Bipolar disorder and schizophrenia are two diseases that have very similar symptoms – mood swings, sometimes hallucinations, manic and depressive episodes. For a long time, they were thought to be the same disease, until Eric Kraeplin, a German psychiatrist, showed that they were in fact two quite different disorders.

However they do have a common genetic basis, so that if schizophrenia is found in a particular family, bipolar disease is also more likely to affect family members. A grandfather with schizophrenia might well have a granddaughter with bipolar disorder. This can often lead to an incorrect diagnosis, where the symptoms are ‘recognized’ as those of the already diagnosed disorder.

Because they are different diseases, they need to be diagnosed correctly so that the right treatment can be received. An incorrect diagnosis can be dangerous, as the treatment for the two diseases is very different, particularly with regard to the medications that need to be administered.

Bipolar disorder may display hallucinations in the manic phase which are similar to those experienced by schizophrenics. These are generally experienced only by those suffering an extreme form of the disorder, though. Only 10 to 20 percent of bipolar disorder patients hallucinate; hallucinations occur in over 60 percent of cases of schizophrenia.

Bipolar disorder, in the manic phase, may also display delusions which are connected with the person’s feelings of immense power and creativity. For instance he may feel that he understands everything that is happening in the stock markets, even in the face of evidence that contradicts that assertion.

Delusions of grandeur are often found in the manic phase of bipolar disorder. Schizophrenics also have delusions, which may greatly affect their behavior.

At the same time, schizophrenia has highs and lows, with depressive and manic episodes that resemble those found in bipolar disorder. Depressive symptoms such as apathy, low energy, and emotional withdrawal, are often found in schizophrenia and markedly resemble the depressive phase of bipolar disorder.

One major difference is that someone who has bipolar disorder is not always in a manic or depressive phase; they will have periods during which they do not experience either highs or lows, and during which they do not have delusions or hallucinations. A schizophrenic, on the other hand, will display disordered thinking continually, without ‘normal’ episodes.

There are some differences between the way the symptoms display themselves, though. People diagnosed with bipolar disorder generally recall either depression or, less often, mania as their initial experience of the disorder; it is very rare that psychotic symptoms such as hallucinations and delusions are the first manifestation of the disorder, Classically, schizophrenic delusions are often strange and bizarre, rather than the delusions of grandeur that occur in the manic phase of bipolar disorder.

Because both bipolar disorder and schizophrenia display common characteristics, it is easy for non-medical professionals to confuse the two. Even generalist physicians have been known to misdiagnose, so that a psychiatrist should generally be involved in the diagnosis to avoid mistakes.

The treatment for the two diseases does share some drugs, with some of the antipsychotics prescribed for schizophrenia also used to control acute manic presentations of bipolar disorder. However, the overall treatment is generally different. Drugs that are effective for one will not work effectively on the other condition. For instance, clorazil is generally used to control schizophrenia, while lithium is used to treat bipolar disorder and prevent manic episodes. Neither drug will have a beneficial effect on the other condition.

In fact some drugs used to control schizophrenia, such as first-generation neuroleptics, actually make bipolar disorder worse.

Accurate diagnosis is therefore important before any treatment program is undertaken.

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