schizophrenia.

“Relatives of people with schizophrenia have a greater risk of developing the illness, the risk being progressively higher among those who are more genetically similar to the person with schizophrenia,” wrote Colorado Recovery founder Richard Warner in his book The Environment of Schizophrenia.

“Evidence accumulated during the 20th century for a substantial genetic contribution to the etiology of both schizophrenia and bipolar disorder, with the genetic influences initially appearing to be largely distinct for each disorder. This reinforced the traditional concept of the Kraepelinian dichotomy, in which the two disorders were viewed as etiologically independent. The picture has now significantly changed to one of partial overlap in genetic influences, although many of the details about what is shared and independent remain to be elucidated. The dichotomy concept has thus been severely weakened but persists in diagnostic classification systems,” wrote Alastair Cardno and Michael Owen in their 2014 study on the genetic relationships between schizophrenia, bipolar disorder, and schizoaffective disorder.

Not only is there an overlap in genetic influences in schizophrenia and bipolar disorder, but more than half of patients diagnosed with one psychiatric disorder will also be diagnosed with a second or third mental illness in their lifetime. About a third have four or more.

A comprehensive new analysis of eleven major psychiatric disorders offers new insight into why comorbidities are the norm, rather than the exception. The study, published in the journal Nature Genetics, found that while there is no particular gene or set of genes driving an underlying risk for all of them, subsets of disorders—including bipolar disorder and schizophrenia; anorexia nervosa and obsessive-compulsive disorder; and major depression and anxiety—do share a common genetic architecture.

“Our findings confirm that high comorbidity across some disorders in part reflects overlapping pathways of genetic risk,” said lead author Andrew Grotzinger, an assistant professor in the Department of Psychology and Neuroscience at the University of Colorado at Boulder.

For the study, Grotzinger and colleagues at the University of Texas at Austin, Vrije Universiteit Amsterdam, and other collaborating institutions analyzed publicly available genome-wide association (GWAS) data from hundreds of thousands of people who submitted genetic material to large-scale datasets, such as the UK Biobank and the Psychiatric Genomics Consortium.

They found that 70 percent of the genetic signal associated with schizophrenia is also associated with bipolar disorder. That finding was surprising as, under current diagnostic guidelines, clinicians typically will not diagnose an individual with both.

The researchers also found that anorexia nervosa and obsessive-compulsive disorder have a strong, shared genetic architecture and that people with a genetic predisposition to have a smaller body type or low body mass index also tend to have a genetic predisposition to these disorders.

The eleven disorders included in the study were schizophrenia, bipolar disorder, major depressive disorder, anxiety disorder, anorexia nervosa, obsessive-compulsive disorder, Tourette syndrome, post-traumatic stress disorder, alcohol misuse, ADHD, and autism.

While more research is necessary to find out what the identified genes do, Grotzinger sees the results of his study as a first step toward developing therapies to address multiple disorders with one treatment.

“People are more likely today to be prescribed multiple medications intended to treat multiple diagnoses and in some instances, those medicines can have side effects,” he said. “By identifying what is shared across these issues, we can hopefully come up with ways to target them in a different way that doesn’t require four separate pills or four separate psychotherapy interventions.”

Colorado Recovery provides services for adults with serious mental illnesses that will stabilize their illness, minimize symptoms, improve functioning and enhance each person’s social inclusion, quality of life, and sense of meaning in life. We provide residential and outpatient treatment options for schizophrenia, bipolar, schizoaffective disorder, and other mental health conditions. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Signs and Symptoms of Schizoaffective Disorder

Schizoaffective disorder is a mental health disorder that is marked by a combination of schizophrenia symptoms, such as hallucinations or delusions (psychosis), and mood disorder symptoms, such as depression or mania.

As the Mayo Clinic explains, there are two types of schizoaffective disorder: bipolar type, which includes episodes of mania, and sometimes major depression, and depressive type, which includes only major depressive episodes but no mania. 

