Is schizophrenia worse than bipolar

There is a risk of confusion with mental illnesses

It has long been known that mental disorders occur more often in families. Professor Avraham Weizman from Tel Aviv University in Israel reminded us of this. Not only are there often several schizophrenia patients in families, there are also other mental disorders, such as bipolar diseases, more often than the average in such families, according to the expert at an event supported by the Pfizer company at the Psychiatry Congress in Munich.

Twin studies suggest genetic predisposition

 In depressed people, it is always necessary to rule out manic episodes.

However, the familial accumulation of certain mental illnesses alone is not sufficient evidence of a genetic cause or genetic similarities between different mental illnesses, said Weizman. It would also be possible that family members are exposed to the same psychologically stressful conditions and that this explains the familial accumulation as a reaction to this. Sick people could even be considered as disease-causing factors for other family members.

However, the results of twin examinations and adoption studies clearly indicate a genetic predisposition, which put the share of genetics in the disposition for schizophrenia, for schizoaffective and bipolar disorders up to 85 percent. In molecular biological analyzes, several typical gene changes have already been localized in patients with schizophrenia and in patients with bipolar disorders, some of these changes being the same in both forms of the disease, said Weizman.

Structural changes in the brain of patients with schizophrenia can now also be detected with imaging methods. A significant reduction in gray matter in the temporal lobes, hippocampus, thalamus, amygdala and cingulum is found in these patients above average. Similar changes are often found in healthy first-degree relatives of schizophrenia sufferers and in patients with bipolar disorder.

Similarities in the brain in different diseases

Similarities between schizophrenia and bipolar disorder also exist at the neurotransmitter level. Both in schizophrenia patients and in a large number of manic-depressive patients there is an increased activity of dopamine-D2-Receptor detectable. Accordingly, neuroleptics that block such receptors can be useful for both patient groups.

Decreased levels of the enzyme GAD67 can be detected in both schizophrenic and bipolar patients. This enzyme is crucial for the synthesis of gamma-aminobutyric acid (GABA). GABA is the main inhibitory neurotransmitter in the central nervous system.

The overlapping symptoms in bipolar, depressive and schizophrenic diseases often lead to misdiagnosis in practice, as the US psychiatrist Professor Rajiv Tandon has emphasized. In particular, bipolar disorders are significantly underdiagnosed and are often misunderstood as typical depression in depressive episodes and as schizophrenia in manic phases.

The misdiagnosis of bipolar disorder as depression is dangerous in that drug therapy exclusively with antidepressants can trigger manic episodes and worsen the long-term prognosis. Depressed bipolar patients also need therapy with mood-stabilizing drugs such as lithium or anticonvulsants.

In depressed patients, it is therefore always necessary to rule out manic or hypomanic episodes based on their medical history. However, even the most conscientious anamnesis does not guarantee complete diagnostic certainty, especially since patients with bipolar disorder often initially have a series of exclusively depressive episodes, said Tandon. In the follow-up monitoring of depressed patients, attention should therefore always be paid to the first signs of mania.

In about 50 percent of all manic episodes of bipolar patients there would also be symptoms of psychosis, said Tandon. In these patients, there is a risk of confusion with schizophrenia when diagnosed. In geriatric patients in particular, their manic symptoms would again and again be misinterpreted as signs of delirium, dementia or agitated depression.