What is the relationship between Bipolar Disorder and Psychosis?

Factual Questions
1

There’s a thread in MPSIMS that is raising a question I’ve had for a while. The OP goes on for quite a while about his wife’s issue with what appears to be some kind of paranoid psychosis, and there a lot of responses from people with Bipolar loved ones that they can relate.

I would like to think I have a pretty firm grasp on what it means to be psychotic – my uncle is schizoaffective. This means that he suffers from a wide range of paranoid delusions and auditory and visual hallucinations. For example, he believes that the local university poisons his food and cigarettes (method of poison being dead cats), he is visited on a regular basis by aliens, and that his Bangles cassette tape was recently laced with LSD. He is completely out of touch with reality and spends a lot of time in the emergency psychiatric ward and on the verge of homelessness. He is not capable of making his own medical decisions and has been court ordered to receive his medications via injection on a regular basis. You can’t meet the guy without thinking, ‘‘Woah, I’m talking to a crazy dude.’’ It shows up in his speech, his gestures, it is written all over his face.

The ‘‘affective’’ part, best as I understand it, means that not only is he psychotic, but he also suffers from a mood disorder that is Bipolar in nature. It is probably the sort of thing that leads him to have violent outbursts and destroy all of his furniture.

My grasp of Bipolar disorder is a chemical imbalance that results in cycling from extreme depression to extreme mania, and that the mania can be self-destructive, violent, and occasionally (rarely) even accompanied by psychosis. I am even aware that with major depressive disorder, major depressive episodes are occasionally (rarely) accompanied by psychosis.

What I don’t get is when Bipolar with psychosis is just Bipolar with psychosis, and when it is schizoaffective disorder. What is the chemical (or even diagnostic) difference?

I know this isn’t an easy question to answer, given how little we understand about schizophrenia. I’m aware there seems to be at least a pretty strong relationship between schizophrenia and Bipolar… I just wondered what the key differences were, and how they present themselves symptomatically.

2

As a bipolar person with an academic background in behavioral neuroscience, I am fairly certain there is not a link between bipolar disorder and schizophrenia. Some extreme forms of mania can cause symptoms that overlap with schizophrenia but they aren’t the same.

Bipolar disorder is very easy for anyone to recognize in other people once they have been exposed to it. It is actually rare for bipolar people to exhibit symptoms that are delusional or the type found in schizophrenia but they do happen. Bipolar depression mimics that found in major depressive disorder yet it isn’t. Bipolar true mania is very easy to spot. Hypomania is almost easy to spot as well but it can have true positive qualities. Bipolar disorder is about the best major mental illness one can have from a therapeutic standpoint because complete, long-term remission is expected with proper drug therapies. Other metal illnesses like schizophrenia don’t always respond so completely clinically.

3

IANAD, but, in the US a book called the DSM contains the guidelines to diagnosing different mental disorders. It is sort of an odd system (IMO), since it comes across to me almost like a Chinese restaurant menu (Patient has symptoms X, Y, Z, and needs to have one from column A & two from column B to be diagnosed), but this is what is currently used.

Using information from the DSM, a very good site called Internet Mental Health gives full descriptions of various diagnoses and the similarities & differences between them, with symptomatology.

Anyway, this doesn’t directly answer your question, but this is a good site to use to do some of your own research.

Just trying to help, a little. :slight_smile: