- Bipolar disorder vs. schizophrenia: How to tell the difference
- Symptoms of mania
- Symptoms of depression
- Disorganized thinking and speech
- Abnormal behavior
- Inability to function regularly
- Psychotic episodes
- Disorganized thinking
- A physical examination
- A psychological evaluation
- Diary of symptoms and moods
- Treatment for bipolar disorder
- Treatment for schizophrenia
- Bipolar Disorder and Schizophrenia Treatment
- Bipolar Disorder and Schizophrenia Treatment at McLean
- McLean’s Bipolar Disorder and Schizophrenia Programs
- More Information
- What Are Bipolar Disorder and Schizophrenia?
- Bipolar Disorder and Schizophrenia Resources
- Books about Bipolar Disorder and Schizophrenia
- Learn More
- By Age
- Is It Bipolar Disorder or Schizophrenia?
- Schizophrenia vs Schizoaffective Disorder
- Schizoaffective Disorder
- What the Doctor Will Want to Know
- Schizophrenia vs. Schizoaffective Disorder
- How Bipolar Disorder and Schizophrenia Are Similar but Different
Bipolar disorder vs. schizophrenia: How to tell the difference
Bipolar disorder and schizophrenia are psychiatric conditions that have some common traits, but also key differences. Bipolar disorder causes shifts in mood, energy levels, and thinking. Schizophrenia causes a person to appear to lose touch with reality.
People with bipolar disorder may experience episodes of mania and depression, often separated by periods of relative stability.
Individuals with schizophrenia experience symptoms of psychosis, such as hallucinations or delusions. Some people with bipolar disorder also experience psychotic symptoms.
Because of some overlap in symptoms, getting the right diagnosis can be challenging. Also, a person can have both schizophrenia and bipolar disorder, which can complicate diagnosis.
Some people have schizoaffective disorder, which involves a combination of schizophrenia symptoms and those of a mood disorder.
In this article, we look at the similarities and differences between bipolar disorder and schizophrenia. We also discuss methods of diagnosis and treatment options.
Symptoms of bipolar disorder and schizophrenia vary and can differ in type and severity.
They may get worse, then significantly improve or go away for a period, which some doctors call remission.
People with bipolar disorder experience extremes in mood. Doctors may classify “highs” as mania or hypomania, while “lows” involve a decrease in mood and often depression.
In some types of bipolar disorder, people experience a less severe form of mania, known as hypomania. The symptoms are the same, but in hypomania, they are less severe. Nonetheless, they affect a person’s life and relationships.
A manic episode is all that is necessary for a diagnosis of bipolar I, while hypomania preceding or following a major depressive episode is necessary for a diagnosis of bipolar II. A person often experiences periods of relative stability in between.
Symptoms of mania
Mania can involve:
- anger or irritability
- difficulty sleeping or less need for sleep
- excessive energy and restlessness
- high self-esteem
- inability to concentrate or make decisions
- increased engagement in pleasurable activities, such as sexual activity or drug use
- intense excitement
- racing thoughts
- reckless behavior, such as overspending
In a person with bipolar disorder, depressive symptoms are the same as those in major depressive disorder.
Symptoms of depression
The primary symptom is a feeling of sadness or hopelessness that persists for 2 weeks or longer.
Other symptoms include:
- changes in appetite
- changes in sleep habits
- fatigue and low energy
- a loss of interest in things once enjoyed
- low self-esteem
- physical aches and pains without an apparent cause
- suicidal thoughts or behaviors
Bipolar disorder can also cause anxiety and psychotic episodes, during which a person loses touch with reality.
Approximately half of all people with a bipolar disorder diagnosis experience psychotic hallucinations or delusions.
When people display psychotic symptoms, doctors may be unsure whether they have bipolar disorder or schizophrenia.
Schizophrenia symptoms affect a person’s thoughts, emotions, and behaviors. They include:
These are false beliefs, and most people with schizophrenia experience them.
