What is schizophrenia?

Schizophrenia is a severe mental illness that belongs to a group of mental health problems known as the psychotic disorders. All the psychotic disorders include psychosis as a key part of the condition.

According to the Diagnostic and Statistical Manual of Mental Disorders [1], used by mental health professionals in the US to diagnose mental health problems, people with schizophrenia will experience two or more of the following symptoms, including at least one of the first three, for at least a month (or less if treatment has begun and has been successful):

  • Delusions, which are beliefs that aren’t real, held even in the face of evidence that disproves the belief. The most common kinds of delusion are ‘persecutory’, which means believing that you are being followed, watched or are going to be harmed for example. Other delusions include believing that you are special or exceptional in some way, or that signs and symbols in the external environment are deliberately designed to communicate a special message to you.
  • Hallucinations, which is when you see or hear something that isn’t actually there. Both auditory and visual hallucinations will seem very real to the person experiencing them. In psychosis, the person will have no insight into the fact that they are hallucinating. This distinguishes it from other types of hallucination where the person knows that what they are experiencing isn’t real, such as the hallucinations that occur during a migraine. Auditory hallucinations are often described as ‘hearing voices.’
  • Disorganized speech, which is usually a sign of disorganized thinking. This includes, for example, switching topics quickly or giving odd answers to questions.
  • Strange behavior. This can range from behaving in a silly, childlike way, to suddenly becoming agitated. Strange behavior also includes ‘catatonia’, which is when someone doesn’t respond to what is happening around them.
  • ‘Negative symptoms’, which is an absence of standard human behavior and interaction. This includes, for example, a lack of emotional expression or a lack of motivation to do anything unless prompted.

In addition, symptoms must have a significant impact on a person’s work, education, relationships or self-care. Overall, for a diagnosis of schizophrenia to be made, the person must have been unwell for at least six months (including a month of the symptoms described above).[1]

What is bipolar disorder?

Bipolar disorder used to be called manic depression. It is a kind of mental illness known as a mood disorder and is usually characterized by periods of both mania and depression.

Manic episode

A manic episode is a period lasting at least one week during which someone’s mood is significantly elevated. They may be unusually optimistic, energetic or euphoric, perhaps focused on achieving a particular goal. Symptoms include:[1]

  • An increase in self-esteem or self-confidence
  • Sleeplessness or feeling that you don’t need to sleep
  • Being unusually talkative and talking very quickly
  • Racing thoughts and having lots of new ideas
  • Feeling easily distracted
  • Focusing on achieving a particular goal or else feeling a compulsion to do repetitive tasks or movements
  • Doing things that might be seen as reckless, such as spending lots of money, being sexually promiscuous or indulging in drugs or alcohol.

A manic episode will have a significant impact on someone’s life and many even require them to be hospitalized for their own safety. Someone may experience psychosis during a manic episode, meaning they may have delusions (beliefs that aren’t real) or hallucinations (seeing or hearing things that aren’t there).[1]

In addition to at least one manic episode, someone with bipolar disorder might experience hypomania. Hypomania is similar to mania but symptoms and impact on functioning are less severe.[1]

Major depressive episode

A major depressive episode is characterized by a period of at least two weeks where five or more of the following symptoms are experienced, including at least one of the first two:[1]

  • Low mood, most of the time
  • Loss of interest in activities that would normally bring pleasure
  • Significant weight loss or gain
  • Sleep problems
  • Restlessness or feeling slowed down
  • Lack of energy or tiredness
  • Feelings of worthlessness or guilt
  • Difficulty concentrating
  • Suicidal thoughts, plans or attempts 

There are two kinds of bipolar disorder:

  • Bipolar I disorder is diagnosed if someone has a period of mania. It is not necessary to see evidence of hypomania or depression, though these are common in people with bipolar I disorder.[1]
  • Bipolar II disorder is diagnosed if someone has experienced hypomania and at least one major depressive episode, but not a manic episode.[1]

Schizophrenia vs Bipolar Disorder: Symptoms

Schizophrenia and bipolar disorder are both serious mental illnesses. They share some symptoms in common but are different conditions.

