Q:  I was wondering if schizophrenia and bipolar go hand in hand?


Dear Vivian -- 
Interesting you should ask: one of the biggest diagnostic issues in psychiatry, in my view, is the distinction between schizophrenia and bipolar disorder.  They're supposed to be two different illnesses, you see.  In theory, a given patient is "supposed" to only have one or the other.  If she/he has some intermediate form in which "thought disorder" symptoms like hallucinations and delusions are prominent even at times when no mood symptoms are prominent, then we use the label "schizoaffective" to indicate this "in between" condition. 

But you know, even though we have these different labels, whatever we're labeling seems not to really be amenable to the distinctions we're trying to draw.  For one thing, doctors disagree about which label to use rather frequently.  For another, the treatment for one can often benefit a person who's been diagnosed with the other!  That is, usually people with schizophrenia are treated with antipsychotics; and people with bipolar disorder are treated with mood stabilizers.  But several recent studies have shown that people with schizophrenia can get better with mood stabilizers faster than with antipsychotics alone, in some cases at least.  And for years we've used antipsychotics for people with bipolar disorder (too much, too reflexively when they're hearing voices or paranoid, in my opinion).  

So, I think that with time we'll see this distinction breaking down even further.  It was originally made, this distinction, back around 1900.  

Dr. Phelps

Published October, 2001