There are critical differences between bipolar and schizophrenia. Bipolar disorder involves extreme mood swings, from emotional highs to lows, while schizophrenia typically includes hallucinations, delusions, and disorganized thinking. Though separate conditions, some individuals may be diagnosed with both.
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What is Bipolar Disorder?
Bipolar disorder is a diagnosable mental health condition characterized by intense mood swings between manic and depressive episodes.1 During manic episodes, individuals may experience elevated mood, increased energy, and reduced need for sleep, while depressive episodes involve persistent sadness, low energy, and feelings of worthlessness. In more extreme cases, individuals may experience intrusive thoughts and/or engage in high-risk behavior such as substance use, suicide attempts, and otherwise.
Bipolar Disorder Statistics estimate that around 2.8% of U.S. adults have bipolar disorder each year,2 while 4.4% experience the condition at some time in their lives.3 Worldwide, that number is near approximately 46 million people (0.6%).3 Bipolar disorder can affect all genders equally, with symptoms often appearing in late adolescence or early adulthood, though it can develop at any age.
The four types of bipolar disorder include:
- Bipolar I: Bipolar I is characterized by manic episodes lasting at least seven (7) days and/or severe enough to require hospitalization, which is often followed by major depressive episodes. This condition is regarded as the most severe of the four types of bipolar disorder.4
- Bipolar II: The key characteristic of bipolar II is the presence of hypomanic episodes, which are less severe than full-blown manic episodes associated with bipolar I.5 These episodes are shorter in duration, lasting for at least four (4) days, and are less likely to cause significant impairment or require hospitalization.
- Cyclothymic: Cyclothymia is an affective disorder characterized by emotional reactivity and affective dysregulation.6 Though not as severe as the other bipolar disorders, diagnosing may be difficult as individuals often present with non-specific symptoms that resemble those associated with other psychiatric conditions.
- Other types: Other types of bipolar disorder may include rapid cycling bipolar, bipolar with seasonal pattern, and unspecified bipolar.5 Insofar as unspecified bipolar, this category includes other specified and unspecified bipolar and related disorders, which may not fit into the specific criteria for the mentioned types but still exhibit significant mood disturbances. Despite some ambiguity, this does not indicate that the condition is any less invasive or challenging insofar as daily life functioning.
Symptoms of Bipolar Disorder
Bipolar disorder primarily encompasses three main diagnoses: bipolar I, bipolar II, and cyclothymic disorder. In bipolar I, individuals experience manic episodes that may include inflated self-esteem, reduced need for sleep, and reckless behavior, often followed by major depressive episodes. Bipolar II involves depressive episodes and hypomanic episodes characterized by elevated mood and increased energy. Cyclothymic disorder is marked by numerous periods of hypomanic symptoms and depressive symptoms that do not meet the full criteria for major depressive episodes.
Across all categories, bipolar symptoms can include mood swings, changes in energy and activity levels, and disturbances in sleep, concentration, and decision-making. Accordingly, individuals may feel as though they are often unbalanced—experiencing high highs and low lows. While the high highs are oftentimes better received, and even sometimes welcomed by individuals with the diagnosis, each presents with their own challenges that may prove debilitating without appropriate treatment.
A person diagnosed with bipolar may exhibit a combination of these symptoms:
- Erratic or unpredictable behavior: Individuals may engage in risky activities or impulsive decision-making during manic episodes, such as overspending, unsafe sexual practices, or substance abuse.
- Impulsivity: Impulsivity in bipolar disorder can manifest as acting without considering the consequences, engaging in risky behaviors, or making sudden and oftentimes irrational major life decisions during manic episodes.
- Fluctuating energy levels: Shifts between periods of high energy during manic episodes and low energy during depressive episodes are common in bipolar disorder. One may feel atop of the world or even like a superpower while manic to hardly having the energy to get out of bed or interact with others while depressed.
- Increased goal-directed activity: During manic episodes, individuals may eagerly take on multiple tasks or projects simultaneously without completing them.
- Changes in sleep patterns: Fluctuations in sleep, such as insomnia during manic episodes or excessive sleeping during depressive episodes, are prevalent. This further throws off an individual’s equilibrium and may further complicate one’s physical health as well.
