2006-03-05

No schizophrenia?

2 NAMES, 1 DISEASE: Does schizophrenia=psychotic bipolar disorder? in Current Psychiatry suggests that schizophrenia is actually severe bipolar I psychosis and not a separate diagnosis. A comprehensive review references questions going back many years, and argues that incorrect diagnosis has many implications. For the patient they include "less likely to receive a mood stabilizer or antidepressant...symptoms worsen, more likely to receive neuroleptics for life, increasing risk for severe and permanent side effects, and greater stigma with schizophrenia."

Three disorders—schizophrenia, schizoaffective disorder, and psychotic bipolar disorder—have been evoked to account for the variance in severity in psychotic patients, but psychotic bipolar disorder expresses the entire spectrum. We concur with others that psychotic bipolar disorder includes patient populations typically diagnosed as having schizophrenia and schizoaffective disorder. In other words, there is no schizophrenia or schizoaffective disorder.


It's worth considering, but I'd like to read reaction to this idea. Starting with your comments?

3 Comments:

Anonymous dylan said...

hmmm interesting,
there seems to be a greater emphasis on dopamine imbalance in schizophrenia than bipolar (classicly 5HT and perhaps inositol....).
added to that the genetic aspect of schizophrenia. it seems to me that although aspects of the way they present correlate, they may be differing underlying mechanisms.

the real problem is still misdiagnoising bipolar patients, and giving them prozac instead of lithium!

18/3/07 18:19  
Blogger Sandra said...

Definitely agree with all that, especially the last sentence.

18/3/07 20:38  
Anonymous Jesse said...

This makes very little sense; significant affective (mood) symptoms specifically exclude a diagnosis of Schizophrenia. That is not, of course, to say that Schizophrenics cannot experience depression or mania but that those symptoms will usually have a definable experiential cause, rather than an indefinite organic one.

First generation neuroleptics, used to treat Schizophrenia, often make Bipolar Disorder worse; thus, suggesting that they are separate illnesses is not unreasonable.

Schizoaffective Disorder is basically defined as a mood disorder with psychotic symptoms presenting in the absence of significant mood symptoms (i.e when the patient is neither significantly depressed nor manic)

On a more personal note, I was diagnosed as having Major Depression as a young child and tried many different antidepressants, over the years, without success; it was only recently, when I complained of hallucinations, delusional/bizarre thinking (I am lucky in that I am aware that these experiences are not real; many are not so fortunate), and mixed affective symptoms, that I was prescribed a medication that actually helped me feel better.
That medication is Abilify, an atypical antipsychotic.

As the difference made by Abilify was so profound, I would like to emphasize the importance, for patients, of being truthful with psychiatrists; it can mean the difference between years of suffering and mere days or weeks until the remission of symptoms.

My psychiatrist is currently unsure of my exact diagnosis but he has stated that he suspects it to be either Schizoaffective Disorder or Schizotypal Personality Disorder.
Either way, the treatments are similar enough to make little difference.

14/5/08 22:56  

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