Schizophrenia and bipolar affective disorders: likenesses and differences.

We pay tribute to Lew Robbins and Hillside Hospital for the opportunity given me to develop work in the psychopharmacological treatment of mental disorders. A historical review is given of early experience with antipsychotics and antidepressants and the failed attempts to relate therapeutic effect of psychoanalytic formulations. Work done at Hillside demonstrated the importance of developmental history for schizophrenic prognosis and drug responsivity. Surprising findings such as the positive antidepressant benefits of chlorpromazine are detailed and discussed. The resemblances between bipolar affective disorder and schizophrenia are detailed and related to the peculiar finding that all anti-schizophrenic drugs are also anti-manic. The converse of this is also discussed. The psychopharmacological resemblances between bipolar disorder and schizophrenia, as well as the relationship to genetic findings, lead to a two factor theory of schizophrenia and hypotheses concerning the nature of delusional and deteriorative processes.