Bipolar 2, Bipolar 1, Schizoaffective Disorder

I've been researching for years, and still I'm not clear on the differences/similarities. Who would like to throw out some ideas or experiences about which is which, how the diagnoses overlap, and so on?

ugh. diagnosis. psychiatry is subjective...and that opens it up to all sorts of problems. anyway...

bipolar II usually means no mania, frequent depression, hypomania and/or milder mixed states (agitated depression I think qualifies with some shrinks). at the softer end, it seems to overlap with some 'personality disorders' ... at the more severe end, it can overlap with what would once, perhaps not so long ago, been considered 'severe endogenous depression.'

bipolar i- mania. severe depression. it used to be understood that the person was normal(ish), even high functioning when not in the midst of an episode...that's changed, somehow. psychosis, if it occurs, is limited to the mood episode...severe mania might bring psychosis, less often psychotic depression is an issue.

schizoaffective-- the manic type is more similar to bipolar I, in terms of long term outlook. psychosis occurs outside of mood states, but is not the core, defining feature, as one sees in Schizophrenia. the depressive sub-type is, from what I understand (and I could be wrong) a lot more like Schizophrenia, in terms of long term outlook and such...severe depressive states, psychosis both during the depressive states and when in a more or less normal mood.

now, that's just -my- understanding of dsm-checklists. i could be wrong. i think its also worth noting that the labels are mostly useful for billing and guiding treatment, to a point...where the rubber hits the road, go to 2 shrinks, get 3 opinions. it is what it is...

:-)

Hi BethRags. I'm not a mental health professional, but from all of my research the following are the core similarities/differences:

• Bipolar type 2 - Experienced(s) a full depressive episode(s) that meets the criteria of the DSM, AND, experienced(s) at least one hypomanic episode (never full manic) that meets the DSM criteria. Hypomania is not as severe as full blown mania, and does not result in psychiatric hospitalization. One can be hospitalized for bipolar 2 depression or mixed states, but the mixed state's hypomanic portion is not as severe as full blown mania. It is generally the case that people with bipolar 2 experience much more depression than hypomania. One study projected that the average period spent ratio is 39:1 (depression to hypomania).*

• Bipolar type 1 - Experienced(s) at least one full blown manic episode that meets full DSM criteria and is more severe than hypomania. The period must be a minimum of 1 week, symptoms most of the day, OR severe enough to warrant psychiatric hospitalization. Though most people with bipolar type 1 do experience depressive episodes, depression is not required for a bipolar type 1 diagnosis.The study mentioned above stated an average of 3:1 (period in depression compared to mania).* People with bipolar type 1 can experience hypomania, but again, there must be a full blown mania for this diagnosis.

• Schizoaffective Disorder -Update - I've removed my bit about this because of lack of full understanding on my part.

I have read many people ask the question about how you know when an elevated episode is hypomanic vs. manic.Saying "full blown mania is more severe" is the case, but as for the dividing line, generally only a psychiatrist or psychologist can determine the difference. As stated in the bipolar type 1 bullet, only full blown mania (not hypomania) generally results in psychiatric hospitalization. That doesn't mean everyone with full blown mania ends up in the hospital. Psychosis can be a clear indicator of the difference. If no psychosis is present, I guess the severity of the damage and dysfunction in life is considered. In both cases of hypomania and mania, the behavior is noticeably different than baseline/stable behavior, but the dysfunction is noticeably different between hypomania and mania.

Resources:

1. DSM-5 (Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition)

2. Statistics on average ratios of depression to hypomania (or mania) appears in several articles online, including The National Center for Biotechnology Information journal article at Treatment of acute bipolar depression which references the following:

Judd LL, Akiskal HS, Schettler PJ, Coryell W, Endicott J, Maser JD, et al. A prospective investigation of the natural :history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry. 2003;60:261–9.

As someone who has been diagnosed with all three at different times...

Bipolar 2: Severe depression with mild mania that doesn't interfere with life
Bipolar 1: Severe depression AND mania that interferes with life and/or needs hospital to keep safe
Schizoaffective: Same as the bipolars, but with the addition of psychotic symptoms (hallucinations and delusions) that occur even when mood is normal ("euthymic")

just to throw this in the loop:
bipolar 1 doesn't have to have depression, just hypo mania or mania. If you have been hospitalized with psychosis then you are BP1.
bizi
this is me.

No, having psychosis outside of an episode does not mean you qualify for a schizoaffective diagnosis. I think that's a common misconception about the diagnosis. In fact, I think it is a bad idea to diagnose someone with schizoaffective just because they have psychosis outside of an episode, even if the psychosis is persistent or occurs more than a few times.

