Psychosis is the term used to describe two major disruptions in mental health — hallucinations and delusional thinking — that seriously interfere with the ability to stay grounded in reality. Most people probably associate these disruptions with the mental illness schizophrenia. However, significant numbers of people with bipolar disorder also develop psychosis symptoms. Without knowing what to look for, it’s easy to mistake bipolar psychosis for schizophrenia. However, doctors can use a detailed checklist to tell the difference between the two conditions. 

Schizophrenia Basics

Mental health experts classify hallucinations and delusions as “positive” schizophrenia symptoms. They use this term to describe symptoms in schizophrenic individuals that don’t typically appear in mentally healthy individuals. Other “positive” symptoms of schizophrenia include:  

  • Uncontrolled, pointless body movements, and  
  • Non-delusional but significantly disordered thought patterns 

Schizophrenia also produces “negative” symptoms that point to a lack of certain typical behaviors or moods. Examples of these symptoms include: 

  • A lack of vocal emotion 
  • A lack of facial emotion 
  • Reduced participation in verbal communication, and 
  • A declining ability to feel pleasure 

In addition, the illness can produce changes in the normal capacity for thought, such as: 

  • Short-term memory disruptions 
  • A decline in logical thinking, decision-making and other “executive” brain functions, and 
  • A poor ability to focus attention 

Bipolar Psychosis and Schizophrenia

Psychosis is not a typical feature of bipolar illness. However, if you experience severe episodes of mania or bipolar depression, these episodes may be accompanied by hallucinations and/or delusional thinking. At first glance, the symptoms of bipolar psychosis can look exactly the same as the symptoms of schizophrenia-related psychosis. Unfortunately, even a doctor can potentially mistake a case of bipolar disorder for a case of schizophrenia or a closely related condition called schizophreniform disorder. 

How to Tell the Difference

Fortunately, doctors can distinguish bipolar psychosis from schizophrenia and schizophreniform disorder if they probe their patients’ symptoms more thoroughly and take a detailed personal and medical history. Important steps in this process include: 

  • Looking for a match between the symptoms of psychosis and a patient’s mood – In a person with bipolar disorder, the symptoms of psychosis often mirror the presence of a manic episode or a depressed episode. This means that delusions that occur in manic states often have an upbeat or grandiose quality, while delusions that occur in depressed states often have a downcast or negative quality.
  • Checking for previously reported mood-related symptoms – A person with undiagnosed bipolar disorder may have a history of mood-related symptoms, or even an actual diagnosis for another type of mood disorder.
  • Checking previous medication usage – Whether or not a patient reports a history of bipolar disorder, the use of certain medications points to the presence of significant mood-related problems. Examples of these medications include mood stabilizers such as valproic acid (valproate) or lithium.
  • Checking for emotional expressiveness – People with bipolar disorder don’t typically develop the kinds of “negative” symptoms that appear in people with schizophrenia. This means that a person with psychosis who displays emotional expressiveness may have a bipolar illness instead of a schizophrenic illness.
  • Assessing the ability to function socially – When not experiencing an episode of mania or depression, people affected by bipolar illness often function quite well in social situations. This means that a periodic history of good social function may point toward a bipolar disorder diagnosis, not schizophrenia. The same holds true for people currently in a psychotic state who nevertheless have generally functional relationships with others. 

A misdiagnosis of bipolar disorder can lead to serious negative consequences. For example, failure to treat a bipolar illness with mood-stabilizing medication can lead to more frequent episodes of mania and depression. It can also lead to worse symptoms during these episodes. In addition, doctors typically use stronger doses of antipsychotic medication for patients with schizophrenia than for patients with bipolar-related psychosis. This means that people who actually have bipolar disorder, but are incorrectly diagnosed with schizophrenia, may receive unnecessarily large amounts of antipsychotic medications. 


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