People may think, for example, that they are famous or special in a certain way, that they are being harassed or stalked, or that something terrible is about to happen.
During a hallucination, people see, hear, or smell things that are not there. The most common type involves hearing voices.
Disorganized thinking and speech
People may not make sense when communicating with others. They may give unrelated answers to questions, or their sentences may seem meaningless to the people around them.
People with schizophrenia may demonstrate unpredictable behavior, for example, by making child actions, strange postures, or excessive movements.
Inability to function regularly
Schizophrenia can affect a person’s ability to take care of their personal hygiene, engage with others in socially acceptable ways, or perform everyday activities.
The following symptoms can occur with bipolar disorder or schizophrenia:
For some people with bipolar disorder, these hallucinations or delusions arise during severe episodes of mania or depression.
This is common among people with schizophrenia, but people with bipolar disorder may seem to have disorganized thoughts during episodes of mania. They may struggle to concentrate on a single idea or task at a time.
A physical examination
This helps determine if medical problems are causing psychological symptoms. A doctor may also request specific tests, such as:
- blood tests
- MRI or CT scans of the brain
- drug and alcohol screenings
A psychological evaluation
A doctor, most ly a psychiatrist, will explore a person’s signs and symptoms, including those that affect thoughts, emotions, and behaviors.
They will also ask about family and personal mental health histories, and they may have the person complete a psychological self-assessment form.
During this evaluation, the doctor will also observe the person’s appearance and actions to look for signs of schizophrenia and bipolar disorder.
In addition, they will compare the person’s symptoms with the criteria set out in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, commonly called the DSM-5.
Diary of symptoms and moods
It may help to keep a daily diary of thoughts, moods, and sleep patterns. The doctor may examine this to identify patterns in behavior and other clues that can inform diagnosis and treatment.
Both conditions require lifelong treatment to manage symptoms.
Treatment for bipolar disorder
Share on PinterestAttending psychotherapy sessions can help a person manage their bipolar disorder.
Many people with bipolar disorder require medications to stabilize their moods.
These may include:
Psychotherapy is an important part of bipolar disorder management. It may take place individually or with a group or the person’s family.
Therapy can help people manage their thoughts and emotions, establish a routine, and identify triggers.
Those who do not respond to medications or psychotherapy may benefit from electroconvulsive therapy (ECT). The goal is to alter the brain’s chemistry by sending electrical currents through the brain, causing a seizure.
Other strategies that can help people with bipolar disorder include:
- avoiding alcohol and drugs
- eating a balanced diet
- establishing a daily routine
- exercising regularly
- getting enough sleep
- identifying triggers and taking steps to prevent or lessen manic or depressive episodes
- managing stress
- seeking help and support from family, friends, and others
Treatment for schizophrenia
Antipsychotic medications are a vital part of treatment for most people with schizophrenia. Doctors believe that they alter the brain’s chemistry and reduce symptoms such as hallucinations and delusions.
Some individuals also require other medicines, such as antidepressants or anti-anxiety drugs. For people who do not respond to medications, a doctor may recommend ECT, which can improve psychotic symptoms.
When the symptoms of psychosis are under control, people with schizophrenia typically benefit from psychological and social interventions. These may include:
- psychotherapy, both in individual and family settings
- social skills training, to improve interactions with others
- employment support, to help a person secure or perform a job more easily
- daily living support, to help people find housing and manage daily responsibilities
Other coping strategies include:
- avoiding alcohol and drug use
- joining a support group
- learning about schizophrenia
- making certain healthful lifestyle choices, such as eating a balanced diet, exercising, and maintaining a sleep schedule
- managing stress through meditation, exercise, and yoga
- seeking help from family and friends
Although there are similarities between bipolar disorder and schizophrenia, there are also key differences, particularly relating to symptom severity and treatment.
People with bipolar disorder generally alternate between periods of low and high moods, while people with schizophrenia typically lose touch with reality as they experience hallucinations and delusions.
