Paranoid schizophrenia or bipolar I mixed episodes?

Question

Can someone explain to me the difference between paranoid schizophrenia, and bipolar I with paranoid delusions and mixed episodes? Or does anyone know of a detailed online questionaire that would determine which I have?

Answer 1

Bipolar I mixed mania w/psychosis is an episodic mood state that effects energy and cognition as well.  It is being horribly depressed with manic energy and psychotic thinking.  It's not a permanent state.  With medication or time, the episode ends.  It also is not apt to be the only type of episode the bipolar person experiences.  Schizophrenia is an ongoing condition that may vary a little, but is relatively constant and not effected by mood.  It is a thought disorder, not a mood disorder.  Manic psychosis can appear very much like schizophrenia and has been mistaken for it in the past.  The key difference is that when mood is normal, so too are energy and cognition for the person with bipolar.  

Answer 2

Bipolar disorder is characterized by a cyclical alteration between depression and manic activity, both of which can include psychotic symptoms.  Schizophrenia, in contrast, is not characterized by variations in mood and energy, but by a combination of positive, negative, and organizational symptoms that may include loss of affect, hallucinations, disorganized thoughts, and delusions.  

Some symptoms that can be useful for differentiation include the nature of delusions or hallucinations - manic delusions are typically self-promoting, while schizophrenic delusions are often threatening and persecutory.  Behaviorally, mania is more energetic and focused on self-stimulation.  Schizophrenia has more disorganized behaviors associated with it - word salad, clang, and similar behaviors.  In both cases, symptoms can be influenced by passing moods and feelings - anxiety can exacerbate psychosis considerably.

While it can be somewhat difficult to differentiate between the two, a skilled clinical interviewer with a sufficient case history and an ear for details can accomplish this.  This is something that no online quiz or questionnaire can do with any validity.  If you think you're experiencing either of these conditions, seek psychological assessment.