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August 23rd, 2011
01:29 PM ET

Could my bipolar brother develop schizophrenia?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

Question asked by Benjamin from St. Catharines, Ontario

I was wondering if my brother, who we have been told is bipolar, could develop schizophrenia? My uncle, my mom's brother, was schizophrenic and unfortunately fell victim to the mental illness. We are aware that there have been some mental health issues with males on my mother's side of the family, so could it be possible that he could be schizophrenic as well as bipolar?

Expert answer

Dear Benjamin,

Your question points to a major problem confronting the field of psychiatry, which is the imprecision of our diagnostic categories. The problem has a simple cause but no simple answer.

The cause comes from the fact that all our disease states are based on symptoms and how they are clustered together, rather than on any real biological mechanism.

In this way, our diagnoses are similar to the way most medical illnesses were defined before the 20th century. For example, in the old days people with fluid in the lungs and chest pain were said to have pleurisy - it was defined by its symptoms.

Ask our doctors a question

Nowadays we recognize literally hundreds of different reasons for pleurisy symptoms, many of them with specific treatments that have no effect on other causes for pleurisy.

Diseases such as schizophrenia and bipolar disorder are like pleurisy and not like adenocarcinoma of the lung or pneumococcal pneumonia or an aortic dissection, all of which cause pleurisy, but all of which are disease conditions based on an understanding of physical mechanisms rather than symptoms.

Both schizophrenia and bipolar disorder are better thought of as syndromes rather than specific diseases. As such, someone has schizophrenia if he or she meets symptom criteria for schizophrenia spelled out in the diagnostic manual. The same thing holds for bipolar disorder.

It sounds simple enough, but things immediately get complicated. First, schizophrenia and bipolar disorder share important symptoms; for example, psychotic thought and behavior can be present in both conditions, making the syndromes hard to differentiate.

If a person is heavy on psychosis and relatively light on either depression or mania, he or she looks schizophrenic and is called such. If a person is heavier on depressions and manias and only has psychotic episodes when in a mood state, he or she looks more like someone with bipolar disorder and is called such.

To add to our diagnostic troubles, over time many people's symptom patterns swing from mostly psychotic to mostly mood-related and back again, making them sometimes seem schizophrenic and sometimes bipolar. And other people spend most of their lives in an intermediate state, with lots of psychosis and lots of depression or mania, but not enough to be fully bipolar. These people are called schizoaffective.

By definition, a person can't have bipolar disorder and schizophrenia at the same time. But a person can sure struggle for years with psychosis, odd behavior and mood swings and be hard to classify clearly into one diagnosis or the other, which sounds to be the case with your brother.

In the midst of these complications, there is some good news. More important than his exact diagnosis (which is after all only a description of his symptoms and how they cluster over time) is the fact that both schizophrenia and bipolar disorder respond to similar medications.

The important thing is not his diagnosis, but his need to get into - or remain in - consistent treatment, which offers the best hope of providing a hopeful long-term outcome.

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soundoff (32 Responses)
  1. Naomi

    I think Americans are too saturated with garbage entertainment all the time everywhere. No wonder people become sick. Cut it back to be normal again. Read something plain and realistic yet takes whole energy to fully understand such as the Bible.

    August 23, 2011 at 14:09 | Report abuse | Reply
    • chuckster

      Yes...thank you for this incisive comment straight from the 18th century.

      August 23, 2011 at 14:39 | Report abuse |
    • Tony

      The bible.... right...

      The person that sweareth, and uttereth with his lips, that he would do either evil or good, and bindeth the same with an oath, and his word: and having forgotten it afterwards understandeth his offence, Let him do penance for his sin. And offer of the flocks an ewe lamb, or a she goat, and the priest shall pray for him and for his sin. But if he be not able to offer a beast, let him offer two turtles, or two young pigeons to the Lord, one for sin, and the other for a holocaust.

      Anyone know what time PetSmart closes?

      August 23, 2011 at 15:38 | Report abuse |
    • eugene23

      chuckster I think Naomi was being sarcastic.
      If not, she is a damn fool.

