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Psychosis in Bipolar Disorder
One of the little talked about elements of bipolar disorder is psychosis. Psychosis can be a devastating part of bipolar I and it absolutely needs to be talked about.
Psychosis is the presence of hallucinations and/or delusions. Hallucinations are often thought of as seeing things that aren’t there, but actually, “hallucinations” refers to sensing anything that isn’t there using any sense (smell, sight, sound, touch and taste). Delusions, on the other hand, are false beliefs that are held in spite of evidence to the contrary. For example, a person suffering from delusions may think that they are the Queen of Egypt. And when I say this belief is held, I mean it is held just as strongly as I believe the sky is blue.
Psychosis often presents in a way that horrendously frightens the patient such as believing that there are bombs in the walls of his or her house.
Presentation of Psychosis in Bipolar Disorder
Psychosis can appear in either depression or mania but more commonly appears in mania. In fact, for some it is the defining factor of their mania. Note that psychosis only appears in bipolar I and not in bipolar II (by definition). The psychosis may be consistent or inconsistent with mood.
Examples of Psychosis in Bipolar Mania
I know of several examples of psychosis in bipolar mania. In one case, the woman was convinced she was Eve from the Garden of Eden and proceeded to take off all her clothes and walk next door to find Adam. In another situation, a woman believed she could communicate with the wind. This woman closed her eyes while speeding down a highway, opened her car window, stuck her arm out, and then waited for the wind to tell her when to turn. In both cases of psychosis, the sufferer was okay after treatment.
And it’s worth noting that even after treatment, when reality has been asserted, it’s still hard for the person who suffered from psychosis to tell the difference between what happened to them via psychosis and what reality was. In other words, their beliefs were so strongly held that they seemed real even after they knew that they were not.
Can People with Mania Make Decisions about Treatment?
Well, yes and no. I think it’s really clear from the above examples, some people lose touch with reality to the point where they absolutely can’t make treatment decisions. Certainly Eve from the Garden of Eden is not going to see the need to talk to a doctor. A person in that situation is unlikely to initiate treatment or possibly be open to it at all.
On the other hand, some people who experience psychosis are aware that they are experiencing it. For example, a person may see his wallpaper come to life and be scared of the snakes appearing on it but may be aware that this is a symptom of psychosis and not real. In that case, the person is likely quite capable of making treatment decisions (with the help of a doctor). A person in that situation often will initiate treatment.
So it’s important to take the individual into considerations when making treatment decisions about psychosis (or any element of mental illness, really).
In the next article, I will look at the treatment of psychosis and the role an individual’s decisions can play in that treatment.
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