Because of its hybrid character, schizoaffective disorder is not easy to diagnose correctly. “Many people with schizoaffective disorder are often incorrectly diagnosed at first with bipolar disorder or schizophrenia,” according to the National Alliance on Mental Illness. “Because schizoaffective disorder is less well-studied than the other two conditions, many interventions are borrowed from their treatment approaches.” 

Schizoaffective disorder falls under the schizophrenia spectrum and psychotic disorders category. Bipolar disorder, on the other hand, is a mood disorder. The key difference is that people living with schizoaffective disorder experience symptoms of psychosis independently of any mood episodes. In the case of bipolar disorder, symptoms of psychosis may occur during episodes of mania or depression but not otherwise.

Schizoaffective disorder is relatively rare, with a lifetime prevalence of only 0.3 percent. Sometimes other conditions such as psychotic depression, bipolar disorder I, schizophreniform disorder, or schizophrenia are mistaken for schizoaffective disorder. 

Treatments for schizoaffective disorder, bipolar disorder, and major depression with psychosis are fairly similar. If both manic episodes and depressive episodes are evident, the medications used are likely to include antipsychotic agents and mood stabilizers. If the illness only presents with depressive features and no manic symptoms at any time, then antidepressants are likely to be used.

Mania and depression are usually episodic and can be interspersed with long periods of complete remission of symptoms. If the illness is continuous, with no remission, then the diagnosis may be schizoaffective disorder.

As Nancy Lovering explained in a recent article on PsychCentral about bipolar and schizoaffective disorder, “it’s not possible to have both conditions at the same time. You’d either receive a bipolar disorder with psychotic features diagnosis or a schizoaffective bipolar type diagnosis. The difference would be if you experience mood episodes and psychosis at the same time as in bipolar disorder or if they appear independently at times.”

Colorado Recovery provides services for adults with serious mental illnesses that will stabilize their illness, minimize symptoms, improve functioning and enhance each person’s social inclusion, quality of life, and sense of meaning in life.  We provide residential and outpatient treatment options for schizophrenia, bipolar, schizoaffective disorder, and other mental health conditions. 

The treatment program at Colorado Recovery aims to empower adults with mental illness, and those who support them, with an unrelenting optimism for recovery, purposeful involvement in the community, and an enhanced sense of meaning in life. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Older Age Bipolar Disorder 

Bipolar disorder (BD) is a mental illness that causes dramatic shifts in a person’s mood, energy, and ability to think clearly. People with bipolar experience high and low moods—known as mania and depression—which differ from the typical ups-and-downs most people experience.

The average age of onset is around 25, but it can also occur in the teenage years, and more uncommonly, in childhood. In some cases, however, people develop the condition much later in life. Bipolar disorder affects men and women equally, about 2.6 percent of the US population has a BD diagnosis, and more than 80 percent of cases are classified as severe.

“About one-quarter of all people with bipolar disorder are 60 years of age or older,” wrote Eleesha Lockett on Healthline. “While the symptoms of bipolar disorder can vary with age, the frequency, severity, and overall impact of the disorder are generally different in older adults versus younger people.”

Changes in the frequency and severity of episodes are among the most obvious changes in bipolar disorder at an older age. A study authored by Arnold, Dehning, et al. suggests that people with older age bipolar disorder (OABD) often experience:

  • more frequent episodes
  • more depressive episodes and less time spent in manic or hypomanic states
  • less severe manic symptoms and fewer psychotic features with mania
  • new symptoms, such as irritability and poor cognition
  • lower risk of suicide, although this may be due to survivorship bias
  • resistance to treatment options, such as certain medications

Arnold, Dehning, et al. note that BD patients over sixty are becoming an increasingly significant cohort. “The elderly represent the fastest-growing group of the population. The share of those >60 years of age has duplicated since 1980. In developed countries, the percentage of those >80 years of age will quadruple by 2050. It is fair to assume that the portion of old age patients suffering from bipolar disorder will grow in a similar manner.”

The authors point out that OABD patients constitute a heterogeneous population. Two major groups have been distinguished: “late-onset” patients (LOBD), and “early-onset” patients (EOBD), elder patients with a long-standing clinical history.

