Can Psychosis Be a Symptom of Bipolar Disorder?
Medically reviewed by Ripal Shah, MD
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.
This article will discuss psychosis features in bipolar disorder and how to receive a diagnosis and treatment.
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Psychosis Features in Bipolar Disorder
Psychosis in bipolar disorder is characterized by delusions, hallucinations, and/or paranoia.
The person may have lost some or all contact with reality and have difficulty distinguishing between what is real and what is not.
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:
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. Psychosis symptoms are also more common during mania than depressive episodes.
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.
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.
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.
Other bipolar psychosis behaviors can include speech that doesn't make sense or is not in the context of the situation.
Outside of characteristic bipolar psychosis behaviors, someone may also have:
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.
Psychotic Depression vs Bipolar Psychosis
Psychotic depression is a subtype of major depressive disorder where the person experiences psychosis symptoms.
Bipolar psychosis is when someone who has bipolar disorder also experiences psychosis.
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.
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. 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.
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.
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.
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.
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.
Read the original article on Verywell Health.
