Bipolar disorders are a group of disorders characterised by episodes of mania or hypomania and depression. In between episodes, mild symptoms of mania and/or depression may, or may not, be present. The bipolar disorders include bipolar I, bipolar II, and cyclothymic disorder. Bipolar I disorder is characterised by mania, while bipolar II disorder is characterised by less severe hypomania. Cyclothymic disorder is the mildest of the bipolar disorders.

A major depressive episode is at least two weeks of at least five of the following symptoms. Intense sadness or despair; feelings of helplessness, hopelessness or worthlessness; loss of interest in activities once enjoyed; feelings of guilt, restlessness or agitation; sleeping too little or too much; slowed speech or movements; changes in appetite; loss of energy; difficulty concentrating, remembering or making decisions; and/or thoughts of death or suicide.

A manic episode is at least one week of extremely high spirits or irritableness most of the time. A manic episode involves changes in normal behaviour. These include exaggerated self-esteem, less sleep, talking a lot and loudly, being easily distracted, doing many activities at once, risky behaviour, uncontrollable racing thoughts, and quickly changing ideas or topics. These changes in behaviour are significant and clear to friends and family and are severe enough to cause major dysfunction. A hypomanic episode is similar to a manic episode but less severe and need only last four days. Hypomanic symptoms do not lead to major dysfunction that mania often causes.

What is the evidence for rates of bipolar disorders in people with PTSD?

Moderate quality evidence finds current bipolar disorder in people with PTSD ranges between 4% for bipolar II disorder and 19% for bipolar I disorder. For any lifetime diagnosis, the rate ranges between 20% for bipolar II disorder and 35% for bipolar I disorder.

August 2021

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Schizoaffective disorder is on the schizophrenia spectrum of illnesses. Diagnosis of schizoaffective disorder requires schizophrenia-like symptoms of psychosis, in addition to affective/mood symptoms such as depression. There is some debate as to whether schizoaffective disorder represents a unique diagnosis or an intermediary between schizophrenia and mood disorders. There are also considerable differences between different diagnostic criteria regarding the definition of schizoaffective disorder; particularly the Diagnostic and Statistical Manual (DSM) and the International Classification of Diseases (ICD) criteria. Specifically, the ICD and also the Research Diagnostic Criteria (RDC) require simultaneous and equally prominent presence of psychotic and affective symptoms; conversely, the DSM requires an additional period (>2 weeks) where the psychotic symptoms alone are present.

What is the evidence relating to schizoaffective disorder diagnosis?

Moderate to low quality evidence suggests schizoaffective disorder occupies an intermediary position between schizophrenia and mood disorders, but is not clearly distinct from either disorder.

Moderate quality evidence found people diagnosed with schizoaffective disorder using RDC/ICD criteria may have had fewer hospitalisations, are more likely to be male, and are more likely to be older or married than people diagnosed using DSM IIIR/IV criteria. Compared to people with schizophrenia, people with schizoaffective disorder may be more likely to be male, Caucasian, married, have a longer duration of illness, have lower levels of functioning, more depression, and more negative symptoms. Compared to people with bipolar disorder, people with schizoaffective disorder may be younger, have an earlier age at onset, fewer years of education, not Caucasian or African American, never married, have a longer duration of illness, more positive and negative symptoms, more depression, and higher IQ.

Around 36% of people initially diagnosed with schizoaffective disorder have their diagnosis changed at the second assessment. Conversely, around 55% of people diagnosed with schizoaffective disorder at the second assessment were originally diagnosed with other disorders. Schizophrenia or affective disorders were the most common original or subsequent diagnosis.

February 2022

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