Bipolar Psychosis

In this episode, Wendy takes a look at Bipolar Psychosis. A part of the disorder that is not much talked about but should be!




Don't forget to check out Wendy's novel "Involuntary Hold." It's the story of a girl who wakes up on the psych ward and her struggles to survive. It's available on Amazon and on Audible.

International Helpline Info

 For those living outside the United States, I finally found some helpful information. The International Association for Suicide Prevention has a directory of crisis centers and helplines for over 50 countries! 

Just got to the internet and type in:

       findahelpline.com/i/iasp

 And it will bring you to a drop-down menu where you can input your country and region, and it will give you the information for your location. Granted, it doesn’t cover everywhere, but it’s a start!

** Remember if you, or a loved one, is in emotional crisis... Help is just a phone call away. Simply dial 9-8-8 for the Suicide and Crisis Hotline, or text "HOME" to 741741 to chat with someone via text 24/7 across the United States. **

Please contact us at bipolarforlife@myyahoo.com with any questions, suggestions, or comments.

Transcript

Bipolar for Life

 Ep 7/S2-Bipolar Psychosis

Good evening and welcome to “Bipolar for Life.” I’m your host, Wendy Foard, and I’ve managed to live with bipolar disorder for 44 years now. It hasn’t always been pretty, but I’ve survived several suicide attempts, four psychiatric hospitalizations, and one disastrous trip to rehab. Yet, I’m still here!

Let me say up front that I am NOT a medical doctor. I am simply a seasoned manic-depressive trying to help others survive this deadly mental illness through shared information and experiences.  

As we discuss issues, please remember that I am speaking from my own experience; your bipolar experiences may be entirely different. Yet, I suspect highly that we have more in common than not. 

Tonight, I thought we’d take a look at something that I have only experienced a few times myself: bipolar psychosis. 

There are a lot of misconceptions about bipolar disorder, and one of the most commonly misunderstood aspects is the link between bipolar disorder and psychosis.

Psychosis is often described as a loss of contact with reality. People who experience episodes of psychosis often aren’t able to recognize what’s real in the world around them. 

I know this sounds ridiculous to those who have never experienced it, but the world of psychosis is as real as what we call “reality.” The most recent hallucination that I know I had, was a bird that flew by me from the kitchen. I could see its eyes and beak, surrounded by mottled brown feathers. It streaked right by me and landed on a bookcase. The ONLY thing that let me know that it wasn’t real, was the fact that no one else in the room was aware of a bird. That, and it never moved again.

Psychosis is a legitimate reality for some medical and mental health conditions, including bipolar disorder. Psychosis is a symptom of a condition, not a disorder itself. 

It is difficult to know the number of people who experience psychosis. Studies estimate that between 15 and 100 people out of 100,000 develop psychosis each year.

Psychosis often begins in young adulthood when a person is in their late teens to mid-twenties. However, people can experience a psychotic episode at younger and older ages and as part of many disorders and illnesses. For instance, older adults with neurological disorders may be at higher risk for psychosis.

People experiencing psychosis may have hallucinations or delusions. Sometimes, a person with bipolar disorder may experience symptoms of psychosis. This often occurs during a severe episode of mania or depression.

When people hallucinate, they experience things that aren’t real to anyone but themselves. They may hear voices, see things that aren’t there, or experience unexplained sensations such as being touched when no one is touching them. Hallucinations can encompass all the senses. 

Delusions are 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. In bipolar disorder, delusions of grandeur are common during episodes of mania. 

If a person with bipolar disorder experiences depressive episodes, they may have paranoid delusions. For example, they might believe someone is out to get them or their property. 

People experiencing psychosis often have irrational thoughts. Their speech may be fast, rambling, or hard to follow. They may move from subject to subject, losing track of their train of thought. 

Many people experiencing psychosis may not be aware that their behavior isn’t consistent with what’s really happening. They may not recognize that their hallucinations or delusions aren’t real, or notice that other people aren’t experiencing them. 

