Some mental disorders are, at first glance, similar and have similar symptoms. These include bipolar disorder and schizophrenia. What they have in common is the presence of a common, similar feature — psychosis. But despite this, they have several differences that you should be familiar too.
The general concept of mental disorders
There is always some prejudice or fear associated with any mental disorder. Most people are sure that such a problem will never touch them, and those who have encountered it are afraid to talk about it for fear of public condemnation. But the human psyche is rather mysterious and incomprehensible, so many still do not fully understand that it can and should be treated like any other organ.
It seems to us that a mental disorder cannot be overlooked, and often we associate it with the bad or strange behavior of someone from our environment. All kinds of situations happen in life, and we experience them in different ways, experiencing different emotions:
- panic;
- anger;
- apathy;
- euphoria;
- hopelessness;
- despair, etc.
Reaction to the same situation can vary dramatically. Here it all depends on the temperament and psychological background of the person. Normal is a relative concept. If a constant excitement, activity, and vigor — a normal state, the lethargy and lack of initiative can be perceived as pathology, and vice versa. A person's mental state is considered normal when they feel peace and joy while showing their maximum capacity for work and efficiency.
Modern psychiatry is aimed at combating two major diseases. These are schizophrenia and bipolar personality disorder. The state of psychosis is peculiar to both of them. Real events are perceived inadequately, hallucinations, delusions, various manias, and the most incredible phobias are present.
It is impossible for a person who is not related to psychiatry to determine the presence of one or another disorder by eye. It is impossible to say anything without knowing the main symptoms and manifestations of the disease, without proper diagnosis, which takes quite a long period.
Bipolar disorder
Bipolar affective disorder is the same as manic-depressive psychosis, renamed to a more acceptable and tolerant version. Mental disorders of this type are characterized by periodic changes of states and cardinally opposite transformations of mood.
Each phase is characterized by its manifestations. At some point, it seems to the person that the entire world revolves around him, he is the most successful, the most intelligent, and he has no equal in beauty. Many ideas visit him, and he is ready to bring them to life immediately. He needs little or no sleep, and he eats almost nothing. Speech is very fast, but it isn't easy to catch the essence of his statements, as his thoughts jump chaotically from one topic to another.
These are typical signs of the period of manic disorder. The depressive phase follows this. Its main characteristics are usually the exact opposite of the previous one:
- a collapse of vitality;
- loss of motivation, apathy;
- pessimism;
- low self-esteem;
- propensity to self-harm or suicide.
The frequency of change of states is a purely individual phenomenon. Phases can alternate during the day or last several months or even years. A state of remission sometimes occurs between periods of bipolar disorder. It can also last for quite a long time without any manifestations of psychosis.
Schizophrenia
It is a severe mental disorder, often leading to socialization or disability. The main symptoms of schizophrenia are visual and auditory hallucinations and delusions. The disease hurts:
- thinking;
- expression of emotions;
- perception of the world;
- self-esteem;
- general behavior.
While delirium and hallucinations become almost constant companions of the person with schizophrenia, some qualities are lost gradually. Concentration and self-control are the first to suffer. Simple and accessible activities such as daily hygiene procedures or going to the store are extremely difficult for a person with schizophrenia. As the disorder progresses, some skills may atrophy together.
Often there is a division of personality. While in one of the separated personalities, the person has no memory of what they are doing in the other. It looks terrifying.
Differences of Diseases
Schizophrenia and bipolar disorder do not have many differences. Since a psychotic state characterizes these personality disorders, this is what is struggled with throughout the illness. The differences are in how the causes of the uncharacteristic behavior are addressed.
Both bipolar affective disorder and schizophrenia are chronic diseases, but the differences between experienced psychiatrists are obvious. The psychosis that occurs in bipolar disorder leads to extreme nervous system overstimulation. How is it different from schizophrenia? The following:
- Activity. A state of manic psychosis causes a person to be on the verge of experiencing feelings and emotions that overwhelm him. It can be excessive joy or delight. During mania, he can be violent and compulsive, but aggression is only rarely seen.
- Connectivity. The person does not close themself off; they remain open to communication and even strive to do so for themselves.
- The personality remains indivisible. The main difference between bipolar affective disorder and schizophrenia is the effect on the person's integrity. BAR does not destroy it. Between the phases of depression and mania, the patient is normal. No matter how long the period of psychosis lasts, the personality qualities remain unchanged.
Schizophrenic psychosis has a very different focus. The person concentrates on his thoughts and experiences, becomes withdrawn, and degenerates.
Treatment prognosis
Chronic diseases, which include bipolar disorder and schizophrenia, are notoriously impossible to cure. However, current early diagnosis and treatment methods can control these mental disorders in most cases. With the right medication, it is possible to treat the symptoms for a long time and lead a normal life.
While schizophrenia uses medications with a single spectrum of effects, bipolar disorder requires a more careful approach. The medication must match the current phase of the disease. Otherwise, the result will be the opposite of what is expected.
