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What is the difference.. it's been bugging me.

 

Because if you have psychosis through all moods even stable would you be schizoaffective?

 

And

 

if you had psychosis during major mood state (mania or deep depression)... that could just be part of bipolar type 1?

 

 

So may someone explain to me.. cuz i been wondering this for a while.. and still do not have a solid definition.

 

 

Hope to hear something soon and thank you for posting/reading 

 

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From what I understand: Schizoaffective is a mood disorder (depressive or bipolar) plus psychosis, with psychosis also occurring outside of mood episodes. BP I + psychotic features is a mood disorder (depression and mania) with psychosis occurring during one or both types of episodes, but not occurring outside of mood episodes when mood is stable.

 

It's probably more complicated than that in reality, and I'm sure there are murky areas, but I believe that is the simple answer.

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okay so what i thought was right?

 

What hagar said is essentially what pdoc told me

 

 

 

From what I understand: Schizoaffective is a mood disorder (depressive or bipolar) plus psychosis, with psychosis also occurring outside of mood episodes. BP I + psychotic features is a mood disorder (depression and mania) with psychosis occurring during one or both types of episodes, but not occurring outside of mood episodes when mood is stable.

 

It's probably more complicated than that in reality, and I'm sure there are murky areas, but I believe that is the simple answer.

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Yes, what was stated above is basically it.

It gets tricky when dealing with someone, like me, that usually has rapid cycling. There have been times that I was in one mood episode or another so often, it was impossible to know if my psychosis was occurring outside of mood episodes. And I was also unaware for most of my life that much of my thinking was/is delusional, and what I thought were everyday occurrences were hallucinations, so I wasn't a completely accurate reporter. My old pdoc left my Dx as BP1 with psychosis, my new pdoc is leaning more towards sza. I don't really care, as the label doesn't change my life. I'm still just me, with my crazy brain.

Treatment is basically the same, so it doesn't matter much.

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Yes, what was stated above is basically it.

It gets tricky when dealing with someone, like me, that usually has rapid cycling. There have been times that I was in one mood episode or another so often, it was impossible to know if my psychosis was occurring outside of mood episodes. And I was also unaware for most of my life that much of my thinking was/is delusional, and what I thought were everyday occurrences were hallucinations, so I wasn't a completely accurate reporter. My old pdoc left my Dx as BP1 with psychosis, my new pdoc is leaning more towards sza. I don't really care, as the label doesn't change my life. I'm still just me, with my crazy brain.

Treatment is basically the same, so it doesn't matter much.

 

I have psychosis during my mania or mixed.. but happily i am not rapid cycling. I guess the bipolar 1 with psychosis is just stating a fact that this person with bipolar may/most of the time experiences psychosis during major mood states.

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I was diagnosed with schizoaffective disorder because I have had psychotic episodes outside of my mood episodes. I predominantly struggle with mood, but I do experience psychotic symptoms daily as well (mild hallucinations). 

 

Like Dedoubt said, the treatment is exactly the same, so it doesn't really matter what the label is. Schizoaffective would just be a more accurate name for someone who has psychosis (or schizophrenia symptoms) outside mood episodes. 

 

Interestingly, one of my pdoc's criteria for diagnosing me with schizoaffective disorder is that I will need anti-psychotic medication for life. Versus someone with straight bipolar or depression with psychotic features would only need anti-psychotics for a short period of time, typically. In bipolar/depression with psychotic features, if you control the mood, you can control the psychosis. In schizoaffective, the psychosis can come on anytime. 

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Yeah, youre pretty much on the right track. I was diagnosed bipolar with psychosis in the hospital when I came in depressed out of my mind. six months later in another hospital I was diagnosed with depression in remission and no mania but I had worsening psychosis even as my mood stayed fine. Thats when schizoaffective came into the picture, because there was psychosis outside of the mood disorder, but mood disorder was a prominent theme in my overall picture.

What I stil dont get is the difference between schizoaffective and schizophrenia with concurrent depression, but thats sorta tangential....

I think sza is one of those things where the whole lifetime picture of the person has to be scrutinized necause it is kinda confusing. Some just diagnose it by a process of elimination when other dx's dont add up.

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I am perplexed regarding this. I have been diag with bipolar w/psychosis. First of all what bothers me is I only have hypomania, yet I have delusions and occasionally auditory or visual hallucinations. I can not say with certainty if my delusions are dependent or independent of my mood disorder. It's hard for me to differentiate because my mood swings need not be as extreme as BP1. 

 

Here is my concern and I will speak to my T about this next appt.  Is it possible to have psychosis with BP2? Or is this schizoaffective? I am not always sure of my mood really. Some times they are mixed or near baseline with minor ups or downs. It's easy to know when they are extreme enough to detect, but not so easy when they are milder. Honestly I'm inclined to think my delusions are independent of my mood disorder.  I've never given this much thought until threads like this one showing up lately.

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I dont have mania and I was diagnosed with psychotic bipolar last year . I did have mixed episode though, dont know what that counts as. there is still disagreement about if I'm sza depressed or bipolar type. Its a gray area, but gray areas are worth talking about.

I think its a good conversation for pdoc, they are usually receptive to it. I bring in my ideas and we talk about it, sometimes getting everything in the open and transparent eases your own anxiety. They might learn more from those exchanges too and that would help refine your dx. The more you hold back from them the more youre missing out on, I would think.