“The dividing line between OABD and adult-age BD seems to be fluctuating, but ≥60 years of age appears to be the consensual cut-off… EOBD and LOBD appear to be distinct forms of BD. LOBD patients have been reported to present more often with bipolar II disorder than EOBD patients. EOBD is associated with a highly positive family history, whereas LOBD is frequently associated with neurological diseases, cognitive decline, or other somatic conditions.”   

In her Healthline article, Lockett adds that according to experts, “bipolar disorder may speed up aging and contribute to cognitive decline. Older studies have found a link between bipolar disorder and cognitive decline, as well as an increased risk of dementia with each bipolar disorder episode.”

So, if you’ve been diagnosed with bipolar disorder, it’s important to seek treatment for the condition, as it can become progressively worse if left untreated. Since it is a complex condition, effective treatment of bipolar disorder requires a holistic approach. 

The late founder of Colorado Recovery, Richard Warner believed that recovery from mental illness should involve much more than getting rid of symptoms and staying out of the hospital. Dr. Warner’s system at Colorado Recovery includes a residential treatment program, a transitional program, an intensive outpatient program, and a “clubhouse” community mental health service model. The Warner model is based on a warmer and more human familial setting, comprehensive levels of care that result in a path of self-reliance, and community engagement for connection and a feeling of contribution.

Our treatment facility provides the services needed to address bipolar disorder, schizophrenia, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

It All Starts With a Welcoming Admissions Team

A warm familial setting, comprehensive levels of care leading to a path of self-reliance, expert staff to improve diagnoses and treatment plans, and community engagement for clients—these are the hallmarks of the Warner model utilized at Colorado Recovery.

And that warm familial setting starts right at the admissions process. “We carry that welcoming family feel, including during the initial call,” says admissions coordinator Julie Owen, MA. The team at Colorado Recovery treats every client as if they were their next of kin, with respect, compassion, and optimism.

“One of our strengths is listening skills,” says Owen. “Our first question is usually ‘What made you reach out to us today?’ What’s been going on with your friend, family member, or yourself? You will have somebody on the phone who says ‘I hear you, that sounds like it’s been challenging.’ and ‘let me tell you how I can help you.’” 

The flexible treatment model at Colorado Recovery utilizes a range of programs specializing in working with people for whom mental illness is affecting their lives in a negative way. 

“All our programs have the end goal of our clients becoming stable, becoming independent, developing skills that help them work with the issues they are facing, so they can live independent and successful lives,” explains Owen. “We have had many clients see that come to fruition. Many have jobs and their own apartments. Many come back to visit and touch base and it’s always great to see them.”

During the admissions process, clients learn about our recovery model and our dynamic levels of care. The admissions team can competently explain the different options, so clients get the help that’s right for them. The residential level, called Balsam House, where the focus is on stabilization and looking at medication strategy, is the highest level of care. Balsam House is staffed 24 hours a day, 7 days a week, by skilled professional staff who provide a full range of psychiatric services and are able to respond promptly to the needs of each resident. 

After stabilization clients may step down to the middle level of care called Transitional Living—four townhomes connected via their backyards. The focus at this level is on connection. Colorado Recovery’s treatment environment is open-door, non-institutional, non-coercive, pleasant, and inviting because we recognize our clients share with everybody a need for a sense of community, meaning in life, and self-respect. Clients can also be directly admitted to Transitional Living if their diagnosis allows it.  

“Connecting with others experiencing something similar is very powerful and plays a big role in long-term recovery success,” says Owen. “In transitional living, we focus a lot on life skills: learning to do the laundry, learning to do a grocery list, go shopping, and cook meals; learning to pay the bills on time, going to appointments without being prompted. All those skills become so very important when someone is living independently.”

Once somebody is ready to step down from transitional, they’re ready to get by on their own, maybe live in their own home, they most likely have a job at this point. They can also step down to our outpatient level of care. We have a number of outpatient programs, the one most clients step down to is the intensive outpatient program (IOP) which meets three days a week. This level of care is also open for direct admission to those who may be ready to begin their recovery at that level, or for those stepping down from another program. 

