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Table of Contents

Symptoms

Causes

Diagnosis

Treatment

Prognosis

This article will compare bipolar disorder vs. schizophrenia, including symptoms, causes, and treatment.

Laura Porter / Verywell

Bipolar Disorder vs. Schizophrenia: Symptoms

Bipolar Disorder

The symptoms of bipolar disorder include clinically significant episodes of depression, as well as hypomania and/or mania.

Symptoms of depression in bipolar disorder include:

Symptoms of mania in bipolar disorder include:

Bipolar disorder can also cause overwhelming paranoia or an exaggerated sense of self-importance with an extreme detachment from reality. These symptoms may look like schizophrenia.

Mixed-affective episodes occur when mania and depression happen at the same time.For example, a person may feel hopeless but also have racing thoughts or risk-taking behavior.

Mood-Congruent in Bipolar Disorder

Schizophrenia

Schizophrenia includes positive, negative, and cognitive symptoms. Positive symptoms refer to behaviors or thoughts that are not usually present but come up during an episode. Negative symptoms are when behaviors or thinking patterns that are typically present go away during an episode.

Positive symptoms of schizophrenia include:

Negative symptoms of schizophrenia include:

Cognitive symptoms of schizophrenia include:

Cognitive symptoms of schizophrenia, such as memory impairment, can affect a person’s ability to take care of themselves.

Schizoaffective disorder includes the symptoms of schizophrenia, but a person living with the disorder will also have prolonged and persistent mood symptoms.

The Signs and Symptoms of Schizophrenia

What Causes Bipolar Disorder vs. Schizophrenia?

Bipolar disorder and schizophrenia are each believed to stem from genetic, biological, and environmental causes.

Bipolar disorder affects around 2% of the population.Schizophrenia affects around 1% of the population.Schizoaffective disorder is much less common, only affecting about 0.3% of the population.

The average age of onset of symptoms for each of these conditions is in the early 20s, though the age range of symptom onset is wider for bipolar disorder.

Genetic

There appears to be a strong genetic component to both schizophrenia and bipolar disorder.

Bipolar disorder risk is also related to genetic factors. Twin studies have shown similar findings for shared diagnoses between identical and nonidentical twins. The findings were associated with lower volume in certain parts of the brain that researchers think could be linked to the disorder.

Bipolar 1 vs. Bipolar 2 Disorder

Biology

Factors that occur before someone is born (prenatally) may also contribute to the development of schizophrenia.Researchers are also exploring whether prenatal factors also contribute to the development of bipolar disorder.

Parental emotional stress, infections, birth complications, low oxygen levels, and fetal distress are associated with a higher risk of developing schizophrenia.

Environment

A person’s community and environment play a role in the risk of bipolar disorder and schizophrenia. Environmental factors do not cause these conditions, but researchers think they may contribute to symptoms in people who are genetically more likely to get them

Researchers think that exposure to substance abuse and/or excessive stress can cause metabolic changes in the body that cause more expression of the genetic factors that contribute to these disorders. It’s also possible that they lead to brain changes that could be involved in the symptoms of the disorders.

Living in an urban area is one environmental factor that has been associated with mental health conditions like bipolar disorder and schizophrenia. Research has shown that pollution, noise, disrupted sleep, and social stress could all play a role in the development of these conditions.

Contributing environmental factors include childhood trauma, social isolation, and substance abuse.

BPD vs. Bipolar: Similarities and Differences

Are Bipolar Disorder and Schizophrenia Diagnosed in the Same Way?

Other causes of symptoms, such as substance use, brain injury, a medical illness like brain inflammation (encephalitis), or another mental health condition, all have to be ruled out before a person can be diagnosed with any of these conditions.

A bipolar disorder diagnosis requires a person to have at least one manic or hypomanic episode, as well as at least one major depressive episode.

The criteria include having at least two of the following symptoms for at least one month, and at least one needs to be one of the first three symptoms:

The symptoms must be associated with a deterioration in self-care, relationships, or work.

To be diagnosed with schizophrenia, the DSM-5 specifies that a person must have had ongoing signs of schizophrenia for at least six months and had the specific symptoms from the above list for at least one month within that period. The exception is if they have started treatment that has successfully managed their symptoms.

A diagnosis of schizoaffective disorder requires symptoms of schizophrenia. The mood symptoms must be present most of the time, and the symptoms of psychosis must be present for over two weeks without mood symptoms.

There is some debate about whether schizoaffective disorder should be its own diagnosis. Some experts believe schizoaffective disorder should be a category of schizophrenia, severe depression, or bipolar disorder.

