Did you know that schizophrenia and bipolar are connected even though both of these are vastly different mental conditions? To know what’s the connection between both of these, it is important to know how they differentiate and what they actually are, comprehensively. We are going to just do that in the words below, so let’s carry on how bipolar and schizophrenia are a thing and what you can do about it.
Defining Schizophrenia
It is a serious illness that defines how a person feels, behaves, and thinks. Schizophrenia is a debilitating mental disorder that is characterized by two very recognizable symptoms, delusions (grandiose and over-the-top irrational beliefs) and hallucinations (seeing, feeling, and hearing things that are not there), so basically all the things that make psychosis and other symptoms such as disgruntled thinking and behavior, disorganized and unusual movements, especially in hands, poor hygiene, depression and anxiety and the increasing risk of substance abuse. These are positive symptoms as they don’t affect executive functioning right then and there. There are also negative symptoms, which are debilitating from the very start. Negative symptoms refer to the loss of ability to lead a normal life as it is characterized by sub-symptoms such as you might stop making facial expressions, or you speak with a flat, emotionless voice (1), which makes you unbearable in social contexts.
According to the DSM-5 diagnostic manual, a diagnosis of schizophrenia requires the following:
- Presence of five of its main symptoms.
- Symptoms have lasted at least for one month.
- Your symptoms impact your executive functioning (ability to work or have relationships properly)
Read More: Bipolar Disorder – Symptoms, Causes, Types and Treatment
Definition Bipolar Disorder
When it comes to bipolar vs schizophrenia, defining bipolar disorder becomes a must. Bipolar is also a chronic condition whose symptoms of extreme moods often lead to dire consequences. These extreme mood swings are on two opposite sides of a spectrum that goes from mania to depression. Different types of bipolar disorders exist and each of these types is identified by the differences of symptoms that a type of bipolar disorder can contribute to (2).
Bipolar I
This is experienced when there is one instance of a mania episode that at least lasted for a week. Usually, depressive episodes are absent from this type of bipolar.
Bipolar II
In this one, one is affected when there is at least one depressive episode and hypomania (a less intensive form of mania) that has lasted for at least four days.
Cyclothymia
There have been both hypomanic and depressive mood episodes over the course of two years or more and these are not severe enough to be classified as bipolar I or II, although it can gradually develop into two of these.
Rapid Cycling
If you have suffered from a rapid succession of four or more depressive, manic, hypomanic, or mixed episodes within a year, then it is probably rapid cycling. In addition to all four of these, there are also some unspecified and unidentified patterns of bipolar disorders, which is why these can’t be classified as either of the aforementioned types!
Read More: A Comprehensive Guide To Anxiety And Schizophrenia
The Odds of Bipolar and Schizophrenia When Pitted Against Each Other: Bipolar vs Schizophrenia
When it comes to the population affected, it is done more frequently due to bipolar than schizophrenia. In the USA alone, around 2.8 percent are affected with bipolar disorder, which typically appears in young adulthood or late adolescence. In contrast, schizophrenia is much more uncommon but all the more intense and debilitating. Experts estimate that schizophrenia affects less than 1 percent of the U.S. population, although newer research suggests that it could range up to 1.6 percent or higher and is usually seen for the first time between the ages 16 and 30 (5). This suggests that both schizophrenia and bipolar should not be underestimated in any way possible and treatment should be sought if a diagnosis of either of these becomes imminent.
So, What’s the Connection Between Schizophrenia and Bipolar?
There is no such thing as bipolar schizophrenia but there is a significant overlap of similar symptoms in either of these chronic mental conditions (3). Additionally, there is also considerable overlap over familial patterns, hereditary risk factors, and even the outcome and treatment (3). In the 1990s, this overlap of symptoms of both schizophrenia and bipolar was given the name “schizoaffective” disorder, which essentially combined the most recognizable and also most overlapping symptoms of bipolar and schizophrenia and defined it as a whole new mental condition (3). Operational diagnostic criteria, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases and Related Health Problems (ICD), all followed through to improve the reliability of symptom-based diagnosis of this type of disorder (4).
This suggests there is only a nominal difference between bipolar and schizophrenia as under the hood they are more similar than one can possibly imagine. So, in the end, if you had to put into words what is going on between schizophrenia and bipolar or if you are asking questions like “Can you have bipolar and schizophrenia?”, then the answer would be that it is schizoaffective disorder. Schizoaffective is capable of affecting your thoughts, mood, and behavior. You will essentially have symptoms of both bipolar disorder and schizophrenia. These symptoms may include all three, mania, depression, and psychosis similar to bipolar or schizophrenia. Let’s define schizoaffective disorder in a more comprehensive way in the next section.
