Progression Of Psychosis In Bipolar Disorder
Bipolar psychosis moves along a continuum. Explanation, examples of how psychosis progresses in bipolar disorder.
The following section explains how bipolar disorder with psychosis progresses. There are three terms you need to know:
Euphoric Mania: This mania includes expansive, grandiose, upbeat and on top of the world feelings.
Dysphoric Mania: In this episode, the person is agitated and depressed as well as manic. This is also called a mixed episode.
Up to 70% of people with severe euphoric or dysphoric mania have psychosis. Psychosis is more common in euphoric mania.
Psychotic Depression: It’s so easy to confuse the negative, hopeless and often suicidal thoughts of depression with psychotic thoughts- but depression is not psychotic unless there are specific hallucinations and delusions associated with the depression. Up to 50% of people with bipolar depression have some form of psychosis.
Treatments For Bipolar Disorder
The high and low phases of bipolar disorder are often so extreme that they interfere with everyday life.
But there are several options for treating bipolar disorder that can make a difference.
They aim to control the effects of an episode and help someone with bipolar disorder live life as normally as possible.
The following treatment options are available:
- medicine to prevent episodes of mania and depression these are known as mood stabilisers, and you take them every day on a long-term basis
- medicine to treat the main symptoms of depression and mania when they happen
- learning to recognise the triggers and signs of an episode of depression or mania
- psychological treatment such as talking therapy, which can help you deal with depression, and provides advice about how to improve your relationships
- lifestyle advice such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, as well as advice on improving your diet and getting more sleep
It’s thought using a combination of different treatment methods is the best way to control bipolar disorder.
Help and advice for people with a long-term condition or their carers is also available from charities, support groups and associations.
This includes self-help and learning to deal with the practical aspects of a long-term condition.
What Are The Symptoms Of Bipolar Disorder
The symptoms of bipolar disorder can vary. An individual with bipolar disorder may have manic episodes, depressive episodes, or mixed episodes. A mixed episode has both manic and depressive symptoms. These mood episodes cause symptoms that last a week or two or sometimes longer. During an episode, the symptoms last every day for most of the day. Mood episodes are intense. The feelings are intense and happen along with changes in behavior, energy levels, or activity levels that are noticeable to others.
| Symptoms of a Manic Episode | Symptoms of a Depressive Episode |
|---|---|
| Feeling very up, high, elated, or extremely irritable or touchy | Feeling very down or sad, or anxious |
| Feeling jumpy or wired, more active than usual | Feeling slowed down or restless |
| Racing thoughts | Trouble concentrating or making decisions |
| Trouble falling asleep, waking up too early, or sleeping too much | |
| Talking fast about a lot of different things | Talking very slowly, feeling like you have nothing to say, or forgetting a lot |
| Excessive appetite for food, drinking, sex, or other pleasurable activities | Lack of interest in almost all activities |
| Thinking you can do a lot of things at once without getting tired | Unable to do even simple things |
| Feeling like you are unusually important, talented, or powerful | Feeling hopeless or worthless, or thinking about death or suicide |
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Brain Structure And Function
Researchers are learning that the brain structure and function of people with bipolar disorder may be different from the brain structure and function of people who do not have bipolar disorder or other psychiatric disorders. Learning about the nature of these brain changes helps doctors better understand bipolar disorder and may in the future help predict which types of treatment will work best for a person with bipolar disorder. At this time, diagnosis is based on symptoms rather than brain imaging or other diagnostic tests.
Information For Family Carers And Friends
How can I get support?
You can speak to your GP. You should be given your own assessment through NHS mental health services to work out what effect your caring role is having on your health. And what support you need. Such as practical support and emergency support.
These are some other options for you:
- Join a carers service
- Join a carers support group
- Ask your local authority for a carers assessment
- Read about the condition
- Apply for welfare benefits for carers
Rethink Mental Illness run carers support groups in some areas. You can also search for groups on the Carers Trust website:
- Rethink Mental Illness: www.rethink.org/about-us/our-support-groups
- Carers Trust: www.carers.org/search/network-partners
How can I support the person I care for?
You might find it easier to support someone with bipolar disorder if you understand their symptoms, treatment and self-management skills.
You should be aware of what you can do if you are worried about their mental state. It can be helpful to know contact information for their mental health team or GP.
You could find out from your relative if they have a crisis plan. You could help your relative to make a crisis plan if they dont have one.
As a carer you should be involved in decisions about care planning. But you dont have a legal right to this. The medical team should encourage the person that you care for to allow information to be shared with you.
You can find out more information about:
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How Long Do Manic Episodes Last
Untreated, an episode of mania can last anywhere from a few days to several months. Most commonly, symptoms continue for a few weeks to a few months. Depression may follow shortly after, or not appear for weeks or months. Many people with bipolar I disorder experience long periods without symptoms in between episodes.
