Recognizing and Treating Bipolar Disorder and Schizophrenia

Available with English captions and subtitles in Spanish.

Bipolar disorder (BD) and schizophrenia are two very distinct mental health challenges. While BD is characterized by intense mood swings between deeply depressive states and episodes of mania, schizophrenia is marked by psychosis that can include hallucinations, delusions, or disordered thoughts or speech.

Because it’s possible for someone with bipolar disorder to experience psychotic symptoms, people living with BD can sometimes be misdiagnosed with schizophrenia. It’s also common for those living with schizophrenia to be struggling with other mental health conditions.

So, how can clinicians, loved ones, and educators learn to recognize the key symptoms of BD and schizophrenia all while understanding the key similarities and differences in these disorders? How is each condition diagnosed and treated? And what are their respective risk factors?

Audience Questions

Kathryn Eve Lewandowski, PhD, provides an overview of both schizophrenia and the different types of bipolar disorder, shares tips for spotting their signs and seeking treatment, and answers audience questions about successfully supporting someone living with these conditions.

  • Can you give us a working definition of bipolar disorder (BD)?
  • Is it possible for someone’s diagnosis to shift from bipolar I to bipolar II?
  • How prevalent are these two forms of bipolar disorder?
  • What do we know about the causes of bipolar disorder?
  • What are some of the basic signs and symptoms of BD?
  • Can you talk about the diagnostic process for BD?
  • Can someone have a manic episode but not warrant a bipolar diagnosis?
  • What is the distinction between manic and hypomanic episodes?
  • How can family members better understand when their loved one is going through a manic episode?
  • What is the gold standard for treatment of bipolar disorder?
  • Is this treatment done both at an inpatient and outpatient level?
  • What can someone expect in terms of long-term life with bipolar disorder?
  • Would you suggest using a mood disorder questionnaire, not for diagnosing bipolar disorder, but just as a starting point for assessment?
  • Can you share a working definition of schizophrenia?
  • How prevalent is schizophrenia?
  • Have researchers been able to find any causes of schizophrenia?
  • What should we know about treatment for schizophrenia?
  • In terms of prognosis, are you seeing people thrive with schizophrenia after treatment?
  • Many questions have come in about schizoaffective disorder. What should we know about that term and what it refers to?
  • Can you discuss the differentiation between a bipolar diagnosis with psychosis and schizoaffective disorder with a mood component? Is the treatment for these different?
  • What do you want clinicians to know in terms of when it makes sense for them to refer out and when it makes sense for them to treat complex disorders themselves?
  • What is the earliest age of onset for schizophrenia?
  • Is schizophrenia more prevalent in men or women?
  • Is it possible to be diagnosed with bipolar disorder and later wind up being diagnosed with schizophrenia or vice versa?
  • Can you speak to the connection between trauma and bipolar disorder or schizophrenia?
  • How does borderline personality disorder (BPD) differ from bipolar disorder? What should we know about that distinction?
  • How does ADHD fit into today’s conversation about BD and schizophrenia?
  • How often do you find that somebody who comes to you for help has been misdiagnosed?
  • How frequently does substance use disorder co-occur with these diagnoses?
  • How common is suicidality in schizophrenia?
  • Can you talk about the stigma associated with these disorders? What can be done to fight this stigma?
  • What guidance do you have for family members to best support loved ones living with BD or schizophrenia?
  • How does one speak to someone experiencing a psychotic episode to help calm them enough to suggest support by a therapist?
  • What is catatonia? Why does it happen? And what we should know about it?
  • How can someone get more information about the McLean OnTrack™ program?
  • When it comes to all-too-frequent misdiagnoses, what can be done systemically to address the issue?
  • How does PTSD fit into the bipolar, schizophrenia conversation?
  • How can someone help a family member who does not believe they have schizophrenia and are very sensitive to the idea of treatment?
  • Is there an evolutionary explanation for BD and schizophrenia? Are they hereditary?
  • What are some additional resources for people looking for information about BD or schizophrenia?
  • How can schools best support someone who is struggling with psychosis?
  • Can you talk about the hope that the treatments you’ve mentioned can offer people?

The information discussed is intended to be educational and should not be used as a substitute for guidance provided by your health care provider. Please consult with your treatment team before making any changes to your care plan.


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About Dr. Lewandowski

Kathryn Eve Lewandowski, PhD, is the director of clinical programming at McLean OnTrack™, a program for young adults in the early stages of psychotic disorders. She is also an associate professor of psychology in the Department of Psychiatry at Harvard Medical School.

Dr. Lewandowski is a member of the International Society of Bipolar Disorders (ISBD) Targeting Cognition Task Force and the International Consortium Investigating Cognition in Bipolar Disorder (ICONIC-BD). She was awarded the 2018 Connie Lieber Science to Practice Award for her work in implementation of cognitive remediation in early psychosis and mania.

Learn more about Dr. Lewandowski.

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