Bipolar disorder, formerly known as manic depression, is a mental health condition characterized by extreme mood swings. People with bipolar disorder fluctuate between periods of mania (elevated moods and energy) and periods of depression (low, sad moods and low energy). During manic episodes, some people with bipolar disorder can experience psychosis, which causes them to lose touch with reality.
What is bipolar disorder?
Bipolar disorder is a mental illness characterized by extreme shifts in mood and energy levels. A person with bipolar disorder will alternate between periods of mania (elevated moods and energy) and periods of depression (low, sad moods and low energy). These mood episodes can last for weeks or months at a time.
There are three main types of bipolar disorder:
- Bipolar I Disorder – Defined by the occurrence of at least one manic episode. Symptoms can be severe and require hospitalization.
- Bipolar II Disorder – Characterized by less severe manic episodes called hypomanic episodes. Also includes at least one major depressive episode.
- Cyclothymic Disorder – Involves many hypomanic episodes and depressive symptoms that don’t meet the full criteria for a major depressive episode.
While the causes of bipolar disorder aren’t fully understood, a combination of biological, genetic, and environmental factors are thought to contribute to its development. Abnormalities in brain chemicals like serotonin and dopamine as well as differences in brain structure and function have been identified in people with the disorder.
What is psychosis?
Psychosis is a mental state characterized by a disconnect from reality. People experiencing psychosis may have either hallucinations (seeing, hearing, or sensing things that aren’t there) and/or delusions (strong fixed beliefs not based in reality). Other symptoms can include incoherent speech and behavior that is inappropriate for the situation.
Some potential causes of psychosis include:
- Mental illnesses like schizophrenia or bipolar disorder
- Drug or alcohol misuse
- Certain medical conditions or treatments
- Extreme stress or lack of sleep
Psychosis represents a break with reality and significantly impacts a person’s ability to function. Prompt treatment is important.
Can people with bipolar disorder experience psychosis?
Yes, many people with bipolar disorder will experience some form of psychosis during a mood episode, particularly during manic or depressive phases. According to research, around 50-70% of bipolar patients will have symptoms of psychosis at some point.
During manic episodes, people with bipolar disorder may experience:
- Delusions of grandeur – Beliefs they have special powers or are famous.
- Racing thoughts
- Reckless behavior
- Hallucinations – Seeing or hearing things that aren’t there.
In depressive episodes, psychotic symptoms may include:
- Delusions of guilt
- Delusions of poverty
- Hallucinations
These psychotic symptoms generally resolve once the person’s mood episode stabilizes. However, around 5-15% of people with bipolar disorder can experience psychosis even during normal mood states.
Why do psychotic symptoms occur?
Researchers aren’t entirely sure why people with bipolar disorder develop psychotic symptoms. However, there are several theories:
- Neurotransmitter imbalances – Abnormal dopamine activity has been linked to psychosis in bipolar disorder.
- Inflammation – High levels of inflammatory markers are associated with psychotic symptoms.
- Stress – High stress levels may trigger psychosis in those predisposed to it.
- Genetics – Variations in genes involved in dopamine regulation have been tied to psychotic bipolar episodes.
Additionally, factors like lack of sleep, recreational drug use, and life stressors may make someone with bipolar disorder more vulnerable to psychosis.
Are psychotic symptoms dangerous?
Psychotic symptoms have the potential to be dangerous for both the person with bipolar disorder and others around them. Some risks include:
- Reckless behavior – Impaired judgement may lead to dangerous risk taking.
- Self-harm – People may act violently on delusions or hallucinations.
- Harm to others – A small percentage of people experience command hallucinations urging violence.
- Suicidal thoughts – During depressive episodes, psychosis may fuel suicidal ideation.
- Health complications – Lack of self-care, poor decision making may lead to medical issues.
People in a psychotic state also often lack insight into their condition and don’t believe they need intervention. For these reasons, professional treatment is extremely important.
How is psychotic bipolar disorder treated?
Treatment for bipolar disorder with psychotic features often includes:
- Medication – Antipsychotic drugs like olanzapine or risperidone are commonly prescribed along with mood stabilizers.
- Psychotherapy – Cognitive behavioral therapy helps patients identify triggers and cope with symptoms.
- Hospitalization – People with severe mania or psychosis may require inpatient stabilization.
- Social rhythm therapy – Developing and maintaining a regular schedule can help manage bipolar symptoms.
With proper treatment, many people with psychotic bipolar disorder can achieve remission of their symptoms and regain normal functioning. Support from family and mental health professionals also improves outcomes.
Can psychotic bipolar disorder be prevented?
While there’s no guaranteed way to prevent psychotic episodes in bipolar disorder, some strategies may help reduce the risk including:
- Taking medications consistently as prescribed.
- Avoiding drug and alcohol use.
- Reducing stress through regular exercise, meditation, counseling.
- Establishing a regular sleep routine.
- Tracking moods and being alert to signs of mania or depression.
- Having a strong social support system.
Early intervention at the first signs of a mood episode may help prevent full-blown psychosis from developing.
Conclusion
Many people with bipolar disorder will experience psychotic symptoms like delusions or hallucinations, particularly during severe manic or depressive episodes. While the exact causes aren’t fully understood, neurotransmitter imbalances, inflammation, genetics, and stress likely play a role. Psychotic symptoms can be dangerous and professional treatment is crucial. With medication, therapy, social support, and lifestyle changes, many individuals with psychotic bipolar disorder can manage their symptoms successfully.