Treatment of bipolar psychosis entails the use of bipolar medications including antipsychotic medication.

Bipolar psychosis treatment is complicated due to the presence of mania and depression. Luckily, the medications used to treat mania and depression can often end and prevent the psychosis as well. But not always! Which is why many people with bipolar disorder take antipsychotics along with other bipolar medications. (The term neuroleptics is sometimes used in place of antipsychotics.) Before I go into the antipsychotic medication category, here is a recap of the medications used to treat bipolar disorder and whether they affect psychosis. 

Lithium: A naturally occurring salt primarily used to treat bipolar mania - though it can help with depression symptoms as well. This is the only true 'mood stabilizer.' Considering that psychosis is always attached to either mania or depression, it makes sense that using Lithium to manage the mania can also prevent psychosis. The problem is that the side-effects can be very intense at the high doses needed to manage psychotic mania.

Anticonvulsants: Depakote (Divalproex), Tegretol (carbamazepine) and Lamictal (lamotrigine). These drugs are used to regulate moods, but as they were originally created to treat epilepsy, they are not classified as mood stabilizers. Like Lithium, the anticonvulsants Depakote and Tegretol are mainly anti-mania drugs. When they successfully manage mania, possible psychosis can be managed as well. Lamictal is used to treat bipolar depression. I have found that Lamictal also greatly helps with my psychosis and rapid cycling although it is not usually prescribed for psychosis.

Though the above drugs are not classified as antipsychotics, they actually do help treat psychotic symptoms by managing the mania and depression. Because of this, they are the first line of treatment for managing bipolar disorder. The less medications the person can take, the better. When these drugs work successfully, antipsychotics are not as needed.

Unfortunately, these medications do not always work as well as one would hope and the bipolar psychosis needs separate treatment with antipsychotics. These medications are often very effective, but as with many drugs, they can come with some very strong side-effects. It's always important to remember that the medication treatment of bipolar disorder is chemotherapy. This means that the drugs can help immensely, but there is always a trade-off in terms of bipolar medication side effects.

Details on the causes of psychosis and medications for the treatment of bipolar psychosis.

Causes of Psychosis

What happens in the brain to cause psychosis? This is a complicated question, with few clear cut answers. The basics are understood at least. John Preston, Psy.D., a board-certified neuropsychologist and co-author of my books on bipolar disorder and depression, notes:

"The jury is still out on the causes of psychosis. It is very likely caused by a problem with various neurochemicals. We do know for sure the most likely neurochemical is dopamine, as antipsychotics that effectively decrease psychotic symptoms work on the dopamine system. We also know that other substances that affect dopamine, such as cocaine, can cause psychosis. But most researchers still believe there are other chemicals involved."

Dopamine is one of the neurotransmitters, along with serotonin and norepinephrine, that are closely linked to bipolar disorder.

Bipolar Psychosis and the Brain

It's impossible to separate the physical brain from the neurochemicals in the brain, but there are actually structural differences in the brain of people who experience psychosis. There can be a chronic shut down of the frontal lobes and there is a particular part of the limbic system called the septal area, where the dopamine system is especially hyperactive. Antipsychotic medications work by blocking dopamine in this area. The limbic system, the emotional part of the brain, is also central to the causes and ultimately treatment of bipolar psychosis. Brain research into this area is vital as new medications and other treatments are based on new research. In other words, if we do find out exactly where psychosis resides in the brain and specifically what chemicals are affected, medications can be much more targeted.

Psychotic thoughts and paranoid delusions are part of the bipolar psychosis experience. Read more on why bipolar psychosis is so scary to those who suffer from it.

I think it's easier to understand and accept euphoric psychosis than dysphoric psychosis ("Types of Mania"). We all desire the feeling that we are perfect and invincible. A sense of profound well-being is craved by so many of us with bipolar disorder. But when it comes to dysphoric psychosis, the feelings are so uncomfortable and the thoughts and images so awful, it's just downright scary. Psychosis can make a person think the most awful, disgusting, shameful and embarrassing sexual, racial and violent thoughts. As terrible as this is, it's normal.

Psychotic Thoughts

When I get psychotic, I see myself burning alive over a raging fire in a bottomless cave filled with bats.

