Comparison of bipolar disorder and schizophrenia

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Schizophrenia is a primary psychotic disorder, whereas, bipolar disorder is a primary mood disorder which can also involve psychosis. Both schizophrenia and bipolar disorder are characterized as critical psychiatric disorders in the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5). [1] However, because of some similar symptoms, differentiating between the two can sometimes be difficult; indeed, there is an intermediate diagnosis termed schizoaffective disorder. [2]

Contents

While reported and observed symptoms are a main way to diagnose either disorder, recent studies use the advanced technology like magnetic resonance imaging (MRI) scans to try to understand the biology of mood and psychotic disorders. Through MRIs, psychiatrists can see specific structural differences in the brains of people with schizophrenia and bipolar disorder. These differences include volume of gray matter, neuropathological size differences variations and cortical thickness, which are associated with cognitive differences on tests. These differences may sometimes be seen throughout the lifespan of the diseases and often occur soon after the initial episode. [3]

In treating the bipolar disorder and schizophrenia, there are several paths that psychiatrists and psychologists take, some are similar and others are different. [4] [5] [6] However, there are a few conflicts regarding the medical and therapeutic treatments considering the long-term affects and relapse issues in treating both disorders. [4]

Cause and epidemiology

Both bipolar disorder and schizophrenia appear to result from gene–environment interaction. Evidence from numerous family and twin studies indicates a shared genetic etiology between schizophrenia and bipolar disorder. [7] [8] Researchers found a combined heritability for bipolar disorder and schizophrenia of approximately 60%, with environmental factors accounting for the remainder. [8] Genetic contributions to schizoaffective disorder appear to be entirely shared with those contributing to schizophrenia and mania. [7]

Bipolar I disorder and schizophrenia each occur in approximately 1% of the population; schizoaffective disorder is estimated to occur in less than 1% of the population. [7]

Schizophrenia

Schizophrenia is caused by a combination of genetic and environmental factors. [6] Research illustrates that schizophrenia is hereditary and is more likely to strike those who carry particular genes. [9] It is believed that those who are susceptible to the disorder are affected by something in their environment. According to research, alteration in the concentrations of specific chemicals in the brain may also contribute to schizophrenia. [3] Among the 1% of the population affected by this disorder, it is recorded that men are more susceptible than women to being impacted. The disorder typically shows symptoms during adolescence. [5] [3]

Bipolar disorder

There is no conclusive evidence as to what triggers it, but genetic and environmental factors are both being considered as probable causes. [6] It is believed that genetic factors contribute a role in its development. However, not everyone with a family history of bipolar disorder develops the disorder. [5] According to research, people with specific genes are more likely to develop the disorder. Stress, for example, can also precipitate the onset of bipolar disorder. [6]

Signs and symptoms

Schizophrenia

Biological

Patients with schizophrenia have abnormal brain activities which include changes in brain structure or function and abnormal levels of neurotransmitters. These changes may be associated with abnormal social or emotional functioning. [9]

Grey Matter

To be exact, patients with schizophrenia lose the volume of the grey matter in both hemispheres of the brain specifically in the left thalamus and the right caudate. Furthermore, the grey matter loss extends in to the cerebrum, parahippocampal gyrus and hippocampus. However, the gray matter increases in the temporal and parietal lobes along with the anterior cerebellum. The only region in which the volume increases for gray matter is within the right cerebellum, [10] [9] an area that contributes to the cognitive, affective, perceptual, and other deficits seen in schizophrenia. [11]

Neuropathological

MRI studies found that schizophrenia is associated with significantly smaller amygdala volume compared to healthy controls. [12]

Behavioral

Includes withdrawal from social interaction, disorganized speech or behavior, and abnormal motor behaviors. Disorganized speech can include rambling, incoherence, or abruptly switching between topics. [3] People who have schizophrenia may also have delusions or hallucinations. Delusions are false beliefs not supported by evidence—for example, believing that you are being followed or watched or possessing special abilities or powers. Hallucinations are the perception of seeing, hearing, or feeling things that are not present. [9]

