Bipolar Disorder and Schizophrenia
Psychotic symptoms in severe bipolar disorder can be confused with schizophrenia
Differentiating the initial onset of bipolar disorder from schizophrenia is often a difficult task in an acutely psychotic individual, because the symptoms can look the same and include:
- Visual hallucinations
- Auditory hallucinations
- Delusional thinking
SPECT imaging can be helpful in the differential diagnosis of these two complex disorders.
Bipolar disorder has been characterized by increased activity across the cerebral cortex. Clinically, the scans often look hyperactive during the manic phase, especially in the lateral (side aspects) of the frontal, parietal and temporal lobes, as well as showing increased activity in the limbic system. In schizophrenia, SPECT images frequently show decreased activity, especially in the prefrontal cortex.
In disorders such as these, where compliance with medication is a frequent and serious problem, the visual properties of SPECT can be useful to patients for understanding their condition, thus improving compliance with treatment.
Bipolar Disorder Case Study
Sarah was a 53-year-old woman with delusional thinking, bizarre behavior, auditory hallucinations, insomnia, racing thoughts and irritability. She had been previously diagnosed with bipolar disorder and had taken medication to which she responded well. Like many others with this same condition, once she felt better, she believed there was nothing wrong with her and stopped the medication. When she came to see us, she was extremely paranoid and believed everyone was trying to hurt her. She also believed she had special powers that others were trying to take from her. At times, she also appeared very “spacey.” In an attempt to understand what was going on with her, as well as to convince her that her problems were biological, a SPECT study was ordered.
The study revealed an overall increase in activity in the deep limbic system with increased intensity on the left side of her scan and a marked patchy uptake across the cortex—a common pattern with cyclic mood disorders. This was powerful evidence for Sarah and her family, from whom she was able to get a lot of support for staying on the prescribed medication. By complying with the prescribed medication treatment, Sarah finally has a normal life!
Schizophrenia Case Study
A 35-year-old man who had been living on the street was brought in for evaluation by his mother. He had been diagnosed on many occasions with paranoid schizophrenia, but refused medication. His SPECT study revealed marked overall decreased activity throughout the cerebral cortex. Being able to see his own brain activity on the SPECT study was helpful for him and he agreed to take anti-psychotic medication.
One month later, after significant improvement of symptoms with medication, a repeat SPECT study was performed. It showed improved overall blood flow in the brain. Seeing the “before” and “after” treatment images from the SPECT studies was very encouraging to this patient and helped significantly with his willingness to stay on medication.