      August 23, 2011 at 15:38 | Report abuse |
    • James Bond

      I believe what you said was a valid point. Truly understanding the Bible is not simply reading a book of religion and forcing a belief upon others. Rather is is a deep search for your greater understanding of God, Theology is not a simple practice. To greater understand the love of Jesus Christ and His death one must study to fully understand. The trinity. Something that is simple to say, but only studying can give a human the ability to understand. This does not hinder the truth that one must study science, philosophy, art, along with psychology. If the mans brother is bipolar or schizophrenic it does not mean a demon, because one mentions a Bible. It could be a chemical problem, nutritional problem, psychological problem, but we must remember that God is not the force to fight against, but the force to flow with to seek a better more peaceful world. Through Jesus Christ.

      August 23, 2011 at 15:58 | Report abuse |
    • Jason K

      Naomi, I wouldn't call the bible "plain" or "realistic" and I'm a believer in Yeshua. The entire first half of the bible is one depressing story after another with God The Father, constantly smiting, killing, or threatening the human populace of the Earth, Jew and Gentile alike. And even with a proper understanding of doctrine such as s0vereignty and dispensationalism, its still depressing. If you're truly a believer, wouldn't you agree that it would be more likely that people are "sick" because they are sinners and thus lack holy, perfect, immortality rather than "garbage entertainment"?

      That's not my view, but I had to point it out since you played the "I'm a narrow minded 'Christian'" card.

      August 23, 2011 at 16:38 | Report abuse |
    • AllOverThePlace

      Like chuckster said...

      People have had mental issues long before TV, the Internet or even widespread literacy. Back then, the great unwashed masses considered them possessed and did horrible things to them in order to "save" them or release the demons. Most times, those poor people ended up dead.

      So, sarcastic or not, referencing the Bible as a solution is jacked up.

      August 23, 2011 at 22:18 | Report abuse |
    • Mr. Jake

      LMAO. Good one Tony, Petsmart... best laugh of the day.

      September 5, 2011 at 20:21 | Report abuse |
    • passengeroftheroad

      Schizophrenia Bipolar are very real psychotic diseases of the mind. The Bible is unhelpful consider how some mentally individuals exploit the Bible to create cults Jim Jones Charles Manson Etc.
      A number of mentally ill plausibke people actually believe they are God or the mouth piece of God.
      We see what happens when a charismatic Bible thumper does with the Bible, you've only got to look at America to see the craziness in religion & paranoia

      June 2, 2017 at 23:39 | Report abuse |
  2. boodles

    I have read NAMI's whold binder about these illnesses and this is the clearest explanation I have seen. I finally understand what schizoaffective is! Thank you! I DO recommend NAMI, they are great and very, very helpful!!

    August 23, 2011 at 14:22 | Report abuse | Reply
    • C in AZ

      As a parent of a child with bi-polar schizophrenia, I agree.
      NAMI is just AWESOME !
      We are lucky to have it.
      Good luck with your journey into that particular world....our journey with our child has been ongoing for over 20 years now.
      STRENGTH is what we need to deal with this, & NAMI helps with that.

      August 23, 2011 at 14:38 | Report abuse |
    • AllOverThePlace

      Same here. Bipolar/borderline personality disorder/dissociative disorder... It's a lifetime commitment to take care of a family member with combo disorders. You just do what you can and hope for the best.

      August 23, 2011 at 22:14 | Report abuse |
  3. All Better

    My guess would be on either schizoaffective, amphetamine abuse w/psychosis, or severe sleep issues with adaptive adrenaline junkie lifesyle.

    August 23, 2011 at 16:19 | Report abuse | Reply
    • AllOverThePlace

      Paging Dr. Clueless! Line 0...

      August 23, 2011 at 22:14 | Report abuse |
  4. Dale

    Doctor,

    Does proper nutrition, exercise, and rest impact mental health? Can bipolar and schizophrenia be prevented with a balanced lifestyle?

