Schizoaffective disorder and bipolar disorder are two distinct mental health conditions. The two conditions share common, overlapping features such as mood and psychotic symptoms, making them challenging to distinguish.
Psychosis, or the presence of hallucinations and delusions, is common across many psychiatric conditions.
Schizoaffective disorder is a mental health condition characterized by schizophrenia and mood symptoms, such as depressive or manic episodes.
Bipolar disorder causes extreme shifts in energy, mood, and activity levels. Research suggests that more than half of individuals with bipolar disorder experience psychotic mood episodes in their lifetime.
One distinct difference between these two conditions is that psychotic features may be present in people with schizoaffective disorder even when there are no mood symptoms or after they improve.
This article explores the similarities and differences between schizoaffective disorder and bipolar disorder. It also discusses their causes, diagnosis, and more.
What is schizoaffective disorder?
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Schizoaffective disorder is a chronic mental health condition with psychotic and mood symptoms.
There have been no large-scale studies on the epidemiology, incidence, or prevalence of the schizoaffective disorder. However, it appears to be relatively rare. Research from 2007 suggests that only around 0.3% of people develop the condition in their lifetime.
According to the National Alliance on Mental Illness (NAMI), people of all sexes experience schizoaffective disorder at the same rate, but males often develop the illness at an earlier age.
Types
Schizoaffective disorder has two types: bipolar and depressive.
In the bipolar type, manic symptoms are prominent. However, major depressive episodes may also occur. In the depressive type, only major depressive symptoms are present with the psychotic symptoms.
Symptoms
NAMI states that schizoaffective disorder symptoms can vary greatly and depend on the type. They generally include depressive, manic, and psychotic symptoms, including:
- delusions
- hallucinations
- disorganized thinking
- depression
- manic behavior
What is bipolar disorder?
Bipolar disorder is a mental health condition that causes significant shifts in mood, energy, and activity levels.
A person with bipolar disorder may experience episodes of mania, hypomania, or depression. They may have profound “down” periods of depression and hopelessness that alternate with “up” periods of excessively elevated, euphoric, or irritable mood.
Hypomanic episodes are similar to manic episodes. However, their symptoms are less severe and last for a shorter time.
Types
Bipolar disorder has several types, including:
- Bipolar I disorder: This type involves manic and depressive episodes.
- Bipolar II disorder: This type involves periods of hypomania alternating with depressive episodes.
- Cyclothymic disorder: This involves brief symptoms of hypomanic and depressive episodes without meeting the full criteria for either of the above types.
Additionally, doctors need to specify other features when diagnosing the type of bipolar disorder a person has, such as the presence of atypical and psychotic features.
Symptoms
Symptoms of bipolar disorder include:
- grandiosity or elevated self-worth
- a decreased need for sleep
- fast or pressured speech
- being more talkative
- flight of ideas, when a person speaks erratically, jumping rapidly between thoughts
- distractibility
- increased goal-directed activity
- engaging in high risk behavior
- depressed mood
- anhedonia, the inability to feel pleasure from activities
- a change in weight within a month
- sleep changes
- slowing down or speeding up of movements
- an inability to concentrate or focus
- suicidal ideation
Before a doctor diagnoses bipolar disorder, they will check that these symptoms do not relate to drug misuse, medications, or other medical conditions.
Similarities
Bipolar disorder and schizoaffective disorder have symptoms in common.
Schizoaffective disorder may involve manic or depressive episodes occurring with psychotic features. Meanwhile, bipolar disorders typically involve depressive episodes with manic or hypomanic episodes.
Some features that may occur in both conditions include:
- depressive mood
- manic mood
- disorganized thought
- problems with speech and communication
- changes in sleep and weight
A further overlap exists between schizoaffective disorder and bipolar disorder with psychotic features. Research suggests that more than half of people who receive a diagnosis of bipolar disorder may experience psychotic mood episodes in their lifetime.
These psychotic features are delusions or hallucinations that are present at any time during the episode. They may be consistent with the person’s mood. However, they may also not be consistent with mood symptoms.
According to the National Institute on Drug Abuse, substance use disorders are also common among people with schizophrenia, bipolar disorder, and depression.
Some experts believe that schizophrenia, bipolar disorder, and schizoaffective disorder exist in a spectrum, with schizoaffective disorder located between the other two conditions.
Differences
A 2021 study of 309 people in specialized psychiatry centers in Ethiopia suggests schizoaffective disorder may be the most commonly misdiagnosed severe psychiatric condition.
The researchers suggest that some people with schizoaffective disorder receive a diagnosis of bipolar disorder with psychotic features or schizophrenia instead because of the overlapping features.
While bipolar disorder is a mood disorder that can have psychotic features, these are not primary features and should only happen during manic, hypomanic, or depressive episodes.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision helps clinicians differentiate schizoaffective disorder from depressive or bipolar disorder with psychotic features.
