Bipolar Disorder vs. Schizophrenia

  • Medical Author:
    Roxanne Dryden-Edwards, MD

    Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

What Is Bipolar Disorder?

Bipolar disorder vs. schizophrenia facts

  • Bipolar disorder is an illness that involves mood swings with at least one episode of mania and may also involve repeated episodes of depression.
  • Schizophrenia is a chronic, severe, debilitating mental illness characterized by psychotic symptoms, meaning that one is out of touch with reality.
  • Bipolar disorder and schizophrenia are not directly inherited genetically but are likely due to complex genetic, psychological, and environmental risk factors.
  • Since there is no one test that determines the presence of bipolar disorder or schizophrenia, health care professionals diagnose these illnesses by gathering medical, family, and mental health information and performing physical and mental assessments.
  • Medication treatment of bipolar disorder tends to relieve already existing symptoms of mania or depression and prevent symptoms from returning. Antipsychotic medications are most effective in decreasing the positive symptoms of schizophrenia.
  • Psychosocial interventions help treat both bipolar disorder and schizophrenia.

What is bipolar disorder? What is schizophrenia?

Bipolar disorder is a mental illness that involves severe mood swings, at least one episode of mania (an exaggerated or heightened mood, see below) and may include repeated episodes of depression. It is a mood disorder that afflicts up to as many as 4 million people. Schizophrenia is a chronic, severe, debilitating mental illness that involves psychotic symptoms, meaning that one is out of touch with reality. People with either illness are at a higher risk of suicide, substance abuse, and other mental health problems.

What are causes and risk factors for bipolar disorder and schizophrenia?

Like most mental disorders, neither bipolar disorder nor schizophrenia is directly passed down genetically. Rather, each is the result of a complex group of genetic, psychological, and environmental factors. These two illnesses share a number of the same risk genes but also have some unique genetic risk factors. Stress has been found to be a significant contributor to the development of most mental health conditions, including both of these disorders.

There are two types of bipolar disorder: bipolar I and bipolar II.

Types of Bipolar Disorder

Bipolar disorder has a number of types, including bipolar I and bipolar II disorder. Depending on how rapidly the mood swings occur, the episodes of bipolar disorder can also be described as having mixed (mood disordered episodes that last less than the usual amount of time required for the diagnosis) features or rapid cycling (four or more mood disordered episodes per year) features. About two-fifths of people with bipolar disorder have at least one period of rapid cycling over the course of their lifetime. For every type and duration of the illness, the sufferer experiences significant problems with his or her functioning at school, at work, socially or otherwise in their community, may need hospitalization, or may have psychotic symptoms (for example, delusions or hallucinations). The diagnosis of bipolar I disorder requires that the individual has at least one manic episode but does not require a history of major depression. Bipolar II disorder is diagnosed if the person has experienced at least one episode of major depression and at least one episode of hypomania (a milder form of mania).

What are signs and symptoms of bipolar disorder and of schizophrenia?

To qualify for the diagnosis of bipolar disorder, a person must experience at least one manic episode. Symptoms of mania include

  • elevated, expansive, or irritable mood;
  • racing thoughts;
  • pressured speech (rapid, excessive, and frenzied speaking);
  • decreased need for sleep;
  • grandiose ideas (for example, false beliefs of superiority or failures);
  • tangential speech (repeatedly changing topics to topics that are hardly related);
  • restlessness/increased goal-directed activity; and
  • impulsivity, poor judgment, or engaging in risky activity (like spending sprees, promiscuity, or excess desire for sex).

While a major depressive episode is not required for the diagnosis of bipolar disorder, depression often alternates with manic episodes and tends to occur more often than mania in many people.

Symptoms of schizophrenia may include

  • delusions (beliefs not at all based in reality),
  • hallucinations (seeing, hearing, feeling, smelling, or tasting something that is not really there),
  • catatonia,
  • negative symptoms, like not talking (mutism, low motivation, and movement), and
  • disorganized speech or behavior.

What tests do health care professionals use to diagnose bipolar disorder and schizophrenia?

Since there is no one test that determines that someone has bipolar disorder or schizophrenia, health care professionals diagnose these conditions by gathering medical, family, and mental health information. The mental health professional will also either perform a physical examination or request that the individual's primary care doctor do so, including lab tests to assess the person's general health and whether he or she has mental health symptoms that are due to a physical condition.

What are treatments and medications for bipolar disorder and for schizophrenia?

People with bipolar disorder or schizophrenia can expect their mental health professionals to consider several interventions, including medications, psychotherapies, and lifestyle advice. Medication treatment of bipolar disorder tends to address relieving already existing symptoms of the illness and preventing symptoms from returning. For schizophrenia, medications have been found to be effective in treating the positive symptoms (for example, delusions or hallucinations).

Antipsychotic medications that treat the positive symptoms of schizophrenia and the manic and mixed symptoms of bipolar disorder include olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), paliperidone (Invega), asenapine (Saphris), iloperidone (Fanapt), lurasidone (Latuda), and brexpiprazole (Rexulti). Older medications, like haloperidol (Haldol), chlorpromazine (Thorazine), and thioridazine (Mellaril), are more likely to cause muscular side effects, rarely one that can be permanent.

Mood stabilizers like lithium (Lithobid) and antiseizure (anticonvulsant) medications like divalproex (Depakote), carbamazepine (Tegretol, Tegretol XR), and lamotrigine (Lamictal) treat active manic or mixed symptoms and those symptoms from returning. Antidepressants are the primary medical treatment for the depressive symptoms of bipolar disorder. Antidepressants include selective serotonin reuptake inhibitor (SSRI) medications like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), vortioxetine (Trintellix), and vilazodone (Viibryd); serotonergic/adrenergic medications (SNRIs) like venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq), and levomilnacipran (Fetzima), as well as bupropion (Wellbutrin), a dopaminergic antidepressant.

Electroconvulsive therapy (ECT) can treat people whose symptoms of bipolar disorder or schizophrenia are severe and have inadequately responded to psychotherapies and a number of medication trials. Transcranial magnetic stimulation (TMS) can treat resistant depression, as well.

Talk therapy (psychotherapy) is an important part of helping individuals living with bipolar disorder or schizophrenia achieve the highest level of functioning possible by improving ways of coping with the illness. Assertive community treatment (ACT) involves members of the treatment team having daily meetings with the schizophrenia sufferer in community settings (for example, at home, work, or otherwise in the community) rather than just in an office or hospital.

What is the prognosis of bipolar disorder and schizophrenia?

Bipolar disorder sufferers tend to have mood problems up to 60% of the time but can be helped with psychotherapy and medication. Schizophrenia has a more difficult course, less so with treatment. People with either condition are at risk for developing medical problems, other mental health disorders, taking their own life, or otherwise dying younger.

REFERENCE:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Treatment Revision. Washington, D.C.: American Psychiatric Publishing, Inc., 2013.

Last Editorial Review: 5/18/2017

Reviewed on 5/18/2017
References
REFERENCE:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Treatment Revision. Washington, D.C.: American Psychiatric Publishing, Inc., 2013.

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