My psychosis is so scary. I am sure people are following me so that they can kill me. I feel the world is out to get me- and I mean that literally. I am scared of everyone. I hear voices chattering in my head from people who are going to kill me. I feel like there is a gun on me at every location. I almost throw up with fear.

My body is so uncomfortable when I'm psychotic I feel like I'm literally going to explode from the inside.

I thought of raping every woman I saw. I visualized it. I was just well enough at first to be unbelievably ashamed and truly mortified by my thoughts. They were not me. I thought the people around me could hear them. When I got really sick, the thoughts were so much worse. I never acted on them, but I thought them and said them out loud- thank god I was alone when I did.

I said terribly racist things to the staff at the hospital depending on their ethnicity.

Paranoid Delusions: They Want to Kill Me

I spent quite a while talking with a board-certified neuropsychologist and co-author of my books, John Preston, Psy.D., about this topic. I think his words explain it best:

"Paranoid delusions are a huge part of psychosis. With this delusion, the thoughts and experiences are all about feeling vulnerable and out-of-control. People, in this state, fear getting hurt to an unrealistic degree. They may think that people are spying on them in order to kill them. People with depression can suffer horribly, but it's an internal feeling of worthlessness and hopelessness. This is scary, but not to the point of truly feeling persecuted such as when a person says, 'Satan is going to poison me and everyone I know because I'm a horrible person.' So yes, bipolar psychosis can be mean and scary to many people and it's due to these feelings of persecution and fear of society."

Other psychotic episodes involve a complete change in the way a person thinks, talks and behaves. Such as being derogatory towards women when you have always been extremely respectful or saying something extremely hurtful to the person you love. This can also been seen when a person makes extremely suggestive sexual comments in front of their family members or coworkers.

Ivan's Story

As I mentioned at the beginning of the article, my partner Ivan went through a very long and serious manic psychotic episode in 1994. I wrote about his behavior and what he said every day when I got home from the psych ward. Now that you have quite a background in psychosis, you will probably be able to see all of the different symptoms present in the following examples from my journals.

April 30, 1994

He's worse today. Worse. I guess I prepared myself, but it's never enough. Ivan is in his hospital bed. He just looked at me and said, "Nice body!" We had this conversation:

"Julie, they need to stop the Nazi machine." I said, "There is no Nazi machine, Ivan." He winks at me and I wink back. He says, "Do you know what perjury means?" I say, "No. What does it mean." I want to see what he says. He replies, "Just wait a minute. Let me eat my salad." He leans over to shake my hand in a very serious way. He says, "No one needs to shake my hand behind my back. Perjury means when you swear something you do not believe."

Though it was 15 years ago, I remember being in the hospital when Ivan talked this way. The person I knew was basically gone and this person who said these crazy and amazing things was there for months. This is an example of the more euphoric mania side of his psychosis, as he was smiling and seemed pretty happy when he did all of this. When he had the dysphoric mania, he was very, very concerned for my health and believed that people were out to kill me:

I'm at the hospital in Ivan's room. When I got back from the bathroom, Ivan said, "Baby, did they torture you?" He's very, very suspicious. He said, "I feel scary." I said, "Do you mean scary or scared?" He said, "Both." He wants to read what I'm writing. He's about the same as yesterday. He is sitting cross-legged on the bed. His hair looks pretty and he looks handsome. He's very paranoid. He said," Did you see a man called Ross Perot?"

These days were harder as he was so incredibly suspicious and looked at me in a scary way. At one point, he took his pajama top and wrapped it around his head like a turban. He believed he was Jesus Christ. When he was better, I asked him what he was thinking at the time:

I remember that I was Jesus Christ. I did not want to see the misery inflicted on the world so I put my pajama top over my eyes. I thought that I was responsible for the death of many people. For the things I said. A lot of people shot themselves. I moved the fabric back on my head because I was tired of not being able to see.

Psychosis and Culture

Ivan was often very funny during euphoric phases in the hospital and the things he said were beyond anything I had ever experienced in my life- but he was truly distraught most of the time. If you or someone you care about has been in a full-blown manic psychotic state, this may sound quite familiar! This is why I always tell people that psychosis is an illness and nothing personal. In fact, all psychotic behavior is the same; it's simply the context that is different. This is almost always based on the culture of the person who is psychotic.

