Symptoms of Bipolar Psychosis

Around two-thirds of people living with bipolar disorder will experience at least one symptom of psychosis over the course of their lives. Psychosis is defined as the loss of contact with reality, during which time a person cannot tell the difference between what is real and what is imagined. Symptoms include delusions (believing something that is not real) and/or hallucinations (seeing, hearing, touching, smelling, or tasting something that is not real).

Psychosis usually accompanies episodes of extreme mania in persons with bipolar I disorder (the more severe form of the disease). While less common, it can also happen to people with bipolar II disorder.

Psychosis is also a feature seen with other types of mental illness, including schizophrenia and schizoaffective disorder. Certain physical illnesses such as Parkinson's disease, Alzheimer's disease, brain tumors, and stroke can also trigger a psychotic episode, and it can even be an extreme feature of postpartum depression.

Within the context of bipolar disorder, there is no clear understanding of what causes psychosis. While people will often refer to it as a "psychotic break," the reality is that a psychotic episode usually develops slowly over time. Some early warning signs of psychosis include:

• Consistently worrying about grades or job performance
• Struggling to concentrate or think clearly
• Having unwarranted suspiciousness of others
• Failure to keep up with personal hygiene
• Withdrawing from friends and family
• Experiencing strong, inappropriate feelings or no feelings at all

Getting help for psychosis sooner rather than later can make the recovery process faster and easier, so early indicators should not be ignored.

That said, people close to the individual experience psychosis are usually the ones to detect these symptoms. People experiencing psychosis will typically appear incoherent and completely unaware of how extreme their behavior has become. In terms of symptoms, they are typically classified as being either mood-congruent or mood-incongruent:

• Mood-congruent symptoms are those in which the hallucinations and/or delusions match the person's mood. In cases like these, the hallucinations may be contextualized by a person's delusions. The underlying belief that you're being spied on, for example, can manifest with imagined sounds or voices from the next room.
• Mood-incongruent symptoms are those in which a person's mood does not match the hallucination and/or delusion. In this instance, people will often believe that there are voices telling them what to do or that they are being influenced by some unseen force. Episodes like these are considered serious and will more often than not require hospitalization.

Delusions are false beliefs that a person believes are true. Previously referred to as paranoid disorder, delusions are characterized by episodes that are either bizarre (something beyond the realm of possibility) or non-bizarre (things that are within the realm of possibility).

Examples of bizarre illusions include being abducted by aliens or having a CIA tracking device in your head. Non-bizarre delusions, by contrast, often manifest with claims of being poisoned, followed, or loved from afar.

Unlike hallucinations, delusions can often seem perfectly normal in casual situations. Psychotic delusions are typically clustered around one or several of the following themes:

• Jealousy, usually related to a loved one's infidelity
• Grandiosity, characterized by an inflated sense of self-worth
• Erotomania—the belief that someone important loves you
• Persecution, in which you believe others plan to do you harm
• Somatic delusions, by which you believe you are ill or have a physical defect

Hallucinations are characterized by physical sensations that are not real. With regards to bipolar disorder, this may be caused by an extreme manic episode combined with extreme sleep deprivation (the latter of which can also cause hallucinations in people who don't have bipolar).

Hallucinations don't just involve perceptions, but actual sensations involving one or more of the five senses. They can be classified as:

• Visual hallucinations
• Auditory hallucinations, such as hearing voices that aren't there
• Olfactory hallucinations, involving smells
• Tactile hallucinations, such as feeling bugs crawling all over you
• Taste hallucinations

The word "psychosis" can be scary for some people, suggesting the affected person is likely to inflict self-harm or cause harm to others. While this is possible, particularly in cases of severe mood-incongruent psychosis, episodes are usually more troubling than dangerous. If you or someone you know is experiencing these thoughts, contact the National Suicide Prevention Lifeline at 800-273-8255, or dial 911.

With a holistic approach to treatment—including psychotherapy, medication, and social support—most people can fully recover and return to their normal life without further incident.

While bipolar disorder cannot be "cured" in the traditional sense, with proper diagnosis and treatment, symptoms of the disease can be successfully controlled over the long term.