A person will often show changes in their behavior before psychosis develops. Behavioral warning signs for psychosis include:

·     Suspiciousness, paranoid ideas, or uneasiness with others

·     Trouble thinking clearly and logically

·     Withdrawing socially and spending a lot more time alone

·     Unusual or overly intense ideas, strange feelings, or a lack of feelings

·     Decline in self-care or personal hygiene

·     Disruption of sleep, including difficulty falling asleep and reduced sleep time

·     Difficulty telling reality from fantasy

·     Confused speech or trouble communicating 

·     Sudden drop in grades or job performance

Alongside these symptoms, a person with psychosis may also experience more general changes in behavior, such as:

·     Emotional disruption

·     Anxiety

·     Lack of motivation

·     Difficulty functioning overall

In some cases, a person experiencing a psychotic episode may behave in confusing and unpredictable ways, and may harm themselves or become threatening or violent towards others. The risk of violence and suicide decreases with treatment, so it’s important to seek help. 

If you find that you are experiencing these changes in behavior or notice them in a friend or family member, and they begin to intensify or do not go away, reach out to a health care provider.

Psychotic symptoms can start for a person with bipolar disorder at any point but are usually within the confines of either a manic or depressive episode. Symptoms are more common in those with bipolar type I disorder compared to those with bipolar type II disorder. Psychosis is more common in mania than depressive episodes. Although, it can occur in either mood phase.

The duration of a psychotic episode will vary from person to person. It will depend upon whether they have received treatment and how long the symptoms occurred before treatment was sought. Psychosis does not occur in cyclothymia (a less severe form of bipolar disorder).

According to the National Institute of Mental Health (N.I.M.H), people experiencing psychosis can act in unexpected ways and can cause harm to themselves or others. This can be accidental—like falling off a building because they believe they can fly. Or it can be intentional, like committing suicide when depressed. 

To receive a diagnosis of psychosis within an episode of bipolar disorder, a person must work with a health care provider. The provider will perform a physical exam and may request medical testing to rule out other conditions. 

The health care provider may then perform a mental health evaluation and look at the person’s health history, family history, recent traumas, and drug use. A final diagnosis will be made using the Diagnostic and Statistical Manual of Mental Health Disorders Volume 5, or the DSM-5, criteria. The DSM-5 criteria for psychosis are:

1)          Delusions

2)          Hallucinations

3)          Disorganized speech (i.e. frequent derailment or incoherence), and

4)          Grossly disorganized or catatonic behavior.

There is no one cause of psychosis. Psychosis appears to result from a complex combination of genetic risk, differences in brain development, and exposure to stressors or trauma. 

Psychosis may be a symptom of a mental illness, such as schizophrenia, bipolar disorder, or severe depression. However, a person can experience psychosis and never be diagnosed with schizophrenia or any other disorder.

For older adults, psychotic symptoms can be a part of a physical or mental illness that emerges later in life—including Parkinson’s disease, Alzheimer’s disease, and related dementias.

Other possible causes of psychosis include sleep deprivation, certain prescription medications, and the misuse of alcohol or drugs. A mental illness is typically diagnosed by excluding the other causes. 

A qualified mental health professional, (such as a psychiatrist, a psychologist or licensed social worker) can provide a thorough assessment and accurate diagnosis. 

There are three phases of developing psychosis. It begins with the Prodromal Phase, which often includes the previously mentioned 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 the actual aspects of psychosis, such as delusions, hallucinations, and disorganized thinking. 

The third and final phase is Recovery. Even during recovery, a person can have mild or unnoticeable signs of psychosis.

 Treating bipolar disorder with psychotic features is different from treating the disorder without psychosis. When someone begins to have psychotic symptoms, they may need additional medication and different therapy approaches. 

Medications used to treat psychosis are called antipsychotics. For example, Zyprexa, Latuda, and Abilify are all antipsychotics. There are many types of antipsychotics, and their side-effects can vary. As a result, a health care provider needs to 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 anywhere from a few minutes to a few days. However, some symptoms, such as delusions, can take a few weeks to resolve.

 People with bipolar disorder who are experiencing psychosis are usually prescribed what are called atypical antipsychotics, or second-generation antipsychotics, according to the N.I.M.H. They work by affecting various neurotransmitters in the brain, including dopamine. Typical, or first-generation antipsychotics, which also reduce dopamine, are used less often due to the difference in side-effects.