Dr. Preston puts it this way:

"Psychotic symptoms are the result of abnormal neurochemistry, but the content of hallucinations and delusions incorporate figures and themes such as Jesus or Chairman Mao that are understood in a cultural context. For example, a person in Saudi Arabia may have delusions about Mohammed. People often draw from images of power and authority whether they are euphoric or dysphoric. Euphoric visions of grandeur could be about Napoleon or the president or even a famous movie actor. I remember for a while after Elvis died that for about five years people thought they were Elvis or that Elvis spoke to them, but then that ended. Jesus, of course, has been a constant. I guess how enduring a person is as a character in a delusion is a testament to the impact they had on the world."

Interestingly, when Ivan was psychotic, he constantly mentioned Freemasons. I had never heard him say the word before, much less obsess about it. When his psychosis was over, we were both fascinated. He was born in Scotland, the origination of the Freemasons. His culture was deeply ingrained and the psychosis brought it out in an odd way.

The difference between suicidal thoughts from depression and psychotic suicidal thoughts from bipolar psychosis, psychotic bipolar depression.

This is an area where it's very hard to tell the difference between suicidal thoughts and psychotic suicidal thoughts. Suicidal thoughts of wanting to die and then the thoughts of how you are going to do it would certainly meet my idea of bizarre, but within the psychotic realm they are not considered bizarre as they are coming from the normal feelings of helplessness and worthlessness associated with suicidal depression.

These thoughts tend to repeat themselves over-and-over and can last for days and even months, but there are no voices or visions from the outside that would indicate hallucinations- nor are there signs of delusions as the feelings are not false- they fit the mood. Once again, this is part of the bipolar psychosis continuum. Suicidal thoughts are on the left of the gray area.

Psychotic Thoughts: Voices Are Telling Me to Kill Myself

When a person starts hearing voices telling them to kill themselves or believes that the government is plotting to make them commit suicide, the person has crossed over into psychosis.

I have been suicidal, off and on, with psychotic thoughts for all of my adult life. My experience of suicide is psychotic because I hear voices such as, "You don't belong here. You need to get out of here. You should be dead." I see myself get killed by cars and mauled by dogs. This is quite different than the intense pain, shame, hopelessness, and fear that can come with suicidal depression. When the "I" becomes the "you," it's often the point that bipolar depression becomes psychotic bipolar depression. And, as I mentioned earlier in the article, my hallucination in the car where I thought I had cut my wrists was very vivid and completely bizarre as it's pretty impossible to cut your wrists while you're driving and not remember it, no matter how depressed you may be!

Here is a recap of bipolar depression with psychosis:

• Though the thoughts with depression are very uncomfortable and often scary, they are not psychotic in that they match the mood and make sense in terms of your current feelings.
• It is more common to have psychosis with depression that is combined with mania (a dysphoric mania or mixed episode) than isolated psychotic depression.
• Depressed psychotic symptoms often have hallucinations and delusions around the concepts of decay, disease, and death. These symptoms are very mood congruent.

Psychotic thoughts can be associated with bipolar depression. Here's an explanation of bipolar depression with psychosis, plus examples.

Mild to moderate psychosis- the kind that resides on the gray area and just on the other side of the continuum is common with depression. I've had this type of psychosis, on and off, for my entire adult life ever since seeing myself get killed by a bus after breaking up with my first boyfriend at age 19. Paranoid ideas and possibly delusions, such as thinking people are talking about you behind your back, are quite common with depression as well. Full-blown psychosis can be seen with very severe depression.

Depression can lead to such destructive, mean, intrusive, scary and ultimately dangerous thoughts that it's easy to confuse these thoughts with psychosis. A person with depression can think and believe the following things:

I wish I were dead and buried under the ground and trucks would run over my grave every day.

Life is a waste. I'm a waste. I'm the lowest, most disgusting, nasty, unloved creature on the earth. I'm putrid with my disgusting thoughts and face.

If I took that knife and stuck it in my heart, I would not be missed and the world would be a better place.

But this is not psychosis. These are feelings and thoughts fueled by profound unhappiness and self-loathing and disgust. They are scary and outside of the norm, but they are mood congruent. In other words, the person really does feel this bad and their thoughts are a reflection of their mood.

