Schizophrenia
Schizophrenia is a severe brain disorder that can cause psychotic reactions, including hallucinations (seeing things or hearing voices that aren’t there), delusions (thoughts not based in reality), paranoia (the belief that something or someone is out to “get” you), disorganized speech and thoughts, a lack of motivation, social withdrawal, and flat or blunted emotions that can mimic depression.
Since people with bipolar disorder can also experience psychosis during the early stages of the illness, it may be very difficult to tell the two diseases apart, Carlson says Gabrielle Carlson, MD, a professor of psychiatry and pediatrics at Stony Brook University Medical Center in New York.
Over time, symptoms of the two conditions tend to diverge. While bipolar psychosis is typically episodic, schizophrenic delusions become chronic.
Schizophrenia is often treated with antipsychotic medications and psychosocial treatments.
Attention deficit hyperactivity disorder (ADHD)
ADHD can affect both children and adults. It’s marked by impulsivity, inattention, and hyperactivity. However, distinguishing between ADHD and bipolar disorder is more difficult in young patients.
Symptoms of ADHD include difficulty paying attention, careless mistakes at school, becoming easily distracted, the inability to sustain attention on tasks that others easily complete, restlessness, and fidgeting. Some people, but not all, also have hyperactivity.
Because ADHD is more common in children than bipolar disorder, a child’s violent outbursts, discipline problems, and aggression are often assumed to be ADHD, Dr. Carlson says. These problems are more likely to be chronic, rather than episodic, in children with ADHD, she adds.
One key difference between the two conditions is that bipolar children tend to have explosive anger and “hair-trigger” tempers. (Children with bipolar disorder may also experience psychosis, which is not a part of ADHD.) There is little research comparing ADHD and bipolar in adults; Dr. Ghaemi says he doesn’t believe many adults have ADHD.
Prescription stimulants such as methylphenidate (Ritalin) are often prescribed for ADHD; however, they can worsen mania, so it’s important to get a correct diagnosis.
Drug and alcohol abuse
Some drugs, such as cocaine and amphetamines , can mimic mania, while alcohol abuse can mimic (and even cause) depression.
About 60% of people who have bipolar disorder also have a substance abuse problem.
To differentiate, consider behavior during any periods of sobriety. If the person seemed manic, then the cause of their difficulties is probably bipolar disorder and not the drugs. If the mania is only present when a person is abusing a drug, then it’s likely the drug, not the bipolar disorder, that is to blame.
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