How Bipolar Disorder Is Diagnosed

Treatment Options

Bipolar disorder and schizophrenia are not curable, but there are treatments such as medication and therapy.

Treatments for schizophrenia include antipsychotic medications, which are taken daily to prevent symptoms. Treatments for bipolar disorder includelithiumand other mood stabilizers, usually along with antipsychotic medications.

Counseling can also be an important component of management. Certain types of psychosocial therapy can be beneficial for schizophrenia and bipolar disorder.These are often used in addition to medication. Therapy can help a person learn skills to better manage symptoms and navigate their everyday life.

Therapies that can be beneficial for schizophrenia includecognitive behavioral therapy, behavioral skills training, supported employment, and cognitive remediation interventions.Therapies for bipolar disorder include cognitive behavioral therapy,interpersonal and social rhythm therapy(IPSRT), andfamily-focused therapy.

Treatment with electroconvulsive (ECT) therapy can be beneficial for people who have depressive episodes and/or manic episodes of bipolar disorder.ECT has been studied as a potential therapy for the treatment of schizophrenia, and it can relieve some symptoms in the short term. However, it is not considered a routine treatment for schizophrenia.

How Does Shock Therapy Work?

Schizophrenia and bipolar disorder are both lifelong conditions, but treatment can improve the outlook for them.Both conditions can increase a person’s risk of substance abuse andsuicide.

These disorders are also associated with a risk of health problems related to neglecting physical symptoms as well as a lack of motivation or ability to get medical attention. The effects of some treatments for these conditions may also contribute to disease risk.

Both conditions can get worse quickly, with severe dissociation from reality, thoughts of suicide, and/or self-harm.Episodes of acute worseningmay need to be addressed with inpatient hospitalization to ensure a person’s safety.

Summary

Both bipolar disorder and schizophrenia spectrum disorders lead to severe distress and relationship challenges. While these conditions cannot be cured, they can be treated with therapy and medication.

Once a diagnosis is made and treatment is started, a person’s symptoms can often be managed, and their quality of life and safety can get better.

Maintaining a consistent routine, reducing stress, eating a nutritious diet, and staying active can all contribute to a better overall outcome for people with bipolar disorder or schizophrenia.

What Are the Most Common Mental Health Disorders?

21 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institute of Mental Health.Schizophrenia.APA.Bipolar I and bipolar II disorders.National Institute of Mental Health.Bipolar disorder.Chakrabarti S, Singh N.Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review.World journal of psychiatry. 2022;12(9):1204-1232. doi:10.5498/wjp.v12.i9.1204Ather Muneer.Mixed states in bipolar disorder: etiology, pathogenesis and treatment.Chonnam medical journal. 2017;53(1):1-1. doi:10.4068/cmj.2017.53.1.1APA.What is schizophrenia?.McCutcheon R, Richard S.E. Keefe, McGuire P.Cognitive impairment in schizophrenia: aetiology, pathophysiology, and treatment.Molecular Psychiatry. 2023;28(5):1902-1918. doi:10.1038/s41380-023-01949-9National Institutes of Mental Health.Schizoaffective disorder.Patel KR, Cherian J, Gohil K, Atkinson D.Schizophrenia: overview and treatment options.P T. 2014;39(9):638-645.Cao H, Ingvar M, Hultman CM, Cannon T.Evidence for cerebello-thalamo-cortical hyperconnectivity as a heritable trait for schizophrenia.Transl Psychiatry.2019 Aug 20;9(1):192. doi:10.1038/s41398-019-0531-5Squarcina L, Fagnani C, Bellani M, Altamura CA, Brambilla P.Twin studies for the investigation of the relationships between genetic factors and brain abnormalities in bipolar disorder.Epidemiol Psychiatr Sci. 2016 Dec;25(6):515-520. doi:10.1017/S2045796016000615Stilo SA, Murray RM.Non-genetic factors in schizophrenia.Curr Psychiatry Rep. 2019 Sep 14;21(10):100. doi:10.1007/s11920-019-1091-3NIMH.Schizophrenia.Misiak B, Stramecki F, Gawęda Ł, Prochwicz K, Sąsiadek MM, Moustafa AA, Frydecka D.Interactions between variation in candidate genes and environmental factors in the etiology of schizophrenia and bipolar disorder: a systematic review.Mol Neurobiol.2018 Jun;55(6):5075-5100. doi:10.1007/s12035-017-0708-ySubstance Abuse and Mental Health Services Administration.Table 3.20, DSM-IV to DSM-5 Psychotic Disorders. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD) (US); 2016 Jun.Parker G.How well does the DSM-5 capture schizoaffective disorder?.Can J Psychiatry. 2019;64(9):607-610. doi:10.1177/0706743719856845Laws KR, Darlington N, Kondel TK, McKenna PJ, Jauhar S.Cognitive behavioural therapy for schizophrenia - outcomes for functioning, distress and quality of life: a meta-analysis.BMC Psychol. 2018;6(1):32. doi:10.1186/s40359-018-0243-2Perugi G, Medda P, Toni C, Mariani MG, Socci C, Mauri M.The role of electroconvulsive therapy (ECT) in bipolar disorder: effectiveness in 522 patients with bipolar depression, mixed-state, mania, and catatonic features.Curr Neuropharmacol. 2017;15(3):359-371. doi:10.2174/1570159X14666161017233642Sinclair DJM, Zhao S, Qi F, Nyakyoma K, Kwong JSW, Adams CE.Electroconvulsive therapy for treatment-resistant schizophrenia.Schizophr Bull.2019 Jun 18;45(4):730-732. doi:10.1093/schbul/sbz037Dome P, Rihmer Z, Gonda X.Suicide risk in bipolar disorder: A brief review.Medicina (Kaunas). 2019;55(8):403. doi:10.3390/medicina55080403Zaheer J, Olfson M, Mallia E, Lam JSH, de Oliveira C, Rudoler D, Carvalho AF, Jacob BJ, Juda A, Kurdyak P.Predictors of suicide at time of diagnosis in schizophrenia spectrum disorder: A 20-year total population study in Ontario, Canada.Schizophr Res. 2020 Aug;222:382-388. doi:10.1016/j.schres.2020.04.025