When a person in a depression mood swing moves into psychosis, the thoughts are similar to those above, but they become bizarre:

I am dead. My body has rotted and I am the only one who can see this. I must cut out the dead parts of my body so it doesn't spread. I have the plague.

There is a demon inside of me that will kill my family if I let him out. I am never going to leave my room so that no one will get killed. The demon talks to me when the lights are out and there is no one to protect me.

Interestingly, the above thoughts are psychotic, but they are easy to follow. Board-certified neuropsychologist, John Preston, Psy.D. explains, "You can have severe psychotic symptoms with depression, but you don't have the gross disorganization of thinking you can see with severe manic or dysphoric manic psychosis. Despite their very odd and unreasonable thoughts and actions, people with psychotic depression usually have logical sentence structure and can answer questions in a realistic way that makes grammatical sense. Depressed people are reclusive and there are behavioral changes, but they are not bizarre."

Symptoms of psychotic mania and full-blown mania are similar, but there's one important distinction between the two. Find out what it is.

Psychotic mania and full-blown mania can look so similar. When someone thinks they are such a genius at picking stocks that they open their own firm in a week and bring along a lot of new employees on the adventure until they crash, this is certainly very odd behavior. However, even if the behavior is completely out of character, it's not bizarre. Psychosis is bizarre. Here is how board certified neuropsychologist, John Preston, Psy.D. describes the difference:

"People who are really manic have reckless and very impaired judgment. They will drive at 150 miles an hour and truly believe they are invincible. But when you ask them, hey, so you think that's safe? They may say, "It's probably not safe for others, but it's fine for me! It feels goooooood!" This is dangerous and impulsive, but not bizarre. Now, if that same person believed they were a superhero who could stand in front of a car going 150 miles an hour and not get killed because they are invisible, that is psychosis because it's a bizarre delusion. A person with full-blown mania may think they can fly, but they have a realization that it might kill them. A person with full-blown manic psychosis will falsely believe they can fly and may jump off a building."

Full-blown Mania vs Mania with Psychosis:

Here is an example of the difference between the two:

Full-blown Mania

I thought I was the gift of god. That I could do anything. I could beat anyone at anything. I decided to go from New York to LA and be a movie star. I went to a modeling agency and got a contract and I'm 5'1"! I felt beautiful and people thought I was beautiful. It was like they fed off my energy. I drove around on a little scooter I bought that was too dangerous- but I felt wild and free! I slept with three men... at once. No one could tell this was not the real me. I felt it, so they felt it! I was pretty hot stuff!

Sherri, 45

Mania with Psychosis

In 1997, I received a message from God that said I needed to go to Honduras and feed the poor. I heard His voice. I needed a lot of money. I decided to pray all night every night to get the money. I read the Bible and felt God was giving me clues on every page. It wasn't hard to stay up. I just wasn't tired, but I was very physically uncomfortable. I went outside with a bowl and asked for money. My parents were extremely upset, but I believed in what I was doing. I had this idea that I was going to save orphans just like Mother Theresa. It never entered my mind that I had zero training, no money, didn't speak the language and had never traveled outside of the US. But I kept seeing myself as a savior. I soon stopped eating and wanted to get as thin as possible to show my worthiness. I lost 40 pounds. I heard God all of the time. I was finally committed on a 72-hour hold by my parents.

Mark, 53

Psychotic mania has poor judgment with impaired thought processes. Sherri functioned in society even when she was phenomenally manic and making dangerous decisions. She made plenty of normal decisions such as remembering to eat, drive and participate in normal conversations. Mark could not. His ideas were not only out of character, they were bizarre and divorced from reality.

If a healthcare professional asked Sherri and Mark the same question: "I know you're feeling all of this very strongly and that you're confident about your success and most importantly, you don't worry about risk or failure, but is there a chance this is not the smartest thing for you to do? Is there a chance this won't work out?" Sherri would say, "Well, maybe, but I'm the best and I know I can do it. I just won't let anything stop me!" Mark would said, "God talked to me. He sent me a message and I have to do what he says. The children will die if I don't go."

