Bipolar psychosis is a severe manifestation of bipolar disorder. It stems from a mix of factors, including genetics, stress, and brain chemistry imbalances.
Diagnosis typically involves evaluating symptoms like mood swings, hallucinations, and delusions. Early detection facilitates timely treatment and improves long-term outcomes for most people.
Below, we discuss the common bipolar psychosis causes along with treatment options.
What Is Bipolar Psychosis?
Bipolar psychosis is a complication of bipolar disorder where a person loses touch with reality. Around 63% of people with bipolar I disorder experience these episodes. However, not everyone with bipolar disorder undergoes psychosis.
Common symptoms include but aren’t limited to the following.
- Hallucinations (seeing or hearing things that aren’t there)
- Disorganized speech
- Delusions (believing in things that aren’t true)
- Racing thoughts
- Lack of awareness about the illness
- Insomnia
- Unusually high energy levels
These symptoms may occur during severe mood episodes, such as depressive or manic episodes.
Bipolar Psychosis Causes
The precise cause of bipolar psychosis remains elusive. However, some studies highlight numerous factors that may contribute to its onset and progression. Below, we explore some primary bipolar psychosis causes.
Genetics
Bipolar disorder, including bipolar psychosis, is believed to run in the family. For instance, if you have a family history of bipolar disorder, you’re at a higher risk of developing this condition.
Research suggests that certain genes may play a role in the development of bipolar disorder (and schizophrenia). However, the exact genetic mechanisms are complex and not fully understood.
Cannabis Use
Marijuana use might worsen the symptoms of bipolar psychosis. A few studies indicate a link between marijuana use and an increased risk of psychotic symptoms. Cannabis contains compounds that can affect neurotransmitter levels and might alter the brain function.
These changes in brain chemistry are often associated with severe mood swings and other psychotic symptoms.
Stress
Environmental factors might also influence the development of bipolar disorder and psychosis. Stressful life events and trauma can disrupt circadian rhythms and are believed to contribute to the onset of mood episodes.
Research indicates that people who undergo traumatic experiences have a higher risk of developing both conditions.
Sleep Deprivation
Sleep deprivation may also be associated with an increased risk of psychosis.
Lack of sleep disrupts the body’s internal clock, known as circadian rhythms. These rhythms help regulate mood and behavior. In individuals with bipolar disorder, disturbances in circadian rhythms can intensify psychotic symptoms. A study, for instance, highlights that severe sleep deprivation might lead to hallucinations and psychosis.
Additionally, sleep deprivation impairs our cognitive function and weakens the brain’s ability to cope with stress. This, in turn, worsens the bipolar symptoms and increases susceptibility to psychosis.
Pregnancy In Women With Bipolar I
For women with bipolar I disorder, the postpartum period can pose significant challenges. The hormonal fluctuations during pregnancy and childbirth can disrupt mood regulations. This may potentially precipitate psychotic episodes.
A National Library of Medicine research mentions that women with bipolar 1 who give birth are at a higher risk of experiencing postpartum psychosis and mania.
Chemical Imbalances In the Brain
Some studies suggest that bipolar disorder might be linked to chemical imbalances in the brain. Neurotransmitters, including dopamine, serotonin, and norepinephrine, play a crucial role in regulating our mood and behavior.
Imbalances in these neurotransmitters are thought to contribute to bipolar disorder and psychotic symptoms.
For instance, boosted levels of dopamine during manic episodes may lead to psychosis. Likewise, serotonin dysregulation may contribute to depressive symptoms.
Co-Occurring Disorders
Bipolar disorder often co-occurs with other mental health conditions. These include:
- Anxiety disorders
- Substance use disorders
- Attention-deficit/hyperactivity disorder (ADHD)
The presence of these comorbid conditions can complicate the clinical picture and increase the risk of psychosis.
Certain Medications
Certain medications, including antidepressants, might also trigger manic or psychotic episodes in individuals with bipolar disorder. Therefore, it is often recommended to take them alongside a mood stabilizer. However, the accurate suggestion varies depending on a patient’s unique symptoms, and it’s best to consult with a doctor concerning that.
Psychotic Bipolar Diagnosis
Bipolar psychosis is typically diagnosed by mental health professionals like psychiatrists and psychologists.
The doctor may talk with the patient about their symptoms, mood swings, and any episodes of psychosis they’ve experienced.
A few psychiatrists prefer using questions or interviews to gather more information about the patient.
During this time, they may review the patient’s medical history, including any family history of mental illness or psychosis episodes.
The doctor then compares the patient’s symptoms to the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This helps them determine if they meet the criteria for psychotic bipolar disorder.
Here’s what the criteria include:
- Bipolar disorder I. Characterized by at least one manic episode, with or without a major depressive episode.
- Bipolar disorder II. Involves at least one hypomanic episode and one major depressive episode, but no full manic episodes.
The psychotic features in this context are specified as a separate specifier. This specifier applies when mood episodes (manic, hypomanic, or depressive) are accompanied by psychotic symptoms such as delusions or hallucinations.
