FROM BIPOLAR MANIA TO SCHIZOAFFECTIVE DISORDER: A DIAGNOSTIC DILEMMA IN A YOUNG ADULT WITH OVERLAPPING AFFECTIVE AND PSYCHOTIC FEATURES

Abstract

Introduction: Schizoaffective disorder is a complex psychiatric condition characterized by the coexistence of mood and psychotic symptoms, often creating significant diagnostic challenges. Differentiating schizoaffective disorder from bipolar disorder with psychotic features remains difficult, particularly in early stages of illness where symptom overlap and diagnostic instability are common. This report aims to present a case of diagnostic transition from bipolar mania to schizoaffective disorder in a young adult and to highlight the challenges of distinguishing mood disorders from schizophrenia spectrum disorders Methods: This study is a descriptive case report of a 19-year-old male with evolving psychiatric symptoms. Clinical data were collected retrospectively from medical records and supplemented by interviews with the patient and family. Diagnosis was established based on clinical evaluation using the International Classification of Diseases 10th Revision (ICD-10) criteria, and symptom severity was assessed using the Positive and Negative Syndrome Scale–Excited Component (PANSS-EC). Results: The patient initially presented with symptoms consistent with a manic episode, including irritability, decreased need for sleep, impulsivity, and aggressive behavior, leading to a diagnosis of bipolar affective disorder. During hospitalization, the clinical picture evolved with the emergence and persistence of psychotic symptoms independent of mood disturbances, including hallucinations and impaired reality testing. Longitudinal evaluation led to a revision of the diagnosis to schizoaffective disorder, manic type. The patient was treated with a combination of antipsychotics and mood stabilizers, resulting in gradual clinical improvement. Discuss: Serial assessment of the temporal relationship between mood and psychotic symptoms was essential in distinguishing bipolar disorder with psychotic features from schizoaffective disorder. Therefore, early diagnoses should be considered provisional, with continuous reassessment to improve diagnostic accuracy, optimize treatment selection, and support appropriate prognostic evaluation. Conclusion: This case highlights the diagnostic dilemma between bipolar disorder and schizoaffective disorder, emphasizing the importance of longitudinal assessment in early psychiatric presentations. The observed diagnostic transition supports the concept of diagnostic instability and the psychosis–mood spectrum, underscoring the need for flexible diagnostic and therapeutic approaches.