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B
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ipolar
disorder is a mood disorder that features extreme mood swings, during which
psychosis can occur. Psychosis refers to a disconnected view of reality.
A
person with bipolar disorder can experience extreme
shifts in mood and other symptoms. It can impact energy, activity levels,
sleep, communication, and the ability to function on a daily basis.
Moods can range from manic to depressive episodes. Manic episodes include
periods of extreme elation and great energy. During depressive episodes, if
they occur, the person may feel so low that they are unable to function or take
any kind of action.
Psychosis can
happen at different stages of bipolar disorder. However, it is not always
present, and not everyone with bipolar disorder will experience it.
It can be a frightening experience for the person and those around them,
but a psychiatric provider can offer treatment to control and relieve the
symptoms.
Psychosis
Psychosis happens when a
person's thinking becomes detached from the reality around them.
Psychosis can occur with bipolar disorder, schizophrenia, some types of dementia, and other conditions.
The person's thinking becomes disconnected, or dissociated with reality.
A psychotic episode can involve:
·
hallucinations
·
delusions
·
confusion
and disturbed thoughts
·
a
lack of insight and self-awareness
The pattern of symptoms will vary between individuals and according to the
situation.
In a study published
in 2015, researchers noted that there is not just one type of psychosis, but
different types, some of which have a more severe impact than others.
The scientists found that different biomarkers in the brain seemed to
correlate with different types and severity of symptoms. This may indicate that
different changes in brain function and brain chemicals lead to different forms
of psychosis.
Bipolar psychosis
Bipolar psychosis happens when a person experiences an episode of severe
mania or depression, along with psychotic symptoms and
hallucinations.
The symptoms tend to match a person's mood. During a manic phase, they may
believe they have special powers. This type of psychosis can lead to reckless
or dangerous behavior.
If bipolar psychosis occurs during a low period or a depressive episode,
the individual may believe that someone is trying to harm them, or that they
themselves have done something wrong.
These beliefs can trigger feelings of extreme anger, sadness, or fear in
the person.
Psychosis in
bipolar disorder and in schizophrenia
Bipolar shares some symptoms with schizophrenia, another brain disorder.
Psychosis can occur with both conditions.
Both disorders can disrupt a person's life enough to interfere with daily
activities and their ability to maintain close relationships or hold down a
job.
Bipolar psychosis generally lasts for brief periods of time. A person who
is experiencing an episode of bipolar psychosis is likely to return to a lucid
state with treatment.
In children and adults
The fifth edition of the Diagnostic and Statistical
Manual (DSM-5) lists the same symptoms of bipolar disorder for
children and adults. Bipolar disorder may include psychotic features.
Bipolar disorder and psychosis are difficult to diagnose, particularly in
children and teens. A psychiatrist needs to confirm that the behaviors they are
exhibiting are not due to other factors.
Other causes of symptoms could include:
·
everyday
highs and lows, the result of stress that is common in teens
·
acute
trauma
·
another mental health problem
However, if children and teens show signs of psychosis or experience mood
swings that are more severe than usual for their age group, they should consult
a doctor.
Symptoms
The DSM-5 lists the criteria for
diagnosing bipolar psychosis.
When psychosis happens during
a low mood, a person with bipolar disorder may experience fear and paranoia.
A person may experience the following:
·
Visual
and other hallucinations: The person sees, hears, and maybe
smells things that are not there.
·
Delusions: The person may
be certain that something is true when it is not. They may believe that they
are important, have contacts in high places, or have a lot of money, or are
related to royalty, when in fact they are not. Some people become afraid that
someone is seeking to hurt them or that others are working against them, such
as the government.
·
Paranoia
and fear:
The individual may believe that they have done something terrible or that
someone wants to cause them harm.
·
Unusual
or racing thought patterns: This can lead to rapid, constant, or
confused or disjointed speech with rapid changes of topic. The person may forget
what they were talking about.
·
Lack of
insight:
The person is unable to recognize unusual behavior in themselves, though they
may recognize it when they see it in others, whether it actually exists or not.
These symptoms can occur during episodes of mania, depression, or during a
mixed episode, when a person with bipolar disorder shows signs of both a low
and high mood.
They can cause the person to behave in unusual ways, and this can impact
their relationships with others, whether in their personal life, at work, or in
other situations.
If the person believes they are very important, they may behave in ways
that are outside the law. In some cases, this can lead to aggression, for
example, if someone confronts the person.
An individual who believes that they have committed a crime or that
someone is coming after them may become defensive or talk about suicide.
If a person has bipolar disorder and they shows signs of psychosis, they
should see a doctor, if possible, as there is a risk of unwanted consequences.
Diagnosis
A doctor will ask about the person's symptoms, medical history, and any
recent events, such as a trauma, that they may have experienced. They will also
ask about the use of prescription or other drugs.
To receive a diagnosis of bipolar disorder, a person needs to display some
or all of the symptoms listed in the DSM-5.
Psychosis can be difficult to diagnose because it can share symptoms with
depression, anxiety,
and other mental health disorders.