This highly flexible umbrella of programs is able to address the needs of clients on an individual basis and the level of care can easily be adjusted according to their progress. “We are quite flexible depending on where the person is,” says Peggy Caspari, MA, LPC, RN, Colorado Recovery’s executive director. “This flexibility is really empowering clients which is our core philosophy. We want to do what’s in their best interest and meet them where they are in their recovery.”  

The mission of Colorado Recovery is to help adults with serious mental health issues such as  psychotic disorders or severe depression stabilize their condition, minimize symptoms, improve functioning, and enhance each person’s social inclusion, quality of life, and sense of meaning in life. Healing, inclusion, and client empowerment are at the core of our treatment philosophy and it all starts with your first chat with the admissions team.

If you have questions about our recovery model or our services to treat schizophrenia, bipolar disorder, and similar mental illnesses, call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

 

Dynamic Levels of Care to Empower Clients

Last year, Colorado Recovery expanded its services and started admitting directly into its intensive outpatient program (IOP) clients who may be ready to begin their recovery at the IOP level of care or those in the process of stepping down from another program. 

The same applies to our Transitional Living Program which is offered to clients progressing from residential care or intensive outpatient treatment but also admits directly clients who are ready to begin this phase of their recovery. Every client is different and should be evaluated on an individual basis.

“We are quite flexible depending on where the person is,” says Peggy Caspari, MA, LPC, RN, Colorado Recovery’s executive director. “This flexibility is really empowering clients which is our core philosophy. We want to do what’s in their best interest and meet them where they are in their recovery.”  

Clients may start at the IOP level of care because they think it’s the best fit for them. “In that case, they’re coming in 3–4 days a week,” explains Caspari. “They’re developing a relationship with a psychiatrist and different therapists. That includes therapists who work at Balsam House, our residential facility.” 

Sometimes, the treatment team realizes that an IOP client could benefit from a higher level of care—a little more structure and 24/7 services. Occasionally, it’s the clients themselves who come to that conclusion while in group therapy with peers who are in residential treatment.  

“People at various levels of care meet in therapy at Colorado Recovery. They form relationships and start to trust each other. IOP clients become friends with Balsam House clients,” says Caspari. “And sometimes, they start wondering if they can benefit from what’s being offered there. Sometimes the recommendation to switch to a different level of care comes from clinicians and sometimes it comes from a client who might say ‘I would like to move up, I’m interested in your Balsam House services.’ There is a distinct comfort level when you already know people who are living there and therapists who are working there—when you know the psychiatrist there and you know you can go there and still come to the outpatient groups while living at Balsam House.” 

The “wrap-around” services at Colorado Recovery are highly flexible. We employ two full-time case managers for inpatient residential and intensive outpatient treatment for clients with bipolar disorder and schizophrenia. The case managers help clients access needed services, housing, and financial benefits. They are generally available to help clients as needs and services present themselves in a dynamic manner. 

“We believe in empowerment and let you decide,” says Caspari. “IOP or Balsam House, what do you want? If you want the IOP—great, let’s see how it goes. If you want Balsam House because you think you need more—no problem, we can try that.” 

The involvement of clients in the decision-making process is really empowering for them and part of our treatment approach focused on setting a course for a life of engagement, purpose, and connection. Community integration and social engagement continue to be at the heart of the treatment model pioneered by Colorado Recovery founder Richard Warner.

“We try to help clients find true meaning and purpose in their lives and a connection with the community, so we are really looking for that community piece—for example, if you look at our Treehouse model,” explains Caspari. “Our employment support is another important element. And we facilitate social events like museum visits or trips to the farmers’ market in town. All of these activities reinforce their autonomy and that all-important connection to the community to help clients gain meaning and purpose in their lives.” 

The treatment program at Colorado Recovery provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Study Highlights Need to Prioritize Mental Healthcare Among Survivors of COVID-19 

As of the end of February, more than 78 million people have been infected with COVID-19 and more than 945,000 people have died in the United States—roughly 16 times the number of Americans killed in the Vietnam War. SARS-CoV-2 (the virus that causes COVID-19) has not only attacked the lungs and other organs of infected people, though. The pandemic has also had a devastating impact on the mental health of many Americans, according to new research. “A study of more than 11 million people shows a 60 percent increase for mental health disorders up to one year after having COVID-19,” reported Andrea Rice on PsychCentral in February.

