How Is Bipolar Disorder Diagnosed
To diagnose bipolar disorder, a doctor or other health care provider may:
- Complete a full physical exam.
- Order medical testing to rule out other illnesses.
- Refer the person for an evaluation by a psychiatrist.
A psychiatrist or other mental health professional diagnoses bipolar disorder based on the symptoms, lifetime course, and experiences of the individual. Some people have bipolar disorder for years before it is diagnosed. This may be because:
- Bipolar disorder has symptoms in common with several other mental health disorders. A doctor may think the person has a different disorder, such as schizophrenia or depression.
- Family and friends may notice the symptoms, but not realize that the symptoms are part of a more significant problem.
- People with bipolar disorder often have other health conditions, which can make it hard for doctors to diagnose bipolar disorder.
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.
Psychosis Often Involves A Break From Reality And Can Manifest In Many Different Ways Learn More About The Types Of Psychosis And How Long They Last
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Psychosis can refer to a variety of conditions where a person experiences something that is not happening in reality. They may have a hard time distinguishing between what is happening in their minds and what is real. Psychosis can result in hallucinations, where a person sees, hears, tastes, or feels things that arent actually there. It can also present as delusions, where a person strongly believes something to be true despite it going against what is generally accepted or reality. It can also present as disorganized or confused thinking, speech or behaviors.
The psychosis duration and recovery time will depend on how the person experiences psychosis and what induces the psychotic episode. Psychosis can be brought on by mental health issues such as bipolar disorder or schizophrenia, but it can also be the result of drug use.
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Where Do I Go From Here
In addition to talking to your family doctor, check out the resources below for more information about psychosis:
Early Psychosis Intervention
Early psychosis intervention or EPI programs help people recognize and receive appropriate treatment for psychosis as early as possible. In BC, EPI programs are offered by your local health authority. Visit www.earlypsychosis.ca to find and connect with local programs. You’ll also find more information on psychosis, treatment and recovery, and supports for family and other loved ones.
BC Schizophrenia Society
Visit www.bcss.org or call 1-888-888-0029 or 604-270-7841 for resources and information for family members on schizophrenia and psychosis.
Kelty Mental Health Resource Centre
Visit www.keltymentalhealth.ca or call 1-800-665-1822 or 604-875-2084 for information, referrals and support for children, youth and their families in all areas of mental health and addictions, including psychosis.
BC Partners for Mental Health and Substance Use Information
Visit www.heretohelp.bc.ca for info sheets, workbooks and personal stories about psychosis. You’ll find more information, tips and self-tests to help you understand many different mental health problems. You’ll also find resources in our Q& A section on what to do if a person in your life who might be experiencing psychosis refuses help.
About the author
What Causes A Psychotic Disorder
For every potential cause of these disorders, its easy to find a passionate defender of a theory supporting it. Twin studies suggest that at least a susceptibility to psychosis may be hereditary, while the experiences with organic, postpartum and drug-induced psychosis point to a potentially identifiable cause or trigger that will set the disorder in motion. Research into what causes a psychotic disorder is ongoing.
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Psychosis And The Bipolar Mind
When I was first diagnosed with bipolar disorder, I was not familiar with the term psychosis or psychotic break. My guess is that my doctors did not want to explain it to me while I was full-blown manic and right in the middle of a psychotic break.
How can you tell someone who has lost touch with reality that what they are experiencing is, in fact, not real? It is impossible to explain away a hallucination or delusion to someone experiencing them. At least, that has been my experience.
In hindsight, this all makes sense.
Bipolar 1 Disorder With Mood
Around 50% of patients with bipolar 1 disorder will exhibit mood-congruent psychotic features.
Individuals who have mood-congruent psychosis will have hallucinations and delusions that are consistent with their current mood.
For instance, a patient going through a manic episode might believe that they are friends with the Queen of England and have had tea with her on many occasions when they clearly have not.
On the other hand, the patient might experience deep feelings of guilt over something that was completely out of their control when they are going through the depressive phase.
Doctors and researchers are still not sure what causes these psychotic features.
You can take a look at the DSM 5 Guided Film Preview Bipolar I Disorder with Mood-Congruent Psychotic Features to get an up close look of how Bipolar 1 disorder presents itself in a patient.
If youre interested in more DSM 5 Guided Film Previews, Symptom Media provides a free trial that you can redeem now.
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Psychosis During A Bipolar Mood Episode Can Look A Lot Like The Psychotic Episode Of Someone Who Has Schizophrenia
If a doctor saw a new patient in the middle of a manic or depressive episode with psychosis, without any knowledge of their medical history, it would be extremely difficult to tell whether they were looking at somebody with bipolar disorder or schizophrenia, Dr. Malaspina explains. Indeed, people with bipolar disorder who experience psychosis are sometimes misdiagnosed with schizophrenia, according to the NIMH. This is why its important to get a full medical history and observe the patient over time.
How Long Can Bipolar Mood Episodes Last
Thereâs no hard-and-fast rule about how long bipolar mood episodes last. Often, Dr. Potash says, people experience major depressive symptoms for several weeks or months, then move into a period of mania or hypomania for several weeks or months. âItâs typically a slow change process,â he says.
Some people with bipolar disorder experience rapid cycling, in which they shift from high to low mood quickly over the course of days or even hours. According to Dr. Elmashat, rapid cycling involves one episode of either depression or mania or hypomania four times in 12 months, and it can occur in both bipolar 1 and bipolar 2. Most often, Dr. Potash says, rapid cycling with bipolar affects younger people, like teenagers, and it requires more intensive treatment than typical mood cycling.
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What Are The Triggers Of Manic Episodes
Manic episode triggers are unique to each person. Youll have to become a bit of a detective and monitor your mood and start to track how you feel before an episode and when it occurs. Ask family and close friends who you trust and have close contact with to help identify your triggers. As outside observers, they may notice changes from your usual behavior more easily than you do.
Knowing your triggers can help you prepare for an episode, lessen the effect of an episode or prevent it from happening at all.
Common triggers to be aware of include:
- A highly stimulating situation or environment .
- A major life change .
- Lack of sleep.
- Substance use, such as recreational drugs or alcohol.
Risk Factors For Bipolar 1 Disorder
Bipolar disorder is more common in high-income countries than in low-income ones.
Research shows that the chances of bipolar 1 disorder increase by 10-fold if there is a family history of the illness.
Those chances increase further with closer relationships. For instance, if a biological mother or father had bipolar 1 disorder then the chances of getting diagnosed with the disorder are higher.
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Can Psychosis Go Away On Its Own
If the psychosis is a one-time event, such as with brief psychotic disorder, or substance-induced psychosis, it may go away on its own. However, if the psychosis is a result of an underlying mental health disorder, it is unlikely the psychosis will go away naturally. Studies have found that shortening the time between the first psychotic episode and when a person receives treatment can help improve their overall success with treatment. The length of time for psychosis to go away following the start of treatment can also be shortened by seeking treatment early after symptoms start to occur.
The Second Phase Is The Acute Phase
This is the stage when characteristic psychotic symptoms such as hallucinations, delusions and very odd or disorganized speech or behaviours emerge and are most noticeable. The experiences are often very distressing for the person. It is during this phase when appropriate treatment for psychosis needs to be started as soon as possible.
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The Third Phase Is Recovery
Within a few weeks or months of starting treatment, most people begin to recover. Many of the symptoms get less intense or disappear, and people are generally better able to cope with daily life. Some of the symptoms that emerged in the Acute Phase may linger in the Recovery Phase, but with appropriate treatments, the vast majority of people successfully recover from their first episode of psychosis.
Antipsychotic Drug Addiction Dependence And Withdrawal
Since the drugs that are used in the treatment of psychosis typically dont produce a high, they are generally not considered addictive. Antipsychotic drug addiction is therefore quite rare.
Questions of psychological dependence aside, it is possible to become physiologically dependent on some antipsychotic drugs. Dependence and withdrawal are always potentially hazardous and should only be undertaken under the supervision of a licensed medical practitioner. For help in finding resources in your area, please call .
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How Do I Get Help If I Am Experiencing Psychosis
You may decide to get help for your experiences. You can get help from:
- The NHS
- Self help
How can the NHS help me?
You can speak to your GP about your concerns. They will be able to talk to you about treatment options and coping strategies. You dont have to do what your GP thinks that you should do. But you should listen to them. Make sure that you understand the pros and cons of your treatment options before you make a decision.
Your GP should not give you antipsychotic medication without first talking to a psychiatrist.
Your GP should refer you to a secondary mental health team if this is the first time that you have experienced psychosis and asked for help. You should be assessed quickly. A secondary mental health team will usually be called the:
- early intervention team
- community mental health team , or
- crisis team.
You or your carer should be able to make a self-referral to a secondary mental health team if this is the first time that you have experienced psychosis.
EITs specialise in helping people who experience psychosis for the first time. But they arent available in all areas of England. To find your local secondary mental health team you can try the following.
- You can ask your GP for their details.
- You can call NHS 111.
- Use an internet search engine. Use a term like community mental health team in Cheshire or early intervention in psychosis Camden.
There is more information about this in the section below.
