Posted on 02/18/2024 2:41:01 PM PST by nickcarraway
Psychosis is a symptom that people with various mental health disorders can experience, including those with bipolar disorder. Psychosis exists on a spectrum and can include paranoia, delusions, as well as hallucinations of a visual or auditory nature. A little more than half of people with bipolar disorder will experience psychosis symptoms at some point in their life.1
This article will discuss psychosis features in bipolar disorder and how to receive a diagnosis and treatment.
Psychosis Features in Bipolar Disorder
Psychosis in bipolar disorder is characterized by delusions, hallucinations, and/or paranoia.2
The person may have lost some or all contact with reality and have difficulty distinguishing between what is real and what is not.3
Start of Symptoms
Psychosis symptoms can start for a person with bipolar disorder at any point but usually are within the confinements of either a manic or depressive episode.
Changes in behavior can often precede psychosis. These behavioral changes, also referred to as warning signs, can include:3
Difficulty thinking clearly and logically
Suspiciousness
Paranoid ideas
Spend more time alone
Decreased self-care or hygiene
Sleep changes
Intense feelings or ideas
Lack of feelings
Difficulty communicating
Disorganized thoughts
Psychotic symptoms are more common in those with bipolar type I disorder compared to those with bipolar type II disorder.2 Psychosis symptoms are also more common during mania than depressive episodes.2
Symptom Duration
The duration of a psychosis episode will vary from person to person. It will depend upon whether they have received treatment and how long symptoms occurred before treatment was sought.4
There are three phases of developing psychosis. It begins with the prodromal phase, which often includes the aforementioned behavioral changes and fluctuations in the person's ability to be in or out of reality. The second phase is the acute phase. This is when the person experiences aspects of psychosis such as delusions, hallucinations, and disorganized thinking.
The third and last phase is recovery. During recovery, the person can still have mild or unnoticeable signs of psychosis.4
Examples of Bipolar Psychosis Behaviors
People with bipolar psychosis will display behaviors that reflect their disconnection with reality.
They may be paranoid that someone is trying to hurt them or that people on TV are sending special messages. Or they may have hallucinations where they see or hear things that other people cannot see or hear.3
Other bipolar psychosis behaviors can include speech that doesn't make sense or is not in the context of the situation.3
Outside of characteristic bipolar psychosis behaviors, someone may also have:
Anxiety
Decreased motivation
Poor functioning
According to the National Institute of Mental Health, people experiencing psychosis can act in unexpected ways and can harm themselves or others. This can be accidental—like falling off a building because they think they can fly—or intentional—like committing suicide when depressed.3
Psychotic Depression vs Bipolar Psychosis
Psychotic depression is a subtype of major depressive disorder where the person experiences psychosis symptoms.5
Bipolar psychosis is when someone who has bipolar disorder also experiences psychosis.2
These two conditions are similar, and psychosis symptoms are involved in both. However, the underlying condition is different.
Receiving a Bipolar Psychosis Diagnosis
To receive a diagnosis of psychosis within an episode of bipolar disorder, a person must work with a healthcare provider. The provider will perform a physical exam and may request medical testing to rule out other conditions.6
The healthcare provider may then perform a mental health evaluation and look at the person's health history, family history, recent trauma, and drug use.6 A final diagnosis will be made using the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5-TR) criteria.
Experiencing bipolar psychosis can be scary and confusing. However, acknowledgment will open the doors to treatments that can successfully manage the symptoms and allow the person to live as full and productive a life as possible.
How Is Psychosis Different From Bipolar Mania Episodes?
When looking at psychosis vs mania, it can be difficult to see the difference. Psychosis is a symptom that some people with bipolar disorder may experience. It causes hallucinations and delusions.
Bipolar mania is a part of bipolar disorder. There are two distinct mood episodes in those with bipolar disorder: manic and depressive episodes. Manic episodes are characterized by feeling an intense amount of energy, talking fast, having lots of ideas, an increased need for pleasurable activities, and feeling important or powerful.6
How to Treat Bipolar Psychosis Treating bipolar disorder with psychotic features is different than treating bipolar disorder without psychosis.