It's also important to note here that Mark is having psychotic delusions and they are bizarre, but unlike in schizophrenia, his speech and actions are coherent enough to seem real; which is why a psychotic episode can go on quite a while before the person becomes ill enough to need hospitalization. Unfortunately, in a case like Mark's, it's often extremely difficult to get the person into the hospital as they feel their actions are 100% normal.

Explanation of the different types of mania and how they relate to bipolar psychosis.

Now that you have some basic information about psychosis, this section of the article will explain how psychosis directly relates to mania and depression. But first, I'd like to recap the different types of bipolar mania as this is what makes bipolar psychosis so complicated and often difficult to treat.

Two Types of Mania: Euphoric and Dysphoric

Here is the lowdown on bipolar disorder mania. There are two main types of bipolar disorder:

• Bipolar I
• Bipolar II

The difference between the two is the severity of the mania. People with Bipolar I have full-blown mania. This is the kind of mania that puts people into the hospital if it's not monitored carefully. People with Bipolar II have hypomania. This is a milder form of mania that can cause significant impairment in judgment, but it never goes over-the-top as it can with the full-blown mania seen in Bipolar I. People with Bipolar I can start with hypomania and then move into full blown mania very, very quickly.

The next thing you need to know is that there are two types of mania:

• Euphoric mania
• Dysphoric mania

I have covered this briefly, but feel it needs a more detailed explanation.

What is Euphoric Mania?

Euphoric mania is just like it sounds- people describe it as wonderful, beautiful, unbelievable, fantastic and expansive. As Teri Cheney, the author of the memoir Manic puts it, "Everything becomes interesting."

Many people with Bipolar II hypomania really enjoy euphoric feelings, but many mistakes can be made when a person feels too good, such as recklessly spending too much money, having sex with anyone who looks appealing, sleeping a lot less and not getting tired and ultimately making very poor life decisions.

Full-blown euphoric mania in Bipolar I is far more dangerous. This mania can become over-the-top grandiose mania where a person believes they are superhuman and the greatest person in their profession. Thoughts such as I'm a genius or I'm a goddess and the most beautiful person in the room can be quite destructive if a person arrogantly acts out these thoughts. It's common for people with full-blown euphoric mania to stay up for weeks, start very risky businesses or simply pick up and leave their current life.

Euphoric mania can be very cruel and selfish as the emphasis is strictly on the person with bipolar. The person can be extremely reckless and unable to judge the safety or effect of their behaviors. This type of mania can lead to a lot of drug and alcohol use as the person feels so good they lose perspective on the amount they consume. Euphoric mania always starts out feeling great, but ultimately the person comes down and often sees a path of destruction that is hard to clean up.

What is Dysphoric Mania?

Dysphoric mania (a combination of mania and agitated depression that is also known as mixed mania) is the opposite of euphoric mania. A person with this mood swing is agitated, uncomfortable, irritated, depressed, pessimistic and filled with negative energy. They don't sleep well, if at all, and ultimately their behaviors are destructive and sometimes life-threatening. Dysphoric mania is especially dangerous due to driving, fighting, and other self-destructive behavior. Dysphoric mania can be mild to moderate (hypomania) or full-blown. I have heard it described as, "It feels like I'm coming out of my skin. My body and mind are in a civil war."

Ultimately, until it goes too far, people with euphoric mania feel PAIN-FREE and GREAT while people with dysphoric mania feel UNCOMFORTABLE and AWFUL.

Are you ready for your test? I'm just joking of course, but there is a reason you need to know this information. Everyone with bipolar disorder has experienced at least one form of the above manias or hypomanias and you need to know what they are like without psychosis before you can understand what they look like when combined with psychosis. As you have read, 70% of people with Bipolar I experience mania with psychotic features. Of that 70%, over half are euphoric manias. These euphoric psychotic manias are particularly difficult to diagnose as they can be so appealing and fun to the people around the manic person! For some reason, crazy behavior can attract people who want to join you for the ride.

Psychosis test to help determine if you have experienced psychotic symptoms.

This psychosis test will provide insight into your question: "Am I psychotic?" Before I delve more deeply into bipolar psychosis and its symptoms, here is a psychosis test to help you see if you, or the person you care about, may have experienced psychosis. So many people with bipolar disorder assume that the illness is basically mania and depression. Because of this, they may live with psychotic symptoms for years and not know what they are!