 

Using data from the US Department of Veterans Affairs national healthcare databases, Yan Xie, Evan Xu, and Ziyad Al-Aly examined the risks of mental health outcomes among individuals who survived at least 30 days following a positive COVID-19 test between March 2020 and January 2021 (before COVID vaccines became available).

 

While the new study was composed of more than 11 million people, only about 150,000 individuals were examined closely. Participants in the study were largely white men in their early 60s, though women and minority groups were also included. The results suggest that, compared to mental health disorders typically seen after influenza, a COVID infection exacerbated the risk of onset among the 153 848 people observed.

 

Study co-author Ziyad Al-Aly, MD, chief of research and development at Veterans Affairs St. Louis Health Care System and a clinical epidemiologist, told PsychCentral the “neuropsychiatric manifestations” associated with long COVID could offer a possible explanation for the increased risk for mental illness following infection. “We see higher risk in COVID versus flu. We also see higher risk in people hospitalized for COVID versus those hospitalized for any cause,” Al-Aly said.

 

The researchers concluded that their findings “show an increased risk of mental health disorders in people with COVID-19. Evidence also suggests that people with mental health disorders are at increased risk of becoming infected with SARS-CoV-2 and having serious outcomes.”

 

“Given the large and growing number of people with COVID-19 … the absolute risks of incident mental health disorders might translate into large numbers of potentially affected people around the world. Our results should be used to promote awareness of the increased risk of mental health disorders among survivors of acute COVID-19 and call for the integration of mental healthcare as a core component of post-acute COVID-19 care strategies.”

 

A new wave of pandemic-related mental health disorders is also likely to exacerbate America’s substance misuse epidemic since there is a well-established strong correlation between experiencing traumatic events (such as a pandemic), depression, anxiety, and substance use disorder (SUD). 

 

Co-occurring mental health disorders and SUD should be addressed concurrently in a comprehensive treatment program addressing all needs of such patients. “Dual diagnosis” is a term used to describe the presence of addiction and other co-occurring mental health conditions such as depression and post-traumatic stress disorder.

 

Colorado Recovery understands the importance of coordinated and integrative treatment care and provides substance use services to all clients who require them as part of a specialized dual diagnosis track. We have taken great care to address COVID stress for clients and staff alike throughout the pandemic.

 

Colorado Recovery offers multiple comprehensive treatment options for a variety of mental health conditions including residential options, intensive outpatient programming (IOP), and transitional living. If you or a loved one is experiencing persistent episodes of depression, anxiety, or has had suicidal thoughts, contact your doctor or call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

 

“High-functioning” Depression is Still Depression

This article discusses depression and suicide. If you or someone you know is at risk of suicide please call the US National Suicide Prevention Lifeline at 1-800-273-8255, text HOME to 741741, or go to SpeakingOfSuicide.com/resources for additional resources.

Depression is a serious mental health condition that requires attention and medical care. “Left untreated, depression can be devastating for those who have it and their families,” warns the National Alliance on Mental Illness (NAMI). “About 21 million US adults—8.4 percent of the population—had at least one major depressive episode in 2020.”

It’s normal to feel down occasionally but if you’re sad most of the time and it has a negative impact on your life, you may have clinical depression—a condition that can be treated with medication, psychotherapy, and lifestyle changes.

There are different types of depression. One is major depressive disorder or MDD. You may have this type if you feel depressed most of the time for most days of the week. Symptoms include loss of interest or pleasure in your activities, weight loss or gain, trouble sleeping or feeling sleepy during the day, feeling restless and agitated, being tired and without energy, feeling worthless or guilty, and suicidal ideation. 

Another variety is persistent depressive disorder (PDD), frequently referred to as “high-functioning” depression. Someone struggling with PDD may experience many of the symptoms of MDD, but often less severely and less frequently. This allows the person to appear to function almost normally, going to work or school, performing well, keeping up with responsibilities at home, and engaging in most social activities.

