Q:  Bipolar or Schizoaffective?  (Jessica)

Hi Dr Phelps,

I have the diagnosis of bipolar 1, mixed, rapid cycling with psychotic
features (including episodes where psychosis dominates, and delusions
etc. are mood incongruent, leading to another label of schizoaffective).
I have been in and out of hospital, and have truly suffered from this,
yet there is one thing that makes me feel I don't truly have this
disorder: When I am manic (even euphoric type), I don't seem to
experience the same extreme decrease in sleep as others do. In fact, I
can sleep quite normally. I can find no information on this, and have
lied consistently to all my doctors for fear of being re-diagnosed. On
the flip side, when I am depressed, I experience hypersomnia, as one
might expect.

If you can give me an answer on this, or point me in the direction of
studies that I could check out, I would be incredibly grateful.


Dear Jessica -- 
You're right to wonder, because usually sleep is a nearly perfect marker for mania (lack thereof, that is).  However, once in a while I see a person like you with clear bipolar-like symptoms who sleeps ok.  You logically added that hypersomnia matches the diagnosis.  Like others, you are nearing the point where diagnosis is not going to guide you much anyway.  You will have to learn whether mood stabilizers alone will help you remain stable, or whether an antipsychotic will be needed all the time (I'm sure you've been given them when hospitalized, yes?) -- that's the point of "schizoaffective", as you know.  

Similarly, you may already have learned whether antidepressants are destabilizing; that might be less true, the less like true "bipolar" you are.  So there you are: mixing mood stabilizers with whatever else you need to get well and stay well, and cautiously tapering off antidepressants or antipsychotics (over months) when well until it becomes clear that every time you do you relapse.  What diagnosis you use doesn't matter too much in that scenario, would you agree?   Good luck with the process. 

Dr. Phelps

Published March, 2001