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How Does Bipolar Disorder with Psychotic Features Work?

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Bipolar disorder is a complex mental health issue that can get in the way of many aspects of your life. If left untreated, it can affect your health, relationships, your ability to maintain employment, and many other areas of life. Bipolar disorder can be even more complicated if it includes psychotic features. 

While bipolar disorder can be frustrating and psychotic symptoms can be frightening, it is treatable. But why does bipolar disorder cause psychotic symptoms, and how can it be properly diagnosed? Learn more about bipolar disorder with psychotic features. 

What Is Bipolar Disorder?

Everyone feels highs and lows. Some days you feel content and happy and other days leave you feeling sad. Even more likely, you will feel highs and lows throughout the day. Chemicals can influence your mood in your brain and how you respond to events and thoughts that can make you feel happy or sad. 

A typical person’s brain will strike a balance between the highs and lows of your mood to not experience the extremes very often. Extreme emotions may come when you experience the loss of a loved one or if you get fantastic news, but they don’t happen every day. 

People with bipolar disorder experience these highs and lows often. Bipolar disorder is a mood disorder, and it’s often mistakenly thought that bipolar disorder is characterized by quick and extreme mood swings that can happen from moment to moment. However, it’s more likely that extreme moods last for hours and even days before shifting back to normal or to the other extreme. 

There are two major types of bipolar disorder that are characterized by the types of extremes you experience. Type 1 has extreme highs known as a manic phase. Mania is characterized by extreme elation, irritability, high energy, and a feeling of being invincible. This is often seen as a positive aspect of bipolar disorder, but it can come with dangerous consequences like increased risk-taking, paranoia, and psychosis. 

Type 2 is characterized by less extreme high moods and longer, more extreme low moods like depression. Depression can lead to feelings of worthlessness, a loss of interest in things that brought you joy, and suicidal thoughts or actions. There are also other types that involve fewer extreme moods but cause significant imbalances in mood. 

What Is Bipolar with Psychotic Features?

Bipolar disorder can sometimes present with symptoms of psychosis. Psychosis is characterized by a loss of touch with reality. Psychosis can also be caused by certain medications, illicit drugs, and other mental health issues like schizophrenia. Because psychosis is so complicated and can be caused by other things, bipolar with psychotic features can be difficult to diagnose.

Psychotic symptoms may include delusions, which are false beliefs that contradict or conflict with reality. Examples of a common delusion that are seen in people with bipolar disorder include the following:

  • Delusions of grandeur. This kind of delusion involves thinking that you’re extremely important, powerful, famous, or intelligent. This can make you engage in risky behavior because you feel invincible. 
  • Paranoid delusions. This can involve conspiracy theories, feelings of impending doom, or the idea that people or organizations are out to get you. This can sometimes appear alongside delusions of grandeur if a person thinks there is a major threat that only they can oppose or solve.
  • Somatic delusions. This is similar to hypochondria. It’s the belief that you have a disease or a physical defect even if doctors can’t find anything wrong. 
  • Delusions of reference. This is the feeling that there are codes or hidden means in the world around you. For instance, you may believe the weather person on the news is communicating with you a code, or there is a hidden meaning behind what they’re saying.
  • Delusional jealousy. This involves jealousy about a spouse or partner based on the false belief that they’re unfaithful. These beliefs may persist no matter what your partner says to assure you that it’s not true. 

Psychosis can also cause hallucinations, which is seeing or hearing things that aren’t really there. Hallucinations can be separated into three categories: visual, auditory, and tactile. Visual hallucinations can include shadows in the corner of your eyes or plainly visible people, animals, or objects that other people can’t. 

Movement or shadows in the corner of your eye may be common in people who are experiencing paranoid delusions. Auditory hallucinations involve hearing voices or other sounds that other people can’t hear. This can include hearing voices that give you commands or put you down with insults. 

bipolar-disorder-with-psychotic-features

How Is Bipolar with Psychotic Features Diagnosed?

When you’re seeking help for a mental health problem, a proper diagnosis is essential in finding the right treatment for your needs. However, mental health issues can be very difficult to diagnose when compared to many physical health issues. That’s because mental health has to do with the brain and how it functions. 

