A person with bipolar disorder can experience 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 can range from manic to depressive episodes. Manic episodes include periods of extreme elation and great energy. During depressive episodes, if they occur, the person may feel so low that they are unable to function or take any kind of action.
Psychosis can happen at different stages of bipolar disorder. However, it is not always present, and not everyone with bipolar disorder will experience it.
It can be a frightening experience for the person and those around them, but a psychiatric provider can offer treatment to control and relieve the symptoms.
Psychosis happens when a person's thinking becomes detached from the reality around them.
The person's thinking becomes disconnected, or dissociated with reality.
A psychotic episode can involve:
- confusion and disturbed thoughts
- a lack of insight and self-awareness
The pattern of symptoms will vary between individuals and according to the situation.
In a study published in 2015, researchers noted that there is not just one type of psychosis, but different types, some of which have a more severe impact than others.
The scientists found that different biomarkers in the brain seemed to correlate with different types and severity of symptoms. This may indicate that different changes in brain function and brain chemicals lead to different forms of psychosis.
Bipolar psychosis happens when a person experiences an episode of severe mania or depression, along with psychotic symptoms and hallucinations.
The symptoms tend to match a person's mood. During 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
Bipolar shares some symptoms with schizophrenia, another brain disorder. Psychosis can occur with both conditions.
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 with treatment.
In children and adults
The fifth edition of the Diagnostic and Statistical Manual (DSM-5) lists the same symptoms of bipolar disorder for children and adults. Bipolar disorder may include psychotic features.
Bipolar disorder and psychosis are difficult to diagnose, particularly in children and teens. A psychiatrist needs to confirm that the behaviors they are exhibiting are not due to other factors.
Other causes of symptoms could include:
- everyday highs and lows, the result of stress that is common in teens
- acute trauma
- another mental health problem
However, if children and teens show signs of psychosis or 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.
When psychosis happens during a low mood, a person with bipolar disorder may experience fear and paranoia.
A person may experience the following:
- Visual and other hallucinations: The person sees, hears, and maybe smells things that are not there.
- Delusions: The person may be certain that something is true when it is not. They may believe that they are important, have contacts in high places, or have a lot of money, or are related to royalty, when in fact they are not. Some people become afraid that someone is seeking to hurt them or that others are working against them, such as the government.
- Paranoia and fear: The individual may believe that they have done something terrible or that someone wants to cause them harm.
- Unusual or racing thought patterns: This can lead to rapid, constant, or confused or disjointed speech with rapid changes of topic. The person may forget what they were talking about.
- Lack of insight: The person is unable to recognize unusual behavior in themselves, though they may recognize it when they see it in others, whether it actually exists or not.
These symptoms can occur during episodes of mania, depression, or during a mixed episode, when a person with bipolar disorder shows signs of both a low and high mood.
They can cause the person to behave in unusual ways, and this can impact their relationships with others, whether in their personal life, at work, or in other situations.
If the person believes they are very important, they may behave in ways that are outside the law. In some cases, this can lead to aggression, for example, if someone confronts the person.
An individual who believes that they have committed a crime or that someone is coming after them may become defensive or talk about suicide.
If a person has bipolar disorder and they shows signs of psychosis, they should see a doctor, if possible, as there is a risk of unwanted consequences.
A doctor will ask about the person's symptoms, medical history, and any recent events, such as a trauma, that they may have experienced. They will also ask about the use of prescription or other drugs.
To receive a diagnosis of bipolar disorder, a person needs to display some or all of the symptoms listed in the DSM-5.
Psychosis can be difficult to diagnose because it can share symptoms with depression, anxiety, and other mental health disorders.
In addition, people with bipolar disorder often do not see that their actions are unusual.
They may think that their problems stem from the people around them rather than themselves.
Effects of not using medication for bipolar disorder
Because a manic phase makes a person feel good, they may not want to change, and they may not see any need to seek help. As a result, they often do not seek help, and they remain without a diagnosis.
People who have received a diagnosis in the past—often during a low period—may stop taking their medications. If this leads to a manic episode, they may not want to seek help.
Effect of antidepressants
Sometimes, a person who has never had a diagnosis of bipolar disorder shows signs of depression. At this stage, they may receive antidepressants from a doctor.
If the person has underlying features that make them susceptible to bipolar disorder, some antidepressants can trigger a manic episode.
Friends and family who are aware of bipolar disorder and its symptoms can help a person who is experiencing psychosis by encouraging them to seek help.
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, or a friend or loved one should encourage them to do so.
If a person talks about suicide or attempts suicide, someone should 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 will include treatment for psychosis, if necessary. It usually combines counseling services and appropriate doses of medication.
A number of medications are available for treating psychosis in bipolar disorder.
Antipsychotics are typically used with psychotic symptoms. There are older and newer types. The newer types may have fewer side effects.
The older treatments include:
- Chlorpromazine (Thorazine)
- Haloperidol (Haldol)
The newer ones include:
- Aripiprazole (Abilify)
- Clozapine (Clozaril)
- Quetiapine (Seroquel)
- Olanzapine (Zyprexa)
- Risperidone (Risperdal)
A person will use these medications in addition to mood stabilizers and appropriate antidepressants.
However, research into how these drugs can help people with psychosis is limited, according to an article published by the National Institutes of Health. As a result, it can take time, sometimes years, to find a suitable drug and dosage.
Antipsychotic medications can also have adverse effects.
Unwanted and uncontrollable muscle movements can result, especially with the older medications. Often, these go away after the person stops using the drug, but they can be permanent in some cases.
Serious infection due to a low white-blood-cell count, when using clozapine. Peoeple who use clozapine should expect to have regular blood tests to monitor their white blood cell count.
During pregnancy, a doctor may advise against using antipsychotic medication, as the effect on an unborn child remains unclear. However, they may advise taking it if stopping might increase the risk to the woman or her unborn child. For example, there may be a risk that she may harm herself or her child.
Continued treatment needs planning to make sure the symptoms remain under control.
- ensuring that medication is available
- making sure the person takes their medication regularly
- ensuring that they attend any counseling sessions 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.
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.
Tips for caregivers
Family and friends can help by learning about bipolar disorder and making sure the person stays on track with their treatment plan.
Bipolar disorder 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.
Here are some tips:
- Learn as much about bipolar disorder as possible, to develop an understanding of what it means to have the condition, how the individual feels, and how to respond to it.
- Find ways to manage stress through exercise and other activities, group counseling, and other outlets. This applies to both the person with bipolar disorder and their loved ones.
- Join a support group for family member or friends of people with bipolar disorder.
- Help the person to set goals, as far as possible, and to join support groups, get involved in the community, and follow treatment.
- Set boundaries and limits, and seek support to stick with them if needed. This can help prevent behaviors that can arise at times, such as excessive alcohol consumption and shopping sprees.
Psychosis can be a feature of bipolar disorder. Scientists believe it happens because of changes in the brain, but there is still not enough information to explain it fully.
Not everyone with bipolar disorder will experience psychosis, and it does not happen all the time.
When it happens, it can be frightening for the one who experiences it and for those around them, too.
How the person reacts to psychosis can also put them at risk sometimes of physical, social, or other types of harm. For this reason, it is important to seek help if someone experiences psychosis.
Medication can help to control psychosis. It is not always easy to diagnose or treat, but, with a doctor's help, it is usually possible to bring symptoms under control.
As scientists learn more about changes in the brain that occur with psychosis, more effective, targeted treatments may become available in time.