Known in the past as manic depression, bipolar disorder is a mental illness involving extreme shifts in mood and other symptoms. It can impact energy, activity levels, sleep, communication, and the ability to function on a daily basis.
Moods may range from manic episodes to depressive episodes. Manic episodes include periods of extreme elation and great energy. During depressive episodes, the person may experience such feelings of sadness and hopelessness that they are unable to function, or take any kind of action.
Around 2.2 million Americans are affected by this condition.
The British National Health Service (NHS) list the four main symptoms of a psychotic episode as:
- Confused and disturbed thoughts
- Lack of insight and self-awareness.
The pattern of symptoms will vary between individuals and according to the situation.
A person who experiences hallucinations may see, hear, smell, feel, or taste things that are not there.
A person who has delusions may be convinced that something is true when it is not. Delusions of grandeur, for example, can cause a person to believe that they are important. Paranoid delusions make people afraid that someone is seeking to hurt them or that they, themselves, have done something terrible.
Confused and disturbed thoughts can lead to rapid and constant speech, disjointed speech, or the person forgets what they were thinking or talking about.
When people have a lack of insight, they are unable to recognize unusual behavior in themselves, though they may recognize it when they see it in others, whether it actually exists or not.
Bipolar psychosis may include hallucinations.
The symptoms tend to match the patient's mood. If the person is in a manic phase, they may believe they have special powers. This type of psychosis can lead to reckless or dangerous behavior.
If bipolar psychosis occurs during a low period or a depressive episode, the individual may believe that someone is trying to harm them, or that they themselves have done something wrong.
These beliefs can trigger feelings of extreme anger, sadness, or fear in the person.
Psychosis in bipolar disorder and in schizophrenia
Schizophrenia is another brain disorder that involves a dissociative state.
Bipolar psychosis and schizophrenia psychosis share some overlapping features. Both disorders can disrupt a person's life enough to interfere with daily activities and their ability to maintain close relationships or hold down a job.
Bipolar psychosis generally lasts for brief periods of time. A person who is experiencing an episode of bipolar psychosis is likely to return to a lucid state. A person with schizophrenia may not be able to return to an associative state.
In children and adults
The fifth edition of the Diagnostic and Statistical Manual (DSM-5) lists the same symptoms for children and adults.
Bipolar psychosis is difficult to diagnose, particularly in children and teens. A psychiatrist needs to confirm that the behaviors they are exhibiting are not due to everyday highs and lows, the result of stress that is common in teens, acute trauma, or symptoms of another mental health problem.
However, if children and teens experience mood swings that are more severe than usual for their age group, they should consult a doctor.
The DSM-5 lists the criteria for diagnosing bipolar psychosis. Psychosis can include hallucinations, delusions, and paranoia. These symptoms can occur during episodes of mania, depression, or when the signs are mixed.
Some of the signs of bipolar disorder include:
- Manic episodes followed by hypomanic episodes, or extreme highs and extreme lows
- Episodes of depression
- Increased anxiety
- Showing signs of all stages of bipolar at once
- Loss of pleasure in activities.
The list is not exclusive, and other symptoms may occur. A person who thinks they may have bipolar disorder should see a qualified medical professional for a diagnosis and appropriate treatment.
To receive a diagnosis of bipolar disorder, a person needs to display some or all of the symptoms listed in the DSM-5.
It is difficult to diagnose because it can be confused with depression, anxiety, and other mental health disorders.
Another factor that makes diagnosis difficult is that people with bipolar disorder often fail to see that their actions are unusual. They may think that their problems stem from the people around them rather than themselves. Because a manic phase makes a person feel good, they will not want to change or see any need to seek help. As a result, they often do not seek help, and they remain undiagnosed.
When to see a doctor
If a person experiences severe episodes of depression or mania, they should seek help from a doctor or a mental health professional.
If a person attempts suicide or even talks of suicide, seek emergency treatment immediately. People with bipolar disorder are often unaware of their symptoms or reluctant to seek help. Family and friends may need to encourage the person to talk to someone about what is going on.
Treatments for bipolar disorder usually combine counseling services and appropriate doses of medication. It can take time, sometimes years, to find a suitable drug and dosage.
Support from caregivers may be important to help maintain treatment.
A psychiatrist is normally the best guide for treatment, but a treatment team may consist of social workers, therapeutic support staff, counselors, a family doctor, and other specialists.
Initial treatment usually involves finding the right balance of medication, combined with counseling from a psychiatrist.
Continued treatment requires planning to make sure the symptoms are well controlled - that medication is available and taken regularly, and that the person attends counseling as needed.
In some cases, the person may attend day or substance abuse programs. Sometimes, they may have to go to the hospital for a short time.
Tips for caregivers
Bipolar often affects family members and friends, as well as the person who has the condition.
Caregivers may need to seek help in order to manage situations.
Some tips include:
- Learn as much about bipolar disorder as possible, to develop an understanding of what it means to have the condition and how to respond to it
- Find ways to manage stress through exercise, groups, and other outlets that can reduce stress levels
- Join a support group for family member or friends of people with bipolar disorder
- As far as possible, help the person with the condition to set goals, join support groups, get involved in the community, and follow treatment
- Set boundaries and limits, and seek support to stick with them if needed.