Known should that schizophrenia is a more severe illness than BAR. It destroys brain activity and the structure of the patient's personality. A person loses the urge for life and becomes uninterested in those around him. Instincts, including self-preservation, are blunted, which often ends in suicide.
BIPOLAR DISORDER: SYMPTOMS AND DIAGNOSTIC FEATURES
Bipolar affective disorder (BAD) is a chronic mental disorder manifesting itself by pronounced ups and downs in mood, energy level, activity and concentration, and ability to function in everyday life.
There are usually two types of bipolar disorder (BAR I, BAR II) and Cyclothymia; some researchers speak of a whole group of "bipolar spectrum disorders. All types of bipolar disorder are characterized by mood and behavioral fluctuations: from a feeling of desolation, hopelessness, and apathy (depressive phase) to emotional enthusiasm, extreme energy, increased social activity, propensity for risk (manic phase or its milder form — hypomania).
The main thing in bipolar disorder is the presence of periods (phases) of highs and lows in the mood. The level of energy and activity differs significantly from the person's norm.
Bipolar disorder type I (formerly "manic-depressive psychosis," MDP) is characterized by the presence of at least two phases: manic and depressive; the predominance of one phase (the so-called "predominant polarity") is individual for each patient and should be considered when choosing a therapy. The mixed phase — a combination of manic and depressive symptoms simultaneously — is also possible.
The course with long periods of intermissions — normalization of a mental condition — is often characteristic.
Bipolar disorder type II is characterized by the presence of phases of depression and hypomania, with depressive episodes predominating as a rule. Manic episodes in this type of bipolar disorder are absent.
The duration of intermissions varies, but the phases often tend to become more frequent.
✔ Cyclothymia is characterized by multiple periods of isolated symptoms of hypomania and depression for at least two years, which never reach the degree of an unfolded depressive or hypomanic episode. Symptoms are present at least half the time, and periods of stable mood usually last less than two months.
SYMPTOMS AND SIGNS OF BIPOLAR DISORDER
People are suffering from bipolar disorder experience extremely severe emotional swings, affecting their daily functioning, relationships with loved ones, and overall well-being.
Each phase of bipolar disorder is characterized by its symptoms, but sometimes individual symptoms of different phases may combine (a "mixed condition"), manifesting simultaneously.
The main sign of the bipolar disorder is the alternation of manic (hypomanic) and depressive phases. Sometimes, individual symptoms of different phases can be combined (mixed conditions). The main differences between bipolar disorder from normal mood swings are:
- Their severity and intensity.
- Their duration (at least at the onset of illness).
- They are essentially differing from a person's usual condition.
It is noticeable to the person themself and people close to them.
SYMPTOMS OF THE PHASES OF BIPOLAR DISORDER:
- Increased energy level, persistent thirst for activity, desire to take on many things at once, emotional lift;
- Exaggerated self-esteem, feeling of own importance and grandiosity;
- Irritability, sensitivity, nervousness;
- Difficulties with concentration, instability of attention;
- Reduced need for sleep;
- Reduced appetite;
- Increased talkativeness, very high rate of speech, frequent changes in the topic of conversation;
- Acceleration of thinking, feeling of "flight of thought," "leaps of ideas";
- Increased social activity, craving for entertainment;
- The tendency to risk, the lowered social responsibility and criticality of thinking;
- antisocial behavior, often alcohol and drug abuse, large and reckless monetary expenditures, casual sexual relations, dangerous driving;
- Feeling of own inadequacy, excessive feelings of guilt;
- Sleep disorders: insomnia or increased need for sleep;
- Change in appetite from normal levels (decreased or increased);
- Slow speech, reluctance to engage in conversation, feeling that communication is meaningless;
- Psychomotor retardation or agitation (agitation);
- Reduced interest in almost any type of activity, lack of pleasure (anhedonia) even from those activities which brought joy before (bring joy in the normal state);
- Feelings of helplessness, inability to cope even with simple daily activities, and lack of motivation;
- Often — abuse of alcohol and drugs;
HYPOMANIA: HOW IT DIFFERS FROM MANIA AND WHY TREAT IT
A hypomania is a mild form of mania. This phase is often not regarded by the person as a sad state. On the contrary, he considers it a period of the best well-being, functioning, and productivity. In the meantime, hypomania may also lead to reckless monetary expenditures, conflicts with colleagues and loved ones, casual sexual intercourse, and other adverse consequences.
The main problem of this phase, however, is that without proper treatment, hypomania can develop into an unfolding manic episode or change into a deep and long-lasting depression.
Hypomania may look harmless, but in fact, this phase often provokes the development of a severe manic episode or changes into a deep depression.