21 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institute of Mental Health.Schizophrenia.APA.Bipolar I and bipolar II disorders.National Institute of Mental Health.Bipolar disorder.Chakrabarti S, Singh N.Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review.World journal of psychiatry. 2022;12(9):1204-1232. doi:10.5498/wjp.v12.i9.1204Ather Muneer.Mixed states in bipolar disorder: etiology, pathogenesis and treatment.Chonnam medical journal. 2017;53(1):1-1. doi:10.4068/cmj.2017.53.1.1APA.What is schizophrenia?.McCutcheon R, Richard S.E. Keefe, McGuire P.Cognitive impairment in schizophrenia: aetiology, pathophysiology, and treatment.Molecular Psychiatry. 2023;28(5):1902-1918. doi:10.1038/s41380-023-01949-9National Institutes of Mental Health.Schizoaffective disorder.Patel KR, Cherian J, Gohil K, Atkinson D.Schizophrenia: overview and treatment options.P T. 2014;39(9):638-645.Cao H, Ingvar M, Hultman CM, Cannon T.Evidence for cerebello-thalamo-cortical hyperconnectivity as a heritable trait for schizophrenia.Transl Psychiatry.2019 Aug 20;9(1):192. doi:10.1038/s41398-019-0531-5Squarcina L, Fagnani C, Bellani M, Altamura CA, Brambilla P.Twin studies for the investigation of the relationships between genetic factors and brain abnormalities in bipolar disorder.Epidemiol Psychiatr Sci. 2016 Dec;25(6):515-520. doi:10.1017/S2045796016000615Stilo SA, Murray RM.Non-genetic factors in schizophrenia.Curr Psychiatry Rep. 2019 Sep 14;21(10):100. doi:10.1007/s11920-019-1091-3NIMH.Schizophrenia.Misiak B, Stramecki F, Gawęda Ł, Prochwicz K, Sąsiadek MM, Moustafa AA, Frydecka D.Interactions between variation in candidate genes and environmental factors in the etiology of schizophrenia and bipolar disorder: a systematic review.Mol Neurobiol.2018 Jun;55(6):5075-5100. doi:10.1007/s12035-017-0708-ySubstance Abuse and Mental Health Services Administration.Table 3.20, DSM-IV to DSM-5 Psychotic Disorders. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD) (US); 2016 Jun.Parker G.How well does the DSM-5 capture schizoaffective disorder?.Can J Psychiatry. 2019;64(9):607-610. doi:10.1177/0706743719856845Laws KR, Darlington N, Kondel TK, McKenna PJ, Jauhar S.Cognitive behavioural therapy for schizophrenia - outcomes for functioning, distress and quality of life: a meta-analysis.BMC Psychol. 2018;6(1):32. doi:10.1186/s40359-018-0243-2Perugi G, Medda P, Toni C, Mariani MG, Socci C, Mauri M.The role of electroconvulsive therapy (ECT) in bipolar disorder: effectiveness in 522 patients with bipolar depression, mixed-state, mania, and catatonic features.Curr Neuropharmacol. 2017;15(3):359-371. doi:10.2174/1570159X14666161017233642Sinclair DJM, Zhao S, Qi F, Nyakyoma K, Kwong JSW, Adams CE.Electroconvulsive therapy for treatment-resistant schizophrenia.Schizophr Bull.2019 Jun 18;45(4):730-732. doi:10.1093/schbul/sbz037Dome P, Rihmer Z, Gonda X.Suicide risk in bipolar disorder: A brief review.Medicina (Kaunas). 2019;55(8):403. doi:10.3390/medicina55080403Zaheer J, Olfson M, Mallia E, Lam JSH, de Oliveira C, Rudoler D, Carvalho AF, Jacob BJ, Juda A, Kurdyak P.Predictors of suicide at time of diagnosis in schizophrenia spectrum disorder: A 20-year total population study in Ontario, Canada.Schizophr Res. 2020 Aug;222:382-388. doi:10.1016/j.schres.2020.04.025

