Schizoaffective Disorder vs Bipolar Disorder
Bipolar

Schizoaffective Disorder, Bipolar Type versus Bipolar Disorder with Psychosis

Schizoaffective disorder has features of both schizophrenia and mood disorders. Patients with Schizoaffective disorder generally respond better to treatment than people with schizophrenia but worse than those with a mood disorder.  For more about the basics of this disorder, click here.

On the other hand, bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. To read more about the basics of Bipolar Disorder, click here.

There are so many similiarities between Schizoaffective Disorder and Bipolar Disorder or Schizoaffective Disorder and Schizophrenia.  These similarities cause confusion in general of what the actual diagnosis is. This is a review of the differences between Schizoaffective Disorder, Bipolar Type and Bipolar Disorder with Psychosis. The table illustrates the similarities and differences.

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Schizoaffective Disorder, Bipolar Type Bipolar Disorder with Psychosis
Prevalance
  • In regional studies, lifetime prevalence for schizoaffective disorder varies from 0.32% to 1.1%. [7] [8]
  • An estimated 4.4% of U.S. adults experience bipolar disorder at some time in their lives
Pathophysiology
  • Reductions in both the gray and white matter, predominantly in the frontal and temporal regions
  • Deficits of emotional regulation
  • Deficits of emotional regulation
  • Loss of gay and white matter
Cognitive Deficits
  • Deficits in executive functioning
  • Disorganized thinking
  • Slow thinking
  • Difficulty understanding
  • Poor concentration
  • Poor memory
  • Difficulty expressing thoughts
  • difficulties with word retrieval
  • difficulties with planning, prioritizing and organizing of behavior (executive functioning)
  • problems with retention of what’s been read or listened to
  • Slow thinking
Risk Factors Family history of schizophrenia, substance use, age of father at patient’s birth, environment

Substance use

Brain Structure and Functioning, genetics, family history
DSM 5 Criteria

(United States)

  1. Schizoaffective disorder is an uninterrupted period of illness, during which there is an episode of mania or depression with a schizophrenia episode characterized by 2+ symptoms present for a considerable part of a 1-month period:
    • delusions
    • hallucinations
    • disorganized speech (e.g., frequent derailment or incoherence)
    • grossly disorganized or catatonic behavior
    • negative symptoms (i.e. affective flattening, alogia, or avolition).
  2. During this time, there should be a period of at least 2 weeks with delusions and hallucinations without mood symptoms.
  3. Mood symptoms have been present for the majority of time.
  4. Other possible symptoms have been ruled out.

Bipolar Type:

Specify whether bipolar type if manic episode is part of the presentation.

More info here.

  1. Criteria have been met for at least one manic episode (Criteria A-D under “Manic Episode” below).
  2. The occurrence of the manic or major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

For a diagnosis of bipolar I disorder, it is necessary to meet the following criteria as noted here.

ICD 10 Criteria

(International)

Schizoaffective Disorder:

  • A disorder in which the individual suffers from both symptoms that qualify as schizophrenia and symptoms that qualify as a mood disorder for a substantial portion (but not all) of the active period of the illness; for the remainder of the active period of the illness, the individual suffers from delusions or hallucinations in the absence of prominent mood symptoms.
Bipolar Disorder:

  • A major affective disorder marked by severe mood swings (manic or major depressive episodes) and a tendency to remission and recurrence.
  • A major affective disorder marked by severe mood swings (manic or major depressive episodes) and a tendency to remission and recurrence. (mesh)
Treatment
  • Atypical antipsychotics, then typical antipsychotics if no response
  • Mood Stabilizers
  • Antidepressants are avoided (at least at first)  due to the possibility of triggering mania
  • Mood stabilizers
  • Atypical antipsychotics
  • Antidepressants are avoided (at least at first)  due to the possibility of triggering mania

 

Wrap Up:

In a differential diagnosis, a doctor chooses between two disorders.  In this case, the disorders are Schizoaffective Disorder, Bipolar Type versus Bipolar Disorder with Psychosis.  Sometimes there is not enough information in the history that the patient provides to tell the difference between the two diagnoses. However, in mood disorder with psychosis, the mood disorder generally occurs before the psychosis, and the psychosis normally begins as mood symptoms increase and stops when the mood symptoms stop.  Generally speaking, there are periods of psychosis in Schizoaffective Disorder, Bipolar Type that occur outside of the mood episode.

Hopefully, this post cleared up any questions you may have about Schizoaffective Disorder, Bipolar Type and Bipolar Disorder with Psychosis.  Please note I am not a doctor and this is not medical advice but research that I uncovered for this blog post. Please see a psychiatrist if you are seeking a mental health diagnosis.  Read about the differences between Borderline Personalilty Disorder and Bipolar here.  Leave questions, comments, and prayer requests below.

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