Monozygotic twins with early-onset schizophrenia and late-onset bipolar disorder: a case report

Richard O’Reilly, E Fuller Torrey, Jay Rao, Shiva Singh

Schizophrenia and bipolar disorder are generally considered to be distinct illnesses. One piece of evidence supporting their distinctness is the rarity of schizophrenia and bipolar disorder occurring in monozygotic co‒twins. We describe a well-characterized pair of African American, female, monozygotic twins assessed at 53 years of age.Case 1: Twin A developed psychotic symptoms at age 23. She was hospitalized and diagnosed with schizophrenia. Twin A was subsequently hospitalized several more times and was consistently diagnosed as suffering from schizophrenia. At the time of assessment, Twin A was single, lived with her parents and attended a day program. Case 2: In contrast, Twin B worked in a professional career, married and raised a family. She remained well until age 48 when she developed a depressive disorder requiring medication treatment. Four years later, Twin B abruptly developed grandiose delusions and mood-congruent auditory hallucinations. She was hospitalized and diagnosed with a manic episode. Since then Twin B has remained symptom-free on the mood stabilizer sodium valproate. Schizophrenia and bipolar disorder can occur in identical co-twins. We speculate on what it tells us about the meaning of discordance and the putative role of de novo mutations.