Bipolar Disorder and Schizophrenia: What Are the Differences?

Medically reviewed by Timothy J. Legg, PhD, PMHNP-BC on August 2, 2017Written by Daniela Ginta

Overview

Bipolar disorder and schizophrenia are two different chronic mental health disorders. People can sometimes mistake the symptoms of bipolar disorder for schizophrenia symptoms. Read on to learn how these conditions are alike and how they differ.

Bipolar disorder vs. schizophrenia

Bipolar disorder and schizophrenia have some aspects in common, but here are two of the main differences:

Symptoms

Bipolar disorder causes strong shifts in energy, mood, and activity levels. A person with bipolar disorder will switch between extreme excitement, or mania, and depression. These shifts can affect your ability to perform daily activities. In some cases, a person with bipolar disorder may also experience hallucinations and delusions (see below).

Schizophrenia causes symptoms that are more severe than the symptoms of bipolar disorder. People with schizophrenia experience hallucinations and delusions. Hallucinations involve seeing or hearing things that aren’t there. Delusions are beliefs in things that aren’t true. People with schizophrenia may also experience disorganized thinking in which they are unable to care for themselves.

Frequency and ages affected

Bipolar disorder affects approximately 2.2 percent of people in the United States. Typically, it first appears between the late teen years and early adulthood. Children can also show signs of bipolar disorder.

Schizophrenia isn’t as common as bipolar disorder. It affects 1.1 percent of the U.S. population. People usually learn they have it between the ages of 16 and 30. Schizophrenia isn’t usually seen in children.

Symptoms of bipolar disorder

People with bipolar disorder experience episodes of intense emotions. These include three main types of episodes:

  • Manic episodes are times of increased activity and energy. A manic episode can make you feel extremely happy or elated.
  • Hypomanic episodes are similar to manic episodes, but they’re less intense.
  • Depressive episodes are similar to those of people with major depression. A person having a depressive episode will feel severely depressed and lose interest in activities that they used to enjoy.

To be diagnosed with bipolar disorder, you have to have at least one episode of depression that meets the criteria for a major depressive episode. You must also have at least one episode that meets the criteria for a manic or hypomanic episode.

Other behavioral changes that may be symptoms of bipolar disorder include:

  • restlessness
  • hyperactivity
  • tiredness
  • trouble staying focused
  • irritability
  • extreme self-confidence and impulsivity, in the case of a manic episode
  • suicidal thoughts, in the case of a depressive episode

People with bipolar disorder can also experience psychotic symptoms during a manic or depressive episode. These can include hallucinations or delusions. Because of this, people may mistake their bipolar symptoms for those of schizophrenia.

Symptoms of schizophrenia

The symptoms of schizophrenia are divided into two groups, generally referred to as “positive symptoms” and “negative symptoms.” This isn’t based on whether a symptom is good or bad, but on whether the symptoms involve what could be described as “adding” or “removing” a behavior. Positive symptoms involve adding a behavior, such as delusions or hallucinations. Negative symptoms involve removing behavior. For instance, the symptom of social withdrawal involves removing social interactions.

Some of the early warning signs of schizophrenia may include:

  • social isolation
  • a loss of interest in activities
  • moodiness
  • a lack of any feelings
  • making irrational statements
  • surprising or unusual behavior
  • an altered sleep schedule
  • getting either too much or too little sleep
  • an inability to express emotions
  • inappropriate laughter
  • violent outbursts
  • acts of violence toward yourself, such as cutting yourself
  • hypersensitivity to smells, touches, tastes, and sounds
  • hallucinations, which often appear as threatening or condemning voices that may tell you to act in violent ways
  • delusions

Risk factors for bipolar disorder and schizophrenia

No one knows what causes bipolar disorder or schizophrenia. However, genetics are probably a risk factor, as both conditions likely run in families. This doesn’t mean that you’ll definitely inherit the disorder if your parent or sibling has it. Your risk increases, however, if multiple family members have the disorder. But knowing there’s a risk increases the chance of early detection and treatment.

Environmental factors may also contribute to your risk, but this connection isn’t entirely understood yet.

Diagnosis of bipolar disorder and schizophrenia

There are no blood tests for diagnosing bipolar disorder or schizophrenia. Instead, your doctor will do a physical and psychological exam. During the exam, they’ll ask you about any family history of mental disorders and your symptoms.

Your doctor may want to do a complete blood test to help rule out other conditions. They may also request an MRI or CT scan. Finally, they make ask you to agree to a drug and alcohol screening.

You may need to return for several visits before your doctor can make a diagnosis. These visits will help your doctor fully understand your symptoms. They may ask you to keep a daily record of your mood and sleep patterns. This can help your doctor see if any patterns emerge, such as manic and depressive episodes.

Treating bipolar disorder

Treatment for both bipolar disorder and schizophrenia involves therapy and medication.

For bipolar disorder, psychotherapy may include:

  • learning about mood swings and how to effectively manage them
  • educating family members about the disorder so they can be supportive and help with overcoming episodes
  • helping you improve your relationships with friends and coworkers
  • learning to manage your days to avoid possible triggers, such as a lack of sleep or stress

Your doctor may prescribe medications to control mood swings and related symptoms, such as:

People with bipolar disorder often have trouble sleeping. Your doctor may also prescribe sleep medication.

Treating schizophrenia

Treatment for schizophrenia includes antipsychotics and psychotherapy. Some of the more common antipsychotics used to treat schizophrenia include:

Psychotherapy approaches may include cognitive behavioral therapy.

It’s possible to have an initial schizophrenic episode and never experience another one. You may find a coordinated specialty care program called Recovery After an Initial Schizophrenia Episode (RAISE) to be helpful if you’ve experienced one episode only. This program includes:

  • psychotherapy
  • medication
  • family education and support
  • work or education support, depending on each situation

What you can do

People can often manage the symptoms of bipolar disorder and schizophrenia with medication and therapy. Having a support system in place will increase your chances of successfully managing your symptoms. A support system may include family, friends, and the people in your workplace.

If you have either bipolar disorder or schizophrenia, you have an increased risk of suicide. See your doctor if you have thoughts of suicide. They can provide treatment. Support groups can help to reduce the risk of suicide. You should also avoid alcohol and drugs to further reduce your risk.

If you have bipolar disorder, you should do the following:

  • Follow a relatively stable lifestyle.
  • Get an adequate amount of sleep.
  • Maintain a healthy diet.
  • Use techniques to manage stress.
  • Take medications as prescribed.

Identifying episode triggers may also help you to manage the condition.

If you have schizophrenia, you should follow your treatment plan. That includes taking medication as prescribed. This will help you to control symptoms and reduce your chances of a relapse.

Talk to your doctor if you think you may have either bipolar disorder or schizophrenia. Early diagnosis is an important first step toward returning to a symptom-free life.

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