Although our family history is a great indicator to determine whether we will develop a psychiatric disorder like schizophrenia or bipolar, it’s not always the case. Mental illness can affect anyone and be quite challenging to learn about. Even worse, stigma is attached to schizophrenia and bipolar disorders, meaning many people who need help will avoid it based on the societal stigma alone. If you’ve seen any of these conditions on TV or in movies, it’s important to note that symptoms could be totally different. For that reason, learning about the similarities and differences can help you potentially seek the help you need.
Bipolar disorder is a severe mental health disorder affecting an estimated 5.7 million adults in the United States. This translates to about 2.6 percent of the total population aged 18 and older. Those affected by the condition typically see an onset of their symptoms around the age of 25. However, the disorder can arise anytime from early childhood to your late 40s or 50s. Men and women are affected equally by bipolar disorder, which is found in all races, ages, social classes, and ethnic groups. Family history plays a significant role, and two-thirds of those with the condition have one relative with the illness. It’s considered the sixth leading cause of disability globally.
Like bipolar disorder, schizophrenia is another severe mental health disorder considered one of the top 15 leading causes of disability globally. According to the World Health Organization’s (WHO) most recent data, the condition affects a staggering 24 million people, equating to one in 300 globally. While it’s far less common than other conditions and affects only 0.45 percent of the population, it’s completely debilitating in those who receive a diagnosis. Schizophrenia often causes psychosis and disables a person in all areas of life, including their personal, social, family, educational, and occupational functioning. Also concerning is that two out of three people with psychosis will not seek care.
Discrimination, stigma, and violation of human rights are widespread for those with bipolar disorder and schizophrenia. They’re conditions that cause individuals to be otherwise “discarded” and forgotten about. According to BMC Psychiatry, schizophrenia, bipolar disorders, and other co-occurring disorders significantly contribute to the homeless population throughout the United States and abroad. Of 31 studies conducted on 51,925 people without homes, 10.29 percent were diagnosed with schizophrenia, and 9 percent showed signs of other psychotic disorders not listed.
The only way to prevent these conditions from worsening and becoming a statistic on the street is to learn about them. If you or someone you love has noticed changes and you want to know the differences between schizophrenia vs. bipolar disorder, the similarities, differences, and other co-occurring mood disorders, we’ll explain it in-depth below.
What Is Schizophrenia?
The actual diagnosis is much different than the one you might have seen portrayed on television. The American Psychiatric Association (APA) defines it as a chronic brain disorder that affects less than 1 percent of the population and can lead to symptoms of delusions, disorganized speech, hallucinations, trouble recalling memory, and a lack of motivation. While treatment can help diminish symptoms, many people will not seek the help they need because of the factors listed above.
Although treatment is adequate, scientists have not been able to come up with a cure for schizophrenia. Experts have spent years studying the genetics of those diagnosed with the disorder and conducted intensive behavioral research, consisting of advanced imaging of the brain’s structure and function, to determine its cause and find more effective therapies. Schizophrenia is a complex disease, which answers why stigma exists and the misconceptions surrounding the condition.
Most people are under the impression that schizophrenia means a split personality or multi-personality. However, that’s not the case. Those diagnosed with schizophrenia are no more dangerous or violent than anyone in the general population. A diagnosis doesn’t always mean someone will become homeless or hospitalized, as most live with their families or alone. However, if left untreated, it can drive people to the street. The condition also means you’re likely to die younger than others due to co-occurring medical conditions like diabetes and heart disease caused by a lack of self-care.
There are various definitions of schizophrenia, including the following below.
Hallucinations are when you see, hear, taste, smell, or feel things that don’t exist in reality. To those experiencing them, they’re extremely clear and vivid, which appear to be a normal interpretation of their life experience. The most common hallucinations for those with schizophrenia are auditory or hearing voices.
These are fixed beliefs an individual diagnosed with schizophrenia will hold, no matter the evidence against them. Paranoid delusions, which are the most common delusions, occur when the person believes they’re going to be harmed or harassed by other people or groups.
This refers to a set of symptoms characterized by losing touch with reality, which happens when there is a disruption in how the brain processes information. During a psychotic episode, thoughts and perceptions are disrupted, and deciphering between fact and fiction is a challenge.
Disorganized Thoughts and Speech
A person diagnosed with schizophrenia may exhibit thoughts and speech that make no sense. For example, they may switch to an entirely different topic during a discussion that’s irrelevant. Symptoms can be severe enough to inhibit normal communication.
Negative symptoms include examples of decreased speech output, impaired emotional expression, and a decreased experience of pleasure. These are often severe.
Abnormal Motor Behavior
This consists of movements that occur without purpose to childlike silliness. It can lead to significant issues with daily life, including catatonia, which is when the individual is in a daze with little response to the outside world.
Symptoms of Schizophrenia
Those with active schizophrenia will endure episodes where they cannot distinguish the difference between fact and function. The duration, severity, and frequency of symptoms will vary from one person to the next, but someone with the disease will decrease in intensity as the individual ages. Alcohol and drug use, not taking medications, and stressful situations will cause the symptoms to worsen.
