[BNLsMOM]

What is the difference between bipolar with psychotic features and schizoaffective disorder?

I thought I once knew, but a lot of people here who write that they have the "Bipolar with Psychotic Features" seem to make me question my original understanding. Thanks for asking this question, BNLsMOM!

During some of my worst episodes (severe episodes), I have had psychosis of various sorts. I've never been given a flat label of "Bipolar type 1 with psychotic features". I have had "Bipolar type 1 - mania, severe, with psychosis" written on hospital records, as well as "Bipolar type 1 - manic, severe, with mixed features and psychosis" and "Bipolar 1 - depressed, severe, with psychosis". Back then I was under the impression that these extra modifiers referred to the episodes themselves, at that precise time, not as part of a formal permanent diagnosis. Frankly, I don't know how that works. I still have bipolar type 1 in all of my records. Sometimes I didn't have psychosis. My last major one was in May 2018. I thought that psychosis in bipolar disorder was only possible during severe episodes, not milder ones or stability. It was my understanding that psychosis when not in severe episodes of bipolar disorder automatically meant Schizoaffective Disorder - Bipolar type, which is a diagnosis I think I understand. But it seems I might be wrong. What the heck "Bipolar 1 with psychotic features" means, otherwise is a mystery, to me. Is it just that such people always have psychosis and a whole mess load of it even compared to me? A higher % of their clocked mania/depression? Or if they do have psychosis outside of severe episodes, then why would it be "Bipolar 1 with psychotic features" as opposed to Schizoaffective Disorder - Bipolar type? What is the difference between those two diagnoses?

Some people here (or in the past) have written about currently having psychosis when they otherwise, to me, seem not to be in a severe episode. Some literally say "I am psychotic". I also don't understand that. I'm not challenging its validity, but I don't relate to it at all. When I am psychotic, I lack insight into it completely. I believe the hallucinations or delusions/paranoia to be true. Of course I can "look back" at psychoses, but I have never said "I am psychotic" in the present tense. I guess that shows a difference between my flavor of bipolar disorder and some others'. Maybe people with schizophrenia know they are psychotic at a given moment?

Truly, when I am psychotic, I can barely speak/write in a rational manner, or it at least becomes very odd, quickly. Dysfunctional. It is noticed and can be scary to others. How I am writing now? That would not be possible when I am full blown manic with psychosis. Yes, I am verbose, but I don't believe this is totally disjointed, reflecting thought disorder, delusions, paranoia, or hallucinatory experiences. I am not grandiose, and know I am not God (or anything akin to that).

[Sometimes psychotic]

I have bp1 with psychotic features...I had a single one month period of psychosis with mania then a few isolated hallucinations every now and then like less than ten a year.

It’s still a possibility I have sza, pdoc says it could be either.

The simplest way I can put it: schizoaffective (SzA) is basically schizophrenic symptoms alongside a mood disorder like MDD or BP. I say "schizophrenic symptoms" because you do not need to qualify for a schizophrenia diagnosis in order to be diagnosed with SzA, but you typically need to have at least some schizophrenic "negative" and "positive" symptoms, with "negative symptoms" referring to behavior and presentation like flat affect, catatonia, etc. and "positive symptoms" being hallucinations, delusions, paranoia, etc..

So, for example... Having hallucinations with BP does not mean you have SzA. It means you have ONE symptom that overlaps with schizophrenia criteria, but having one "schizophrenic" symptom does not mean much. You need multiple schizophrenic symptoms for a doctor to consider SzA.

FWIW, I did testing to see if I had BP or SzA, but the psychologist said that I had linear thinking and I did not present in an "unusual way" (that is me summarizing what she said if she were blunt about it, but I basically did not mark off enough checkboxes for negative symptoms). I do have psychosis independent of mood disturbances, but when we look at the symptoms for schizophrenia as a whole, I pretty much only have psychosis, flat affect, and flat vocal tone... and well, autism runs in my family, so it is entirely possible the flat affect and flat vocal tone go alongside autism or something. I hope that makes some kind of sense? Sorry if I am rambling...

[*Beth*]

^^^^^ What blue posted.