Schizoaffective bipolar type *literally* implies that you have bipolar with schizophrenic symptoms. For example, flat affect, catatonia, word salad, warped thought processes, etc.. (Basically, there are certain behaviors/mannerisms that come packaged with disorders on the schizophrenic spectrum.) Also, in some cases, level of functioning is taken into consideration as well. Psychosis is just one symptom of schizophrenia.

I know personally that psychologists at one point thought I might have schizoaffective disorder because of my stubborn psychosis that never goes away no matter what. However, when I underwent specialized psychological testing, the psychologist said I didn't have enough of the schizophrenic type symptoms to qualify for such a schizoaffective diagnosis. For example, I have flat affect, flat vocal tone, social problems, isolation, etc., but the psychologist said I didn't 100% portray as someone who actually has schizophrenia or schizophrenia-like disorder. (Basically, I only somewhat portrayed and she wrote that down.)

People who do not have schizoaffective disorder but who have psychosis independent of mood episodes are supposed to be Dx'ed with bipolar w/ mood-incongruent psychotic features, using the shortened "with psychotic features" specifier. Since there is no such "bipolar 2 w/ psychotic features" label, I guess you're automatically Dx'ed with bipolar 1 even though you technically have bipolar 2 w/ psychotic features. I'm not sure why there is no such "bipolar 2 w/ psychotic features" label, but I don't think bipolar 2 has more than one diagnostic code to begin with.

Whatever you end up having, though, as long as you get treatment for your symptoms and your insurance doesn't complain about said treatment, then that's all that matters. But I just wanted to point out the differences between schizoaffective and the "psychotic features" BP specifier since, well, that was asked. I was confused myself until the psychologist who did my assessment told me the differences, and my therapist (also PhD psychologist) chimed in down the road.

Thanks for explaining this for me, bluebicycle! I knew I might have been wrong about that particular one. The differences between "schizoaffective - bipolar type" and "bipolar with mood-incongruent psychotic features" are interesting. Both sound like real challenges, though. Hugs

I've edited out my bit about this in my post above.

I was diagnosed schizoaffective when I had my first episode for mania because there were mood and thought processing issues together which met both . Then I had a severe depression episode and another manic episode so was diagnosed for bipolar. For a while it was there but less severe so I became bipolar 2 and later I became more severe and was determined to be bipolar 1 . I think diagnosis is used to treat and communicate sets of symptoms so as you have more history the easier it is to get right. I have psychosis in episodes also and a seasonal pattern.

Quote:

Originally Posted by still_crazy ugh. diagnosis. psychiatry is subjective...and that opens it up to all sorts of problems. anyway... bipolar II usually means no mania, frequent depression, hypomania and/or milder mixed states (agitated depression I think qualifies with some shrinks). at the softer end, it seems to overlap with some 'personality disorders' ... at the more severe end, it can overlap with what would once, perhaps not so long ago, been considered 'severe endogenous depression.' bipolar i- mania. severe depression. it used to be understood that the person was normal(ish), even high functioning when not in the midst of an episode...that's changed, somehow. psychosis, if it occurs, is limited to the mood episode...severe mania might bring psychosis, less often psychotic depression is an issue. schizoaffective-- the manic type is more similar to bipolar I, in terms of long term outlook. psychosis occurs outside of mood states, but is not the core, defining feature, as one sees in Schizophrenia. the depressive sub-type is, from what I understand (and I could be wrong) a lot more like Schizophrenia, in terms of long term outlook and such...severe depressive states, psychosis both during the depressive states and when in a more or less normal mood. now, that's just -my- understanding of dsm-checklists. i could be wrong. i think its also worth noting that the labels are mostly useful for billing and guiding treatment, to a point...where the rubber hits the road, go to 2 shrinks, get 3 opinions. it is what it is... :-)

For someone who doesn't prefer diagnoses, you sure know your stuff! In my opinion The "DSM" dx's are too limited. I'm interested in what people's personal experiences within their dx's are. So, thank you

I've always received the same diagnosis (over about 30 years) - until these past few years, when my standard BP2 seems to be spending some time in either BP1 or Schizoaffective.