Both conditions can cause psychosis, which is a set of symptoms that indicate someone has experienced a break from reality. The two main symptoms of psychosis are hallucinations and delusions.[2]

Both conditions also involve noticeable changes to speech and behavior, which may look similar to others.[3]

However, there are some key differences. Bipolar disorder is a mood disorder, causing significant shifts in mood from elated and euphoric to depressed. With bipolar disorder, psychotic episodes happen only during a major depressive or manic phase. In schizophrenia, delusions and hallucinations are not linked to mood in the same way.[1]

Schizophrenia vs Bipolar Disorder: Causes

It is thought that schizophrenia and bipolar disorder might be caused by the same genes, as both conditions are more common in families where there is a family history of either condition.[1]

Studies also suggest that factors relating to pregnancy and birth can increase the risk of schizophrenia. These factors include the age of the father, stress during pregnancy, when in the year a person was born, low blood oxygen levels, and the mother’s health problems.[1]

Schizophrenia vs Bipolar Disorder: Treatment

Both schizophrenia and bipolar disorder can be treated with a combination of medication and psychotherapy.

Medication

In schizophrenia, the main medication used in treatment is a class of drugs called antipsychotics, which help to alleviate the symptoms of psychosis.[4]

The main medication for bipolar disorder is mood stabilizers. Some antipsychotics can also be used as mood stabilizers.[5]

Psychotherapy

Psychotherapy may also help with managing symptoms of both schizophrenia and bipolar disorder.

Cognitive behavioral therapy (CBT) can be used to treat both schizophrenia [7] and bipolar disorder[8].

There is a kind of CBT that has been adapted to help people who have experienced psychosis. CBT helps you understand your emotions and find ways to manage your behavior. CBT for psychosis (CBTp) is specifically designed to help people understand their symptoms and reduce the distress caused by them.[6]

Family therapy may be helpful for both schizophrenia and bipolar disorder. A therapist will work with the person affected as well as their family to help everyone understand mental illness and how the family can support their loved one effectively.[6]

Can you have schizophrenia and bipolar disorder at the same time?

If a person has symptoms of schizophrenia as well as bipolar disorder, they may be diagnosed with schizoaffective disorder, rather than receiving a diagnosis of both schizophrenia and bipolar disorder.

Schizoaffective disorder is essentially the presence of schizophrenia symptoms accompanied by either depression or mania.[1] Schizoaffective disorder is also treated primarily with antipsychotic medication, mood stabilizers and psychotherapy.[9]

 

Resources:

  1. American Psychiatric Association. (2013, May 27). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5(5th ed.). American Psychiatric Publishing. Retrieved December 9, 2022, from https://psychiatry.org/psychiatrists/practice/dsm
  2. Arciniegas, D. B. (2015). Psychosis. Continuum, 21(3), 715-736. doi:10.1212/01.CON.0000466662.89908.e7
  3. Demily, C., Jacquet, P., & Marie-Cardine, M. (2009). How to differentiate schizophrenia from bipolar disorder using cognitive assessment? Encephale, 35(2), 139-145. DOI: 10.1016/j.encep.2008.03.011
  4. Keepers, G.A., et al. (2020). The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. The American Journal of Psychiatry, 177(9), 868-872. https://doi.org/10.1176/appi.ajp.2020.177901
  5. Rethink Mental Illness. (n.d.). Bipolar disorder. Retrieved December 8, 2022, from https://www.rethink.org/advice-and-information/about-mental-illness/learn-more-about-conditions/bipolar-disorder/
  6. Rethink Mental Illness. (n.d.). Retrieved December 9, 2022, from https://www.rethink.org/advice-and-information/about-mental-illness/learn-more-about-conditions/psychosis/?gclid=CjwKCAiAs8acBhA1EiwAgRFdw89QFn-2SWflOAaUCs1DOnN2BIhi-YCl2_yOtnaWgA9Fhgzk35_TJRoCjIIQAvD_BwE
  7. (2020, November). Schizophrenia.Retrieved December 9, 2022, https://www.mind.org.uk/information-support/types-of-mental-health-problems/schizophrenia/treatment/ 
  8. (2022, February). Bipolar disorder. Retrieved December 9, 2022, https://www.mind.org.uk/information-support/types-of-mental-health-problems/bipolar-disorder/treatment-for-bipolar/
  9. (2019, May). Schizoaffective disorder. Retrieved December 9, 2022, https://www.mind.org.uk/information-support/types-of-mental-health-problems/schizoaffective-disorder/treatment-and-support/