The brain is much more complicated than other parts of your body, like your heart or liver. In many cases, mental health disorders have overlapping symptoms, or you can have more than one mental illness at the same time. In some cases, distressing symptoms of one issue can lead to mood problems like depression.

Bipolar disorder shares a lot of symptoms with other mood disorders like various kinds of depression. If you have psychotic symptoms, your problem might share symptoms with other psychotic disorders. However, bipolar disorder has some distinct features that set it apart from other mental health problems. 

According to the DSM-5, you need to have experienced at least one manic episode to be categorized as Bipolar I. A manic episode is identified using seven common symptoms that are abbreviated to DIGFAST. These symptoms including:

  • Distractibility
  • Impulsivity or indiscretion 
  • Grandiosity (inflated self-importance)
  • Flight of ideas 
  • Activity (increased projects or endeavors)
  • Sleep (decreased need for sleep)
  • Talkativeness

To qualify as a full manic episode, you’ll have to have experienced four of the seven mania symptoms that last at least one week or if symptoms require hospitalization. You may or may not experience a major depressive episode and still qualify for Bipolar I. Bipolar II involves a hypomanic episode, which is less severe than a full manic episode but still involves three manic symptoms.

What’s the Difference Between Bipolar Disorder and Schizoaffective Disorder?

Schizoaffective disorder is a different diagnosis that can be very similar to bipolar disorder. Like schizophrenia, it involves psychotic symptoms, but it also involves mood problems like depression, which may not happen with schizophrenia. Both schizoaffective disorder and bipolar disorder can have mood and psychotic symptoms. However, psychosis that’s associated with bipolar disorder comes as a result of extreme moods. 

If psychosis is a feature of bipolar disorder, symptoms will come as a manic or depressive episode gets worse. As episodes subside, psychosis will subside, too. Psychotic symptoms may also be directly related to your mood symptoms. For instance, if you enter a manic phase and start feeling paranoid and like you’re uniquely gifted, you may start to think there’s a conspiracy that you have to do something about. 

On the other hand, schizoaffective disorder may cause mood and psychotic symptoms independent from one another. You may feel like you have a normal mood, but you think you’re being watched and that the characters on a television show are sending you messages. As your mood starts to go into extremes, your psychotic symptoms may stay the same or change regardless of your mood.

Getting the Right Diagnosis

To help get the most accurate diagnosis, there are a few important tips to consider. Keep track of your symptoms and let your doctor or therapist know about your experience. Only you know how you feel and think, so doctors with incomplete information can make an inaccurate diagnosis. You should also avoid taking a diagnosis for granted. As your understanding of your mental health grows or as symptoms change, it may become apparent that a different diagnosis may be more accurate.

You should also have a medical evaluation with physical examinations and lab tests. In some cases, physical issues like vitamin deficiencies, diseases, and injuries can cause psychological symptoms that can mimic mental health disorders. You should also have a psychological evaluation, as well. Some family doctors or general practitioners may try to prescribe medications to help your symptoms, but a full psychological evaluation can yield a clearer diagnosis. 

Finally, it’s important to ask questions and advocate for yourself. Sometimes it’s good to bring a trusted loved one with you to help advocate for your needs. Making sure your medical and clinical professionals understand you and that you understand them is important in getting the best treatment. 

Sources

Carlat, D. (1998, November 01). The psychiatric review of Symptoms: A screening tool for Family Physicians. from https://www.aafp.org/afp/1998/1101/p1617.html

Mayo Clinic. (2019, November 9). Schizoaffective disorder. from https://www.mayoclinic.org/diseases-conditions/schizoaffective-disorder/symptoms-causes/syc-20354504

National Institute of Mental Health. (2020, January). Bipolar Disorder. from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

National Institute of Mental Health. (2018, February). Depression. from https://www.nimh.nih.gov/health/topics/depression/index.shtml

Substance Abuse and Mental Health Services Administration. (2016). Table 12, DSM-IV to dsm-5 Bipolar i Disorder comparison – Dsm-5 changes. from https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t8/

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