Schizophrenia symptoms fall into the following three categories:
- Positive symptoms: Hallucinations, or hearing voices or seeing things that don’t exist in reality, as well as paranoia and exaggerated behaviors or beliefs.
- Negative symptoms: The inability to speak, find pleasure, or express emotions.
- Disorganized symptoms: Disordered thinking and speech. The individual has issues with logical thinking, leading to unusual behavior or movements.
Another area of functioning affected by schizophrenia is cognition, which leads to issues with concentration, memory, attention, and a decline in educational performance.
Causes of Schizophrenia
The precise cause of schizophrenia is unknown. While scientists have poured their lives into developing cutting-edge treatment and determining the cause of this horrible disease, they have only come up with the idea that a combination of genetic, physical, environmental, and psychological factors play a role in someone developing the condition.
The following put you at an increased risk of developing schizophrenia:
- Genetics: Schizophrenia runs in families. However, there isn’t a specific gene responsible for the disease. If identical twins develop the condition, the other twin has a one in two chance of developing it.
- Brain development: Those with schizophrenia have subtle differences in the structure of their brain, which are not seen in everyone with the disease, suggesting it’s partly a disorder of the brain.
- Neurotransmitters: There is a connection between schizophrenia and neurotransmitters because drugs that alter their levels relieve symptoms in the brain.
- Birth complications: Those who encounter complications during birth, such as low birth weight, premature labor, or a lack of oxygen, can affect brain development.
Schizophrenia is a potentially severe disease. Below, we’ll examine bipolar disorder and find some of the differences and similarities between the two.
What Is Bipolar Disorder?
Have you ever heard someone mutter the phrase, “you’re acting bipolar?” Unless you’ve researched the condition, most people believe an abrupt switch from happy to sad, angry, or anxious is bipolar disorder. While extreme mood swings are cause for concern and could indicate signs, it’s only part of it. The Mayo Clinic defines it as a mental health condition that leads to emotional highs (mania or hypomania) and lows (depression). It was formerly referred to as manic depression.
Experiencing depression is common in life. Sometimes we lose pets or friends or go through periods where we don’t feel well. However, normal depression will eventually wane, and you’ll get back in line with your life. You’ll experience some sadness and hopelessness, but it’s not what you’ll encounter if you’re diagnosed with bipolar disorder. For example, when your moods shift to mania or hypomania, a person will be brimming with energy, euphoria, and confidence. These mood swings will interfere with judgment, sleep, and your ability to think clearly.
Bipolar disorder affects each individual in a different manner. Mood swings might seldom occur in some, whereas others experience them multiple times a year. Some won’t encounter any. Even though bipolar disorder is a lifelong condition, mood swings and other symptoms can be treated with a plan that includes medication and psychotherapy.
Types of Bipolar Disorder
Like schizophrenia, there are varying types of bipolar disorder and other related co-occurring mood disorders. These include mania, hypomania, and depression. Symptoms range from unpredictable changes in mood to significant distress in the person’s life.
Below are the most common types of bipolar disorders:
Bipolar I Disorder
This consists of one manic episode that is preceded or followed by major depressive episodes. Some people report that their mania triggers psychosis.
Bipolar II Disorder
Bipolar II disorder consists of one major depressive episode and one hypomanic episode. However, individuals with this form of the disease have not had a manic episode.
For adults, you’ve had two years of hypomania symptoms and periods of depressive symptoms that are less severe than major depression. For children, this timeline is one year.
Symptoms of Bipolar Disorder
Many are under the impression that bipolar II disorder is less severe than bipolar I disorder. However, that’s not true. They are separate conditions. Although manic episodes found in bipolar I disorder have the potential to be severe and dangerous, those with bipolar II disorder can be depressed for prolonged periods, leading to disability.
Bipolar disorder can appear at any age but is most common during your teens or early 20s. Symptoms will range from mild to severe. Below are the most common bipolar symptoms:
Mania & Hypomania
These are two distinct types of bipolar episodes but have similar symptoms. Mania is considered more severe than hypomania and causes significant disruptions at work, school, and other social activities. Mania might also cause psychosis, which requires hospital care. Both manic and hypomanic episodes include three or more of the following symptoms:
- Unusually upbeat, wired, or jumpy
- Racing thoughts
- Increased energy, activity, or agitation
- An exaggerated sense of self-confidence
- Unusually talkative
- Less need to sleep
- Easily distracted
- Poor decision-making, such as taking sexual risks, spending money on unneeded items, or other poor investments
Major Depressive Episode
Symptoms of a major depressive episode are bad enough to cause challenges in day-to-day activities. Someone experiencing a depressive episode will exhibit five or more of the following symptoms:
- Insomnia or sleeping too much
- Losing interest and feeling no pleasure in activities you once found joy in doing
- A mood marked by depression, including feeling sad, hopeless, or empty – life has no meaning
- Significant weight loss or weight gain without trying
- A loss of energy or constant fatigue
- Feeling worthless or guilty for no reason
- Inability to concentrate
- Thinking about or planning suicide
Causes of Bipolar Disorder
Like schizophrenia, doctors still haven’t found what causes bipolar disorder. Although they’ve gained clarity on the topic due to their intensive studies, an exact cause is still to be determined. Bipolar disorder typically runs in families and has a strong genetic tie. There is also growing evidence that lifestyle issues and a person’s environment play a role in its development, including alcohol or drug abuse. WebMD cites a Johns Hopkins study that found that 40 percent of first-degree relatives of bipolar II patients also have bipolar II disorder.