With treatment, a person who has either condition can manage their symptoms and reduce the impact that it has on their life.
Bipolar disorder is typically more manageable after a person receives appropriate treatment. Schizophrenia is more challenging to treat, and people who have it tend to require greater support.
- Mental Health
- Psychology / Psychiatry
Bipolar Disorder and Schizophrenia Treatment
Bipolar disorder and schizophrenia are severe mental illnesses commonly referred to as psychotic disorders, meaning symptoms can include psychosis—impaired thoughts and emotions severe enough to induce a disconnect from reality. McLean Hospital offers comprehensive treatment and education to help individuals understand and manage symptoms of their illness.
Bipolar disorder causes severe shifts in mood, ranging from depressive lows to manic highs. These changes in mood are different from what may be experienced by most people, and if left untreated, often worsen. Bipolar disorder is treatable, and with proper care and attention to symptoms and recovery, individuals can learn to manage their disorder.
Schizophrenia is a complex brain disorder. Symptoms can include a disconnect from reality, paranoia, seeing or hearing things that aren’t there, and disorganized thinking. Though this a lifelong psychiatric illness, there are successful treatments, including medications and therapies, that allow individuals to live well with schizophrenia.
Find the help you need. Learn more below about treatment options at McLean, definitions, and helpful resources.
Bipolar Disorder and Schizophrenia Treatment at McLean
For patients who live with schizophrenia, bipolar disorder, or other severe forms of mental illness, McLean Hospital offers an array of mental health services. Successful treatment of these disorders involves a combination of elements, including medications, talk therapy, symptom education, and rehabilitation and social supports.
Staff in our inpatient, residential, outpatient, and community-based programs have specialized expertise in treating this patient population and in providing individualized support and education to family members. McLean is dedicated to continuity of services during transitions and helps to coordinate care with community clinicians, social service agencies, families, and other support systems.
McLean’s Bipolar Disorder and Schizophrenia Programs
Appleton provides comprehensive diagnosis, treatment, and rehabilitative care for adults ages 18 and over who have schizophrenia, bipolar disorder, or persistent psychiatric illness.
Our self-pay, longer-term residential program focuses on personalized care that helps individuals understand, accept, and effectively manage their illnesses and symptoms.
We help patients build skills so they can learn to live as independently as possible
Adolescent Acute Residential Treatment (ART) Program
The Adolescent Acute Residential Treatment (ART) Program provides intensive, short-term, and highly focused psychiatric care for teens and young adults through age 19 with emotional and behavioral difficulties. With a length of stay between 10 and 14 days, this insurance-based residential program focuses on stabilizing adolescents in acute crisis.
Call 877.929.6892 to learn more about treatment for bipolar disorder and schizophrenia at McLean
Behavioral Health Partial Hospital Program
This day program helps individuals to develop skills that improve their mood and ability to function in hopes of allowing them to better cope with life circumstances.
To achieve this mission, the BHP utilizes cognitive behavior therapy (CBT) approaches (including dialectical behavioral therapy skills) for a wide range of conditions such as mood and anxiety disorders, depression, personality disorders, bipolar disorder, and substance use disorders.
BHP is useful as a step-down transition from acute inpatient care or as an alternative to inpatient treatment.
McLean-Franciscan Child and Adolescent Inpatient Program
The McLean-Franciscan Child and Adolescent Inpatient Program is a place for hope and healing for children in psychiatric crisis.
Intensive psychiatric stabilization is available for children and adolescents ages 3 to 19. Located in Brighton, Massachusetts, we offer expert assessment and inpatient mental health treatment in a safe and nurturing environment.
The goal of the program is for each child and adolescent to successfully return to his or her home, school, and community.
McLean OnTrack focuses on treating young people ages 18 to 30 who have had their first episode of psychosis during the previous year. The years immediately following the onset of psychosis represent a critical period, and treatment during this time is important for good long-term results. Our self-pay, outpatient program is a leader in first episode psychosis care.