Defining Schizoaffective Disorder
Schizoaffective is a type of mental condition that is characterized by schizophrenic symptoms such as psychosis, and bipolar disorder symptoms like mania (even hypomania, at times) and depression, all are hallmarks of schizoaffective disorder. Which type of symptoms will be more intense and overbearing depends on the type of schizoaffective one is affected with – bipolar or depressive type, both of which have schizophrenic symptoms.
The bipolar type is marked by mania or hypomania episodes that are sometimes overlapped with a rare depressive episode. It is the depressive type of schizoaffective disorder, which is marked by a major depressive episode and therefore extremely excessive depressive bouts tend to rage in the affected individual. One thing that should be noticed is that schizoaffective disorders have a tendency to affect people in myriad ways. Every affectee is different and so are their situations.
Read More: Disorganized Schizophrenia: Understanding The Disorder And Its Challenges
These situations become even more dire than schizophrenia and bipolar put together, as it is hard to function at work or school or in social settings when someone has schizoaffective disorder. It is as if one is being bombarded by different symptoms of two different mental conditions in parallel. All of its symptoms can also transform one’s social anxiety into an untamed monster. People with schizoaffective disorder promptly need help and swift support to manage and live their daily lives. There is no cure, but proper treatment can help manage excessive symptoms and improve quality of life tremendously.
Symptoms of schizoaffective disorder depend on the type, bipolar or depressive. Symptoms may include:
- Delusions, which are having false and fixed beliefs.
- Hallucinations, such as hearing voices or seeing things that are not actually there.
- Disgruntled thinking and speech.
- Bizarre behavior and unusual mannerisms.
- Clinical depression and its symptoms such as feeling empty, sad, or worthless.
- Extended Periods of manic mood, with more energy and less need for sleep over several days, and behaviors that are out of character.
- Poor executive functioning at work or school or in social situations.
- Problems managing personal hygiene.
A major symptom of schizoaffective disorder, which is something that combines schizophrenia and bipolar, is suicidal thoughts and behavior, which is intensified due to the double trouble of the aforementioned disorders. If it is the case that a person you know is affected by schizoaffective disorder and has been talking about suicide lately, then it is your responsibility to call the emergency services before it’s too late or contact the suicide hotline promptly. In the U.S., you can call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week for all!
Read More: Is Bipolar Disorder A Permanent Disability?
Can Bipolar Turn Into Schizophrenia?
A lot of people ask this question, “Can Bipolar turn Into schizophrenia?” That shouldn’t be the question. The real question should be if schizoaffective disorder can turn into something else if it is especially the case that it is left untreated. This question is important to know as if schizophrenia and bipolar are considered to be so debilitating enough for the sufferer, imagine what will happen if something else is added into the mix. Here are a couple of examples (6) that schizoaffective disorder can turn into if it is left untreated entirely or even partially:
- Suicide contemplation and suicide attempts
- Social isolation stemming from disorders such as social anxiety disorder
- Conflicts with family members, friends, and even acquaintances
- Being in between jobs
- Anxiety disorders such as obsessive-compulsive disorder (OCD)
- Alcohol dependence or substance abuse
- Health conditions, such as heart disease, stroke and obesity
- Becoming dirt poor or losing savings due to medical expenditures
- Being assaulted, which if it becomes persistent can turn into physical abuse
- Aggressive episodes, though people with schizoaffective disorder are more likely to be assaulted rather than assault others
Risk of Exacerbating Bipolar and Schizophrenia Symptoms in Schizoaffective
There are a couple of risk factors that are capable of exacerbating bipolar and schizophrenia symptoms in schizoaffective disorder of the affected individual.
Lineage and family history: The odds will be significantly against you if it is a common instance in the family to be affected with schizoaffective disorder, which by proxy is essentially schizophrenia and bipolar.
Traumatic events: Events such as the ones that happen in your life, for example, a collision, or natural occurrences like a Tornado Emergency can be extremely traumatic events to experience, especially if you see a loved one die in these events or you yourself go through a near miss, it can lead to an answer to a question like, “Can bipolar and schizophrenia occur together?”, in the shape of schizoaffective disorder.