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

National Institute of Mental Health.Schizophrenia.APA.Bipolar I and bipolar II disorders.National Institute of Mental Health.Bipolar disorder.Chakrabarti S, Singh N.Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review.World journal of psychiatry. 2022;12(9):1204-1232. doi:10.5498/wjp.v12.i9.1204Ather Muneer.Mixed states in bipolar disorder: etiology, pathogenesis and treatment.Chonnam medical journal. 2017;53(1):1-1. doi:10.4068/cmj.2017.53.1.1APA.What is schizophrenia?.McCutcheon R, Richard S.E. Keefe, McGuire P.Cognitive impairment in schizophrenia: aetiology, pathophysiology, and treatment.Molecular Psychiatry. 2023;28(5):1902-1918. doi:10.1038/s41380-023-01949-9National Institutes of Mental Health.Schizoaffective disorder.Patel KR, Cherian J, Gohil K, Atkinson D.Schizophrenia: overview and treatment options.P T. 2014;39(9):638-645.Cao H, Ingvar M, Hultman CM, Cannon T.Evidence for cerebello-thalamo-cortical hyperconnectivity as a heritable trait for schizophrenia.Transl Psychiatry.2019 Aug 20;9(1):192. doi:10.1038/s41398-019-0531-5Squarcina L, Fagnani C, Bellani M, Altamura CA, Brambilla P.Twin studies for the investigation of the relationships between genetic factors and brain abnormalities in bipolar disorder.Epidemiol Psychiatr Sci. 2016 Dec;25(6):515-520. doi:10.1017/S2045796016000615Stilo SA, Murray RM.Non-genetic factors in schizophrenia.Curr Psychiatry Rep. 2019 Sep 14;21(10):100. doi:10.1007/s11920-019-1091-3NIMH.Schizophrenia.Misiak B, Stramecki F, Gawęda Ł, Prochwicz K, Sąsiadek MM, Moustafa AA, Frydecka D.Interactions between variation in candidate genes and environmental factors in the etiology of schizophrenia and bipolar disorder: a systematic review.Mol Neurobiol.2018 Jun;55(6):5075-5100. doi:10.1007/s12035-017-0708-ySubstance Abuse and Mental Health Services Administration.Table 3.20, DSM-IV to DSM-5 Psychotic Disorders. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD) (US); 2016 Jun.Parker G.How well does the DSM-5 capture schizoaffective disorder?.Can J Psychiatry. 2019;64(9):607-610. doi:10.1177/0706743719856845Laws KR, Darlington N, Kondel TK, McKenna PJ, Jauhar S.Cognitive behavioural therapy for schizophrenia - outcomes for functioning, distress and quality of life: a meta-analysis.BMC Psychol. 2018;6(1):32. doi:10.1186/s40359-018-0243-2Perugi G, Medda P, Toni C, Mariani MG, Socci C, Mauri M.The role of electroconvulsive therapy (ECT) in bipolar disorder: effectiveness in 522 patients with bipolar depression, mixed-state, mania, and catatonic features.Curr Neuropharmacol. 2017;15(3):359-371. doi:10.2174/1570159X14666161017233642Sinclair DJM, Zhao S, Qi F, Nyakyoma K, Kwong JSW, Adams CE.Electroconvulsive therapy for treatment-resistant schizophrenia.Schizophr Bull.2019 Jun 18;45(4):730-732. doi:10.1093/schbul/sbz037Dome P, Rihmer Z, Gonda X.Suicide risk in bipolar disorder: A brief review.Medicina (Kaunas). 2019;55(8):403. doi:10.3390/medicina55080403Zaheer J, Olfson M, Mallia E, Lam JSH, de Oliveira C, Rudoler D, Carvalho AF, Jacob BJ, Juda A, Kurdyak P.Predictors of suicide at time of diagnosis in schizophrenia spectrum disorder: A 20-year total population study in Ontario, Canada.Schizophr Res. 2020 Aug;222:382-388. doi:10.1016/j.schres.2020.04.025

National Institute of Mental Health.Schizophrenia.

