title: Monozygotic twins with early-onset schizophrenia and late-onset bipolar disorder: a case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry, University of Western Ontario, St, Joseph's Regional Mental Health Care, 850 Highbury Avenue North, London, ON, N6A 4H1, Canada. roreilly@uwo.ca.
authors.forename: Richard
authors.initials: R
authors.lastname: O'Reilly
authors.forename: E Fuller
authors.initials: EF
authors.lastname: Torrey
authors.forename: Jay
authors.initials: J
authors.lastname: Rao
authors.forename: Shiva
authors.initials: S
authors.lastname: Singh