Bipolar disorder could also stem from issues with neurotransmitters in the brain, including norepinephrine, serotonin, and dopamine. Disruption of these circuits is connected to schizophrenia, psychosis, and bipolar disorder.
Differences Between Schizophrenia and Bipolar Disorder
Psychosis is a hallmark symptom of schizophrenia. However, those with bipolar I disorder are at risk of psychosis during mania or depression, while individuals with bipolar II can have them during a depressive episode. Although schizophrenia and bipolar disorder share a set of severe symptoms, doctors look at the difference between symptoms.
While bipolar disorder leads to a significant shift in your mood, energy, and activity levels, it won’t happen continuously, meaning there will be spontaneous periods of stability. With schizophrenia, symptoms are much more severe than in bipolar disorder due to hallucinations and delusions. Bipolar disorder affects a larger portion of the population than schizophrenia.
How Are Schizophrenia and Bipolar Disorder Diagnosed?
Unfortunately, no tests exist to determine whether someone has schizophrenia or bipolar disorder. Your primary care physician will gather medical, family, and mental health information to pass on to a psychiatrist for a formal diagnosis. Mental health professionals will perform physical examinations, which consist of lab tests to determine other conditions aren’t causing your symptoms, and an array of different tests to rule out other diseases. Once they know what’s at play and have a list of your symptoms, they can make a formal diagnosis. When that’s completed, treatment will be necessary to avoid hospitalization.
How Are Schizophrenia and Bipolar Disorder Treated?
If you’re diagnosed with either of these conditions, your mental health professional will consider several interventions. It could include psychotherapy, medication, lifestyle changes, or a combination of all three. However, medication will likely be dispensed to address existing symptoms of the illness and prevent other symptoms from returning in bipolar disorder. For schizophrenia, drugs are extremely effective in managing positive symptoms like hallucinations and delusions.
Antipsychotic medications used to treat the positive symptoms of schizophrenia and manic symptoms typical of bipolar disorder include the following:
- Olanzapine (Zyprexa)
- Risperidone (Risperdal)
- Quetiapine (Seroquel)
- Ziprasidone (Geodon)
- Aripiprazole (Abilify)
- Paliperidone (Invega)
- Asenapine (Saphris)
- Iloperidone (Fanapt)
- Lurasidone (Latuda)
- Brexpiprazole (Rexulti)
- Haloperidol (Haldol)
- Chlorpromazine (Thorazine)
- Thioridazine (Mellaril)
- Lithium (Lithobid)
- Divalproex (Depakote)
- Carbamazepine (Tegretol and Tegretol XR)
- Lamotrigine (Lamictal)
These drugs treat active manic or mixed symptoms from returning. Antidepressants are the primary treatment for depressive symptoms in bipolar disorder. Selective serotonin reuptake inhibitors (SSRIs) are the most common route and include medications like:
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Vortioxetine (Trintellix)
- Vilazodone (Viibryd)
Other drugs, known as serotonergic adrenergic medications (SNRIs), could be used. These include:
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
- Desvenlafaxine (Pristiq)
- Levomilnacipran (Fetzima)
- Bupropion (Wellbutrin, a dopaminergic antidepressant)
While medication plays a vital role in balancing brain chemistry, psychotherapy is also necessary. It’s crucial to help someone live with schizophrenia or bipolar disorder and achieve the highest level of functioning in society. Psychotherapy will help you find ways to cope with the illness.
Cognitive behavioral therapy is among the most common treatments used to treat both conditions. It involves one-on-one interaction with a therapist. However, it could take place in group settings. There are various approaches, but they all include helping you manage your perceptions, thoughts, and behaviors. It’s the healthiest way to approach your issues. It addresses depressive symptoms in bipolar disorder, as well as feelings of guilt or negative thoughts about manic episodes.
In more severe cases, individuals struggling with their schizophrenia or bipolar disorder could endure electroconvulsive therapy (ECT). This is used to treat symptoms of both conditions that have inadequately responded to psychotherapy or several of the medications listed above. Transcranial magnetic stimulation (TMS) could be used to treat medication-resistant depression.
What Is the Long-Term Outcome of Schizophrenia and Bipolar Disorder?
We get it – it’s a life-changing moment when a doctor says you have one of these two conditions. People with bipolar disorder have significant mood problems, while someone with schizophrenia can lose touch with reality for prolonged periods. However, a combination of medications and psychotherapy helps substantially.
In the rare case that you’re resistant to these treatments, electroconvulsive therapy exists and can help you. There is no reason to suffer, and by staying the course and following through with getting help with getting your life back on track. You are at risk of developing other medical problems as a result of a diagnosis, so make sure to reach out for help to avoid this.