Bipolar disorders create severe mood fluctuation---from depression (feelings of hopelessness and extreme loss of energy) to hypomania (elevation in energy without the extremes associated with mania) to mania (excessive energy, irritability and impulsiveness). It is during the most extreme of these moods episodes that a person may experience psychotic symptoms. Psychoses manifest most frequently in bipolar disorder as auditory hallucinations (sounds or voices that are not present in the environment) and delusional thinking or beliefs that have no logical foundation in reality.
Types of Bipolar Disorder
The American Psychological Association recognizes two types of bipolar disorder: bipolar I and bipolar II. In bipolar I, there is a fluctuation between manic and depressive mood states. In bipolar II, there is a fluctuation between hypomanic and depressive moods---mania is not present in bipolar II. Depending upon the severity of the mood state, psychotic symptoms can exist in either disorder. Psychosis is only present in bipolar during the most severe mood states; therefore, it can manifest in bipolar I during either mania or depression. In bipolar II, these symptoms can manifest during depressive moods.
Psychotic Symptoms
Auditory hallucinations associated with bipolar disorder are commonly unknown voices that comment negatively on the individual's life. Sometimes, the voices seek to engage the person in conversation, and frequently the voices are nonsensical or too vague to understand. Delusions vary greatly between people and can even vary from one episode to another. These delusions range from relatively benign (believing that a friend is in financial trouble) to severe (thoughts about a conspiracy to take their life).
Causes
Research has not led to a full understanding of the causes of psychotic symptoms in bipolar. However, it has been suggested that excessive dopamine activity plays a role. Dopamine increases activity in the brain and too much activity may induce a state of hyper-vigilance. For example, when dopamine levels are normal, an individual would not give too much thought to the time his neighbor comes home from work each day. With excessive dopamine, an individual may become concerned about his neighbor arriving home late and perhaps form a theory involving a conspiracy to take his life.
Treatment
To reduce the distress and impairment associated with psychotic symptoms, it is necessary to begin treatment with antipsychotic medications. Through various chemical mechanisms, antipsychotic medications reduce dopamine activity. Some people have a misunderstanding of how antipsychotics work, believing they "block" psychosis. However, the medications are not that specific, and all dopamine activity is reduced. People on these medications often report a reduction in their overall thinking skills and level of alertness. The discomfort associated with these side-effects frequently results in non-compliance with the doctor's recommendations.
Support
Because of the high rate of non-compliance, support is a necessary and essential component for effective management of bipolar disorders with psychotic symptoms. This support can come from many sources, including professionals, friends, volunteers and public resources such as mental health centers. There are also organizations which provide education and support services to both the person who suffers from the disorder and their family members. One such organization is the National Alliance on Mental Illness (NAMI), which has state and local chapters in all 50 states.
References
- American Psychological Association; The Diagnostic and Statistical Manual of Mental Disorders; 2000
- Francis Mark Mondimore, M.D.; Bipolar Disorder: A Guide for Patients and Families; 2002
- James Hansell & Lisa Damour; Abnormal Psychology; 2005
