Voices in bipolar disorder?
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Voices in bipolar disorder

My sister has been diagnosed as bipolar and has been receiving treatment over the past eight years. She has "forgotten" to take some of her meds about 20 times over this period and almost immediately has to be taken back to the hospital. Since the first "blow up," she has told us she hears voices telling her to hurt herself (and, quite often, her husband). It has been my understanding that a person cannot be bipolar and schitzophrenic at the same time. I know she has repeatedly told her physicians about the voices, but they still identify her condition as bipolar. Can she be both?

Dear David --
There are multiple research studies showing that "voices" can be part of manic (or even psychotic depressed) phases.  Goodwin and Jamison published a nifty summary of this in 1990, reviewing 26 different research studies.  Their table below shows you, for every 100 patients with clear bipolar mania, how many (what "Frequency") had that symptom, on average, over the 26 studies.  Notice that "auditory hallucinations" were seen in 18 out of every 100 patients with mania -- not common, but definitely there.  The "range" means  that voices were part of mania in48% of the patients in one study (although as rare as only 7%in another study)
Frequency (%)
Range (%)
Grandiose delusions
Persecutory/paranoid delusions
Auditory hallucinations
Schneiderian 1st rank symptoms

The "Schneiderian" thing means bizarre psychotic symptoms like "thought broadcasting" -- the sense that others can read one's thoughts.  The point is the same: there is no doubt that all common forms of psychosis can be part of bipolar disorder.  Thus it is not possible to tell "bipolar" from "schizophrenia" on the basis of the types of psychotic symptoms.  Instead, one must rely on the presence (now, or in the past) of  mood stuff like depression.  If someone has psychosis with no history of mood symptoms, they are more likely to have a more schizophrenic-like version of psychosis -- but the best way to tell is to look at several years worth of symptoms, not just symptoms at one particular time.  For this, we usually need a family member's help with the "history".

Hope that helps.
Dr. Phelps

Published September, 2000

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