How Do You Distinguish Between Depression And Schizophrenia?

My husband has severe depression with psychotic episodes. He takes antidepressant and anti-psychotic medications. Recently the doctor has been asking him if he hears voices. What are the signs and symptoms of schizophrenia? We hope to have a family someday — and what would be the chances of our offspring having this condition?

The following answer was largely written by Dr. Arnold Lieber, a board-certified psychiatrist in New York, who has graciously agreed to be my consultant for this psychiatric question.

Hearing voices (hallucinations) and having false fixed beliefs (delusions) commonly occur in schizophrenia but also occur in other conditions such as major depression and manic depressive (bipolar) disease.

Patients with a major depression that includes psychotic features such as hallucinations and delusions are often treated with antidepressants and anti-psychotic medication. Therefore the fact that your husband is taking these medications does not necessarily mean that he has schizophrenia. You should have a talk with his doctor about what the correct diagnosis is since it is important that it be precise.

There does appear to be a familial or genetic predisposition to develop schizophrenia. Social or environmental factors are also important though, since in studies of identical twins who have the exact same genes, both twins become schizophrenic in only about half the cases. Depression — which is much more common than schizophrenia — and bipolar disease — which is about as common — also have strong familial inheritance.

Identical twin studies on depression show that in about 55 percent of the pairs both have the condition. In the case of bipolar disease, in about 70 percent of the pairs both twins have the condition. These findings imply a very substantial inherited component.

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