What is Bipolar Psychosis? Know its Causes, Treatment, Prognosis

Facts and figures regarding bipolar psychosis are often misunderstood and hence, the illness remains under reported until it’s too late. There are many people who are unaware of the situations where psychosis co-exists with manic and depressive episodes of bipolar disorder.

While manic and depressed moods have been observed constantly throughout human history, it was not until the mid-19th century when the researchers started to put together the bipolar puzzle. Jules Baillarger, a French neurologist, described a biphasic mental illness that saw sufferers move between periods of mania and depression; he called this condition folie à double forme or dual form insanity. Meanwhile in Germany, Emil Kraepelin coined the term ‘Manic Depressive Psychosis’, describing how untreated bipolar patients displayed periods of acute depression or mania, followed by periods of mostly symptom free normality. It wasn’t until the 1950s, when German psychiatrists Karl Kleist and Karl Leonhard, coined the term ‘Bipolar’ as a sub-classification of manic-depressive reactions. Bipolar Psychosis is a condition wherein a person experiences symptoms of bipolar disorder such as extreme mood swings along with psychotic symptoms such as hallucinations and delusions during the episodes. Carl Jung differentiated between bipolar disorder with psychosis and without psychosis.

Bipolar disorder is a mental disorder where an individual suffers extreme mood changes between mania and depression. The mood swings can last from a few days to weeks or even months. An episode of mania is characterized by extreme happiness, euphoria, being “on top of the world”, racing thoughts, hyperactivity, and reduced need for sleep, which may sometimes result in rapid speech. An episode of depression is characterized by sadness, lack of energy to do things, losing interest in things, inability to enjoy, feeling helpless and hopeless. People lose on their sleep, weight and appetite. They have trouble concentrating and often have suicidal thoughts. Psychosis is a distorted or nonexistent connection with reality. It is a mental health problem where people lose their ability to distinguish reality from unreality. They interpret or perceive things differently from what exists around them. This involves hallucinations or delusions. This results in paranoia, visual hallucinations and false beliefs in super powers or identity. There are many factors that lead to psychosis, the most common being alcohol or drug abuse, and Parkinson’s disease.

Bipolar psychosis is a condition where an individual with bipolar disorder experiences psychosis. The individual’s thinking is affected along with mood. A characteristic feature of bipolar psychosis is that people lose contact with reality, and subsequently fall into severe depression. Unlike schizophrenic psychosis, bipolar psychosis is more transitory and evanescent. People with bipolar psychosis tend to exhibit extreme or even inappropriate degree of sharing, luck, sense of connection or intimacy. These inflated beliefs can be dangerous and may lead to reckless behavior. The common forms of bipolar hallucinations are visual and auditory. They can lead to delusional beliefs which are often mystical or religious in nature. For example, “seeing the face of God” or having a special connection with the universe. Some people also experience sensory perceptions such as colors being brighter and music being more influential and meaningful etc. Even though these sentiments and these expressions are not negative, they may rise to a point of extremity and must be contained and controlled.

A number of factors are believed to cause bipolar psychosis:

• Genetic Factors Causing Bipolar Psychosis: Genetic factors account for approximately 80% of the cause of bipolar psychosis. There are 10% chances that if one of the parents has bipolar disorder, the child will develop the illness; if both the parents have bipolar disorder, the chances increase to 40%.
• Brain Chemicals Responsible for Bipolar Psychosis Onset: Serotonin, dopamine and the other neurotransmitters when present abnormally in the brain strongly affect the person’s mood and could be responsible for the onset of bipolar psychosis.
• Environmental Factors as a Cause of Bipolar Psychosis: Stress causes emotional pressure that increases the chances of having manic or depressive episodes.
• Medical Illness as a Predisposing Factor for Bipolar Psychosis: Some medical conditions such as HIV/AIDS, malaria, Syphilis, Alzheimer’s disease, Lyme’s disease, brain tumor can increase chances of lowered self-esteem in turn leading to depression. The low mood and mood swings can lead to bipolar psychosis if the genetic and other factors are also present.
• Substances Use as a Cause of Bipolar Psychosis: Misuse of substances and drugs can trigger a psychotic attack. Drug withdrawal also leads to such episodes. Some of the substances frequently abused by people which are responsible for the onset of bipolar psychotic symptoms are alcohol, amphetamine, methamphetamine, ecstasy, cannabis, LSD (acid), psilocybins (magic mushrooms) and ketamine. Under rarer circumstances, episodes may occur as a side effect of another type of medication.
• Physical illness
• Trauma
• Brain injury or brain infection.

