Jillio,
In an earlier post, you mentioned schizoaffective disorder. What's the difference between schizoaffective disorder bipolar type and bipolar I with psychotic features? Can some people originally diagnosed as schizoaffective later be diagnosed as bipolar and vice versa?
Schizoaffective disorder bipolar type: the primary diagnosis is the schizoaffective disorder, and the bipolar type is a qualifier. It means that the schizoaffective disorder manifests the same patterns as a bipolar disorder, but does not meet the diagnostic criteria for dx as a bilpolar disorder.
Bipolar I with psychotic features: The primary diagnosis is the Bipolar I disorder, and the psychotic features are secondary to the Bipolar Disorder. The psychotic features in some individuals may mimic the psychotic features of the schizophrenic disorders, but not always. To be diagnosed with one of the schizophrenic disorders, the psychotic features have to fall within strict criteria. Bipolar I with psychotic features may manifest with one or more of the psychotic features seen in a Schizophrenic Disorder, for instance, only auditory hallucinations, or disconnect from reality, or paranoia.
Also, schizoaffective disorder is classified as a psychotic disorder, and Bipolar Dosrder I is classified as a mood disorder, so they are dignosed on a different Axis.
Gets confusing, doesn't it?
And, yes, a diagnosis can change as information becomes more available. An individual may, at the time of assessment, and for a period of time afterward, fit nicely into the diagnostic criteria for schizoaffective because they have been seen during a period of non-medication and are bordering on a psychotic break. As we observe, and gain more information on long standing patterns and behaviors, the primary diagnosis can change. This is done with an addendum to the diagnostic evaluation. We diagnose on 5 different Axis, and it is not unusual to defer one or more of them until we are able to get a clearer, more detailed picture of what is really going on with that individual. With someone who is very ill, that is quite often difficult without extended time. But, in order for that individual to receive treatment, the insurance company must have a diagnosis before treatment is approved.