PsychSense: Sensible Psychological Solutions

Vincent Van Gogh, believed to have Bipolar I Disorder

Questions by Readers.

Dear Dr Duffy,

I am confused about my daughters illness. She is in a residential treatment facility and we have had a terrible time trying to control her. She has been given a number of different diagnoses including Oppositional Defiant Disorder, Schizophrenia and Bipolar disorder. My question is, is Bipolar and Schizophrenia the same. She seem to have many symptoms that could be either. How do the doctors know the difference between these illnesses? She is on many medications and although she is calmer I am still not able to control her at home. I don’t know what to do.

Any insight would be appreciated.

Worried Mother

Dear Worried,

I am sorry for the you and your daughters distress . This is a very difficult situation to deal with.

For the diagnosis of Schizophrenia to be made, certain symptoms must be present, such as hallucinations and/or delusions. These are not necessary for a diagnosis of Bipolar disorder although may be present in severe cases. I do not know how old your daughter is but Bipolar is a controversal diagnosis in children.

There are 2 types of Bipolar disorder, Bipolar I and 2. Bipolar I is the most serious type and may have psychotic features (out of touch with reality) . Bipolar 2 is often more closely related to personality disorders.

Yes, it is possible to have both a Bipolar and Schizophrenia diagnoses. In fact there are some in the field who think they Schizophrenia and Bipolar are just different presentations of the same underlying illness. Usually persons with Schizophrenia who have severe cycles of mood (depression and mania or hypo-mania (less severe)) are diagnosed with Schizoaffective disorder.

Certainly behavioral problems can also be caused by personality disorder, such as oppositional defiant disorder. When this is the case, medications usually have little success.

Psychotic disorders, including both Schizophrenia and Bipolar disorder are  usually helped by antipsychotic medication. (Risperdal, Seroquel, Zyprexa, Geodon, Abilify, Haldol). Often mood stabilizers are necessary with Bipolar I disorder (Lithium, Depakote, Tegretol, Lamictal)

This is a  complicated situation, and you may want to get a second opinion. Make sure the Psychiatrist or Psychiatric NP you see listens to you and explains what they are thinking in terms of diagnosis and treatment.

Remember Psychiatry is not an exact science.

Good Luck,

Dr. Duffy PhD, NPP