Psychosis Test: Looking for the Symptoms of Psychosis

Have you ever ....

• Heard a voice calling your name as though it were another person?
• Felt that people were talking about you or that someone was following you- but there was absolutely no proof of this?
• Felt as though your brain were fragmented, scrambled and filled with bits and pieces of conversations, music and odd noises?
• Had trouble looking people in the eye and then felt they were looking at you funny?
• Seen yourself get killed as though you were watching a movie?
• Seen animals running around - such as rats running around a chair?
• Had a strong belief that someone you love is having an affair- with no proof or even a reason to feel that way; maybe even to the point of accusation and private detectives?
• Felt like your brain was not connected to your body?
• Heard your name called on a loudspeaker in a grocery store?
• Felt like you were being tortured by an unseen force that wants you dead?
• Had people point out that what you're experiencing is literally impossible, but no matter what they say, it still feels real to you to the point you think people may be lying to you?
• Felt, said and heard things that are scary, such as a devil in the closet?
• Believed you were a great figure from the past such as Cleopatra?

All of the above symptoms represent either a hallucination or a delusion. These are very common psychosis symptoms that many people with bipolar can experience even on a low level. For others, the symptoms pass from these milder forms to more full-blown symptoms where basic functioning and thinking are impossible. With psychosis, you actually see, hear and feel an experience that isn't there and isn't true. There is no sense of ownership- it feels as though the sights, sounds and feelings come from outside the body- not the normal thinking process.

Learn about the meaning and definition of psychosis, how it relates to bipolar disorder and the difference between bipolar psychosis and schizophrenia psychosis.

Having read the previous page, you may think "but what is bipolar psychosis?" What are bipolar hallucinations and delusions? How does this relate to bipolar disorder? How is it treated? This article will answer these questions, but we have to go one step at a time as psychosis can be quite an intricate puzzle. The word psychosis is a Greek word meaning an abnormal state of the mind. In most textbooks, psychosis is usually defined and described as a loss of contact or a break with reality. Here is how The American Psychiatric Press Textbook of Psychiatry (third edition, 1999) describes psychosis:

There are two classic psychotic symptoms that reflect a patient's confusion about the loss of boundaries between the person and the external world: Hallucinations and delusions. Both symptoms reflect a loss of ego boundaries and the patient is unable to distinguish between his or her own thoughts and perceptions and those that he obtains by observing the external world.

Now, what does that really mean? It means that people with psychosis experience hallucinations where they see, smell, taste, feel or hear something that is not there. They also have false and often bizarre beliefs about themselves and the world around them called delusions. Once you understand the characteristics of hallucinations and delusions, you can understand psychosis. You also might be surprised to find that you or someone you care about has experienced hallucinations and or delusions and not known it!

How is Bipolar Psychosis Different from Schizophrenia Psychosis?

To get started, it helps to understand how and why the psychosis experienced with bipolar disorder (a mood disorder) is different from the more classic symptoms seen in psychotic disorders such as schizophrenia. The psychotic symptoms in each illness mimic each other, especially when a person is in a full-blown manic psychotic episode. But there is one main difference: Schizophrenic psychosis is far more 'grossly disorganized' than often seen with bipolar disorder. In other words, the person with schizophrenia often has confused thought processes regarding everyday activities that are a direct result of psychosis. Though people with bipolar psychosis can reach this level where their psychosis mimics schizophrenia psychosis, it's also possible for their psychotic symptoms to be more in touch with the world around them without such a strong effect on behavior.

Dr. Preston explains it this way:

"I had a patient with depression and I didn't know she had psychotic features because she didn't report them. After she recovered, she told me that during the depression she was convinced that all of her internal organs had died and rotted. She was afraid that if she told me I would put her in the hospital. This is an example of bipolar psychosis where the person is lucid and can go on with life despite the psychosis. This is not usually the case with schizophrenia." Another distinction is that unlike chronic schizophrenia psychosis, bipolar psychosis is episodic in that it comes attached to a mood swing that eventually ends.

Comprehensive examination of bipolar psychosis, including signs, symptoms, causes and treatments of psychosis in bipolar disorder. Plus stories of living with bipolar psychosis.