 The most common side-effects of antipsychotics, in general, are sedation and drowsiness, but they can also include things like nausea, blurred vision, and low blood pressure. 

Atypical antipsychotics are more likely to cause metabolic side-effects such as weight gain, while typical antipsychotics are more closely connected with movement-related side-effects, like tremors. As a whole, typical antipsychotics tend to cause more serious long-term side-effects, like the movement disorder tardive dyskinesia, which can prompt uncontrollable muscle movements, often around the mouth. 

 According to the N.I.M.H, antipsychotics begin to treat some symptoms, like hallucinations, within days, while it may take weeks for delusions to fully recede. Often, the person experiencing psychosis needs to be hospitalized, or otherwise under medical supervision to prevent harm to themselves. 

 The duration of treatment is highly variable depending on the person. Some people with bipolar disorder only take antipsychotics when symptoms come on and stop a few weeks or months after they feel normal again. Others may stay on a low dose of antipsychotics for a year or so, before tapering off in order to prevent another episode. And sometimes, people stay on them indefinitely as a maintenance treatment.

Most often, antipsychotics are just one component of the drug regimen used to treat bipolar disorder, according to the N.I.M.H. Other medications, like mood stabilizers, may be used as well. 

 There are two types, or features, of psychosis in people with bipolar disorder: Mood Congruent and Mood Incongruent. In Mood Congruent psychosis, symptoms either amplify or reflect your mood in a manic or depressive episode. In Mood Incongruent psychosis, symptoms totally contradict your mood. 

Most people with bipolar disorder psychosis experience mood congruent features. This means the delusions or hallucinations reflect your moods, beliefs, or current bipolar episode (mania or depression). For example, in a depressive episode, you might have feelings of guilt or inadequacy. In a manic episode, you may experience delusions of grandeur. 

 Mood incongruent symptoms are in opposition to your current mood. This type of psychosis may involve hearing voices or thoughts, or believing you’re being controlled by others. During an incongruent depressive episode, you may also not feel guilt or other negative thoughts that are typical during depression. Mood incongruence may be more severe than congruent psychosis. A 2022 review of research indicated that mood incongruent psychosis is a marker of bipolar severity. 

 Treatment also often includes other elements. There is substantial research support for coordinated specialty care. This type of care is a multi-element, recovery-oriented team approach to treating psychosis that promotes easy access to care and shared decision-making among the specialists, the person experiencing psychosis, and family members. People experience better outcomes from coordinated specialty care if they begin treatment as soon as possible after psychotic symptoms emerge. 

 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 occur, including long-term impacts on the brain. Unmanaged psychosis can affect many areas of a person’s life—social, occupational, personal, and relational.

 Untreated bipolar psychosis can also increase the risk of self-harm and suicide. The highest risk of self-harm is when a person is experiencing their first episode of psychosis and have yet to receive treatment. The risk of suicide is very high in those with psychosis. One in five people with bipolar psychosis will attempt suicide. 

 Not everyone who has bipolar disorder experiences psychosis. Conclusive data on how prevalent psychosis is in bipolar disorder is scarce. One 2007 meta-analysis, pooling data on people with bipolar disorder from 33 studies conducted between 1922 and 2005, found that 61% of them experienced at least one symptom of psychosis at some point in their lives. 

What is clear, is that while psychosis appears to be relatively common in bipolar disorder, a fair number of people with the condition will never experience psychosis. Likewise, not everyone who experiences psychosis during a mood episode will experience it with every episode. And just because someone has never experienced psychotic symptoms before, doesn’t mean they never will. 

 The National Institute of Mental Health reports that, in the United States, as many as 3 in 100 people will have an episode of psychosis at some point in their lives, and according to a study done in 2000, more than half of the people with bipolar disorder experience psychosis at some point.

It’s surprising, then, that psychosis is often left out of the conversation when talking about bipolar disorder. 

 The best way to manage psychosis is to prevent as many mood episodes as possible. The longer a person with bipolar disorder can stay stable early in their illness, the better the prognosis in the long term. 

