A patient with bipolar disorder has mood cycles between mania and depression, though she may have a more predominant mood, depending on the subtype of the disorder she has. For example, a patient with bipolar disorder I has more manic than depressive episodes, while a patient with bipolar disorder II has more depressive episodes. Extreme symptoms can occur when the patient has severe depression or mania. Psychosis can also happen if the patient loses touch with reality during an episode.
Suicide
The National Institutes of Health (NIH) states that bipolar disorder patients are at high risk for suicide, especially during severe depression. During a suicidal depression episode, the patient feels worthless, sad and hopeless. He can also feel guilty for things he was not responsible for, or he may have a lack of self-esteem. The patient also pulls away from other people. Serious signs of suicide include persistent thoughts of death and suicidal behaviors, like saying goodbye to loved ones.
Reckless Behavior
During severe mania, the patient has poor judgment and can participate in risky behaviors that put the patient's health in jeopardy. The Mayo Clinic notes that the patient may use a dangerous amount of alcohol or drugs. The patient may also go on spending sprees, even if she does not have the money to pay for her purchases, or drive recklessly. The NIH adds that the patient may be sexually promiscuous while manic, which can be especially dangerous if the patient does not use protection.
Psychosis
A bipolar disorder patient can lose touch with reality during either a severe manic or depressive episode. The Mayo Clinic states that sudden psychosis, or a psychotic break, may be the first sign of bipolar disorder. Psychosis during bipolar disorder is characterized by two main symptoms: hallucinations, where the patient sees, feels or hears things that do not exist, and delusions, where the patient holds on to a false belief. The psychotic symptoms vary depending on the patient's mood. The National Institutes of Mental Health (NIMH) notes that a patient with manic psychosis may think he "is famous, has a lot of money, or has special powers," while a patient with depressive psychosis may think he "is ruined and penniless, or has committed a crime." A patient with psychotic bipolar disorder may need to be hospitalized during severe episodes.
