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I think with mental illness being more like a spectrum,
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It is. BP's in the spectrum with schizophrenia (and there is a Spectrum within BP called Bipolar Spectrum;
http://en.wikipedia.org/wiki/Bipolar_spectrum). Several of BP/schizophrenia symptoms overlap (severe agitation, psychosis and others).
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I don't doubt it's possible/valid at all, I was just wondering how it happens. I just can't imagine (which doesn't mean it doesn't happen) a psychiatrist doing an evaluation and then coming up with all of this at once (maybe if it's one of those super-long official neuropsych evals it would be different).
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It's very easy. Lots of mental disorders have the same or similar symptoms. I've had every diagnosis since 1986 from schizoaffective to depression to OCD to BP (and most of these were coming from one of the most prestigious Psych Hospitals on East Coast since 1850). Not a great deal is known about mood disorders still. Studies show that a correct diagnosis of BP takes 8 yrs on average. And studies show that 40% of BP patients also have an anxiety disorder (OCD, generalized, etc.) so it's very difficult to diagnose. A diagnosis is not cut and dry especially if you have BP symptoms which run the gamut.
My experience is if someone has severe psychiatric symptoms they do not have good insight into it or any insight at all. That was the case for me. I didn't fully understand what I was feeling for half of my life. I just knew that something definitely wasn't right and didn't know how to correct it. (I just lived with it and it became who I am and controlled me.)
Every hospitalization (x7) I had in early 90's PDOCs would just scratch their heads and was given all sorts of meds including one complete Summer of ECT (x16).