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Today, 07 November 2009

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Question

What is the difference between bipolar disorder and schizophrenia? Can either of these occur later in life, i.e. the mid to late thirties? How are they treated?

Answer

Bipolar disorder is a mood disorder and schizophrenia is a psychosis. The two can be confusing diagnostically, but are very different and the treatment is not the same.

Bipolar disorder can occur at any age. It is characterised by swings between depression and mania. In the full blown manic stage the mood is typically elated, but may also be irritable and hostile. In this phase the person is generally unaware that their behaviour is inappropriate and, lacking insight, they may stop taking any medication. Mania generally alternates with depression, in which the full features of a depressive illness are shown. These are low self esteem, anxiety, poor concentration, disturbed sleep patterns, and loss of appetite. The treatment is lithium. Bipolar disorder can usually be well controlled on Lithium, allowing the person to continue to function in society.

Schizophrenia is defined as a mental disorder which tends to be chronic, with impaired functioning within society, and psychotic symptoms involving disturbances of thought, perception, feeling and behaviour. It is effectively a breakdown of the ego barriers which allow us our personality. It rarely occurs for the first time after the age of 40. Psychosis is a state of mind in which there is loss of touch with reality. For example a schizophrenic will hear his/her thoughts broadcast over the radio. Auditory hallucinations are common. There is a break down in thought patterns, preventing logical thought processes. Mood is blunted, that is they do not show appropriate emotional responses to situations. Personality tends to break down to such an extent that normal social functioning is very difficult.

Although schizophrenia tends to be chronic, something like 30% of patients recover completely and most of the remainder will show some improvement. The psychotic symptoms can generally be controlled with anti-psychotic drugs, but the blunting of emotion may be permanent. The treatment is with anti-psychotic drugs, as mentioned.

MORE PSYCHIATRIC ILLNESS Q&A'S
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