It could also include:
- Turning Point.
Outlook For Postpartum Psychosis
The most acute symptoms of postpartum psychosis can last anywhere from two to 12 weeks. Some women may need longer to recover, from six to 12 months. Even after the major psychosis symptoms go away, women may have feelings of depression and/or anxiety. Its important to stay on any prescribed medications and seek continued treatment and support for these symptoms.
Women who are breast-feeding their infants should ask their doctor about safety. Many medications used to treat postpartum psychosis are passed through breast milk.
This statistic shouldnt keep you from having another baby, but it is something to keep in mind as you prepare for delivery. Sometimes a doctor will prescribe a mood stabilizer like lithium for a woman to take after giving birth. This could potentially prevent postpartum psychosis.
Having an episode of postpartum psychosis doesnt necessarily mean youll have future episodes of psychosis or depression. But it does mean its important for you to know the symptoms and where to seek medical attention if your symptoms do start to return.
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Icipating In Clinical Research
Clinical research is medical research that involves people like you. People volunteer to participate in carefully conducted investigations that ultimately uncover better ways to treat, prevent, diagnose, and understand human disease. Clinical research includes trials that test new treatments and therapies as well as long-term natural history studies, which provide valuable information about how disease and health progress.
Please Note: Decisions about participating in a clinical trial and determining which ones are best suited for you are best made in collaboration with your licensed health professional.
Longitudinal Course Of The Illness
Four years postpartum, women were re-evaluated using the SCID . Women were not seen in between hospital discharge and follow-up for the purposes of this study. Recurrence was defined as the occurrence of any depression, mania, psychosis or mixed state episode fulfilling DSM-IV criteria, admission to hospital or a restart of medication. All women with a recurrence were asked retrospectively about the timing of their episode, including whether this was in relation to a subsequent pregnancy. Additionally, we collected information on the timing of tapering or stopping medication if applicable. The patients medical records were consulted to validate the information.
Based on information collected at follow-up, women were categorized into one of two groups: women with recurrence of non-postpartum mood or psychotic episodes within the follow-up period, or women with mania/psychosis in the postpartum period and no mood or psychotic episodes outside the postpartum period during follow-up .
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Residential Rehab For Drug Addiction
If you or a loved one is experiencing drug-induced psychosis, immediate hospitalization or medical detox is necessary. If and when youre ready to commit to recovery, getting treatment at a residential rehab center is often the first step.
Inpatient rehab is most often the ideal treatment situation for individuals who have experienced drug-induced psychosis because it provides intensive, individualized care in a safe environment. Clients also receive this care from a team of addiction treatment experts that collaborate and work together to treat each clients substance use disorder, psychosis, and mental health issues.
Residential rehab for drug addiction provides several unique benefits for those who have underlying mental health issues, such as:
- A secure and substance-free living environment
- Round-the-clock medical care
- Access to a variety of different therapies and holistic treatment methods for addiction
- Professional referrals and planning for ongoing care after rehab is over
Research shows that substance abuse increases the risk that you may experience certain psychotic conditions. Since relapse and continued substance abuse could potentially cause another psychotic episode or trigger mental health issues, the best way to reduce that vulnerability is to get treatment right away.
When youre ready to get help, call 605-2955 for more information. A Nova admissions representative is waiting to take your call.
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How To Treat Psychosis
Another stereotype about psychosis? That it isnt treatablewhich is completely untrue, Kopelovich stresses. Despite this fact, some people who experience symptoms of psychosis are regarded as though they are doomed.
There are still people who go to inpatient care for a first episode of psychosis and are told theyre never going to work again and should go on disability because stress exacerbates psychosisinstead of being taught how to cope with stress, she says.
People can successfully manage psychosis using a combination of strategies and interventions, including early intervention , medications, cognitive behavioral therapy or other types of psychotherapy, academic or vocational services that help people stay in school or work, and support from family and friends.
For people who dont have schizophrenia, psychosis may last only a few days. If it was caused by alcohol or a drug, it will fade once the substance leaves their system, and if it was caused by an acute medical condition like high fever, it will fade once the condition is resolved.
Longer-term psychosis is best treated as soon as possible, since the longer someone has to deal with the stress and uncertainty of the illness, the greater the risk that their lives will be seriously impacted.
CBT also helps people improve social and problem-solving skills, things that can become impaired due to psychosis, she says.
Emotional Symptoms Of Neurological Problems
The emotional symptoms of neurological problems such as organic psychosis are usually regarded as a combination of disturbed emotions caused by the illness itself, such as uncontrollable anger or paranoia, and the secondary symptoms associated with having a mental disorder, such as depression and thoughts of suicide.