So, for instance, if someone has Bipolar I with psychotic features, the diagnosis would be “Bipolar I Disorder with Psychotic features.”
Likewise, if someone is experiencing Bipolar II Disorder with psychotic features, the diagnosis would be “Bipolar Disorder with Psychotic features,” specifying the current mood state.
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The Role of Neuroimaging & Blood Tests
There is no specific bipolar psychosis test. However, a few doctors may recommend a CT scan or MRI for patients experiencing a sudden mood or behavior change.
This helps ensure that a neurological issue isn’t contributing to the problem. Currently, no imaging study exists to confirm Bipolar Disorder with psychosis in patients.
However, EDIT-B, a valid blood test, helps differentiate bipolar disorder from depression. This has enabled health practitioners to identify the problem, which previously took a decade or so, within a mere 4 weeks.
Besides, certain blood tests can help diagnose around 30% of bipolar disorder cases. In fact, studies highlight that they help “speed up” the process.
The Challenges of Differential Diagnosis
Differential diagnosis is a method used to determine the possible causes of a patient’s symptoms. It may involve considering various potential diagnoses.
This adds another layer of challenge because the symptoms of bipolar psychosis often overlap with other conditions. These may include schizophrenia, schizoaffective disorder, or major depressive disorder with psychotic features. Here’s a quick breakdown.
- Symptom overlap. Many symptoms of disorders mentioned above overlap. These may include delusions, hallucinations, disordered thinking, and mood disturbances. For instance, both bipolar disorder with psychosis and schizophrenia can present with delusions and hallucinations. This makes it difficult to differentiate based solely on symptomatology.
- Response to treatment. Although the response to treatment can sometimes provide clues to the underlying diagnosis, it isn’t always definite. That is, a patient with bipolar disorder may initially show psychotic symptoms during a manic episode but might respond well to mood stabilizers. Contrarily, a patient with schizophrenia may require antipsychotic medication long-term.
- Comorbidity. It isn’t uncommon for individuals to have one or more than one psychiatric disorder concurrently. This further complicates the diagnosis. For instance, someone with bipolar psychosis may also have symptoms of anxiety and substance use disorder, which obscures the primary diagnosis.
The Complexities of Not Using Medication
When individuals with bipolar disorder experience mania, they feel euphoric. This “feel good” episode might make them resist seeking diagnosis or treatment.
Besides, those previously diagnosed may discontinue medications, especially if they feel well during a manic episode. This can result in further avoidance of seeking help and might exacerbate the symptoms.
The Impact of Antidepressants on Psychological Health
If someone with depression who hasn’t been diagnosed with bipolar takes antidepressants, it could be risky. That’s because in case they have underlying characteristics that make them prone to bipolar disorders, certain antidepressants might induce a manic episode.
Early Warning Signs for Diagnosis
Identifying early warning signs can help with the management of symptoms. Here are a few initial signs doctors often consider when diagnosing the problem.
- Mood changes. Sudden mood changes, marked by intense highs and extreme lows, are the primary features of bipolar disorder.
- Irritability. An increased irritability to stressors can be a precursor to bipolar psychosis. This may manifest in the form of anger or impatience.
- Social isolation. A preference for solitude may indicate the onset of bipolar psychosis. Individuals experiencing this condition want to isolate themselves due to fear or paranoia in social settings.
- Confusion. An early warning sign also includes difficulty concentrating and following conversations. Individuals may find it challenging to process information accurately.
When Should You Get Help
If you or someone you know experiences unusual mood changes, mania, or depression, it’s important to seek help. Sometimes, individuals may not recognize the severity of their symptoms or may feel reluctant to reach out due to stigma.
In such cases, friends and loved ones play a vital role in offering support.
Additionally, if someone talks about or attempts suicide, it’s crucial to take immediate action by seeking emergency treatment. This is a sign of distress and requires urgent attention.
Takeaway
Not everyone with bipolar disorder experiences psychosis. However, its occurrence can be disturbing for those who experience it and their loved ones. Fortunately, certain medication and lifestyle changes, guided by a doctor, can improve the outcomes.
FAQs
Q1. How to Help Someone With Bipolar Psychosis?
You can help someone with bipolar psychosis by being supportive and listening without judgment. Encourage them to see a therapist and help them follow their treatment plan.
Q2. Do Bipolar Delusions Go Away?
Yes, proper treatment (including medication and therapy) can help bipolar delusions go away. It’s important to stick to your treatment plan and work closely with healthcare professionals to see positive outcomes.
Q3. What Is the End Stage of Bipolar Psychosis?
The end stage of bipolar psychosis can involve severe symptoms that significantly impact daily life. Besides, a study shows that women with late-stage bipolar had smaller back parts of the brain’s corpus callosum compared to those with early-stage bipolar I disorder. Therefore, a person may experience increased cognitive issues and reduced emotional regulation in the later stage of the condition.
