What's the difference between bipolar psychosis and schizoaffective bipolar type?

You don’t strike me as bipolar – there is a distinct lack of drama in your case. No “wookit me!”

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You shouldn’t have known me a few years back… lol But yeah, no borderline I think.

Oh gawd, you had a notmoses, too? :frowning:


Lol! No, but plenty of manic episodes :smile: And depressed too. :frowning:

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i said to my pdoc could it of been psychotic-depression. not sza, he said no because i had no insight in my psychosis…was he right? in saying that

When you have psychotic depression, generally you are aware that your delusions and hallucinations are not real.


Psychotic depression, also known as depressive psychosis, is a major depressive episode that is accompanied by psychotic symptoms. It can occur in the context of bipolar disorder or major depressive disorder.

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The prognosis for psychotic depression is not considered to be as poor as for schizoaffective disorders or primary psychotic disorders.[1] Still, those who have experienced a depressive episode with psychotic features have an increased risk of relapse and suicide compared to those without psychotic features, and they tend to have more pronounced sleep abnormalities.[1][3]

The families of those who have experienced psychotic depression are at increased risk for both psychotic depression and schizophrenia.[1]

Most patients with psychotic depression report having an initial episode between the ages of 20 and 40. Over a lifetime, it appears that patients with psychotic depression experience an average of 4 to 9 episodes.[citation needed] As with other depressive episodes, psychotic depression tends to be episodic, with symptoms lasting for a certain amount of time and then subsiding. While psychotic depression can be chronic (lasting more than 2 years), most depressive episodes last less than 24 months. Unlike psychotic disorders such as schizophrenia and schizoaffective disorder, patients with psychotic depression generally function well between episodes, both socially and professionally

Psychotic symptoms are often missed in psychotic depression, either because patients do not think their symptoms are abnormal or they attempt to conceal their symptoms from others.[1] On the other hand, psychotic depression may be confused with schizoaffective disorder.[1] Due to overlapping symptoms, differential diagnosis includes also dissociative disorders

I think the phycosis only hits when the major swings happen. For me it is like phycosis with swings. I think the bipolar is swings with some phycosis

@san_pedro, here’s an article on the connection between psychotic depression and schizophrenia. Possibly it’s just a matter of degree.


Here’s another look at it:

This part was interesting:

Psychotic depression was most commonly misdiagnosed as major depressive disorder without psychotic features, depression not otherwise specified (NOS), or mood disorder NOS. It was quite striking that none of the patients with missed diagnoses were considered to have a psychotic disorder. This finding suggests that the clinicians were missing the psychosis rather than the mood disorder.

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In my time I have been diagnosed schizoaffective mixed type with bipolar also occasionally being suggested. For 20 years I was on lithium and then tegretol for a couple of years.
Then they changed the diagnosis and took away the mood stabiliser. Listed symptoms at the time- anxiety/depression/mood swings/paranoid thinking. Went off meds for a year at pdocs say so. Had to go back on them. Pdoc was reluctant to put me on a stand alone AD because of possible negative effects on mood (the kind of thing you think if you suspect bipolarity). Put me on an atypical instead. The atypicals are multi purpose ie anti depressant,anti manic and antipsychotic so can cover a lot of diagnostic bases.
Basically the diagnosis is a crap shot not much better than sending monkeys to med school for 5 years.
The real issue is how much is the treatment you are receiving helping you.
Time to ditch bipolar ,schizophrenia etc and switch to the psychosis spectrum? From mild/transient psychosis to the more persistent and severe psychosis that currently gets called schizophrenia?


Completely agree. Adding the mood elements or removing them.

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