According to the current criteria, delusions or hallucinations must be present for at least 2 weeks in the absence of a major depressive or manic episode at some point during their condition for a person to receive a diagnosis of schizoaffective disorder.
Causes
There are various potential causes for schizoaffective disorder and bipolar disorder.
Schizoaffective disorder causes
Limited studies exist on the causes of schizoaffective disorder. However, research suggests a combination of factors may contribute to its development:
- Genetics: Some studies suggest people with first degree relatives with schizoaffective disorder, schizophrenia, or bipolar disorder may be at an increased risk of developing schizoaffective disorder.
- Brain chemistry: Certain brain chemicals behave differently in the brains of people with the condition. A 2016 study found that issues related to dopamine, a chemical involved in mood, may play a significant role in psychotic conditions such as schizophrenia and schizoaffective disorder.
- Childhood trauma: A 2019 study indicates that childhood trauma may play a role in the neurodevelopment of schizophrenia and schizoaffective disorder.
Bipolar disorder causes
Like schizoaffective disorder, bipolar disorder can develop as a result of biological and psychosocial factors.
Psychosocial factors include life stressors and coexisting personality traits that may trigger a depressive episode.
A 2017 study found an association between childhood adversity and increased sensitivity to the effects of stress, which can trigger a depressive episode. Another study from 2017 suggests that stressful life events may precipitate more than one-third of all episodes of bipolar disorder.
Several biological factors may also contribute to bipolar disorder. The National Institute of Mental Health states that genetic factors and differences in brain structure and functioning may play a role.
Diagnosis
There are similar diagnostic procedures for schizoaffective disorder and bipolar disorder.
Schizoaffective disorder diagnosis
A healthcare professional will do a thorough medical history and physical and mental examination before diagnosing schizoaffective disorder. They will look for the following:
- a period of either depression or mania at the same time that symptoms of schizophrenia are present
- delusions or hallucinations for 2 or more weeks in the absence of a major mood episode
- the presence of symptoms that meet the criteria for a major mood episode during the majority of the total duration of the illness
They will also ensure that a person’s symptoms are not the result of medications, drug misuse, or other illnesses. Sometimes, they may run lab or imaging tests to rule out other potential causes.
Bipolar disorder diagnosis
Healthcare professionals also diagnose bipolar disorder by reviewing a person’s history and clinical course. The diagnostic criteria include the following:
- persistent and atypically elevated, expansive, or irritable mood with increased goal-directed activity for at least 4 days in the case of a hypomanic episode, or more than 1 week for a manic episode
- the presence of three or more mood symptoms of mania during the episode
- mood symptoms that are unrelated to illegal drugs, medications, or other medical conditions
Depressive episode symptoms lasting more than 2 weeks may also be present. However, a person does not have to experience these to receive a diagnosis.
Treatment
The treatment of both conditions typically involves the use of prescription medications and psychotherapy.
Mood stabilizers, particularly lithium, are the main type of medication doctors prescribe to treat bipolar disorder. Sometimes, they may combine atypical antipsychotics with mood stabilizers.
Doctors may use antipsychotics to treat psychosis and aggressive behaviors in people with schizoaffective disorder. They may also prescribe mood stabilizers and antidepressants.
People with schizoaffective and bipolar disorders may benefit from talk therapy. Examples of this are group therapy and cognitive behavioral therapy.
If doctors consider a person experiencing a severe mental health condition a danger to themselves or others, they may consider a period of inpatient hospitalization. This includes those who may be experiencing difficulty fulfilling daily living activities or are functioning far below their usual baseline.
When to speak with a doctor
Sometimes, a person with schizoaffective disorder or bipolar disorder may need urgent care. They should seek emergency care or call 911 if they are experiencing suicidal thoughts or thoughts of self-harm or if they feel they may be a danger to others.
In cases where a person is unaware or not physically or mentally able to seek help for themselves, a family member or friend may intervene to get them the help they need.
Suicide prevention
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
Early signs of a psychotic episode include:
- a drop in performance at school or work
- uneasiness or suspiciousness toward others
- trouble thinking clearly or concentrating
- a reduced level of personal hygiene and other forms of self-care
- spending more time in isolation
- having no feelings or experiencing intense, disproportionate emotions
These can be difficult to distinguish from typical behavior and may not be a cause for concern. A healthcare professional can offer advice if a person is worried about symptoms such as these.
Summary
Schizoaffective disorder and bipolar disorder are chronic mental health conditions with similar presentations. The overlapping symptoms often cause doctors to mistake them for each other.
One way to differentiate schizoaffective disorder from a mood disorder is that a person with the former may experience delusions or hallucinations in the absence of depressive or manic episodes.
If a person is experiencing psychotic symptoms and mood episodes, it is best to speak with a healthcare or psychiatric professional. They can help a person identify the cause of the symptoms and provide appropriate treatment.
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