    August 23, 2011 at 19:01 | Report abuse | Reply
    • natasha

      while they can't be prevented with proper nutrition, exercise, etc., they can be controlled to some extent. Bi-polar disorder has a direct relation to stress and stressful situations (I don't know enough about schizophrenia). My experience with my brother and my husband (both are bi-polar) is that when they are stressed out they use up chemicals in their brains (like we all do) to combat their stress, however, bi-polar people don't "regenerate" those chemicals at the same rate where they need to be in the brain as someone without bi-polar disorder does. If my husband exercises he releases stress in a way that generates those kind of chemicals at a faster rate and thus doesn't exhibit the symptoms as quick as he would have had he not exercised.

      I also try to let him sleep more if I notice he is leaning toward hypomania because I believe that is where we build up those brain chemicals that bi-polar people use up and don't regenerate as quickly. His own physiology seems to make him sleep longer on those days too...Kinda tired, so hope that makes sense of what I see...

      August 23, 2011 at 23:00 | Report abuse |
  5. Webspy

    I have been diagnosed with many things over the years and wondered nature or nurture...A problem seems to be the boys on my father side...the government step in and said I suffered PTS, Post Traumatic Shock or as was "Nervous Shock"...threw the years as a child I cracked my joints 300 times a day and carried my emotions around internally...Was told manic depressive on my mothers side and my father suffered alzheimer's dementia,,,Overachiever fear of failure...Bipolar then was finally told Schizophrenic...I have had a rat in a maze to study 40 some years as a subject namely me,,, been keeping charts and graphs on my self for a life time... It is hard going threw the 40s whats the meds, whats simple forgiveness slowness in speech, whats the disease...it does or I do note I was bipolar self medicating beer, that persisted to schizophrenia, but I'm scared sometimes its a little like a pizza I recognize all there at certain points, its easy to say when I hear voices and see things, I'm skizy,,, when I'm doing so so party I'm bipolar fight and flight,,,and when I cant think Carrie on a simple conversation its a form of dementia that makes me a bit obsessive compulsive...I ride and take each wave as they come,,,as I like to think ,I cant control the voices or delusion's but I can only control my reaction to them,,,I lucked out in only one way, My partial deprivation and ESP has given me a high cognitive level, for that i am happy and study science and me self! and on that note I will leave you with a joke you never heard before. I was at the doctors and he said," no no no, that's the illness your delusional" I said "Hate to break the news to you your the one delusional,,I'm not even here right now"!!! funny

    August 23, 2011 at 19:29 | Report abuse | Reply
    • Webspy

      I also believe in the future they will find a link to the brains internal clock,,,when I'm coming up to a rough patch I notice a constant jitteriness, constant deja vu repeating,,,so a loose sense of time dilation,,,if I have to do something in the morning, I tend to stay up all night, that starts to compound problems of a type of sleepwalk that's running in a non stop day dream state, that's why I hear and see things unreal, any one who worked 23 or 24 hours straight goes threw this, only for me its a constant now after 40 years of bad sleep and can recall every dream till I was 2.

      August 23, 2011 at 19:40 | Report abuse |
  6. Omotayo

    I either suffer from Schizophrenia or Bipolar Affective Disorder. Or maybe Schizoaffective disorder. My doctors have not told me and this may be because of the risks of doing so. Hoever, I used to see visions and dream dreams and in one particular case while seeing a vision, I also heard a voice. From what I infer from above both Schizophrenia and Bipolar Affective Disorder might have different outcomes. It seems the one for Schizophrenia might not be all that good since they might hear voices and see no one as I had once. In the vision in which I heard a voice, I was outside the house in terrble darkness with a little light from a full moon. At another time I was in the house in a vision this time in a very beautiful situation and a message was passed on to me saying Tayo (that's a shortened version of my name) do not worry these two people understand themselves by a friend. In thefirst vision under darkneess a similar message was passed on to me, Tayo do not worry water is now flowing from the taps by my sister. Both messages were passed on to me at the very end of the message. So it seems to me worry is an underlying factor of both Schizophrenia and BipolarAffective Disorder. What am I getting at? I think I was formerly Schizophrenic and now I am now Bipolar. These illnesses are spiritual in nature, you can see some of my writings on them on my blog http://www.tayo123.blog.co.uk. When I was confessing my sin I was Schizophrenic and under the wrath of God, under the Aaronic prieshood. This is symbolized as being outside of the house in the vision. But when I believed my sins have been totally washed I am now Bipolar symbolised as being in a house and I can now marry (Do not worry these two people undersyand themselves), the Melchisedec priesthood. All these illnesses are about sin really. I can now be completely healed when my female part marries the male part. In the second vision I was not with a female partner just like Adam necessitating the illness. A married couple who were both with the other gender were now free from mental illness( they were also in the vision). The Bible says we have not come to a mount quaking under terrible tempest ( the Aaronic priesthood) but to mount zion yhe city of the living God ( the Melchesedec priesthood). The difference in outcomes is as a result. Of different dispositions to the forgiving of sins.