Waverley Place is a community-based support program which provides a therapeutic community for adults experiencing severe mental illness, including conditions such as schizophrenia and bipolar disorder. Staff, peer counselors, and other community members assist each member to design and implement a plan of action customized to the individual’s needs and goals.
Program of Assertive Community Treatment (PACT)
PACT brings clinicians into individuals’ homes and local communities. This allows us to best meet the ongoing needs of people with psychotic disorders such as schizophrenia, bipolar disorder, and psychosis.
As a “hospital without walls,” PACT strives to provide customized, person-centered care for individuals at any stage of the rehabilitation process.
The program is structured to make sure people receive the help they need, when they need it, and for as long as they need it.
Find more information about bipolar disorder and schizophrenia care and treatment at McLean:
What Are Bipolar Disorder and Schizophrenia?
According to National Alliance on Mental Illness (NAMI), every year, 2.9% of the U.S. population is diagnosed with bipolar disorder, with nearly 83% of cases being classified as severe.
Bipolar disorder is a chronic mental illness that causes dramatic shifts in a person’s mood, energy, and ability to think clearly.
People with bipolar disorder have high and low moods, known as mania and depression, which differ from the typical ups and downs most people experience.
With mania, people may feel extremely irritable or euphoric. People living with bipolar may experience several extremes in the shape of agitation, sleeplessness, and talkativeness or sadness and hopelessness.
They may also have extreme pleasure-seeking or risk-taking behaviors. If left untreated, the symptoms usually get worse.
However, with a good treatment plan and a strong lifestyle that includes self-management, many people live well with the condition.
Schizophrenia is a chronic and severe mental health disorder that affects how a person thinks, feels, and behaves.
People with schizophrenia may seem they have lost touch with reality and can experience hallucinations, delusions, and disorganized thinking.
Although schizophrenia is not as common as other mental illnesses, the symptoms can be very disabling. With treatment, often including medications and coping skills, it is possible to live well this condition.
According to NAMI, schizophrenia affects about 1% of Americans. The average age of onset tends to be in the late teens to the early 20s for men, and the late 20s to early 30s for women. It is uncommon for schizophrenia to be diagnosed in a person younger than 12 or older than 40.
Psychosis is characterized by an impaired relationship with reality. People who are psychotic may have either hallucinations or delusions. Hallucinations are sensory experiences that occur within the absence of an actual stimulus.
For example, a person having an auditory hallucination may hear their mother yelling at them when their mother isn’t around. Someone having a visual hallucination may see something, a person in front of them, who isn’t actually there. Psychosis is manageable with therapy and medications.
Early intervention (recognizing and treating the symptoms when they first arise) is an important part of best outcomes for this diagnosis.
Bipolar Disorder and Schizophrenia Resources
You may find the following organizations useful for more information on bipolar disorder and schizophrenia:
Books about Bipolar Disorder and Schizophrenia
McLean Hospital faculty have penned more than 50 books in recent years, including these books about psychotic disorders.
Social Cognition in Psychosis
by Kathryn Eve Lewandowski and Ahmed A. Moustafa
Chemotherapy in Psychiatry: Pharmacologic Basis of Treatments for Major Mental Illness, 3rd ed.
by Ross J. Baldessarini
Living with Someone Who’s Living with Bipolar Disorder: A Practical Guide for Family, Friends and Coworkers
by Chelsea Lowe and Bruce M. Cohen, MD, PhD
(Jossey-Bass/John Wiley & Sons, Inc., 2010)
Looking for information on another mental health condition? Visit one of these pages to find out more.
Is It Bipolar Disorder or Schizophrenia?
It's sometimes tricky to tell whether someone you care about has bipolar disorder or schizophrenia. They're both mental illnesses that affect how people think and act, and some of the symptoms look a lot a. But there are big differences, too.
When you have bipolar disorder, you have huge swings in mood and energy that can make it hard to do everyday activities. With schizophrenia, mood problems aren't so central, but your senses can play tricks on you, making it hard sometimes to know what's real and what's not. It can be difficult to think clearly and relate to people.
