The differences in symptoms and treatment between two often-misunderstood mental illnesses.
Bipolar disorder, which used to be known as manic-depressive disorder, is a chronic mental illness characterized by extreme shifts in mood and behavior. The National Alliance on Mental Illness reports that bipolar disorder is most often diagnosed in early adulthood, though it can develop at any point from childhood through old age. About 2.9 percent of people in the United States have some form of bipolar disorder, and is equally common in both men and women.
Schizophrenia, by contrast, is a psychotic disorder that affects a person’s perceptions, thought processes, and emotional responsiveness. The National Institutes of Health categorizes schizophrenia as chronic, severe, and disabling. It is primarily characterized by hearing and seeing things that aren’t there, known as hallucinations, and false beliefs, known as delusions.
Schizophrenia affects approximately 1.1 percent of the adult population in the United States. According to the Centers for Disease Control and Prevention, men tend to have their first schizophrenic episode at a younger age than women, around 21 versus 29 years old.
Both disorders have a genetic component and are likely to run in families. They may also be related to environmental and developmental factors, such as exposure to chemicals or malnutrition before birth.
Signs of schizophrenia
Symptoms of schizophrenia, which usually start between the ages of 16 and 30, fall into three categories: positive, negative, and cognitive.
Positive (meaning, the symptoms are present) schizophrenic symptoms are psychotic traits not generally seen in healthy people. These may include visual and auditory hallucinations, dysfunctional ways of thinking, delusions, or uncontrolled body movements.
Negative symptoms are a lack of the healthy behaviors seen in people without the disorder. These can include difficulty completing activities, reduced speaking, lack of pleasure in everyday life, and an inability to express emotions, often displayed as flat affect or emotionless voice.
Cognitive symptoms are a disruption in mental processes. They include an inability to process information or use it to make decisions, trouble focusing, or poor working memory. These symptoms can be subtle and difficult to spot, or they may be extreme and very obvious to outside observers.
A person with schizophrenia is often unable to see the difference between what they feel and believe and the reality that other people around them see. This can cause paranoia, confusion, or damage to personal relationships.
Signs of bipolar disorder
Unlike schizophrenia, bipolar disorder is characterized by elated mood and overly energized behavior offset by periods of depressed emotions and low physical energy. These are known as manic and depressive episodes. Hypomania, or less frenzied manic episodes, is also common.
Unlike the typical emotional highs and lows that most people experience, the emotional shifts associated with bipolar disorder are extreme and uncontrollable, often resulting in destructive and impulsive decisions. Episodes can happen simultaneously or in rapid succession, or they may be absent altogether for a period of time and return without warning.
During a depressive episode, a person with bipolar disorder has extremely low energy. He or she may sleep too much or feel exhausted but unable to sleep. Depressive episodes are usually accompanied by feelings of worthlessness and sadness, trouble concentrating, eating too much or too little, and a feeling of being physically slowed down.
A person in the middle of a manic episode is the exact opposite: excited and elated, with high levels of physical energy. They may have increased activity levels or feel jumpy and irritable. Manic episodes often include impulsive decisions about money, safety, or personal relationships, as well as an inability to sleep or relax.
Treating schizophrenia and bipolar disorder
Like most mental illness, schizophrenia and bipolar disorder are the result of chemical imbalances in the brain that affect how information is processed and used. Though it is impossible to know the exact causes of these imbalances in every case of schizophrenia or bipolar disorder, drugs and therapies are available to help correct them.
Depending on the severity of symptoms and the needs of the patient, both disorders can be treated with antipsychotic drugs, though these must be carefully prescribed and regulated due to the side effects they can cause. Bipolar patients may also be prescribed mood stabilizers or antidepressants.
Once symptoms are more under control, psychotherapy is helpful for both disorders. This may include cognitive behavioral therapy, which helps a patient develop coping mechanisms for symptoms that aren’t controlled by medication, as well as learning to respond to normal social cues and maintain interpersonal relationships.
For both disorders, it is important to seek professional, medical help. If you think that you or a loved one may have either bipolar disorder or schizophrenia, talk to your doctor as soon as possible.
April 25, 2018
Christopher Nystuen, MD, MBA