APA.Bipolar I and bipolar II disorders.

National Institute of Mental Health.Bipolar disorder.

Chakrabarti S, Singh N.Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review.World journal of psychiatry. 2022;12(9):1204-1232. doi:10.5498/wjp.v12.i9.1204

Ather Muneer.Mixed states in bipolar disorder: etiology, pathogenesis and treatment.Chonnam medical journal. 2017;53(1):1-1. doi:10.4068/cmj.2017.53.1.1

APA.What is schizophrenia?.

McCutcheon R, Richard S.E. Keefe, McGuire P.Cognitive impairment in schizophrenia: aetiology, pathophysiology, and treatment.Molecular Psychiatry. 2023;28(5):1902-1918. doi:10.1038/s41380-023-01949-9

National Institutes of Mental Health.Schizoaffective disorder.

Patel KR, Cherian J, Gohil K, Atkinson D.Schizophrenia: overview and treatment options.P T. 2014;39(9):638-645.

Cao H, Ingvar M, Hultman CM, Cannon T.Evidence for cerebello-thalamo-cortical hyperconnectivity as a heritable trait for schizophrenia.Transl Psychiatry.2019 Aug 20;9(1):192. doi:10.1038/s41398-019-0531-5

Squarcina L, Fagnani C, Bellani M, Altamura CA, Brambilla P.Twin studies for the investigation of the relationships between genetic factors and brain abnormalities in bipolar disorder.Epidemiol Psychiatr Sci. 2016 Dec;25(6):515-520. doi:10.1017/S2045796016000615

Stilo SA, Murray RM.Non-genetic factors in schizophrenia.Curr Psychiatry Rep. 2019 Sep 14;21(10):100. doi:10.1007/s11920-019-1091-3

NIMH.Schizophrenia.

Misiak B, Stramecki F, Gawęda Ł, Prochwicz K, Sąsiadek MM, Moustafa AA, Frydecka D.Interactions between variation in candidate genes and environmental factors in the etiology of schizophrenia and bipolar disorder: a systematic review.Mol Neurobiol.2018 Jun;55(6):5075-5100. doi:10.1007/s12035-017-0708-y

Substance Abuse and Mental Health Services Administration.Table 3.20, DSM-IV to DSM-5 Psychotic Disorders. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD) (US); 2016 Jun.

Parker G.How well does the DSM-5 capture schizoaffective disorder?.Can J Psychiatry. 2019;64(9):607-610. doi:10.1177/0706743719856845

Laws KR, Darlington N, Kondel TK, McKenna PJ, Jauhar S.Cognitive behavioural therapy for schizophrenia - outcomes for functioning, distress and quality of life: a meta-analysis.BMC Psychol. 2018;6(1):32. doi:10.1186/s40359-018-0243-2

Perugi G, Medda P, Toni C, Mariani MG, Socci C, Mauri M.The role of electroconvulsive therapy (ECT) in bipolar disorder: effectiveness in 522 patients with bipolar depression, mixed-state, mania, and catatonic features.Curr Neuropharmacol. 2017;15(3):359-371. doi:10.2174/1570159X14666161017233642

Sinclair DJM, Zhao S, Qi F, Nyakyoma K, Kwong JSW, Adams CE.Electroconvulsive therapy for treatment-resistant schizophrenia.Schizophr Bull.2019 Jun 18;45(4):730-732. doi:10.1093/schbul/sbz037

Dome P, Rihmer Z, Gonda X.Suicide risk in bipolar disorder: A brief review.Medicina (Kaunas). 2019;55(8):403. doi:10.3390/medicina55080403

Zaheer J, Olfson M, Mallia E, Lam JSH, de Oliveira C, Rudoler D, Carvalho AF, Jacob BJ, Juda A, Kurdyak P.Predictors of suicide at time of diagnosis in schizophrenia spectrum disorder: A 20-year total population study in Ontario, Canada.Schizophr Res. 2020 Aug;222:382-388. doi:10.1016/j.schres.2020.04.025

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