- Racing thoughts: Individuals may experience a rapid flow of ideas and heightened mental activity that can be difficult to control during manic episodes. Interpersonally, it may prove difficult for individuals to hold a coherent conversation during this time.
- Difficulty concentrating: Both manic and depressive episodes can lead to a decreased ability to focus, make decisions, or remember things. Corresponding symptoms here may include confusion, frustration, and otherwise undesirable effects.
- Feelings of hopelessness: During depressive episodes, individuals may experience persistent feelings of sadness, worthlessness, or guilt. They may begin to believe that they are the problem and/or inherently flawed when the reality is that the experience is a manifestation of bipolar symptoms and not anything tied to their actual personality.
- Suicidal thoughts: Severe depressive episodes can lead to thoughts of death or suicide, requiring immediate professional intervention and support.
What is Schizophrenia?
Schizophrenia encompasses a spectrum of disorders and is a chronic mental health disorder characterized by distorted thinking, emotions, and perceptions.1 Individuals with schizophrenia may experience hallucinations, delusions, disorganized thinking, and reduced emotional expression. Symptoms are often categorized as negative (e.g., lack of motivation or emotional expression), positive (e.g., hallucinations or delusions), and cognitive (e.g., difficulties with attention or memory).
Schizophrenia typically emerges in late adolescence or early adulthood, affecting men slightly more than women, though numbers are close in prevalence and incidence.7 Generally, it is less common than bipolar disorder, with a prevalence of about 1 in 300 people, or 0.32% of the world population,8 compared to bipolar disorder’s approximate 0.6%.2
Symptoms of Schizophrenia
Schizophrenia symptoms are often categorized into three groups: negative, positive, and cognitive. Negative symptoms of schizophrenia involve disruptions to normal emotions and behaviors, such as reduced emotional expression, apathy, decreased sense of purpose, and social withdrawal. Positive symptoms of schizophrenia include hallucinations, delusions, and disorganized thinking, representing an excess or distortion of normal functions. Cognitive symptoms relate to difficulties with attention, memory, and executive functioning.
While both positive and negative symptoms significantly impact individuals with schizophrenia, negative symptoms often have a more pervasive and long-lasting effect on a person’s overall functioning and quality of life.9 Since some patients may lack insight into the presence of negative symptoms, these are generally not the reason that patients seek clinical care.9 Accordingly, positive symptoms are typically what leads one toward seeking or being encouraged to seek treatment.
A person diagnosed with schizophrenia may exhibit a combination of these symptoms:
- Hallucinations: Individuals may perceive sensations that are not real, such as hearing voices or seeing things that others do not.
- Delusions: These are false beliefs that are not based in reality, often involving paranoia or grandiosity.
- Disorganized speech: Speech may become incoherent or fragmented, making it difficult for others to understand the person’s thoughts.
- Difficulty concentrating: Individuals may struggle to maintain focus or follow a conversation due to cognitive impairments.
- Anhedonia: This symptom involves a decreased ability to experience pleasure or interest in previously enjoyable activities.
- Social withdrawal: Individuals may avoid social interactions and isolate themselves from others.
- Disorganized behavior: This can manifest as unpredictable or inappropriate actions, such as agitation or aimless wandering.
- Apathy: Individuals may lack motivation and ultimately struggle with initiating and sustaining goal-directed activities, often leading to neglect of personal hygiene or responsibilities.
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Differences Between Bipolar Disorder & Schizophrenia
Despite their similarities, bipolar disorder and schizophrenia are distinct mental health conditions with key differences. Bipolar disorder primarily involves mood disturbances, characterized by episodes of mania and depression, while schizophrenia primarily affects an individual’s perception of reality, often involving hallucinations, delusions, and disorganized thinking.
A recent article states, “provided support for the view that schizophrenia, schizoaffective disorder, and bipolar disorder are in the continuum of severity of impairment, with bipolar disorder closer to normality and schizophrenia at the most severe end.”10 While both disorders can include psychotic symptoms, such as hallucinations and delusions, schizophrenia tends to be more invasive, with pervasive and enduring disruptions in thinking, emotions, and behaviors, often leading to chronic impairment in daily functioning.10
Similarities Between Bipolar Disorder & Schizophrenia
Symptomatic overlap is a common similarity between bipolar disorder and schizophrenia. Both conditions can involve depressive episodes, psychotic symptoms such as hallucinations and delusions, as well as disorganized speech and behavior. Additionally, individuals with either disorder may experience challenges with concentration, cognitive function, and social withdrawal.