Quote:

Originally Posted by BirdDancer Hi BethRags. I'm not a mental health professional, but from all of my research the following are the core similarities/differences: Bipolar type 2 - Experienced(s) a full depressive episode(s) that meets the criteria of the DSM, AND, experienced(s) at least one hypomanic episode (never full manic) that meets the DSM criteria. Hypomania is not as severe as full blown mania, and does not result in psychiatric hospitalization. One can be hospitalized for bipolar 2 depression or mixed states, but the mixed state's hypomanic portion is not as severe as full blown mania. It is generally the case that people with bipolar 2 experience much more depression than hypomania. One study projected that the average period spent ratio is 39:1 (depression to hypomania).* Bipolar type 1 - Experienced(s) at least one full blown manic episode that meets full DSM criteria and is more severe than hypomania. The period must be a minimum of 1 week, symptoms most of the day, OR severe enough to warrant psychiatric hospitalization. Though most people with bipolar type 1 do experience depressive episodes, depression is not required for a bipolar type 1 diagnosis.The study mentioned above stated an average of 3:1 (period in depression compared to mania).* People with bipolar type 1 can experience hypomania, but again, there must be a full blown mania for this diagnosis. Schizoaffective Disorder -Update - I've removed my bit about this because of lack of full understanding on my part. I have read many people ask the question about how you know when an elevated episode is hypomanic vs. manic.Saying "full blown mania is more severe" is the case, but as for the dividing line, generally only a psychiatrist or psychologist can determine the difference. As stated in the bipolar type 1 bullet, only full blown mania (not hypomania) generally results in psychiatric hospitalization. That doesn't mean everyone with full blown mania ends up in the hospital. Psychosis can be a clear indicator of the difference. If no psychosis is present, I guess the severity of the damage and dysfunction in life is considered. In both cases of hypomania and mania, the behavior is noticeably different than baseline/stable behavior, but the dysfunction is noticeably different between hypomania and mania. Resources: 1. DSM-5 (Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition) 2. Statistics on average ratios of depression to hypomania (or mania) appears in several articles online, including The National Center for Biotechnology Information journal article at Treatment of acute bipolar depression which references the following: Judd LL, Akiskal HS, Schettler PJ, Coryell W, Endicott J, Maser JD, et al. A prospective investigation of the natural :history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry. 2003;60:261–9.

Thank you, Birdie I appreciate your detailed explanation.

If you feel like sharing it...what is your experience of hypomania vs. mania?

Quote:

Originally Posted by franz kafka As someone who has been diagnosed with all three at different times... Bipolar 2: Severe depression with mild mania that doesn't interfere with life Bipolar 1: Severe depression AND mania that interferes with life and/or needs hospital to keep safe Schizoaffective: Same as the bipolars, but with the addition of psychotic symptoms (hallucinations and delusions) that occur even when mood is normal ("euthymic")

Thanks, franz kafka. Short and sweet...I appreciate your experiential reply. Which dx do you feel fits you at this time in your life (if you'd like to share)?

Quote:

Originally Posted by bizi just to throw this in the loop: bipolar 1 doesn't have to have depression, just hypo mania or mania. If you have been hospitalized with psychosis then you are BP1. bizi this is me.

Thanks, bizi. Your input is so helpful...makes sense.

Quote:

Originally Posted by bluebicycle No, having psychosis outside of an episode does not mean you qualify for a schizoaffective diagnosis. I think that's a common misconception about the diagnosis. In fact, I think it is a bad idea to diagnose someone with schizoaffective just because they have psychosis outside of an episode, even if the psychosis is persistent or occurs more than a few times. See, that's where I've been confused, I think. Thanks for the clarification. Schizoaffective bipolar type *literally* implies that you have bipolar with schizophrenic symptoms. For example, flat affect, catatonia, word salad, warped thought processes, etc.. (Basically, there are certain behaviors/mannerisms that come packaged with disorders on the schizophrenic spectrum.) Also, in some cases, level of functioning is taken into consideration as well. Psychosis is just one symptom of schizophrenia. Very clear - thank you. And as I understand it, a person doesn't have to "appear" a certain way (flat affect, word salad, etc.) to be dx'ed as schizoaffective. For example, I know a woman who has the diagnosis. She's well medicated; I have not been with her when she's not medicated, true. But to just see her or speak with her, I don't think anyone would "know" that there's anything going on as far as psychosis. It was after I knew her quite well that she disclosed symptoms (hearing people's thoughts, for example, and paranoia). I know personally that psychologists at one point thought I might have schizoaffective disorder because of my stubborn psychosis that never goes away no matter what. However, when I underwent specialized psychological testing, the psychologist said I didn't have enough of the schizophrenic type symptoms to qualify for such a schizoaffective diagnosis. For example, I have flat affect, flat vocal tone, social problems, isolation, etc., but the psychologist said I didn't 100% portray as someone who actually has schizophrenia or schizophrenia-like disorder. (Basically, I only somewhat portrayed and she wrote that down.) People who do not have schizoaffective disorder but who have psychosis independent of mood episodes are supposed to be Dx'ed with bipolar w/ mood-incongruent psychotic features, using the shortened "with psychotic features" specifier. Since there is no such "bipolar 2 w/ psychotic features" label, I guess you're automatically Dx'ed with bipolar 1 even though you technically have bipolar 2 w/ psychotic features. I'm not sure why there is no such "bipolar 2 w/ psychotic features" label, but I don't think bipolar 2 has more than one diagnostic code to begin with.