In addition, people with bipolar disorder often do not see that their
actions are unusual.
They may think that their problems stem from the people around them rather
than themselves.
Effects of not
using medication for bipolar disorder
Because a manic phase makes a person feel good, they may not want to
change, and they may not see any need to seek help. As a result, they often do
not seek help, and they remain without a diagnosis.
People who have received a diagnosis in the past—often during a low
period—may stop taking their medications. If this leads to a manic episode,
they may not want to seek help.
Effect of
antidepressants
Sometimes, a person who has never had a diagnosis of bipolar disorder
shows signs of depression. At this stage, they may receive antidepressants from
a doctor.
If the person has underlying features that make them susceptible to
bipolar disorder, some antidepressants can trigger a manic episode.
Friends and family who are aware of bipolar disorder and its symptoms can
help a person who is experiencing psychosis by encouraging them to seek help.
When to see a doctor
If a person experiences severe episodes of depression or mania, they
should seek help from a doctor or a mental health professional, or a friend or
loved one should encourage them to do so.
If a person talks about suicide or attempts suicide, someone should seek
emergency treatment immediately.
People with bipolar disorder are often unaware of their symptoms or
reluctant to seek help. Family and friends may need to encourage the person to
talk to someone about what is going on.
Treatment
Treatments for bipolar disorder will include treatment for psychosis, if
necessary. It usually combines counseling services and appropriate doses of
medication.
Medications
A number of medications are available for
treating psychosis in bipolar disorder.
Antipsychotics are typically used with psychotic symptoms. There are older
and newer types. The newer types may have fewer side effects.
The older treatments include:
·
Chlorpromazine
(Thorazine)
·
Haloperidol
(Haldol)
The newer ones include:
·
Aripiprazole
(Abilify)
·
Clozapine
(Clozaril)
·
Quetiapine
(Seroquel)
·
Olanzapine
(Zyprexa)
·
Risperidone
(Risperdal)
A person will use these medications in addition to mood stabilizers and
appropriate antidepressants.
However, research into how these drugs can help people with psychosis is
limited, according to an article published
by the National Institutes of Health. As a result, it can take time, sometimes
years, to find a suitable drug and dosage.
Side effects
Antipsychotic medications can also have adverse effects.
Unwanted and uncontrollable muscle movements can
result, especially with the older medications. Often, these go away after the
person stops using the drug, but they can be permanent in some cases.
Neuroleptic malignant syndrome can
occur in very rare cases. This is a life-threatening condition that involves a
high fever and
sweating, muscle stiffness and changes in blood pressure.
Serious infection due to a low
white-blood-cell count, when using clozapine. Peoeple who use clozapine should
expect to have regular blood tests to monitor their white blood cell count.
During pregnancy, a doctor may
advise against using antipsychotic medication, as the effect on an unborn child
remains unclear. However, they may advise taking it if stopping might increase
the risk to the woman or her unborn child. For example, there may be a risk
that she may harm herself or her child.
Ongoing
treatment
Continued treatment needs planning to make sure the symptoms remain under
control.
This includes:
·
ensuring
that medication is available
·
making
sure the person takes their medication regularly
·
ensuring
that they attend any counseling sessions as needed
In some cases, the person may attend day or substance abuse programs.
Sometimes, they may have to go to the hospital for a short time.
Treatment team
A psychiatrist is normally the best guide for treatment, but a treatment
team may consist of social workers, therapeutic support staff, counselors, a
family doctor, and other specialists.
Tips for caregivers
Family and friends can help
by learning about bipolar disorder and making sure the person stays on track
with their treatment plan.
Bipolar disorder often affects family members and friends, as well as the
person who has the condition.
Caregivers may need to seek help in order to manage situations.
Here are some tips:
·
Learn as
much about bipolar disorder as possible, to develop an understanding of
what it means to have the condition, how the individual feels, and how to
respond to it.
·
Find ways
to manage stress through
exercise and other activities, group counseling, and other outlets. This
applies to both the person with bipolar disorder and their loved ones.
·
Join a
support group for
family member or friends of people with bipolar disorder.
·
Help the
person to set goals, as far as possible, and to join support groups,
get involved in the community, and follow treatment.
·
Set
boundaries and limits, and seek support to stick with them if needed.
This can help prevent behaviors that can arise at times, such as excessive
alcohol consumption and shopping sprees.
Psychosis can be a feature of bipolar disorder. Scientists believe it
happens because of changes in the brain, but there is still not enough
information to explain it fully.
Not everyone with bipolar disorder will experience psychosis, and it does
not happen all the time.
When it happens, it can be frightening for the one who experiences it and
for those around them, too.
How the person reacts to psychosis can also put them at risk sometimes of
physical, social, or other types of harm. For this reason, it is important to
seek help if someone experiences psychosis.
Medication can help to control psychosis. It is not always easy to
diagnose or treat, but, with a doctor's help, it is usually possible to bring
symptoms under control.
As scientists learn more about changes in the brain that occur with
psychosis, more effective, targeted treatments may become available in time.
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