I wish I could add something more definitive, but all I can say is that I've known people who have SzA and I've known people who have BP1 and the SzA people seemed...flatter in affect. For example, even when manic they were talkative, but they also spoke a lot about their psychotic symptoms, asking others if we thought certain symptoms might be psychotic...but then hardly giving anyone a chance to answer before moving back to the same questions in a rather toneless manner.

The BP1 people I've known (myself included) get very colorful and furious and wild in general when manic. There's no "flatness."

Or something like that. Definitely not scientific, just what I've noticed.

[bpcyclist]

In my world, the word 'psychosis' simply menas 'loss of contact with some aspect(s) of reality.'

As such, becoming paranoid or thinking I am being followed when there is no threat and I am not, in fact, being followed, represenst some degree of psychosis. For me, the term does not merely describe its most florid manifestations, it describes all its varied manifestations. Perhaps, this is somehwat ananlagous to hypomania and mania. Degrees. So, when I notice that I think there are cameras in my wall again, which occurs regularly, and that they are being operated by spies spying on me, that, for me, is a psychotic symptom of my bipolar disorder. Psychotic because, in fact, according to everyone in my life other than me, there are, in fact, no spies and no cameras in my walls. So far. People have come over to my apt. and actually looked for them for me before. Noone has ever found an infrared camera in my wall.

So, for me, anyhow, psychosis is a process that runs from mild symptoms to profound lack of ability to function. Being able to say "I think I am a bit psychotic" is merely a reflection of the fact that I trust the people in my life to tell me when they see me becoming symptomatic in this fashion yet again. It does not mean that I fail fo believe there are cameras in my wall. I almost always believe that. But I can admit when others tell me they believe this is due to my illness and not real.

So, fo rme anyhow, the use of the term psychosis does not requrie total and complete loss of contact wtht all reality. It is a spectrum and a process, from mild to severe. And it is certainlly possible to receive fedback from others that, in fact, there is not a nuclear bomb that I need to defuse and that, even if there were, I actually do now know how to defuse a nuclear bomb. True example there. It is a continuum. Mild to severe. At least for me.

[Blue_Bird]

I have schizoaffective disorder bipolar type and definitely have a flat affect. I experience episodes of mania and depression but my psychosis can occur both in and outside of mood episodes. I have other negative symptoms of schizophrenia also.

[Tucson]

My doctor tells me that schizoaffective is when psychosis happens independent of one’s mood swings. Bipolar with psychotic features happens related to one’s mood swings, for instance mania.

[DocJohn]

Someone asked that I chime in to this thread to help shed light on the question asked.

I turn to the DSM-5 to see what it says, and it says this:

Schizoaffective disorder can be distinguished from a depressive or bipolar disorder with psychotic features based on the presence of prominent delusions and/or hallucinations for at least 2 weeks in the ABSENCE of a major mood episode. (emphasis added).

In contrast, in depressive or bipolar disorder with psychotic features, the psychotic features primarily occur DURING the mood episode(s). (emphasis added)

In the end, the differential between these two isn't likely overly important, since their respective treatments would be very similar.

Hope this helps....

Originally Posted by DocJohn

Someone asked that I chime in to this thread to help shed light on the question asked.

I turn to the DSM-5 to see what it says, and it says this:


In the end, the differential between these two isn't likely overly important, since their respective treatments would be very similar.

Hope this helps....

Thanks so much, @DocJohn!

[*Beth*]

Informative and interesting thread!

Originally Posted by bpcyclist

In my world, the word 'psychosis' simply means 'loss of contact with some aspect(s) of reality.'.....

.....So, for me, anyhow, psychosis is a process that runs from mild symptoms to profound lack of ability to function. Being able to say "I think I am a bit psychotic" is merely a reflection of the fact that I trust the people in my life to tell me when they see me becoming symptomatic in this fashion yet again. It does not mean that I fail to believe there are cameras in my wall. I almost always believe that. But I can admit when others tell me they believe this is due to my illness and not real.

So, for me anyhow, the use of the term psychosis does not require total and complete loss of contact with all reality. It is a spectrum and a process, from mild to severe. And it is certainly possible to receive feedback from others that, in fact, there is not a nuclear bomb that I need to defuse and that, even if there were, I actually do now know how to defuse a nuclear bomb. True example there. It is a continuum. Mild to severe. At least for me.

Thanks for this, Birdie! That is also how I experience psychosis. You've explained it so well.