Treatment Options For Bipolar Disorder
If a person isn’t treated, episodes of bipolar-related mania can last for between three and six months. Episodes of depression tend to last longer, for between six and 12 months.
However, with effective treatment, episodes usually improve within about three months.
Most people with bipolar disorder can be treated using a combination of different treatments. These can include one or more of the following:
- medication to prevent episodes of mania, hypomania and depression these are known as mood stabilisers and are taken every day on a long-term basis
- medication to treat the main symptoms of depression and mania when they occur
- learning to recognise the triggers and signs of an episode of depression or mania
- psychological treatment such as talking therapies, which help you deal with depression and provide advice on how to improve relationships
- lifestyle advice such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, and advice on improving your diet and getting more sleep
- quetiapine
- risperidone
They may also be used as a long-term mood stabiliser. Quetiapine may also be used for long-term bipolar depression.
Antipsychotic medicines can be particularly useful if symptoms are severe or behaviour is disturbed. As antipsychotics can cause side effects such as blurred vision, dry mouth, constipation and weight gain the initial dose will usually be low.
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What Happens In The Manic Phase Of Bipolar Disorder
Medically Reviewed By: Aaron Dutil
Are you or someone you know affected by mood swings that seem extreme or out of the ordinary? Do those changes in mood affect your ability to stay focused or complete tasks? While occasional changes in mood are normal, when those changes occur often, or without obvious reason, they may be a reason for concern. For some, these could be signs of a mental health disorder known as bipolar disorder. Because not everyone who has bipolar disorder has been properly diagnosed or is receiving treatment, it is important to understand the symptoms and know when to seek help.
What Should I Do While Im Waiting To Come Down
If youre currently experiencing a manic episode, there are a few things you can do.
- Reach out to your treatment team. Your doctor, psychiatrist, or therapist can help you navigate your episode. They may recommend that you start or change medication.
- Avoid mind-altering substances like alcohol or recreational drugs. Becoming intoxicated can worsen your manic episode or interfere with your medication management.
- Get plenty of sleep. It might be hard to sleep during a manic episode, but try to go to bed and wake up at a regular time. You might find that certain sleep hygiene practices help.
- Eat according to a regular schedule. Hunger can destabilize your mood. Reduce your consumption of caffeine and sugary foods, as these can also affect your mood.
- Spend time with others. If you attend a support group, this might be helpful. Spending time with people close to you and your condition can help you feel more validated and less isolated.
- Stay consistent with meds. No matter whether youre experiencing a manic episode or not, its important to consistently take medication thats been prescribed to you according to your doctors directions. Setting a reminder on your phone might help you during episodes.
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What Does Your Brain Look Like When You Have Depression
Grey matter in the brain refers to brain tissue that is made up of cell bodies and nerve cells. People with depression were shown to have thicker grey matter in parts of the brain involved in self-perception and emotions. This abnormality could be contributing to the problems someone with depression has in these areas.
Is Bipolar 1 Or 2 Worse
The difference between bipolar 1 and 2, and how to recognize the symptoms. The main difference between bipolar 1 and bipolar 2 is the intensity of manic episodes. Those with bipolar 1 experience more severe mania, whereas people with bipolar 2 may have less intense manic symptoms, and more depressive episodes.
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Patterns Of Depression And Mania
If you have bipolar disorder, you may have episodes of depression more regularly than episodes of mania, or vice versa.
Between episodes of depression and mania, you may sometimes have periods where you have a “normal” mood.
The patterns are not always the same and some people may experience:
- rapid cycling where a person with bipolar disorder repeatedly swings from a high to a low phase quickly without having a “normal” period in between
- mixed state where a person with bipolar disorder experiences symptoms of depression and mania together for example, overactivity with a depressed mood
If your mood swings last a long time but are not severe enough to be classed as bipolar disorder, you may be diagnosed with a mild form of bipolar disorder called cyclothymia.
Mixed Episode Criteria For Bipolar Disorder
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
We tend to think of bipolar disorder as a disease characterized by alternating bouts of depression and mania. While it is true that some people with the disorder will experience a distinctive pendulum swing in moods, with clear highs and lows, more often than not the clinical picture will not be so obvious.
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Who Has Rapid Cycling
Anyone with bipolar disorder can experience rapid cycling, but it is more likely to affect women than men.
According to the Mood Disorders Association of Ontario, around 1020 percent of people with bipolar disorder experience rapid cycling. Between 7090 percent of these are women.
It can happen at any time during a persons experience of bipolar disorder, and it can come and go. Not everyone with rapid-cycling will experience changes four times every year.
A study published in 2014 in the Journal of Clinical Psychiatry also suggests that rapid cycling might be more likely to affect those who:
- have had bipolar symptoms for a longer period of time
- were relatively young when bipolar symptoms first appeared
- are more prone to substance and alcohol abuse
- have a higher risk of suicide
This does not mean that these factors cause rapid cycling, only that they are more likely to occur with this type of disorder.