Bipolar disorder

Biological

Unlike schizophrenia, bipolar disorder has very little differences for gray matter volume. [13] [10] Overall, there is no difference in brain tissue volumes between bipolar patients and healthy control patients. [10]

However, some research has observed that patients with mood disorders had abnormalities including cortical tissue and subcortical regions of brain. Left anterior lesions, whether cortical or subcortical predicts high level of depression in patients suffering from mood disorders. Both the left cortical and subcortical showed a significant relationship between the severity of depression and the location of the lesion in regard to the frontal lobe. [14]

Behavioral

Behavioral symptoms of patients with bipolar disorder include changes in mood, activity levels, and behavior. Bipolar disorder patients may be delighted during a manic episode and extremely sad during a depressive episode. They may also experience changes in their level of activity. [5] They may be highly active during a manic episode and then extremely inactive during a depressive episode and exhibit behavioral changes. They may engage in behaviors they would not normally engage in during a manic episode, such as excessive spending. [3]

Treatment

While there is no cure for either condition, effective treatments can help people manage their symptoms and live productive lives. [9]

Most treatments are designed to control symptoms and make them more tolerable due to low rates of complete remission for both disorders and poorly understood and under-researched change mechanisms. [6] Treatments for these disorders include medication, psychotherapy, rehabilitation, and electroconvulsive therapy.

Medication

Medication is the cornerstone of treatment for both bipolar disorder and schizophrenia. Antipsychotic medications are the most commonly prescribed for both conditions. [4] Antipsychotics work by helping to regulate the levels of certain chemicals in the brain that are involved in mood and thinking. [2] Moreover, mood-stabilizers, such as lithium, are the primary medication treatment for bipolar disorder. [4]

Furthermore, second generation antipsychotics (dopamine antagonist and serotonin antagonist) medications may also be used for bipolar disorder, often in combination with antidepressant medications (which typically increase serotonin availability). Antipsychotics (usually second generation but also first generation) are the major class of medications used to treat schizophrenia. [2] [4]

Side effects

Common side effects of antipsychotic medications include dry mouth, weight gain, drowsiness, and constipation. Some antipsychotic medications can also cause a temporary worsening of symptoms known as akathisia. [9]

Psychotherapy

Psychotherapy is a treatment for patients with both disorders. They guide the patients in their thoughts, and use communication or behavioral work as a means of healing. [15] [16] The most common and effective type of therapy is Cognitive behavioral therapy (CBT) that can help people manage their symptoms and improve their overall functioning. It aids people identify and change negative thinking and behavior patterns. CBT is used to treat both bipolar disorder and schizophrenia. [5]

Families of the affected also benefit from this treatment, as they can sit on sessions and talk to the therapist as well. [15] [16] Other type of therapy that can be helpful for people with bipolar disorder and schizophrenia include family therapy, psycho-education, and support groups. [2]

Rehabilitation

Rehabilitation is one of several psychosocial treatments for schizophrenia. It involves social and job-skills training to improve an individual's ability to function in society. [16]

Electroconvulsive therapy

Electroconvulsive therapy (ECT) may be used to treat bipolar disorder when other treatments are ineffective or when medication would be dangerous because of another medical condition. [15]

See also

Related Research Articles

<span class="mw-page-title-main">Antipsychotic</span> Class of medications

Antipsychotics, also known as neuroleptics, are a class of psychotropic medication primarily used to manage psychosis, principally in schizophrenia but also in a range of other psychotic disorders. They are also the mainstay together with mood stabilizers in the treatment of bipolar disorder.

Mania, also known as manic syndrome, is a mental and behavioral disorder defined as a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together with lability of affect." During a manic episode, an individual will experience rapidly changing emotions and moods, highly influenced by surrounding stimuli. Although mania is often conceived as a "mirror image" to depression, the heightened mood can be either euphoric or dysphoric. As the mania intensifies, irritability can be more pronounced and result in anxiety or anger.

<span class="mw-page-title-main">Mood stabilizer</span> Psychiatric medication used to treat mood disorders

A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by intense and sustained mood shifts, such as bipolar disorder and the bipolar type of schizoaffective disorder.

Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

<span class="mw-page-title-main">Schizophrenia</span> Mental disorder with psychotic symptoms

Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations, delusions and disorganized thinking. Other symptoms include social withdrawal and flat affect. Symptoms typically develop gradually, begin during young adulthood, and in many cases are resolved. There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person. For a diagnosis of schizophrenia, the described symptoms need to have been present for at least six months or one month. Many people with schizophrenia have other mental disorders, especially substance use disorders, depressive disorders, anxiety disorders and obsessive–compulsive disorder.

<span class="mw-page-title-main">Psychiatric medication</span> Medication used to treat mental disorders

A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. These medications are typically made of synthetic chemical compounds and are usually prescribed in psychiatric settings, potentially involuntarily during commitment. Since the mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization, thereby lowering the cost of mental health care. The recidivism or rehospitalization of the mentally ill is at a high rate in many countries, and the reasons for the relapses are under research.

<span class="mw-page-title-main">Atypical antipsychotic</span> Class of pharmaceutical drugs

The atypical antipsychotics (AAP), also known as second generation antipsychotics (SGAs) and serotonin–dopamine antagonists (SDAs), are a group of antipsychotic drugs largely introduced after the 1970s and used to treat psychiatric conditions. Some atypical antipsychotics have received regulatory approval for schizophrenia, bipolar disorder, irritability in autism, and as an adjunct in major depressive disorder.

Schizoaffective disorder is a mental disorder characterized by abnormal thought processes and an unstable mood. This diagnosis requires symptoms of both schizophrenia and a mood disorder: either bipolar disorder or depression. The main criterion is the presence of psychotic symptoms for at least two weeks without any mood symptoms. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses.

The dopamine hypothesis of schizophrenia or the dopamine hypothesis of psychosis is a model that attributes the positive symptoms of schizophrenia to a disturbed and hyperactive dopaminergic signal transduction. The model draws evidence from the observation that a large number of antipsychotics have dopamine-receptor antagonistic effects. The theory, however, does not posit dopamine overabundance as a complete explanation for schizophrenia. Rather, the overactivation of D2 receptors, specifically, is one effect of the global chemical synaptic dysregulation observed in this disorder.

Thought broadcasting is a type of delusional condition in which the affected person believes that others can hear their inner thoughts, despite a clear lack of evidence. The person may believe that either those nearby can perceive their thoughts or that they are being transmitted via mediums such as television, radio or the internet. Different people can experience thought broadcasting in different ways. Thought broadcasting is most commonly found among people that have a psychotic disorder, specifically schizophrenia.

<span class="mw-page-title-main">Psychotic depression</span> Medical condition

Psychotic depression, also known as depressive psychosis, is a major depressive episode that is accompanied by psychotic symptoms. It can occur in the context of bipolar disorder or major depressive disorder. It can be difficult to distinguish from schizoaffective disorder, a diagnosis that requires the presence of psychotic symptoms for at least two weeks without any mood symptoms present. Unipolar psychotic depression requires that psychotic symptoms occur during severe depressive episodes, although residual psychotic symptoms may also be present in between episodes. Diagnosis using the DSM-5 involves meeting the criteria for a major depressive episode, along with the criteria for "mood-congruent or mood-incongruent psychotic features" specifier.

Schizophreniform disorder is a mental disorder diagnosed when symptoms of schizophrenia are present for a significant portion of time, but signs of disturbance are not present for the full six months required for the diagnosis of schizophrenia.

