Talk to Psychiatry on Confusion Between Bipolar Disorder And Schizophrenia – Need Psychiatric Guidance

Assalam-o-Alaikum, Doctors.

I would appreciate your guidance regarding my 35-year-old sister(unmarried) , who has been suffering from a psychiatric illness for nearly 20 years. We have received different diagnoses over the years. One psychiatrist diagnosed schizophrenia, while another diagnosed bipolar disorder, so we remain uncertain about her actual diagnosis. Her illness follows a recurring pattern. Around periods of academic stress (especially examinations), she develops episodes during which she sleeps less, talks rapidly, becomes unusually active, suspicious, impulsive, and sometimes develops beliefs that people are reading her messages, spying on her, or that TV news is sending her messages. She has also expressed beliefs related to black magic and has occasionally reported hearing somebody speak to her. These episodes are followed by severe depression with prolonged crying, staying in bed, poor self-care, hopelessness, and repeated statements that she does not want to live. She has attempted suicide four times in the past and currently continues to express suicidal thoughts, although she does not usually describe a specific plan. For many years, she has also complained of a constant feeling that something very heavy is hanging from the right side of her back. She believes this is a physical illness and has consulted multiple specialists, but no clear medical cause has been found. Her brain imaging reportedly showed minor findings suggestive of Fahr’s disease (Primary Familial Brain Calcification). She is currently taking: * Olanzapine 2.5 mg at night * Clonazepam (Rivotril) 2 mg at night * Melatonin at night These medications have been continued for several years without regular psychiatric follow-up, and she has never knowingly been prescribed a mood stabilizer.