In response to a thought-provoking article the other day suggesting that schizophrenia is really bipolar I psychosis and not a separate diagnosis, Current Psychiatry Online published a rebuttal titled Schizophrenia is psychotic bipolar disorder? What a polarizing idea!
While commending the first authors on spotting the misdiagnosis of one patient, Dr. Henry Nasrallah highlights some of the differences between schizophrenia and bipolar disorders, such as response to different types of treatment, and concludes:
I agree with Drs. Lake and Hurwitz that most cases of schizoaffective disorder, especially the “schizomanic” type, are probably bipolar disorder with severe psychotic features. To assert, however, that schizophrenia does not exist at all and should be reclassified as bipolar disorder with psychotic features would contradict a massive body of clinical and biological evidence.
It’s persuasive, but then so is the original argument…and it still leaves the issue of at least some people being misdiagnosed.
Please leave a comment or join us in the forum; we’d like to hear your opinions on this “polarizing” debate.
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5 Comments to
“Schizophrenia as Bipolar? Revisited”
This is so fascinating, I can see how both arguments could be really persuasive.
I actually don’t find the original article that persuasive at all. They demonstrated how someone with bipolar disorder with psychotic features can be easily misdiagnosed as schizophrenic. I don’t disagree with that. But then they make the huge leap that bipolar disorder and schizophrenia are the same in all cases.
They said that the problem of misdiagnosing a bipolar patient as schizophrenic is that the bipolar patient gets the wrong kind of treatment; they are given anti-psychotics for life instead of mood stabilizers. But, if the illnesses are actually the same thing, why should there be two ways of treating it? Why is one way correct and the other way wrong in some cases?
Because they are two separate disorders. I’m glad this new article came out; now I don’t feel so insecure in my confusion.
As a patient, I find this discussion very interesting. My
diagnosis is either Schizophrenia or Biopolar I or something else. In the end, I find it really doesn’t matter.
I take an anti-psychotic (Ability) to keep me well. This drug also is approved for Bipolar I so I’m prompted to ask: in my case, what difference does the diagnosis make?
Hi Barb - It’s great that Abilify covers both bases. Other drugs like olanzapine and Seroquel do as well - they’re all antipsychotics.
But there are additional approaches to treatments to consider. One thing that’s very important in treating bipolar disorders is regulating things like sleep cycles and having an action plan to implement when you see an episode coming on. Schizophrenia doesn’t have the same patterns so you wouldn’t be able to tell, for example, that you’re headed into a hypomanic episode, from the same kind of warning signs bipolar disorders have.
Another thing is that there’s a risk of severe side effects like tardive dyskinesia (a movement disorder) from long-term use of antipsychotics.
My ten year old son is bipolar and adhd. He has been on medication since age 4. After several doctors and hospitals; and 19 different medications later he is still uncontrollable. WBR LeoP
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Last reviewed: By John M. Grohol, Psy.D. on 10 Mar 2006