Bipolar disorder in children, or pediatric bipolar disorder (PBD), is a rare and controversial mental disorder in children and adolescents. PBD is hypothesized to be like bipolar disorder (BD) in adults, thus is proposed as an explanation for periods of extreme shifts in mood called mood episodes. These shifts alternate between periods of depressed or irritable moods and periods of abnormally elevated moods called manic or hypomanic episodes. Mixed mood episodes can occur when a child or adolescent with PBD experiences depressive and manic symptoms simultaneously. Mood episodes of children and adolescents with PBD deviate from general shifts in mood experienced by children and adolescents because mood episodes last for long periods of time and cause severe disruptions to an individual's life. There are three known forms of PBD: Bipolar I, Bipolar II, and Bipolar Not Otherwise Specified (NOS). Just as in adults, bipolar I is also the most severe form of PBD in children and adolescents, and can impair sleep, general function, and lead to hospitalization. Bipolar NOS is the mildest form of PBD in children and adolescents. The average age of onset of PBD remains unclear, but reported ages of onset range from 5 years of age to 19 years of age. PBD is typically more severe and has a poorer prognosis than bipolar disorder with onset in late-adolescence or adulthood.

In medicine, a prodrome is an early sign or symptom that often indicates the onset of a disease before more diagnostically specific signs and symptoms develop. It is derived from the Greek word prodromos, meaning "running before". Prodromes may be non-specific symptoms or, in a few instances, may clearly indicate a particular disease, such as the prodromal migraine aura.

The glutamate hypothesis of schizophrenia models the subset of pathologic mechanisms of schizophrenia linked to glutamatergic signaling. The hypothesis was initially based on a set of clinical, neuropathological, and, later, genetic findings pointing at a hypofunction of glutamatergic signaling via NMDA receptors. While thought to be more proximal to the root causes of schizophrenia, it does not negate the dopamine hypothesis, and the two may be ultimately brought together by circuit-based models. The development of the hypothesis allowed for the integration of the GABAergic and oscillatory abnormalities into the converging disease model and made it possible to discover the causes of some disruptions.

<span class="mw-page-title-main">Postpartum psychosis</span> Rare psychiatric emergency beginning suddenly in the first two weeks after childbirth

Postpartum psychosis(PPP), also known as puerperal psychosis or peripartum psychosis, involves the abrupt onset of psychotic symptoms shortly following childbirth, typically within two weeks of delivery but less than 4 weeks postpartum. PPP is a condition currently represented under "Brief Psychotic Disorder" in the Diagnostic and Statistical Manual of Mental Disorders, Volume V (DSM-V). Symptoms may include delusions, hallucinations, disorganized speech (e.g, incoherent speech), and/or abnormal motor behavior (e.g., catatonia). Other symptoms frequently associated with PPP include confusion, disorganized thought, severe difficulty sleeping, variations of mood disorders (including depression, agitation, mania, or a combination of the above), as well as cognitive features such as consciousness that comes and goes (waxing and waning) or disorientation.

Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.

The causes of schizophrenia that underlie the development of schizophrenia, a psychiatric disorder, are complex and not clearly understood. A number of hypotheses including the dopamine hypothesis, and the glutamate hypothesis have been put forward in an attempt to explain the link between altered brain function and the symptoms and development of schizophrenia.

The diagnosis of schizophrenia, a psychotic disorder, is based on criteria in either the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or the World Health Organization's International Classification of Diseases (ICD). Clinical assessment of schizophrenia is carried out by a mental health professional based on observed behavior, reported experiences, and reports of others familiar with the person. Diagnosis is usually made by a psychiatrist. Associated symptoms occur along a continuum in the population and must reach a certain severity and level of impairment before a diagnosis is made. Schizophrenia has a prevalence rate of 0.3-0.7% in the United States

Dopamine supersensitivity psychosis is a hypothesis that attempts to explain the phenomenon in which psychosis occurs despite treatment with escalating doses of antipsychotics. Dopamine supersensitivity may be caused by the dopamine receptor D2 antagonizing effect of antipsychotics, causing a compensatory increase in D2 receptors within the brain that sensitizes neurons to endogenous release of the neurotransmitter dopamine. Because psychosis is thought to be mediated—at least in part—by the activity of dopamine at D2 receptors, the activity of dopamine in the presence of supersensitivity may paradoxically give rise to worsening psychotic symptoms despite antipsychotic treatment at a given dose. This phenomenon may co-occur with tardive dyskinesia, a rare movement disorder that may also be due to dopamine supersensitivity.

References

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