The phrase “high-functioning” depression highlights “a really important point that people can be suffering with mental illness and still appear outwardly to be able to function or not appear mentally ill to an outside observer,” Rebecca Brendel, president-elect of the American Psychiatric Association told the Washington Post.

But the term could exacerbate shame and misunderstanding about mental health and depression, Brendel added. “Saying that somebody is high-functioning even though they have a mental illness in and of itself raises the stigma associated with mental illness.”

A tragic recent case is Cheslie Kryst who died in January after jumping from a high-rise apartment building in Manhattan. According to her mother April Simpkins, the 30-year-old television correspondent, model, and former Miss USA “was dealing with high-functioning depression which she hid from everyone—including me, her closest confidant—until very shortly before her death.”

According to the Mayo Clinic, PDD symptoms typically don’t disappear “for more than two months at a time. In addition, major depression episodes may occur before or during persistent depressive disorder — this is sometimes called double depression.”

If you persistently experience sadness, emptiness, hopelessness, or suicidal thoughts, seek help. Persistent symptoms of depression are correlated with an elevated risk of substance misuse and suicide.

Don’t Lose Hope!

Although depressive disorders can have a devastating impact, they often respond to treatment. “The key is to get a specific evaluation and treatment plan,” recommends NAMI. After a careful assessment, patient-centered treatment plans may include any of the following:

  • Psychotherapy, including cognitive behavioral therapy, family-focused therapy, and interpersonal therapy.
  • Medications, including antidepressants, mood stabilizers and antipsychotic medications.
  • Exercise can help with prevention and mild-to-moderate symptoms.
  • Brain stimulation therapies can be tried if psychotherapy and/or medication are not effective. These include electroconvulsive therapy (ECT) for depressive disorder with psychosis or repetitive transcranial magnetic stimulation (rTMS) for severe depression.
  • Light therapy, which uses a lightbox to expose a person to full-spectrum light in an effort to regulate the hormone melatonin.
  • Alternative approaches including acupuncture, meditation, faith, and nutrition can be part of a comprehensive treatment plan.

Co-occurring mental health and substance use disorders should be addressed concurrently in a comprehensive treatment program addressing all needs of such patients. “Dual diagnosis” is a term used to describe the presence of addiction and other co-occurring mental health conditions such as depression and post-traumatic stress disorder.

Colorado Recovery offers multiple comprehensive treatment options for depression, including residential options, intensive outpatient programming (IOP), and transitional living. Clinical depression in any form requires treatment even if the person with the disorder is believed to be “high-functioning.” If you or a loved one is experiencing persistent sadness, feelings of hopelessness, or has had suicidal thoughts, contact your doctor or call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Keeping Connected in Mental Health Therapy During COVID

Peggy Caspari, MA, LPC, RN, Colorado Recovery Executive Director

After suffering through two years of COVID-19, the mental health of many Americans is in a bad place. According to the just-released Mental Health Index: US Worker Edition, cases of post-traumatic stress disorder (PTSD), depression, and addiction are soaring amid the current Omicron surge of the pandemic.

An alarming one in four American workers screened positive for post-traumatic stress disorder (PTSD)—that’s a 54 percent increase in just the past three months and 136 higher than levels before the pandemic. Depression is also surging—up 87 percent since the fall and 63 percent higher than before COVID.

“We expect mental health declines around the holidays; however, nothing of this sheer magnitude,” said Mathew Mund, the CEO of Total Brain, one of the partners publishing the Index. “We see a very troublesome surge in mental health concerns at a time when Omicron begins to grip the nation; workplace vaccine mandates are put in place, and the holiday season is in full swing. Employers must be prepared to address trauma in the workplace.”

Colorado Recovery has been addressing this kind of stress for clients and their staff throughout the pandemic. “There’s just a lot going on in the world. The fears around the pandemic, anxiety, the inability to travel—it’s affecting everyone, our clients and our staff,” said Peggy Caspari, MA, LPC, RN, Colorado Recovery’s executive director. “People worry about how sick they might get and about the possibility of giving COVID to their children. These are complicated scenarios and different individuals react differently to them.” Caspari said. “There’s a lot of anxiety and unfortunately anxiety is contagious. It can easily be transmitted to co-workers and clients.”