HOW OFTEN CAN THE PHASES CHANGE
In the classical course of bipolar disorder, the patient's condition returns completely to normal between phases, and intermissions occur. It can last indefinitely, including years and decades. However, phases may replace each other without an intermediate return to normality (continuum course). Sometimes, the patient may go through several phases of one pole before the other phase occurs.
The frequency of phase changes varies; they may alternate every few years, months, or weeks. The frequency of phase changes, the fast cyclic type (4 or more phases per year), and the ultra-fast cyclic type (4 or more affective phases in one month) are considered unfavorable.
CAUSES OF BIPOLAR DISORDER AND RISK FACTORS
Despite numerous studies, the nature of BIA is not precisely defined. Most researchers agree that no single universal cause causes the development of bipolar disorder. BAR is a multifactorial illness, the onset of which is influenced by:
✔ genetic factors (genetic predisposition), whose role is quite high;
✔ changes in brain structure, mediator exchange, and neural network interaction between individual brain regions;
✔ environmental factors, such as physical or mental trauma, stress, or major life changes (biopsychosocial model of the disease).
While type I BAR occurs with approximately equal frequency in women and men and first manifests mostly in adolescence and young adulthood, type II BAR is more common in women and is characterized by a later onset age (25–35 years) and often manifests during pregnancy or after childbirth. Sometimes symptoms of the disease occur in childhood or old age.
WHAT IS THE DANGER OF BIPOLAR DISORDER?
The risk of suicide with bipolar disorder is extremely high: 20–30 times higher than in the general population.
Bipolar disorder negatively affects the quality of life of the people directly suffering from it and their relatives and loved ones. Socially unacceptable or problematic behavior, a tendency to rash risky behaviors, alcohol and drug abuse, and an increased risk of other mental and somatic disorders are just a few things that negatively affect the life of a person with Bipolar disorder.
Bipolar disorder is an illness with an extremely high risk of suicide: cases of completed suicide in BAR are 20% over a lifetime, much higher even than in recurrent depression, and 20–30 times higher than the population average.
HOW IS THE BAR DIAGNOSED? WHAT TESTS DO I NEED TO UNDERGO?
Diagnosing bipolar disorder is extremely difficult. Until now, there is no sufficiently reliable method of instrumental examination. MRI, CT, EEG, and tests are used only to exclude the disorder's organic causes, examine the functions of other organs, and determine contraindications to prescribe certain drugs.
Diagnosis is based on:
✔ examination of symptoms;
✔ a thorough clinical evaluation;
✔ if necessary — application of psychometric scales (test psycho diagnosis);
✔ often requires not only a single assessment of the patient's condition at a given moment but also a detailed study of the course of the disease, hereditary predisposition, reaction to previous therapy, if it has ever been prescribed;
✔ In many cases, accurate diagnosis is only possible with regular patient follow-up over time.
A special problem with the diagnosis of bipolar disorder is that the manifestations of this disease and the nature of the course are extremely diverse. Very often, the symptoms of BAR have much in common with other mental disorders — recurrent depression, schizophrenia, schizoaffective disorder, personality disorders and substance abuse (SAW), etc. BAR can also be combined with other psychiatric disorders, such as anxiety, eating disorders, and attention deficit hyperactivity disorder. Patients with BAR are often prone to substance abuse and social and occupational maladjustment and have an increased risk of migraines, heart disease, diabetes, and other somatic diseases.
The number of diagnostic errors is very high; in particular, when differentiating type I BAR with psychotic symptoms from schizophrenia and type II BAR with recurrent depressive disorder, the rate of diagnostic errors exceeds 40%.
As a result, it often takes 8–10 years before a correct diagnosis is made. During this time, a person usually undergoes a multitude of doctors of various specialties. Incorrect treatment of patients with BIA when a diagnostic error is made usually results in a significant deterioration of health.
It is important to go to psychiatrists who specialize specifically in the diagnosis and treatment of bipolar disorder for a diagnosis. It will greatly reduce the chance of a diagnostic error and improper treatment.
When bipolar disorder is suspected, it is important to contact psychiatrists who specialize specifically in the treatment of bipolar disorder and who have specific knowledge, training, techniques, and protocols for treating BPA.
Diagnosing BIA is often challenging, even for experienced professionals, and cannot always be accomplished in a single consultation, especially when there is no objective information from relatives and loved ones, concurrent psychiatric disorders, psychotic symptoms, and substance abuse. A comprehensive approach to diagnosis and treatment, regular contact with the doctor, ongoing observation, including during intermissions, as well as the possibility of supervision or a second opinion, can significantly reduce the frequency of errors in diagnosis and increase the effectiveness of treatment.
An accurate diagnosis and the right treatment make a huge difference in patients' ability to cope with their symptoms and impact their overall quality of life.
Bipolar affective disorder
The causes of bipolar affective disorder are not yet fully understood. What is known is that patients with bipolar affective disorder have a slightly different brain function than people without BIA. It is due to the functioning of the brain's neurotransmitters.