Although the exact cause of psychosis in bipolar disorder isn’t well understood, we do know some factors that may play a role in developing psychosis.

·     Sleep Deprivation-Sleep disturbances have been associated with the onset of mood episodes, and may trigger worse symptoms.

 ·     Sex-Women with bipolar I disorder, who give birth, have a high risk of postpartum mania and psychosis.

 ·     Hormones-Since psychosis has been associated with childbirth and early signs occurring during puberty, hormones may play a role in developing bipolar psychosis.

 ·     Cannabis-Cannabis is the most frequently used drug among people with bipolar disorder. Some research suggests the frequency of cannabis use increases in proportion to the risk of psychotic disorders.

 ·     Genetic Differences-Some research suggests there may be some genetic differences in people with schizophrenia and bipolar disorder.

 People who have experienced bipolar psychosis report a holistic approach as the most effective. This means that your treatment might benefit from:

1)          Monitoring psychosis on a calendar or planner, noting your setting, diet and events before and after the episode

 2)          Having an accountability partner, treatment team, or support group to advise you at the onset of an episode or think you may be in the middle of one

 3)          Avoiding alcohol, which is known to intensify everyday bipolar disorder symptoms and possibly be a trigger for mania and psychosis

 4)          Developing a routine for wellness that includes consistent sleep, taking medications as prescribed, a balanced and nutritious diet, and healthy social time

 5)          Keeping space for your favorite activities that help you stay grounded, like a custom playlist, a movie, exercise, or whatever usually gets you laughing

 Those strategies are suggested alongside the following formal treatments:

Prescriptions: A 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 medications and therapy don’t lessen psychosis. It’s an outpatient procedure used to “reboot” the brain, and we spoke about it in a previous episode.

 Bipolar disorder can present with episodes of psychosis that last a week or longer and can look a lot like schizophrenia. If a doctor saw a new patient in the middle of a manic or depressive episode with psychosis, without any knowledge of their medical history, it would be extremely difficult to tell whether they were looking at someone with bipolar disorder or schizophrenia. 

 Indeed, people with bipolar disorder who experience psychosis are sometimes misdiagnosed with schizophrenia, according to the N.I.M.H. This is why it’s so important to give your full medical history when asked. 

 Bipolar disorder and psychosis aren’t yet curable, but they are both treatable. If a friend or a loved one is experiencing psychosis, there are ways to effectively help them and communicate when they’re having an episode. For example, DON’T do this:

·     Don’t talk down to the person, challenge or “egg on” a delusion or hallucination

·     Don’t verbally or nonverbally judge, disapprove or argue

·     Don’t label with combative stereotypes like “crazy,” “psychotic,” “postal,” or “raging”

·     Don’t try to touch or physically move the person

 With tools, knowledge, and a connection with your health care team, you can manage your condition and maintain your well-being.

 Man... Look at the clock! We have run out of time tonight, friends. Geez…

Psychosis is difficult because it questions reality. If you can see it and hear it, it must be real, right? Psychosis proves this is not always the case. The problem is how to tell what is real… but hasn’t that always been the problem? 

I’ll stop there before we get into a deep discussion of what is the essence of reality. 

 If you, or a loved one, find yourself in immediate need of emotional help due to a crisis in your life, or a mental health condition, call 9-8-8 and talk to someone at the Suicide and Crisis Lifeline. They are available 24/7 and are ready to help. They even speak Spanish! Or, if you’d rather not get that personal, you can chat with a crisis counselor via text. Just text H-O-M-E to 741741 and find the help you need.

For those of you living outside the United States, I finally found some helpful information. The International Association for Suicide Prevention has a directory of crisis centers and helplines for over 50 countries! 

Just got to the internet and type in:

      findahelpline.com/i/iasp

 And it will bring you to a drop-down menu where you can input your country and region, and it will give you the information for your location. Granted, it doesn’t cover everywhere, but it’s a start!

Again, that’s:

        findahelpline.com/i/iasp

I want to thank you for joining me this evening. It has been a pleasure! As always, be safe in all your travels. Until we meet again on “Bipolar for Life,” good night.