To counter any stress they may experience, Colorado Recovery staff practice being calm. It has been said, “If you remain calm in the midst of great chaos, it is the surest guarantee that it will eventually subside.”

At Colorado Recovery, “we practice calm in our lives so we can counteract anxiety,” said Caspari. “That way we will get through this together and we will help each other. We avoid catastrophizing and remain calm internally.“ Individuals who catastrophize become anxious as they overestimate the likelihood of a poor outcome. 

Not projecting their own anxiety is especially important for therapists working with people who have a mental illness. “We the helpers have to meet our clients with calmness and convey the message ‘we will get through this together’ instead of spreading toxic anxiety which is not helpful.” 

With a bit of luck and solid mitigation measures, Colorado Recovery was able to continue serving clients while preventing COVID cases on its campus—until December. After two clients tested positive, they had to isolate themselves in their rooms. It was a tough challenge given that Colorado Recovery’s treatment approach emphasizes social connections which are at the core of its Warner model

Fortunately, staff and clients were able to rise to the occasion. “It was interesting to witness the creativity brought on by this challenge,” remembered Caspari. In order to counteract the forced isolation, “they played board games on Zoom. They did art projects with our art therapist on Zoom. They did their group therapy sessions remotely. The vocational therapist did game nights with them online.”

This situation lasted ten days before they were cleared to rejoin in-person activities. But the team at Colorado Recovery was adamant to mitigate the isolation and provide connections with therapists and peers to minimize emotional stress all around. 

“The groups were determined to keep going and they were very creative in order to achieve that. They were just amazing,” Caspari said. “It was a little bit of a roadblock but they worked through it.”

The treatment program at Colorado Recovery aims to empower adults with mental illness, and those who support them, with an unrelenting optimism for recovery, purposeful involvement in the community, and an enhanced sense of meaning in life.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

The Importance of Small Social Interactions

In 1973, Stanford sociology professor Mark Granovetter—one of the pioneers of social network theory—published an influential paper entitled “The Strength of Weak Ties.”

He argued that “in social networks, you have different kinds of links, or ties, to other people. Strong ties are characterized as deep affinity; for example family, friends, or colleagues,” Everett Harper explained on Tech Crunch. “Weak ties, in contrast, might be acquaintances, or a stranger with a common cultural background. The point is that the strength of these ties can substantially affect interactions, outcomes, and well-being.”

Granovetter’s insight was that within a network of strong ties, people with weak ties outside the core network are bridges to other networks. Those bridges have access to new and unique information—like job openings—relative to other members of the network with only strong ties.

Psych Congress 2021 co-chair, Charles Raison, MD, and psychotherapist Saundra Jain, MA, PsyD, LPC, an adjunct clinical affiliate for the School of Nursing at The University of Texas at Austin, recently discussed the idea of connectivity during the COVID-19 pandemic. They highlighted the idea of micro- versus macro-connectivity, and how important even small social interactions are in maintaining overall health and well-being.

Dr. Raison pointed out that Saundra and Rakesh Jain have been researching wellness for the past 25 years, and created WILD 5 Wellness (W5W), “an effective, scientifically-based wellness program designed to increase your overall level of mental wellness.” Wellness activities of the program include exercise, mindfulness, sleep, social connectedness, and nutrition. 

“There’s much to be said for even more passing social connections,” said Raison. Even “how you interact with somebody that is checking out your groceries.” 

Saundra Jain said she had read more recently on the differences between weak and strong social ties. “We coined the phrase micro and macro socialization. There is something very powerful in the checker talking, engaging, but also just passing someone on the street, even with a mask on. They feel the smile. They may not see it, but the eyes brighten. There’s this connection of human-to-human contact that is incredibly powerful.” 

This kind of “micro positivity” is just as important as macro socialization, said Raison. “It adds up. If you’re struggling with major mental illnesses, sometimes it’s hard to get the deeper things. Drawing some nourishment from connections that are maybe not as personal, not as powerful, but they still signal our brains and our bodies in ways that give us a little boost of feeling better.” 