Substance Abuse: Although it can be a complication of the said disorder, it can also be something that causes it. Mind-altering drugs and the addiction to them can change the brain in a way that the new wiring of neurons leads to a diagnosis of schizoaffective disorder.
Treatment of Schizophrenia and Bipolar in Schizoaffective Disorder
While there is no such thing as a bipolar or schizophrenia test or cure, there are standards of treatments, which may essentially be related to schizophrenia and bipolar but can also treat schizoaffective by proxy.
Read More: Understanding Residual Schizophrenia
How is Schizoaffective Disorder Diagnosed?
An expert will diagnose schizoaffective disorder after a mental health assessment. It might take more than one assessment for the psychiatrist to reach a diagnosis due to the overlapping symptoms of schizophrenia and bipolar. You or your loved one may get a diagnosis of schizoaffective disorder if you have depressive or manic symptoms with symptoms of schizophrenia or bipolar schizophrenia symptoms directly. A diagnosis is usually based on standard diagnostic manuals maintained by entities such as the World Health Organisation (WHO) which produces the International Classification of Diseases (ICD-10) or the American Psychiatric Association, which produces the Diagnostic and Statistical Manual (DSM-5). Once a diagnosis has been made, the following options can be selected for treatment or combined together to do the same thing:
Medication: This can be used to stabilize extreme moods via mood stabilizers such as lithium, which helps prevent relapse and manage symptoms through atypical antipsychotics
or anticonvulsants for treating psychosis life symptoms (7).
Psychotherapy: It is a way of coming to terms with the negative patterns of behavior associated with a mental condition. Psychotherapy plays an important part in bipolar disorder management. It can take place individually or in a group or family setting to treat both bipolar and schizophrenia.
Electroconvulsive therapy (ECT): The goal of ECT treatment is to change the brain’s chemistry by sending electrical currents through it, resulting in a controlled seizure. It can help both bipolar (8) type symptoms, and schizophrenia (9) type symptoms found in schizoaffective disorder.
Summary!
If any of the questions look like these, “Is bipolar the same as schizophrenia?”, “How to deal with a bipolar schizophrenic person?”, “Can you have bipolar and schizophrenia?”, “What is the difference between bipolar and schizophrenia?”, “Can bipolar turn into schizophrenia?” or even “Can bipolar and schizophrenia occur together?”, then you need to find treatment such as the ones mentioned above, promptly. Solid Foundation Psychiatry can help you do that and also treat other forms of mental conditions such as anxiety, insomnia, PTSD, or ADHD, through treatment methods described above or via alternative methods such as telehealth psychiatry! Book an appointment today.
References and Footnotes:
- https://my.clevelandclinic.org/health/diseases/4568-schizophrenia
- https://www.mind.org.uk/information-support/types-of-mental-health-problems/bipolar-disorder/types-of-bipolar/
- Yamada Y, Matsumoto M, Iijima K, Sumiyoshi T. Specificity and Continuity of Schizophrenia and Bipolar Disorder: Relation to Biomarkers. Curr Pharm Des. 2020;26(2):191-200. doi: 10.2174/1381612825666191216153508. PMID: 31840595; PMCID: PMC7403693.
https://pubmed.ncbi.nlm.nih.gov/31840595/ - Kasanin J. The acute schizoaffective psychoses. 1933. Am. J. Psychiatry. 1994;151(6) Suppl.:144–154. doi: 10.1176/ajp.151.6.144.
https://pubmed.ncbi.nlm.nih.gov/8192190/ - https://www.nimh.nih.gov/health/statistics/schizophrenia
- https://www.mayoclinic.org/diseases-conditions/schizoaffective-disorder/symptoms-causes/syc-20354504
- Jain A, Mitra P. Bipolar Disorder. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558998/
- Enokida T, Noda T, Usami T, Satake N, Nakagome K. Electroconvulsive Therapy on Treatment-resistant Mania in Bipolar Disorder with No Concurrent Antipsychotics: A Case Report. Clin Psychopharmacol Neurosci. 2022 Feb 28;20(1):190-193. doi: 10.9758/cpn.2022.20.1.190. PMID: 35078962; PMCID: PMC8813320.
https://pubmed.ncbi.nlm.nih.gov/35078962/ - Hany M, Rehman B, Rizvi A, et al. Schizophrenia. [Updated 2024 Feb 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539864/