Part 1: Bipolar with Psychosis

Bipolar disorder is an illness that affects a person's ability to regulate their moods. The two main mood swings are mania and depression and most people familiar with the illness have at least a basic understanding of these two symptoms. But when it comes to bipolar psychosis, knowledge can be limited and this very complex and very normal part of bipolar disorder is often underreported or missed until it's too late. One reason for this is that there are still many people who don't know that psychosis is common for people with Bipolar I (one) during manic and depressive episodes and is often present in Bipolar II (two) depression as well. But the main problem is that the general public has such a distorted view of bipolar psychosis, it's difficult to find real and helpful information regarding this fascinating and often very destructive symptom of bipolar disorder.

About This Section

This section covers the topic of psychosis and how it relates to bipolar disorder. The first section gives a technical description of psychosis. The second section offers more information regarding the relationship between psychosis, mania and depression. The final section explains the medications used for treatment of bipolar psychosis. If you are not familiar with bipolar disorder and its treatment, my article The Gold Standard for Treating Bipolar Disorder gives a full account of the illness along with medication and management plan information. As with all of my articles on HealthyPlace.com, my colleague and co-author, Dr. John Preston, provided the technical information found in this article. You will see his quotes throughout the article. The statistics for the rates of psychosis is bipolar disorder are from the book Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression by Goodwin, F.K and Jamison K.R. (2007) Oxford University Press: Oxford and New York.

Basic Facts about Bipolar Psychosis

• Bipolar psychosis is always attached to either mania or depression. It doesn't exist on its own.
• Bipolar psychosis is common in bipolar mania. Up to 70% of people in a full-blown manic episode experience psychosis. (People with Bipolar II hypomania rarely experience psychosis.)
• Though studies vary, it's estimated that 50% of people with bipolar depression experience psychosis. Though it's more common in severe depression, it can be present in moderate depression as well.
• Bipolar psychosis causes a break with reality, loss of reasoning and ultimately, resistance to treatment when it goes too far without medications.
• Bipolar psychosis can be very disruptive and cause significant work and relationship problems due to misperceptions and false beliefs.

Most people are very confused and puzzled by psychosis. I have experienced and studied the topic for years and it can still be an enigma! It's very easy to confuse the thoughts, feelings, and behaviors caused by manic and or depressive mood swings with those caused by psychosis. The goal of this article is for you to easily recognize the difference and then see if you or the person you care about experiences psychosis.

My Story of Living with Bipolar Disorder Psychosis

From my journal: May 21, 1994

Ivan has been on the locked psych ward for 20 days. I walked in the ward yesterday and he said, "How are you, Julie?" I was so pleased with this question. It shows he's getting better! I said, "I'm fine." Then he got the dark look in his eyes. He said, "And how is the baby you had yesterday?" Oh well, so much for getting better.

In 1994, my partner Ivan went into a psychotic/manic episode on his 22nd birthday. Within a few days he was so ill he was hospitalized and stayed in a locked ward for over six weeks. He was eventually diagnosed with Bipolar I. He was alternately happy to see me and then extremely suspicious. He had constant hallucinations and delusions and did not know where he was or if I was safe. I learned a lot about psychosis during his illness, as I visited him on the ward every day. It was devastating to see how the mania and psychosis took over his mind so quickly. I'd never seen anything like it!

Oddly enough, in 1995 after years of excessive depressive and unrecognized hypomanic mood swings, I was diagnosed with Rapid Cycling Bipolar II. After my diagnosis, I realized I had been psychotic off and on since age 19. In fact, you may say that my entire bipolar disorder writing career started with a psychotic hallucination! In 1998, I was more ill than I had been in my life as my treatment was not effective. I went to visit my mother in Hawaii. As I was driving down the street towards Waikiki, I started to cry. I was just so ill and didn't know how to help myself. I stopped at a traffic light and looked down at my hands. Both of my wrists were bleeding and I thought to myself- oh no, I have finally tried to kill myself. Then I looked up as the light turned green. When I looked back down at my hands, there was no blood. This strong and very real feeling visual hallucination change my life. It was literally, at that moment, that I decided to take charge of managing my bipolar disorder. Maybe learning about psychosis in this article can be life-changing for you as well!