Schizoaffective disorder has features of both bipolar disorder and schizophrenia. Talk to your doctor about how to distinguish between these overlapping diagnoses.
If you have bipolar disorder, your mood can have big shifts. You may have periods called mania, when you feel extremely happy and full of energy. But you may also go into a depression phase and start to feel sad and hopeless.
There are two main types of bipolar disorder, which vary in how serious your episodes get and how long they last.
Bipolar I disorder involves periods of full-blown mania. You may have high energy, behave recklessly, and act in an extremely impulsive way.
If you have bipolar II disorder, you'll get “low-grade” periods of mania. When that happens, you might have “up” moods and high energy, but your symptoms don't get in the way of your daily life.
With severe bipolar disorder, you may have hallucinations, where you see or hear things that aren't there. You may also have delusions, where you firmly believe in something that just isn't true. This is when it's easy to confuse bipolar disorder for schizophrenia.
Some signs that you've got bipolar disorder are:
Mania symptoms. When you're in an “up” period, you may feel:
- Easily triggered or set off
- Full of energy and great ideas
- Happy and bursting with joy
- Jumpy or wired
You may also:
- Keep jumping from one activity to the next
- Stop eating or sleeping
- Talk fast and have thoughts that are all over the place
- Think you can do anything, so you do something risky spend money you don't have
Depression symptoms. When your mood swings to a depressed phase, you may feel:
- Down and hopeless
- Empty and worried
- Nothing brings you joy or pleasure
- Slow and tired
You may also:
- Eat too much or too little
- Have a hard time focusing
- Sleep too much or too little
- Think about killing yourself
Some folks get more periods of mania, while others get more periods of depression. And in between, you may feel normal.
Other people can have four or more times a year when they get a manic or depressive episode. This is called rapid cycling. And others get mixed states, feeling depressed and active at the same time.
When you have schizophrenia, you may have some of these symptoms:
Hallucinations. You see things or hear voices that aren't there.
Delusions. You totally believe something that isn't true, thinking someone's out to get you.
Confused thoughts. Also called disorganized thinking, you can't stay focused and might feel foggy or hazy. Your speech may also be hard to follow.
Behavior and thought changes. The way you act becomes less normal. You may shout for no clear reason. You may even think that someone's taking over your body.
Unusual body movements. You may move in odd, disturbed ways or hold postures that don't make sense.
You may also find that you no longer do things that you used to, such as:
- Enjoy activities
- Go ten
- Pay attention to cleaning and grooming yourself
- Show emotion (Your voice may be flat and your face may not reveal your feelings)
Doctors don't know for sure, but they think a mix of things can make you more ly to get it.
Brain structure and chemistry. People with the illness may have changes in the brain itself, as well as in the way chemicals called neurotransmitters work. These chemicals send information between nerve cells.
Genes. You're more ly to have it if someone in your family does, so your genes probably have something to do with it.
Stress. Emotional events, the death of a loved one, can trigger bipolar disorder for the first time, so how you handle stress may play a role, too.
There are probably a number of things behind this illness.
Brain structure and chemistry. Just with bipolar disease, the makeup of the brain and neurotransmitters are different in people with schizophrenia.
Mind-altering drugs. Taking certain drugs when you're a teenager or young adult may be a factor.
Problems before birth. If your mother didn't get the right nutrition or had a virus while she was pregnant with you, some theories suggest that your odds of getting schizophrenia may be higher.
Very active immune system. If your immune system — your body's defense against germs — gets triggered often, as with an autoimmune disease, some research suggests that your chances of getting schizophrenia may go up.
With both illnesses, you need treatment for the rest of your life, even if your symptoms get better. The approach to both is similar.
Bipolar disorder. You might take drugs such as mood stabilizers, antipsychotics, antidepressants, and others. You'll also get talk therapy — where you discuss your feelings with a mental health professional — to help you understand and manage the illness.