While these symptoms can be present in both disorders, the nature and duration of these symptoms often differ, aiding in the differential diagnosis between the two conditions. Currently, both are treatable conditions, though neither have a cure. An appropriate diagnosis of either, or in some cases both, is necessary to inform the route of treatment.
Can You Have Both Bipolar Disorder & Schizophrenia at the Same Time?
Yes, it is possible for an individual to have both bipolar disorder and schizophrenia at the same time. In such cases, the person may exhibit symptoms from both the mood disorder spectrum seen in bipolar disorder and the psychotic symptoms characteristic of schizophrenia.
Occasionally, when symptoms from both disorders are present, the diagnosis may be categorized as schizoaffective disorder, a condition that combines features of both schizophrenia and mood disorders.11 Roughly 1 in 200 people develop this condition at some point in their lifetime.11 Accordingly, there are three subtypes of schizoaffective disorder, which include manic, depressed, and mixed types.
How are Bipolar Disorder & Schizophrenia Diagnosed?
Diagnosing bipolar disorder and schizophrenia typically involves a comprehensive psychiatric evaluation conducted by a mental health professional (i.e., psychiatrist, psychologist). This assessment includes a detailed review of symptoms, medical history, and often the involvement of family members or close associates. Additionally, the process may include physical exams, laboratory tests, and imaging studies to rule out other potential causes for the symptoms. One can obtain a diagnosis by seeking evaluation and treatment from a mental health professional.
A doctor may perform or recommend a combination of these methods to diagnose bipolar and schizophrenia:
- Magnetic Resonance Imaging (MRI): MRI scans help to assess the brain’s structure and can aid in ruling out other potential causes for the symptoms seen in both disorders.
- Computed Tomography (CT): CT scans provide detailed images of the brain and can be used to identify any structural abnormalities or injuries that might contribute to the symptoms observed.
- Physical examination: A thorough physical examination can help rule out any medical conditions that may mimic symptoms of bipolar disorder or schizophrenia, such as thyroid disorders or neurological diseases.
- Psychiatric examination: A comprehensive psychiatric assessment involves evaluating a person’s mental state, history, and symptoms to form a diagnosis and develop a suitable treatment plan.
- Other tests: Additionally, laboratory tests such as blood tests may be conducted to rule out other medical conditions that could mimic symptoms of bipolar disorder or schizophrenia.
How Is Schizophrenia Treated?
The most effective schizophrenia treatment involves a holistic combination of treatment methods including antipsychotic medications, psychotherapy, and support services. These interventions aim to alleviate symptoms, improve functioning, and enhance quality of life for individuals with schizophrenia. Additionally, family education and support, as well as vocational and social skills training, play crucial roles in the comprehensive treatment of schizophrenia.
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Medications
For schizophrenia treatment, medications primarily include antipsychotics, which can be categorized as typical or first-generation antipsychotics and atypical or second-generation antipsychotics. Atypical antipsychotics are often preferred as first-line treatments due to their lower risk of movement-related side effects, although they may carry a higher risk of metabolic side effects such as weight gain and diabetes.12
Additionally, long-acting injectable antipsychotics are available, offering the advantage of ensuring consistent medication adherence and reducing the risk of relapse for individuals with schizophrenia. While these medications can effectively manage psychotic symptoms, they may also carry potential side effects, including sedation, metabolic disturbances, and movement disorders.13
Therapy
Therapeutic methods for treating schizophrenia often involve a combination of individual psychotherapy, family therapy, and social skills training. It serves to help address specific symptoms, aid in medication adherence, and assist individuals in developing coping strategies for managing hallucinations, delusions, and other challenges associated with schizophrenia. The goal of therapy is to help individuals manage their symptoms, improve social and occupational functioning, and enhance their overall quality of life.
Therapeutic options for schizophrenia include:
- Cognitive-behavioral therapy (CBT): CBT aims to help individuals identify and modify negative thought patterns and behaviors associated with their symptoms, promoting symptom management and improved coping skills.
- Family therapy: Involving family members in therapy can help improve communication, understanding, and support, and aid in the management of the individual’s symptoms and overall well-being.