When someone begins to have psychotic features, they may need additional medication and different therapy approaches. Medications used to treat psychosis are called antipsychotics. There are many types of antipsychotics, and their side effects can vary. As a result, a healthcare provider can help decide which medication might be the most effective with the least amount of or least intense side effects.3
Antipsychotic medications can help some symptoms resolve within anywhere from a few minutes to a few days. However, some symptoms, such as delusions, can take a few weeks to resolve.7
Complications From Unmanaged Bipolar Psychosis Any aspects of psychosis should be treated as soon as possible. Those who do not seek treatment can experience the progression of the disease and sometimes significant consequences, including long-term impacts on the brain. Unmanaged psychosis can affect many areas of a person's life—social, occupational, personal, and relational.
It can cause a person to lose their job, have financial problems, cause homelessness, and so much more.
Untreated bipolar psychosis can also increase the risk of self-harm and suicide. The highest risk of self-harm is when the person is experiencing their first episode of psychosis and has yet to receive treatment. The risk of suicide is very high in those with psychosis. One in five people with psychosis will attempt suicide.8
If you or someone you know is experiencing suicidal feelings, contact 911 immediately.
Support for Loved Ones and Caretakers There is support for the loved ones and caretakers of those with bipolar psychosis. It is not easy to navigate mental health conditions, and it takes a toll on those who are close to the person suffering.
Caretakers and loved ones can contact local support networks for advice and counseling (like the National Alliance on Mental Illness). Healthcare providers who care for those with bipolar psychosis are a good resource for local support groups.
Another option is to contact a social worker. They specialize in helping people coordinate care and find resources that can benefit the patient and the caretaker.
Summary
Psychosis is a symptom that is associated with several mental health conditions. One of the conditions with which psychosis can occur is bipolar disorder. When someone has psychosis, they can have hallucinations, delusions, and/or paranoia. It is associated with higher rates of hospitalization, self-harm, and suicide.
Treatment with medication and therapy can put symptoms at bay, and the earlier these interventions take place, the higher the chances of a quicker recovery.8
Patty is a registered nurse with over a decade of experience in pediatric critical care. Her passion is writing health and wellness content that anyone can understand and use.
My son has bipolar. He’s on meds, but he never really seems happy. He has a college degree in economics, but he just works at Whole Foods. He’s very smart, but has a terrible self image.
He was such a sweet young boy. It makes me very, very sad. I wish I could help him more.
That's fantastic! Congratulations!! If you don't mind, please put me on your Buyer's list after your published and I'll write you up a nice review to boost your algorithms. I'm taking my first manuscript to a publisher this week, so I can relate to your hard work on this!
Best wishes! Let me know when yours is on sale and I’ll review it on my website :-)
They’re on to us...
Thank you! Awesome! (You can just skim mine. It’s going to be about investing in memorabilia. Nothing too thrilling or deep. 😜)
I don’t doubt there are some legitimate cases of actual mental issues due to physical problems with the brain, but I think otherwise you are on track. Too much of what is diagnosed as mental issues is spiritual in nature.
She’s over 70. Doesn’t want my help. Well, sometimes. She wants me to agree with her. I tell her she needs therapy. Her marriage is a wreck. Yes, it’s a runaway train. She hurts a lot of people, including herself, her kids, her husband, me, my husband, and my kids. I don’t stop trying, but it’s so freaking hard sometimes. She ruins family times together, including vacations. Vacations are for getting away from life’s problems, not for making them front and center, and harder to deal with, but that’s what we’ve gotten with her the last few years. I just never know which person is going to show up.
Can you discuss with his MD? Just a suggestion but if he’s on his own there’s privacy issues. If he allows it maybe you can help with changes?
I don’t know. Sometimes it’s just the environment and the stressors that go with it especially competeing for grades in college, girls, whatever. One good thing with bipolar( if that’s good) there appear to be better medications that help much more so than 20 years ago.