Rapid cycling involves extreme changes in moods four or more times in a 12-month period.
These changes can be mentally and physically exhausting.
Licensed therapist Harold Jonas explains that rapid-cycling bipolar disorder:
Makes a person literally live life at its extreme ranges of emotion and pushes their mental and physical endurance to the brink. Its a literal rollercoaster where the emotional highs are very high, and the lows are dangerously low.
Harold Jonas
The following symptoms can occur when a person has rapid-cycling bipolar disorder.
Changes In Sleep Patterns Or Lack Of Sleep
A change in your sleep pattern is a hallmark symptom of bipolar disorder but it can also be a trigger.
Shift workers, people who work long hours, and students who are short on sleep are all at risk for having a recurrence of a mood episode related to a lack of sleep. In addition, travel beyond ones time zone can be another trigger for a mood episode, says Bennett.
Interpersonal and social rhythms therapy is one of the most effective preventions, Bennett says. This treatment approach, available in group as well as individual sessions, helps you develop an orderly life schedule of sleep, diet, and exercise habits, to make you more effective at managing bipolar disorder.
Other forms of therapy, including and cognitive-behavioral therapy , can also be helpful in managing the illness.
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Mania And Mixed Depressive Episodes
Any antidepressant should be stopped. Haloperidol, olanzapine, quetiapine or risperidone can be used to treat a manic episode. If these do not work well, Lithium can be added.
Once the treatment has started, symptoms usually improve within a few days, but it may take several weeks for a full recovery. You should check with your doctor if you want to drive while taking this sort of medication.
Taking Hold Of Your Bipolar Disorder
One of the most important steps in dealing with bipolar disorder is to become educated on the condition. Its also important to learn as much as you can about your specific type of bipolar disorder. The more knowledgeable you are, the more confident youll feel about living with bipolar disorder and gaining better control over your life.
Pay attention to the things that trigger episodes. Identifying signs that an episode is coming on can help. Include the people close to you in this process. They can offer support. They can also alert you to possible triggers or behavior changes. These may indicate that an episode is starting. When you can recognize that an episode is developing, you can intervene. Use strategies that youve learned in therapy.
You should also try to follow a healthy lifestyle that includes:
- sufficient sleep of at least seven hours a night
- daily exercise
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Symptoms That Lead To A Diagnosis
If youre suffering from any kind of mental health disorder, its important that you identify and understand your symptoms in order for our doctors to correctly diagnose you. Bipolar disorder consists of both manic and depressive episodes that create an unstable mood.
Mania can be extreme changes in mood, or you can have hypomania which is typically less severe. Symptoms of mania include:
Difficulty sleeping Extreme energy Increased self-esteem Difficulty concentrating Racing thoughts
On the opposite end of the spectrum, depression can change your emotional highs to hopeless lows. If you have bipolar disorder with depression, symptoms you may experience include:
Fatigue Sadness Decreased energy Overeating or loss of appetite Suicidal thoughts
Our team at Boston MindCare take a detailed history to decipher your symptoms and give you a definitive diagnosis. With that, we can also form a customized treatment plan for you.
Signs And Symptoms Of Bipolar Disorder
Bipolar disorder can look very different in different people. The symptoms vary widely in their pattern, severity, and frequency. Some people are more prone to either mania or depression, while others alternate equally between the two types of episodes. Some have frequent mood disruptions, while others experience only a few over a lifetime.
There are four types of mood episodes in bipolar disorder: mania, hypomania, depression, and mixed episodes. Each type of bipolar disorder mood episode has a unique set of symptoms.
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What Are The Treatments For Bipolar I Disorder
Manic episodes in bipolar I disorder require treatment with drugs, such as mood stabilizers and antipsychotics, and sometimes sedative-hypnotics which include benzodiazepines such as clonazepam or lorazepam .
Mood Stabilizers
Lithium : This simple metal in pill form is especially effective at controlling mania that involves classical euphoria rather than mixtures of mania and depression simultaneously. Lithium has been used for more than 60 years to treat bipolar disorder. Lithium can take weeks to work fully, making it better for maintenance treatment than for sudden manic episodes. Blood levels of lithium as well as tests to measure kidney and thyroid functioning must be monitored to avoid side effects.
Valproate : This antiseizure medication also works to level out moods. It is faster acting than lithium for an acute episode of mania. It is also often used “off label” for prevention of new episodes. As a mood stabilizer that can be used by a “loading dose” method — beginning at a very high dose — valproate allows the possibility of significant improvement in mood as early as four to five days.
Some other antiseizure drugs, notably carbamazepine and lamotrigine , can have value in treating or preventing manias or depressions. Other antiseizure medicines that are less well-established but still sometimes used experimentally for the treatment of bipolar disorder, such as oxcarbazepine .
Antipsychotics
Benzodiazepines