Difference and comorbidities between bipolar and other disorder; what are some comorbidities of bipolar disorder? What are psychiatric comorbidities?

Bipolar and psychotic patients, although similar to one another in terms of illness, may also have numerous differences. Those patients who have either bipolar I, II, or III tend to have more severe problems with aggression. Similarly, those with bipolar II and can have more complex issues with memory, impulsivity, aggression, and so forth. These two groups also have diverse treatment options. Patients with bipolar II and psychosis can benefit from anti-psychotics, while those with bipolar, as well as Bipolar I, can benefit from anti-depressants and antipsychotics. With more research, however, there is clear evidence that antipsychotics have very little effect on the development of psychotic symptoms and can contribute to their worsening. Hence, patients with schizophrenia that are using antipsychotics should consider seeking a mental health professional who can advise them on which medication best suits their needs. Psychiatrists are able to provide the necessary advice and support needed to the patients so that they can be successful on their treatment plan.

The main difference between the three groups is that the Bipolar Group tends to face less stress when compared to those with psychotic diseases. Since bipolar I, unlike bipolar II, does not include all psychotic symptoms, such as delusions, hallucinations, grandiosity, and so forth, the mentally ill patients can receive more effective interventions and receive adequate support. Nevertheless, despite the various differences, bipolar II or even bipolar I can experience the same symptoms and experiences, such as memory problems, aggressiveness, suicidality, and so forth.

Bipolar II has been classified into two subtypes, namely bipolar II and trichotillomania.

 Trichotillomania involves repetitive actions such as tapping fingers, scratching feet, finger tapping, finger biting, or finger scraping.

Bipolar II is further divided into two subtypes, namely multipolar II and homoerotic I. According to DSM IV edition, a patient can be assigned to either bipolar II or monopolar II, depending on where he or she lives. Both bipolar II and bipolar I, except for the ones that belong to the bipolar II or multi-polar II subtypes, have specific subtypes. There is no clear consensus regarding the subtypes.

Although multiple studies have demonstrated the presence of subtypes, the results are still conflicting. Although patients have been shown to be of two subtypes, DSM IV specifies that only bipolar II patients should receive antipsychotics, while psychiatric specialists need to give preference for patients who are assigned to the multipolar or heterotopia I subtype. Despite the fact that the DSM IV describes a clear classification of bipolar I patients and classifies bipolar I and bipolar II, its criteria and terminology remain unclear.

Most commonly, psychiatrists identify individuals based on comorbidities such as dementia or a bipolar history or a psychotic history. For example, a young adult with a recent family history of schizophrenia can be considered psychotic. Meanwhile, a schizophrenic patient who was hospitalized for short time may be termed psychotic, while a schizophrenic in the past may become psychotic again. Thus, patients’ diagnoses are made according to factors such as comorbidity or past exposure.

The DSM IV uses several approaches to describe patients. First, its case mix approach, which was introduced in DSM V, assigns an overall mental illness to every case. Then, DSM IV identifies the subtype of every patient, followed by the nature of the comorbidities associated with their psychiatric illnesses. At the end, we can observe the DSM IV’s diagnostic criteria-based approach in DSM V and DSM V-TR. Finally, DSM V gives consideration to a patient’s age, gender, genetics, and age at first psychotic onset.

It is worth noting that both DSM V and DSM V-TR both use the case mix approach to classify patients, though DSM V categorizes all patients based on comorbid or comatose comorbidities such as dementia and substance abuse.

Therefore, DSM V will assign a female Hispanic woman with psychotic comorbidities to a schizophrenia patient, whereas DSM V-TR will assign her female Hispanic woman with psychotic comorbidities to a bipolar II patient. But according to DSM V, bipolar II is a single subtype of bipolar I, so DSM V-TR can assign this subtype to both genders.

As a result, DSM V will assign a male African American man with bipolar II comorbidities to a schizophrenia patient, whereas DSM V-TR can assign him to bipolar II patient. To illustrate, DSM V also mentions that a patient can be classified with diagnosable comorbidities. DSM V also mentions that patients can be assigned to both types of comorbidities. Therefore, DSM V-TR would assign him to bipolar II patient, and DSM V-TR would assign him to schizophrenic patient. Thus, DSM V-TR and DSM V-V will assign these patients to bipolar I and bipolar II, respectively.

For future updates, please refer to our articles on what is Comorbidity? What is Comorbidity?