The biggest problem is, and I’m not a doctor, the biggest problem is being able for the care team( and MD) to see changes. That takes a lot of humbling writing on self daily and writing out the changes because no one but your son is with them 24/7.
I do hope the treatment(s) work soon. It’s a tragedy watching a family member slipping into despair.
“In fact, I’m not sure any level of training or education can equip a professional to understand it.”
Agree with your view. As stated, I was an RN with a psych degree and it’s just hard to diagnose. This sounds like a duel dx but I was never in a capacity to diagnose and bipolar, far as my 24 years saw, is very hard to diagnose without a long time of observation of behaviors.
Appeared some psychiatrists had a good education on bipolar but some...I do not know. Some I could not se bipolar. It’s not an easy diagnoses.
Seventy and never dx’ed or just getting worse? Sometimes with age, me included there’s stressors in age that can mimic serious mood swings but it’s the stress of age, diminished capacity, compensation, so much. I hope it’s not bipolar but she does sound like life is hard to cope and needs more help that you( or anyone) can give?
She's entitled to make her own decisions. So that's that.
Oh, she’s been seeing therapists since she was in her mid 30’s. She’s just tired of it. She does have a doctor but the doc isn’t a “shrink”. Just her “female” doctor. She doesn’t want to face it anymore, and the rest of us have to deal with it. Her gynecologist gives her the Rx. No therapy anymore, just drugs. She’s done all she wants to do. She doesn’t even refill her Rx if she doesn’t feel like it, and you know, that’s when all hell really breaks loose.
I just take it a little at a time with her. Her poor husband. He has to live with it daily. I don’t. I’m pretty lucky in that regard.
*** She’s entitled to make her own decisions. So that’s that.**
She is. She makes her own decisions, that’s for sure. I wish I didn’t have to go for the ride with her, and I guess I don’t, but see, there’s that family obligation thing that keeps me tied to her even when I’m worn out. I know she doesn’t want to be *there*, but I swear, nothing I do helps. It’s always up to her, and only up to her. I’m just an annoying fly that she asks for help repeatedly, doesn’t heed anything I say, and she stays miserable…or……exceedingly, overwhelmingly on top of the world!!!!! (Nobody uses exclamation points like my sister, not even me, in this post).
You don't have to do it. But you do it anyway. FWIW, that's what family is like.
When they are in “hypermanic” phase, a bipolar patient can display schizophrenic like behaviour. Not all bipolars get hypermanic however.
IIRC.
Exactly. I don’t have to, but she’s my sister. I’m tied to her whether I want to be or not. Sometimes she’s ok, and sometimes she’s demonic. I never know which sister I’ll have to deal with.
I proceed with caution almost all the time. It’s manipulation. I know that. She doesn’t. Anytime you walk around on eggshells, you’re dealing with a manipulator. I walk on eggshells every time we talk, and it’s even worse in person.
She might give you the clothes off her back, or she might send you to hell. It’s a toss up. You never know which persona she’ll have on any given day. I know she can’t help it, but sometimes, I wish she would just give it a try. I think she likes to be miserable so she can blame me or her husband for her misery. Nothing is ever her fault. Nothing.
I knew a classic bipolar(used to be called manic-depressive). I could see it coming on...person would be working very hard, very talkative, giddy, buying lots of unnecessary stuff, then would get angry, combative, and riled up, want to fight at the slightest provocation, then slowly go into clinical depression...laying in bed for weeks reporting he “had grief in his head”.
Fortunately , lithium, and antidepressants evened his moods out. And he was able to work until retirement. Unfortunately his symptoms in early life hampered any good education or other opportunities.
At least you don’t have to be the husband.
Yes. I’m very glad for that. I wish they would get marriage counseling, but they don’t. They’re not really married, but are common law spouses, about 20 years now. When we are together, I only see her treat him like dirt. We can only mitigate the damage so much. I have no idea why he is still with her. He is a very sweet guy. I don’t get it.
Yikes, now that’s hell. She’s given up
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