    August 23, 2011 at 22:23 | Report abuse | Reply
  7. Dr J

    I am a physician, though not a psychiatrist. I never comment on web articles, but I just wanted to commend the writer on a beautifully written, caring, and conscientious piece about a confusing issue. I was surprised to find such a well-written piece here out on the web tubes.

    August 23, 2011 at 23:01 | Report abuse | Reply
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    Yes there should realize the opportunity to RSS commentary, quite simply, CMS is another on the blog.

    August 28, 2011 at 00:13 | Report abuse | Reply
  9. tracie

    Hi my daughter was diagnosed with bipolar at 13 but now there saying it might not be bipolar personaLly I've been saying schitozoprenia for a while she constantly sees things but has really bad mood swings aswell showing symptoms of bipolar I'm really confused as I want her to get better she's only 15 plz if anyone can help me out thanks

    September 10, 2011 at 07:13 | Report abuse | Reply
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  19. Janice Wells

    Annabel's schizophrenia’s story

    Canada

    My daughter (Annabel) suffered schizophrenia for 5 years. I had no idea what was happening and didn’t know where to turn for help. It was hard then because I really didn’t understand the symptoms earlier until she was diagnosed. There was a time she decided to get away from everyone, I was not excluded. I had to sit and cry almost every day because I felt helpless as a single mother (she is all I have got). The anguish I went through taking care of her alone is beyond explanation because there was no support of whatsoever from the dad or family members. I fought for proper medical care and humane treatment; I did everything within my reach to get her cured but all to no avail. Countless different medications was prescribed (Zyprexa, fluphenazine, Risperdal, quetiapine, etc.) that she was taking but all we could get was myriad of side effects such as rigidity, drowsiness, dizziness, tremors and restlessness which tends to worsen the already damaged situation. Frustration was the order of the day. I wrote couple of messages to Ontario Mental Health Foundation for help because watching my daughter go through such was devastating. It was at this foundation someone shared a testimony about VEEMEON herbal medicine, how effective it is and how she went through the most difficult times of her life trying to help her mom fight Schizophrenia. Being that I was already at the verge of giving up because I just couldn't imagine waking up every morning to fight the same demons that left me so tired the night before. I had to contact the doctor, from our conversation; I was relieved and convinced that the result is going to be positive because I was made to contact people with worse cases. Today, the awful situation of my daughter has gone by. Her happy life is back. She is now a schizophrenia survivor and I am glad because my daily routine activities can now kick off without obstructions. Don't let Schizophrenia hinder you from living a desired life and also, never allow anyone decide for you especially when they don't know what you have to go through to get to where you are. I was almost discouraged by the doctor but then, I remembered that: I have to shield my daughter’s destiny with courage, faith and perseverance because she is not in her right state of mind and that the bravery and freedom from fear is found in the ‘doing’. Her life is now a testimony. After my daughter got cured, she said, Mom “I just thought, ‘Well, I’m a weirdo, I’ll never be normal, then I said, my daughter, life itself is a misery and we get stronger in the places we have been broken. Thanks to you Dr. Austin for your excellent counseling, no more psychotic symptoms for the past 3 years and 4 months now. To know more about Dr. Austin and the effectiveness of his Herbs, You can view his blog: schizophreniacures.blogspot.com. I believe you will testify just like me.

    June 7, 2018 at 00:00 | Report abuse | Reply

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