- Social skills training: This type of therapy focuses on enhancing interpersonal and vocational skills to facilitate better integration into social and work environments, improving overall functioning and independence.
- Supportive therapy: Providing empathetic support and guidance, supportive therapy helps individuals manage stress, enhance self-esteem, and develop effective coping strategies for living with schizophrenia.
- Assertive community treatment (ACT): ACT involves a multidisciplinary team delivering comprehensive support, including medication management, therapy, and assistance with daily living, to help individuals with schizophrenia live independently and engage in the community.
Hospitalization
Hospitalization and in-patient provide a structured and supportive environment that includes medication management and close monitoring. Individuals may receive various forms of therapy, including individual and group sessions, to address their symptoms and develop coping strategies. Moreover, in-patient facilities provide a structured daily routine, social support, and psychoeducation to help individuals understand and manage their condition. This helps stabilize acute symptoms and prepare one for a successful transition back to the community.
How Is Bipolar Treated?
Similar to treating schizophrenia, the most effective bipolar treatment involves a combination of treatment methods, with medications being the primary front-line method. Medications such as mood stabilizers, antipsychotics, and antidepressants are commonly used to manage mood swings and related symptoms. In addition to medication, psychotherapy can be beneficial in helping individuals understand and cope with the challenges of bipolar disorder.
Medications
The primary medications prescribed to treat bipolar symptoms include mood stabilizers such as lithium, anticonvulsants like valproate and lamotrigine, and atypical antipsychotics such as quetiapine and olanzapine. These medications aim to address symptoms such as mood swings, agitation, and psychosis associated with bipolar disorder. Common side effects of these medications may include weight gain, sedation, and metabolic disturbances.14
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Therapy
Various forms of therapy, such as cognitive-behavioral therapy (CBT), psychoeducation, and interpersonal and social rhythm therapy (IPSRT), may be implemented to help individuals understand and manage their condition, identify triggers, and develop coping strategies. Therapy plays a crucial role in enhancing understanding and adherence to treatment, as well as in managing stress and mood-related symptoms, aiding in symptom management, and improving overall quality of life.
Comparatively, therapy may have a different focus and impact for individuals with schizophrenia, as it often targets different symptoms and challenges associated with that condition.
Therapeutic options for bipolar disorder include:
- Cognitive-behavioral therapy (CBT): CBT for bipolar helps individuals identify and modify negative thought patterns and behaviors, manage stress, and develop coping strategies better to handle mood swings and related symptoms of bipolar disorder.
- Family therapy: This form of therapy involves educating family members about bipolar disorder, improving communication, and developing strategies to support the individual’s treatment and recovery.
- Interpersonal and social rhythm therapy (IPSRT): IPSRT focuses on stabilizing daily routines and sleep patterns, which can help regulate mood and prevent relapses in bipolar disorder.
- Psychoeducation: Providing education about the nature of bipolar disorder, its treatment, and management strategies can empower individuals to understand better and handle their condition.
- Support groups: Participation in support groups can offer individuals with bipolar disorder opportunities for shared experiences, emotional support, and practical advice for managing their condition.
When to Seek Professional Help
For those experiencing symptoms such as hallucinations, delusions, severe mood swings, or significant disruptions in their daily functioning, it is crucial to seek professional help for a comprehensive evaluation and treatment. Given that both conditions are pervasive, especially without treatment, the earlier one engages in treatment, the better. Timely intervention is key in managing symptoms of schizophrenia or bipolar disorder and can significantly improve long-term outcomes.
To find a therapist or online psychiatrist, individuals can start by asking for referrals from their primary care physician, contacting their insurance provider, or seeking recommendations from trusted sources, such as the Choosing Therapy therapist directory. When choosing a therapist or online psychiatrist, it is essential to consider their qualifications, experience in treating schizophrenia or bipolar disorder, as well as their approach to therapy or psychiatric care. Additionally, ensuring a good fit in terms of communication style, trust, comfort, affordability, and accessibility is vital in establishing a productive therapeutic relationship.
In My Experience
Bipolar vs. Schizophrenia Infographics
Additional Resources
Education is just the first step on our path to improved mental health and emotional wellness. To help our readers take the next step in their journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy may be compensated for marketing by the companies mentioned below.
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