It can be really difficult to distinguish psychotic bipolar disorder and schizophrenia. Although both are noted for dopamine dysfunction, Dost Öngür makes a compelling argument that they are both more alike than dissimilar by observing pre-synaptic dopamine production. Furthermore, he argues that observations of the underlying biology of these disorders could make for distinction between the two. In this editorial, Öngür compares and contrasts dopamine dysfunction in schizophrenia and bipolar disorder in a paper by Jauhar and colleagues. [1]
Moreover, as the editorial continued, Öngür commented that there was a possibility of evolution of the two disorders, that as time progressed, patients may have crossed-over between psychotic bipolar disorder and schizophrenia in terms of the breadth of their psychosis. I smiled when he commended the authors of the paper on following through with their patients through an 18 month course that tracked the progress of disease. Öngür’s insightful opinion of their work reminds me of the encouragement that I have found in lab, except that this is a case in published work in JAMA Psychiatry. He notes, “This is laudable and mitigates the concern that patients who evolve from schizophrenia to bipolar disorder groups or vice versa could be misclassified for analysis.” [2] I am intrigued by the idea that as mood disorders like schizophrenia and bipolar disorder share so much similarity on a biological scale, that causes presentation for both diseases to look very similar. To conclude, Öngür’s support for the idea of evolution of disease is a curious one, especially when it is linked back to cellular function.
Bibliography:
- [1] Jauhar S, Nour MM, Veronese M, Rogdaki M, Bonoldi I, Azis M, Turkheimer F, McGuire P, Young AH, Howes OD. A Test of the Transdiagnostic Dopamine Hypothesis of Psychosis Using Positron Emission Tomographic Imaging in Bipolar Affective Disorder and Schizophrenia. JAMA Psychiatry. Published online October 11, 2017. doi:10.1001/jamapsychiatry.2017.2943
- [2] https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2656681