Demystifying Psychosis and Bipolar Disorder
Bipolar disorder and psychosis can seem intense and frightening, but help is available.
What is Bipolar Disorder?
Bipolar Disorder is a severe mood disorder involving both an accelerated and elevated (“high”) mood state as well as a depressed or “low’ mood state.
The elevated mood state in bipolar spectrum disorders is more than just being in a good mood. It involves a decreased need for sleep, increased energy levels, accelerated thoughts and speech, a feeling that the world around is going too slowly, changes in judgment and decision making, and sometimes irritability, anger or other symptoms. This state is called mania when extreme, and hypomania when moderate. Manic and hypomanic episodes can last a few hours to many months but tend to be of shorter duration early in the illness.
Depressive states, on the other hand, involve the same types of symptoms we may see in Major Depression, and may also vary in severity from moderate to severe.
Sometimes, the person may feel emotionally depressed while also having the high energy or irritability or mania, called a mixed episode.
Bipolar Disorder may also include periods where the person’s mood is overall “normal” – neither “high” nor “low”. This variation can make both life and diagnosis challenging.
What is Psychosis?
Psychosis is a mental state in which a person has normal types of experiences that are of such an extreme intensity that the person may appear to people around them not to be fully in touch with reality.
These can include sensory experiences, such as hearing voices and sounds or seeing people or shadows, which others don't see or hear. At times, the person may become very afraid that someone might be out to get them in a way that doesn’t make sense to the people around them. The person may also seem confused, or jump from topic to topic when speaking.
These are similar to normal experiences such as thinking our ears are “playing tricks on us”, thinking that someone else may hold something against us, or losing our train of thought. However, in psychosis, the experiences are amped up to an intensity and frequency that are often frightening, confusing and lonely for the person experiencing them. Family and friends may also feel confused and frightened, and uncertain how to help their loved one.
Do bipolar and psychotic symptoms ever occur at the same time?
Psychotic experiences can sometimes occur in bipolar disorders, typically during manic episodes, less frequently while the person is in a depressed state. Sometimes, psychotic and bipolar mood symptoms happen at the same time, regardless of the person’s mood state.
When bipolar and psychotic symptoms occur at the same time, they may seem particularly frightening or intense to the person having them. Because they are so intense, the experiences seem real to the person, who may feel frustrated and alone when their family and friends don't understand or believe them.
This can be distressing and worrisome to family members, who see how scared their loved one is and who feel at a loss about how to help.
Symptoms evaluations for the prevention of psychosis or identification of a first episode of psychosis
Early identification of mild symptoms can be important in the prevention of psychotic disorder and can facilitate access to prompt treatment if they should develop into full psychosis. Early identification of fully developed symptoms is also critical, as prompt treatment is associated with better outcomes.
When psychosis or warning signs of psychosis seem likely, we usually refer clients to the closest First Episode of Psychosis program for evaluation. We work hard to facilitate prompt follow-up with one of the specialized teams in the area, while continuing psychological follow-up if that would be helpful.
How are bipolar disorder and psychosis treated?
Bipolar disorders and psychosis are both considered to be serious mental states requiring prompt medical attention. While their symptoms can be frightening because of their intensity, with prompt and early intervention, the outcomes of bipolar disorder psychosis are often good, and many people who have experienced these difficulties live happy and productive lives.
In addition to medication, both bipolar disorders and psychotic disorders benefit from specialized cognitive behavioral therapy (CBT), which aims to help the person feel heard and understood, to learn to consider their experiences and thoughts differently and to learn new skills for managing their symptoms and improving their quality of life.
CBT for psychosis (CBTp) and CBT for bipolar disorder are backed by substantial scientific support for the management of these difficulties.
Our approach to working with psychosis begins with a strong emphasis on the destigmatization of these disorders. Therapy is grounded in specialized cognitive behavioral therapy and a person-centered, narrative approach, with an emphasis on helping the client find a better balance in life and move toward important goals at a pace they can handle.
We also consult with family members who are worried about loved ones showing signs and symptoms of psychosis.
Our approach is always based in a collaborative care model, in which we work closely with physicians and treatment teams to help the client maintain the best and most consistent state of health possible.