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Quote:

Originally Posted by BirdDancer .... The differences between "schizoaffective - bipolar type" and "bipolar with mood-incongruent psychotic features" are interesting. ...

I think so, too.

Quote:

Originally Posted by USMCBIPOLAR7 I was diagnosed schizoaffective when I had my first episode for mania because there were mood and thought processing issues together which met both . Then I had a severe depression episode and another manic episode so was diagnosed for bipolar. For a while it was there but less severe so I became bipolar 2 and later I became more severe and was determined to be bipolar 1 . I think diagnosis is used to treat and communicate sets of symptoms so as you have more history the easier it is to get right. I have psychosis in episodes also and a seasonal pattern.

Thank you for sharing your experience. I really appreciate it. I know that historically, "manic-depression" usually indicated that spring/summer tended to be manic seasons, whereas fall/winter tend to be depressive seasons. I love fall, but do battle depression during the darker months, whereas spring and summer tend to invoke either mania or mixed states for me.

I don't hear as much about the seasonal aspects of BP as I used to.

Schizoaffective makes the most sense for me. My biggest issue interfering with my life is psychosis, which happens frequently and often without mood symptoms. That, and I never responded well to mood stabilizers. Clozapine (which is an anti-psychotic) is the only med that has dealt with both mood and psychosis.

Quote:

Originally Posted by franz kafka Schizoaffective makes the most sense for me. My biggest issue interfering with my life is psychosis, which happens frequently and often without mood symptoms. That, and I never responded well to mood stabilizers. Clozapine (which is an anti-psychotic) is the only med that has dealt with both mood and psychosis.

That's a rough diagnosis. I genuinely admire you for working hard to stay stable.

I've heard some good stuff about Clozapine. My own pdoc mentioned the possibility of prescribing it, but then she went with Zyprexa for whatever reason. So far, the Zyprexa seems good.

I have been diagnosed with all three during my mental health journey.

Bp 2 with mixed features and rapid cycling was my first bp dx. My symptoms were rather mild. No psychosis.

Bp 1 by every other dr it seems because in my 20s I started getting more destructive mania.

Then came she 25 when I had my first psychotic episode. I got dxd bp with psychotic features. Still rapid cycling and mixed features too.

I’m 32 now and my pdoc still says bp1, rapid cycling with psychotic features. My psychologist however has seen me for longer and is convinced I have schizoaffective bp
Type with rapid cycling and mixed features. So who knows!
But I DO get psychosis even outside a mood episode.

Thank you, thank you, thank you. This is brilliant. I'm so tired of schizoaffective disorder being misunderstood. I had a schizophrenic father, sister, and grandmother. I know what schizophrenic symptoms look like. Just needing "word salad", no eye contact and "flat affect" are enough to disqualify so many people who think they have schizoaffective disorder. No psychiatrist would make that mistake. I think its coming from improperly trained therapists. I had a therapist diagnose me as schizophrenic because I had psychotic symptoms and because of my family history. She nearly ruined my life. My psychiatrist had to fix it.

I have bipolar 1 disorder with psychotic features, DID with a psychotic part, and PTSD with psychosis. No therapist would ever figure that out. It takes an MD.

wow. i think it depends on where you get treatment, too. im at a clinic. they do lots of injections there (eek!), but...for a lot of non-psych reasons, I've been spared that. so....my label has bounced from bipolar I, the kind that = no antidepressants, ever...

to 'high functioning' schizoaffective, manic type...anxiety disorder with a side order of hyper-vigilance; prozac to the rescue.

at -this- place, if it wasn't for my family, I'd be labeled 'schizophrenic, too smart' and probably find myself on injections with a thorazine booster or something ridiculous like that...I've seen it happen.

i dunno. a former shrink swears up and down im 'schizophrenic, too smart', which...makes me scared of shrinks. true story.