The positive effect of such social interactions is measurable. “The truth of the matter is these are not touchy, feely interventions,” said Dr. Jain. “We’ve got some great neurobiological data. The science behind it is very strong.” 

Colorado Recovery has emphasized the importance of social connections in its groundbreaking approach to mental health treatment for many years. The treatment model developed by our founder Richard Warner is based on a warmer and more human familial setting, comprehensive levels of care that result in a path of self-reliance, and community engagement for connection and a feeling of contribution.

The treatment program at Colorado Recovery aims to empower adults with mental illness, and those who support them, with an unrelenting optimism for recovery, purposeful involvement in the community, and an enhanced sense of meaning in life.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

The Relationship Between ADHD and Bipolar Disorder

Research shows that up to 20 percent of adults living with bipolar disorder (BD) also have a diagnosis of attention deficit hyperactivity disorder (ADHD).

 

ADHD and bipolar disorder have similar symptoms—so much so that they’re often confused with one another. Symptoms such as impulsivity and inattention can overlap. This makes it difficult to tell the two disorders apart.

 

A 2018 Danish study found that BD was almost 11 times more likely in people with a prior diagnosis of ADHD, compared with people who had no prior diagnosis of ADHD or anxiety. It is not clear why ADHD and bipolar disorder so frequently occur together. Genetic and biological factors are believed to be partially responsible.

 

It is common for ADHD to be diagnosed first since symptoms usually begin to present in childhood. Approximately two-thirds of ADHD patients continue to have symptoms into adulthood.

 

Bipolar disorder is often not diagnosed before individuals are in their 20s. According to the National Alliance of Mental Illness, more than half of all cases begin between ages 15–25. 

 

“The main difference between the two is that ADHD creates more consistent patterns of behavior, while bipolar disorder can occur in cycles, with a manic episode mimicking many of the symptoms of ADHD,” wrote Hilary Lebow in December on PsychCentral.

 

Lebow offered a tabular overview of the differences and similarities.

 

ADHDBipolar Disorder
Often diagnosed in childhoodOften diagnosed in adulthood
Impact on attention and behaviorImpact on mood and behavior
Chronic or persistentEpisodic (occurs in cycles)
Increased energyIncreased energy during mania
Easily distractedEasily distracted during the manic phase
Talking too much or too fastPressured speech during mania
ImpulsivityImpulsivity during the manic phase
Motor hyperactivity or agitation (fidgeting)Motor hyperactivity during mania
Lower self-esteemIncreased self-esteem during mania
Consistent sleep disturbancesDecreased need for sleep during mania
Difficulty with memoryDifficulty with memory

 

Bipolar disorder is a serious mental illness—especially with co-occurring ADHD. BD is characterized by psychosis, a severe condition in which the person’s ability to recognize reality and emotional responses, thinking processes, judgment, and ability to communicate are so affected that functioning is seriously impaired. Colorado Recovery offers residential treatment for people with psychosis and our bipolar treatment program is highly regarded.

 

“Research shows that those who live with both ADHD and bipolar disorder have an increased chance of suicidal ideation and substance use disorder (SUD), particularly around alcohol,” warned Lebow in her article.

 

ADHD is routinely treated with medications that stimulate the central nervous system. Bipolar disorder, on the other hand, is often treated with antidepressants, mood stabilizers, or benzodiazepines. People with both conditions require thorough assessments and careful calibration of their medications as stimulants for ADHD can cause manic episodes if a co-occurring bipolar disorder is present.

 

“Medications are an important part of treatment but they are only part of the answer,” wrote the late Colorado Recovery founder Richard Warner, MD, in 2000. The mental health professionals at Colorado Recovery utilize a holistic treatment approach to help adults with serious mental health issues stabilize their illness, minimize symptoms, improve functioning, and enhance each person’s social inclusion, quality of life, and sense of meaning in life.

 

If you have questions about our services to treat schizophrenia, bipolar disorder, and similar mental illnesses, call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.