The good news is medication is nearly identical. I take 20 mg saphris and it is used in bipolar as a mood stabilizer, so it keeps my moods even and takes care of most of the psychosis. as long as doctors can bill your insurance for something and get the right meds

Anyway, digressing, I'm really tangential right now sorry, but from my understanding psychosis happens in bipolar 2 but only in depression. I have heard a lot about how psychosis only happens during bipolar one mania, but this indicates otherwise. If psychosis happens in hypomania and at baseline, then schizoaffective might be possible. Again though, meds are the same regardless. theres the whole continuum theory, psychosis is one destination with multiple pathways.

http://www.ncbi.nlm.nih.gov/m/pubmed/20457470/

Edited by kitkatt91
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What I stil dont get is the difference between schizoaffective and schizophrenia with concurrent depression, but thats sorta tangential....

 

I read a book about diagnosing in psychiatry, one day while I was in the bookstore at my school. So feel free to take this with a grain of salt, but I swear to god I read it. 

 

Anyway, what the book said is, that if someone had schizophrenia for let's say 10 years and then randomly had a depressive episode, that wouldn't be re-diagnosed as schizoaffective disorder. That would simply be schizophrenia with a superimposed depressive episode. In schizoaffective disorder, mood symptoms must be present for the majority of the illness. So, when diagnosing schizoaffective disorder, the person's entire history is taken into account, not just their symptoms right now. 

 

Is it possible to have psychosis with BP2? Or is this schizoaffective?

 

Yes. I have schizoaffective - bipolar type and my bipolar component is bipolar NOS/2 and I have psychosis during severe depression. I never have psychosis during hypomania though. According to the DSM, if you have psychosis during hypomania, it's now become mania. So... Technically, yes you could have psychosis in bipolar 2 depression. 

 

We all know the DSM doesn't necessarily describe everyone's experiences though. 

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Huh well I that does make sense! I know they looked into my whole file to to diagnose me, more was taken into account than depression for instance where they just looked at the past month or so. I wonder though what defines a substantial portion of someones history, though. Or, if depression is indicated in someones history but never witnessed by the diagnosing doctor? If schizoaffective patient has a history but goes a long time with no additional depression, does it become a superimposed depression?

I do wonder too, looking into a patients history how much weight do teenage years cary? adolescence is part of ones history but is it fair to look at when they are still developing? If depression predominated throughout high school and then remitted in adulthood and that person developed psychosis, does that depression make it schizoaffective because it occupied a big chunk of their history or is that possibly just...well...adolescence? Can that be superimposed due to whatever happens hormonally during adolescence?

And is there a difference between chemical depression and becoming depressed due to life stressors? If a psychotic patients life gets better and that “reactionary" depression stops but the psychosis does not, is that still schizoaffective or was that a superimposed depression? Is it possible to have a superimposed depressiom for a long time? Or what about patients whose depression is in reaction to psychosis itself?

Sheesh I guess these are all rambly rhetorical questions, but how on earth does one determine these things? :P

I could never be a psychiatrist the more I try to think about it...the more it seems more and more like philosophy, or rhetoric....

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I think I understand the difference between BP with psychosis and schizoaffective (finally!),

 

the main difference between the two is centered around the psychosis, if it's dependent on the mood, it's BP, if it's independent of the mood it's schizoaffective.

 

Am I right?

Edited by IndieVisible
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Huh well I that does make sense! I know they looked into my whole file to to diagnose me, more was taken into account than depression for instance where they just looked at the past month or so. I wonder though what defines a substantial portion of someones history, though. Or, if depression is indicated in someones history but never witnessed by the diagnosing doctor? If schizoaffective patient has a history but goes a long time with no additional depression, does it become a superimposed depression?

I do wonder too, looking into a patients history how much weight do teenage years cary? adolescence is part of ones history but is it fair to look at when they are still developing? If depression predominated throughout high school and then remitted in adulthood and that person developed psychosis, does that depression make it schizoaffective because it occupied a big chunk of their history or is that possibly just...well...adolescence? Can that be superimposed due to whatever happens hormonally during adolescence?

And is there a difference between chemical depression and becoming depressed due to life stressors? If a psychotic patients life gets better and that “reactionary" depression stops but the psychosis does not, is that still schizoaffective or was that a superimposed depression? Is it possible to have a superimposed depressiom for a long time? Or what about patients whose depression is in reaction to psychosis itself?

Sheesh I guess these are all rambly rhetorical questions, but how on earth does one determine these things? :P

I could never be a psychiatrist the more I try to think about it...the more it seems more and more like philosophy, or rhetoric....

 

I am certainly not qualified to answer any of these questions, but it would make for an amazing discussion with a psychiatrist! :P This is why we leave the diagnosing to pdocs, and never try to diagnose ourselves. See how complex it is? Heh. 

 

I think I understand the difference between BP with psychosis and schizoaffective (finally!),

 

the main difference between the two is centered around the psychosis, if it's dependent on the mood, it's BP, if it's independent of the mood it's schizoaffective.

 

Am I right?

 

Yes, I believe this could be a good way to describe schizoaffective. My psychosis seems independent of my mood, anyway. 

 

Again, this would be a wonderful conversation to have with a pdoc. They have years of schooling and experience to help them make diagnoses. As my pdoc says, psychiatry is both art and a science. 

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