Differentiating between schizophrenia and bipolar disorder has been one of the most difficult tasks in the diagnosis of mental disorders. There are several reasons for this, including the overlap of symptoms of agitation between schizophrenia and the manic episodes of bipolar disorder. Any additional tools to help primary care practitioners separate the two by observable symptoms would be a benefit, and the author provides both a general overview of information on the disorders and some degree of specific comparison and contrast between them.
The article provides several astute observations in its overview of agitation, first and foremost regarding the multifaceted impact that agitation has on medical facilities and practitioners, both in terms of physical well-being and economic realities. The author also acknowledges the importance of nonpharmaceutical interventions in modern agitation management, before moving into a more thorough discussion of pharmacologic interventions. Although this core clinical information is of primary importance to readers, they may want to consider additional reading on the applications of nonpharmaceutical strategies for the treatment of agitation to develop an understanding of when referral and collaboration would be most effective.
The overviews of schizophrenia and bipolar disorder provide basic information to practitioners who have little to moderate experience with the disorders, although those already working with patients with these disorders may wish for greater depth. The overview of schizophrenia provides information regarding the symptomatology of the disorder, including a well-framed discussion of comorbidities in patients with this disorder. The overview of bipolar disorder goes somewhat further, emphasizing the fact that patients often wait years for an accurate diagnosis of bipolar due to, in their view, a lack of understanding of the disorder by their physicians. The inclusion of this information may help to reverse the trend.
The author also discusses similarities and differences in agitation between schizophrenia and bipolar disorder, as referenced in the title. The description of possible root causes for agitation and aggressive behavior for each disorder is of academic interest, and the specific description of how agitation may be manifested differently in depressed and manic states of bipolar disorder is highly beneficial. The descriptions for schizophrenia offer a solid introduction, and practitioners may wish to seek further reading on the subject.
The information contained within this article is well-suited to any primary care practitioner, and numerous citations are provided for any reader who wishes to continue learning about agitation in these disorders.