This diagram represents a spectrum perspective of some of the mental disorders psychiatrists treat, indicating positioning relative to each other in terms of symptom clustering & profile rather than a hierarchical or dualistic approach that has been previously propositioned. 

Mood symptoms permeate the rainbow with the exclusion of schizophrenia, which is a categorical entity in this sense ... there is an absence of persistent mood symptoms ... the existence of psychotic symptoms alone.  In this way, it is a primary psychosis ...one that is not being fuelled by another disorder (such as depression, mania, OCD, personality disorder, drugs, medical condition).  Therefore, treatment consists of antipsychotic medication as the cornerstone, both to treat acute symptoms and for relapse prevention.  Of course, many internal and external stressors may influence the risk of relapse (by affecting the CNS), so relapse can further be reduced by educating the patient and family about these factors and helping to devise strategies to address these issues.    Without another disorder colouring the content of the psychotic symptoms, they tend to be bizarre and non-understandable, especially to observers ...non-mood congruent psychotic features. 

Schizo-affective disorder is becoming an increasingly popular diagnosis over the past few decades.  This possibly reflects the increasing acknowledgement that many patients do not have one primary disorder fuelling comorbid conditions (e.g. schizophrenia-like psychotic symptoms causing depression to occur in reaction to the stress and losses), but may have multiple interweaving symptom clusters that are part of a disorder with its own particular characteristics, and all the symptom clusters need to be treated, in parallel, rather than just treating what appears to be the primary condition.   

These patients tend to have low-grade psychotic symptoms and some degree of under-functioning between illness exacerbations, which consist of:

Of course, the other possibility is that we have self-deceived ourselves into believing that there are different, categorical entities, whereas what we have done is to pick out idealised, core symptom clusters in order to devise a classificatory system.  It is a model.  In reality, patients may have symptoms that occasionally match the symptom profiles of these ideal categories, but more commonly they manifest symptoms that reflect the heterogenous pathophysiology of their particular brains, where the parts of their brain affected are similar to but not exactly matching the chosen 'classical' locations.  Also, everyone's brain is different, with subtle genetic differences and different life experiences moulding different neural wiring, receptor densities and sensitivities and neurotransmitter tones within the circuits.  Many people also can wilfully suppress and 'contain' symptoms that are maladaptive, if the symptoms are not too overwhelming and if the individuals have very well-developed defence mechanisms.   It is also becoming increasingly recognised that experiences can be very influential (pathoplastic) regarding whether a disorder develops or not.  

Supporting this notion is the increasing recognition that diagnosis does not necessarily determine prognosis.  

For example, most patients with schizophrenia will function at close to their normal premorbid levels, if they are treated reasonably promptly, have had abrupt onsets, good support networks and do not continue using illicit drugs (if they were).  The presence of mood symptoms also tends to improve their prognosis, although many patients even with BPAD-type 2, which you would imagine to have the best prognosis, may in fact not necessarily fare better than someone with, say, a diagnosis of schizophrenia.  

Another important consideration is the patient's degree of cooperativeness with treaters, such as with regard to complying with medication prescribed, as well as their understanding and acceptance that they have an ongoing vulnerability to developing illness episodes.  The latter point is important because even once the episode is treated and goes into remission, whether other episodes occur may depend on their willingness to continue treatment in order to prevent relapse, even whilst they are feeling well in themselves. 

BPAD-type 1 is the classical form of bipolar affective disorder where a patient has manic episodes, often with psychotic features, which may lead to the need for involuntary hospitalisation.  It comprises of 4 subgroups:

BPAD-type 2 is the more subtle form of bipolar disorder which is poorly understood or recognised and  therefore often inadequately treated.  There tend not to be manic /psychotic episodes, but rather nasty depressive episodes that may well be poorly responsive to antidepressants alone (may also need mood stabilisers or antipsychotics).  The identifying feature of this form of BPAD is the tendency for hypomanic episodes.  The latter occur infrequently and tend to last for very short periods of time only, such as a few days usually, sometimes a week or more, sometimes only only a few hours.  The patients tend to forget about the episodes as soon as they fall into depressed mode again.  They are often misdiagnosed with MDD-melancholia as the brief periods of hypomania may be thought to be psychomotor agitation or euthymia (the patient may not know the difference between a euthymic and hyperthymic state).  

MDD-melancholia and MDD-psychotic features are severe variants of major depressive disorder that often do not remit from treatment with lifestyle measures, psychotherapy and/or antidepressants alone.  They often require the addition of an antipsychotic or lithium/mood stabiliser or ECT.  They often occur in mental  disorders that have more severe courses and often occur in the absence of obvious or significant psychosocial triggers. 

In MDD-psychotic mood-congruent psychotic features are present, meaning ideas and beliefs are held with abnormal conviction, may be illogical or unable to be entertained by external observers, but are understandable from the context of the patient's abnormal, extreme mood perspective they are perceiving the world from.  

In MDD-melancholia the patient's beliefs are often distorted and unrealistic, but not convincingly psychotic.  But what is most apparent is the presence of their body and mind being very affected by the depression.  There are 2 subtypes:

Citation suggestion: Dr Gary Galambos, Illness Spectrum, Metaphor Models (http://www.ep.org.au/gg/mm/spect.htm) [date accessed]

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