Schizophrenia. Drugs called antipsychotics are a key part of treatment to help with your brain chemistry. It may take some time to settle on the right drug and dose.
You'll probably also need daily support. You may get talk therapy, help with social skills, support for your family, and help getting and keeping a job.
National Alliance on Mental Illnesses: “Bipolar Disorder,” “Schizophrenia.”
Mayo Clinic: “Bipolar Disorder,” “Schizophrenia.”
NIH, National Institute of Mental Health: “Bipolar Disorder,” “What Is Schizophrenia?”
National Health Service: “Bipolar Disorder,” “Schizophrenia.”
© 2019 WebMD, LLC. All rights reserved.
Schizophrenia vs Schizoaffective Disorder
Mental illness can often feel overwhelming to those who struggle to understand the signs and symptoms. Doctors, psychiatrists, and other mental health professionals are trained to diagnose mental illness, but knowing the signs of various disorders can help connect you with the proper treatment and improve the quality of your life.
Most people have heard of schizophrenia and can list some of the symptoms, but schizoaffective disorder is less well known. Schizoaffective disorder, which occurs in a very small percentage of the population, is a combination of schizophrenia symptoms with either depression or mania. Here are the major differences between the two disorders.
Schizophrenia affects roughly 1% of the population. Men typically develop schizophrenia in their early 20s; women typically develop it in their late 20s or early 30s.1 In order to receive a clinical diagnosis of schizophrenia, the following symptoms must be experienced for more than a month:
- Delusions – Beliefs that have no evidence in reality.
- Hallucinations – Seeing, hearing, or sensing things that aren’t real.
- Disorganized speech – Meaningless words or sentences that don’t fit together.
- Disorganized or catatonic behavior – Agitated or bizarre behavior or a lack of responsiveness.
- General apathy– neglecting personal hygiene, lack of interest in activities, or a lack of facial expressions.2
The presence of these symptoms typically lasts for at least 6 months, unless mitigated by treatment. They must interfere with self-care, work, or relationships, and cannot be caused by the drugs or alcohol. Schizophrenia is treated with a combination of medication, therapy, and community support.
Article continues below
Schizoaffective disorder affects roughly 0.3% of the population. Men typically develop schizoaffective disorder earlier than women.3 A person with schizoaffective disorder exhibits the symptoms of schizophrenia (listed above) in addition to a mood episode including depression and mania.4
A depressive episode requires five or more of the following symptoms during a two-week period:
- depressed mood
- lack of pleasure in activities formerly enjoyed
- changes in weight or appetite
- changes in sleep
- slowing of movement
- lack of energy
- feelings of guilt or worthlessness
- difficulty concentrating
- thoughts of death or suicide
A manic episode requires a period of elevated or irritable mood and increased activity or energy for at least one week, and at least three of the following symptoms:
- increased self-esteem or sense of grandiosity
- needing less sleep
- becoming more talkative
- racing thoughts
- being easily distracted
- more goal-directed activity (energy)
- engaging in risky behaviors (i.e. sexual, financial, etc.)
Sometimes an individual with schizoaffective disorder only experiences schizophrenia symptoms and depressive episodes. This is known as depressive type schizoaffective disorder. A person who experiences schizophrenia symptoms during mania or during mania and depressive episodes has bipolar type schizoaffective disorder.
Schizoaffective disorder is treated with a combination of medication, therapy, and community support (from, e.g., family and friends). Individuals with schizoaffective disorder are at particular risk for developing co-occurring disorders such as substance use disorders.
What the Doctor Will Want to Know
If you or a loved one are being evaluated for schizophrenia or schizoaffective disorder, a doctor may ask questions which include the following:
- Personal hygiene. Good or poor?
- Is the person generally cooperative or easily agitated?
- Do the facial expressions match the mood?
- Does the patient make eye contact?
- Are the movements slow, as if the person is moving through water?
- Do words and sentences follow a normal thought process?
