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Understanding Psychosis in Bipolar Disorder

What is bipolar psychosis?

Fast fact
The word “bipolar” describes the two poles, or extremes, of mood experienced by people with the disorder — mania and depression.

Psychosis is the inability to recognize what is real in the world around you. This is different from what your thoughts and perceptions tell you. People who are experiencing psychosis often have hallucinations or delusions.

Most people associate psychosis with schizophrenia. But it can be a symptom of other mental and physical conditions and disorders.

People with bipolar disorder may experience hallucinations or delusions. When this occurs, the person is said to have bipolar disorder with psychotic features (with additional specifiers for bipolar I, bipolar II, current phase depressed, manic, or “mixed” presentation). Some refer to this as bipolar psychosis.

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Symptoms

Bipolar psychosis symptoms

Psychosis in bipolar disorder can happen during manic or depressive phases. But it’s more common during manic episodes.

People who have bipolar psychosis experience a combination of symptoms. The symptoms occur in both bipolar disorder and psychosis. Many people believe that psychosis is a sudden, severe break with reality. But psychosis usually develops slowly.

The initial symptoms of psychosis include:

  • diminished performance at work or in school
  • less than normal attention to personal hygiene
  • difficulty communicating clearly
  • difficulty concentrating
  • reduced social contact
  • unwarranted suspicion of others
  • less emotional expression
  • anxiety

Later symptoms of psychosis in bipolar disorder include:

  • hallucinations
  • delusions
  • incoherent or irrational thoughts and speech
  • lack of awareness

Hallucinations

When people hallucinate, they experience things that aren’t real to others. They may hear voices, see things that aren’t there, or have unexplained sensations. Hallucinations can encompass all the senses. They can also have many different causes.

Delusions

Delusion is an unshakeable belief in something that isn’t real, true, or likely to happen. People may have grandiose delusions. This means they believe they’re invincible or have special powers or talents. Grandiose delusions are common during manic phases of bipolar disorder.

When experiencing the depressive phase of bipolar disorder, a person might have paranoid delusions. They might believe someone is out to get them or that their money has been taken, leaving them in poverty.

Incoherent or irrational thoughts and speech

People with psychosis often have irrational thoughts. Their speech may be rapid and hard to follow. And they may move from subject to subject, losing track of their train of thought.

Lack of awareness

Many people experiencing a psychotic episode may not be aware that their behavior isn’t within normal bounds. And they may not recognize that their hallucinations or delusions aren’t real or notice that other people aren’t experiencing them.

Types of psychosis

Types of psychosis

People who have bipolar disorder usually experience symptoms that are either mood congruent or mood incongruent. Sometimes both types of symptoms occur at the same time.

Mood-congruent psychosis

With mood-congruent psychotic symptoms (sometimes called features), the delusions or hallucinations reflect the person’s mood or beliefs. For example, a person might have feelings of guilt or inadequacy. They may also believe they have an illness or are dying. These are common beliefs held by people who have depression.

Mood-incongruent psychosis

In mood-incongruent psychotic symptoms, delusions or hallucinations aren’t related to the person’s beliefs or feelings. Hearing your thoughts or believing you’re being controlled by others are two examples. Mood-incongruent psychosis may be more severe. Results of one study indicated that people with mood-incongruent psychosis are more likely to need hospitalization.

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Causes

Causes of bipolar psychosis

The exact cause of bipolar psychosis isn’t well understood. This is true with most mental disorders. But several factors could play a role, including genetics, a chemical imbalance in the brain, and brain structure.

Diagnosis

Bipolar disorder diagnosis

Bipolar disorder is difficult to diagnose. Typical symptoms of psychosis may make diagnosis easier. If psychosis is treated early, your outcome will often be better. That is usually the case during the first episode of the condition.

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Treatment

Treatment of bipolar psychosis

The most effective treatment for bipolar psychosis is holistic. That means that your treatment should include lifestyle changes, self-help, and personal relationships. These treatments are used with the following traditional treatments:

  • Medications: Your doctor may prescribe mood stabilizers, antidepressants, or antipsychotic medications.
  • Psychotherapy: Therapy may include one-on-one counseling, family therapy and education, group therapy, or peer support.
  • Electroconvulsive therapy (ECT): You may be offered ECT when medication and psychotherapy don’t provide relief. With ECT, an electric current is applied to the brain, which causes a brief seizure. The exact mechanism of action behind this treatment is still debated, but the end result can be described as “resetting” the brain, which provides rapid improvement for many people.
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Outlook

Outlook

It’s not unusual for people to have only one episode of psychosis and recover with treatment. Early diagnosis and treatment are important to controlling the condition and improving quality of life. Bipolar disorder isn’t curable. But for many people it can be controlled successfully.

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