The signs and symptoms of bipolar psychosis include:

• Loss of contact with reality
• Hallucinations (sensory)
• Delusions (false beliefs that they think are true)
• Paranoia
• Anxiety attacks
• Confusion and disturbed thoughts
• Lack of insight and awareness
• Feel “up” or “high”
• Have trouble sleeping
• Become more active than usual
• Talk and think fast
• Thoughts of multitasking and not finishing even one
• Irregular sleep cycle
• Agitation
• Forgetfulness
• Suicidal thoughts.

It is estimated that 1 in every 200 people experience psychosis. While bipolar psychosis is common in bipolar mania, it is reported that the condition is recurrent. 90% of the individuals, who have had a single episode of mania, are bound to experience similar episodes in the future. 70% of the manic episodes occur immediately before or after a depressive episode. 50% of the people with bipolar depression experience bipolar psychosis.

The individuals suffering from bipolar psychosis experience cycles of extreme mood swings throughout their lives and symptoms worsen over time, particularly when they do not seek treatment. Individuals with bipolar psychosis may require more intense intervention. Once a person has experienced psychotic symptoms, it is likely that he or she will have similar episodes in the future.

Identifying the early signs and receiving early treatment is essential for managing bipolar psychosis. In most cases, a phase of depression occurs before mania. It is necessary to identify and cure the depression before it transitions into an episode of mania.

The general practitioner or a psychiatrist generally conducts an assessment to check if they have bipolar psychosis.

While the symptoms of bipolar psychosis can be managed, it is very important to follow up closely to avoid another episode. Studies suggest that the earlier bipolar psychosis is treated, the better the long-term results tend to be.

• In short term, medicines are prescribed to treat the symptoms of bipolar psychosis. A combination of antipsychotic medicines and psychological therapies are used as a first line treatment to treat bipolar psychosis.
• Counseling, behavioral therapy, family therapy, self-help groups can reduce the anxiety and the intensity that is caused by bipolar psychosis.
• An advance conscious decision of taking measures to avoid the possibility of another episode.
• Electroconvulsive therapy or the “shock therapy” provides a quick response to patients suffering from bipolar psychosis.
• Psycho-education of the bipolar psychosis patient and the family members is also important in the treatment process.
• In advanced cases, in-patient treatment might also be required for a brief time period to treat bipolar psychosis.

It is not always possible to prevent bipolar psychosis as they can be a combination of biological, environmental, and physiological factors. However, it can be prevented by avoiding the use of recreational drugs, avoiding stressful conditions and hence avoiding depression, trying to think optimistically and using a problem solving approach to deal with worries, exercising, yoga and meditation, avoid smoking and abuse of alcohol.

Bipolar psychosis individual will forever be afraid of having a normal life if he or she experiences continuous cycles of strong emotions. The thought of these strong emotions are beyond control. Friends, co-workers, and family may sometimes help in intervening the symptoms or the illness altogether. It is very important to keep a close eye on their interests and health especially during bipolar psychosis episodes. It can be challenging if left untreated. Most of the individuals who suffer from bipolar psychosis undergo proper medical treatment and recover partially or fully from this disease; however it is also extremely important to avoid conditions that can cause the illness and be free from any form of mental illness.