- Does the person appear depressed or manic?
- Does he or she have a grandiose sense of self?
- Does the patient know his name? Can he tell you the day of the week?
- Does the patient respond to stimuli that are imaginary?
- Does the patient have paranoid thoughts?
- Are they experiencing suicidal thoughts?
- Has the patient recently used drugs and alcohol?5
The symptoms of schizophrenia or schizoaffective disorder can be managed through treatment, so it’s important to find the right care. People with either diagnosis can live healthy and full lives.
Schizophrenia vs. Schizoaffective Disorder
- Everyday Life
If you have schizophrenia, you may hear voices that aren't real and see things that don't exist. Schizoaffective disorder is a condition that can make you feel detached from reality and can affect your mood.
These two disorders have some things in common. But there are important differences that affect your everyday life and the treatment you get.
While doctors have studied schizophrenia for years, they still don't know exactly what causes it. Problems with brain chemicals glutamate and dopamine may play a role. Doctors have also noticed that people with schizophrenia have physical brain differences from others.
There are other things that may also raise your chances of getting schizophrenia. If you take mind-altering drugs, for example, it can bring on some symptoms. You may be more ly to get the illness if your father was older when you were born, or if your mother had contact with certain viruses while she was pregnant, such as influenza.
Researchers have not studied schizoaffective disorder as long as schizophrenia, but they have some clues about what's going on. Genes that control your body's sleep-wake rhythms may contribute to schizoaffective disorder.
Things that are going on in your life may also play a role, such as stressful events. You may also have greater chances of schizoaffective disorder if you have another mental illness or if you have had developmental delays.
Your risk of both schizophrenia and schizoaffective disorder is greater if you have a close relative with it, a mother, father, brother, or sister.
If you have schizophrenia, you have symptoms that doctors call “psychotic,” which means you lose touch with reality. You will see and hear things that aren't real, called hallucinations. You may also have delusions, which means you believe things that aren't true.
Schizoaffective disorder is a little different. It's almost a blend of the symptoms of schizophrenia and another mental health condition called bipolar disorder.
In bipolar disorder, you have mood swings that include depression and mania. If you have schizoaffective disorder, you can have these bipolar symptoms. But separate from those, you also get psychotic symptoms similar to schizophrenia for at least 2 weeks at a time.
Doctors often diagnose schizophrenia and schizoaffective disorder by checking your symptoms. They may decide you have schizophrenia if you have at least two of these:
- Confused speech or thinking
- Unusual body movements
- What doctors call “negative” symptoms, such as lack of emotion or withdrawal from social activities
Doctors sometimes find it tricky to diagnose schizoaffective disorder because it combines symptoms of other illnesses. Your doctor will ly say you have schizoaffective disorder if these things are happening to you:
- Mood problems depression or mania that happen at the same time as schizophrenia symptoms
- Delusions or hallucinations for at least 2 weeks that show up without mood disorder symptoms
- Symptoms of a mood disorder on a regular basis
There are two main types of schizoaffective disorder, depressive type and bipolar type. Your doctor may diagnose you with one of these types the kind of mood symptoms you have.
Doctors often treat schizophrenia with antipsychotic drugs that help manage delusions and hallucinations. These may be older antipsychotics, chlorpromazine (Thorazine) or haloperidol (Haldol), or newer antipsychotics, olanzapine (Zyprexa) or risperidone (Risperdal). Newer antipsychotics often have fewer side effects.
People with schizoaffective disorder often improve on antipsychotics as well. But your doctor may also prescribe a mood stabilizer, such as lithium (Eskalith), to manage your mood symptoms.
Whether you have schizophrenia or schizoaffective disorder, you can benefit from regular talk therapy. During therapy sessions, you may learn strategies to pursue your goals or deal with unwanted thoughts and mood changes.
Without treatment, both schizophrenia and schizoaffective disorder can cause you to struggle at school, on the job, or at social events. The psychotic symptoms of both disorders, as well as the mood symptoms of schizoaffective disorder, may make you want to withdraw from daily life. But with the right medicine and talk therapy, you can learn to manage your illness.
Mayo Clinic: “Schizophrenia,” “Schizoaffective Disorder.”
National Institutes of Health: “Schizoaffective Disorder,” “Schizophrenia.”
National Alliance on Mental Illness: “Mental Health By the Numbers,” “Mental Health Medications.”
Journal of Psychiatry and Neuroscience: “Maternal Infection During Pregnancy and Schizophrenia.”
Ohio Hospital for Psychiatry: “Schizoaffective Disorder.”
Schizophrenia Bulletin: “Familial Aggregation and Heritability of Schizophrenia and Co-aggregation of Psychiatric Illnesses in Affected Families.”
Cleveland Clinic: “What Is Schizoaffective Disorder (and How Is It Different From Schizophrenia)?”
DSM-5: “Schizoaffective Disorder Diagnostic Criteria,” “Schizophrenia Diagnostic Criteria.”
© 2019 WebMD, LLC. All rights reserved.
How Bipolar Disorder and Schizophrenia Are Similar but Different
Psychosis, which includes hallucinations and delusions, is a hallmark symptom of schizophrenia.
People with bipolar I disorder can have psychotic symptoms during mania and/or depression, and those with bipolar II can have them during an episode of depression.
So while bipolar disorder and schizophrenia can share a set of serious symptoms, when distinguishing between the two disorders, doctors look at the differences between symptoms and also give different weight to some of the shared symptoms.
These are the main symptoms of schizophrenia in adults:
1. For most of a month, a patient must have two of these symptoms:
If only one of these symptoms is present, one of the following must also appear:
- Extreme and abnormal psychomotor behavior, which includes catatonia
- Negative symptoms
- Alogia — A reduction in the amount of speech or quality of speech
- Flattened affect — Having little or no emotion
- Anhedonia — Loss of pleasure
- Avolition — Severe lack of initiative
2. At the same time, there's a marked decrease in at least one important area of functioning, such as:
- Relations with others
- Self-care, such as cleanliness
In addition to the month of acute symptoms, the overall disturbance must have persisted for at least six months.
None of the symptoms of delusions, hallucinations, and disorganized speech and behavior have to be present for someone to be diagnosed with bipolar disorder, although they may be present.
In fact, the only requirement for a diagnosis of bipolar I disorder is that the patient has had one manic episode; though depression is also common, it isn't required for a diagnosis.
And for bipolar II, the requirements are almost as simple: no manic episodes, at least one hypomanic episode, and at least one major depressive episode.
In bipolar disorder, another requirement is that the symptoms cause significant problems with occupational and/or social functioning. This is similar to number two under schizophrenia, but the reasons for the impairment are, in general, profoundly different.
Here's a summary of the differences between the diagnostic requirements for the two illnesses:
|Schizophrenia—Required Symptoms||Bipolar Disorder—Required Symptoms|
1. Two or more of these symptoms:
Required: Hallucinations or delusions
May be required: Disorganized speech, abnormal psychomotor behavior, negative symptoms
2. A significant decrease in the level of occupational, social, and/or personal functioning
Bipolar I: A single manic episode, which may or may not include psychosis
Bipolar II: At least one hypomanic episode, and at least one major depressive episode (which may or may not include psychosis)
Both: Clinically significant disruption with occupational and/or social functioning
|Schizophrenia— Duration||Bipolar Disorder— Duration|
|Overall, six months. During that time, the symptoms listed in #1 must be present most of the time for at least one month (can be less if early treatment succeeds in controlling them).|
Bipolar I: Manic episode lasting at least 1 week.
Bipolar II: Hypomanic episode lasting at least 4 days, and depressive episode lasting at least 2 weeks.
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Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Institute of Mental Health (NIMH). Schizophrenia. Updated online, February 2016.
National Institute of Mental Health (NIMH). Bipolar Disorder. Updated online, January, 2020.