Manic-Depressive Psychosis: Features And Depressive Episodes
Manic-depressive psychosis is an antiquated term that was commonly used to describe what we now know as bipolar disorder. Bipolar disorder is characterized by intense shifts in mood marked by periods of extreme highs (called manic episodes) and extreme lows (called depressive episodes). In addition to shifts in mood, more than half of the people diagnosed with bipolar disorder will experience symptoms of psychosis at some point in their lives. In this article, we’ll explore the defining features of bipolar disorder.
What are the defining features of bipolar disorder (manic depressive psychosis)?
Significant changes in mood, energy, and activity levels characterize bipolar disorder.Bipolar disorder may cause mood swings consisting of alternating manic episodes (extreme highs) and depressive episodes (extreme lows).
Someone experiencing a manic episode may experience an extreme increase in energy levels, irritation, a decreased need for sleep, and euphoria. A person experiencing a depressive episode may experience symptoms like hopelessness, intense sadness, and low energy.
Periods of bipolar depression may be more prevalent than mania, but depressive episodes may be considered more dangerous due to the associated risk of suicide. Features of bipolar depressive episodes tend to be similar to major depressive episodes.
Three main types characterize bipolar disorder. While people diagnosed with different types of bipolar disorder may experience similar symptoms, symptom severity and how long symptoms last will determine someone’s specific diagnosis.
Bipolar I disorder
Usually considered the classic form of bipolar disorder, bipolar I generally involves at least one manic episode. Mania generally refers to a period of at least a week in which a person experiences a normal behavior change, drastically affecting their functioning.
Symptoms of mania typically include talkativeness, rapid speech, a decreased need for sleep, racing thoughts, distractibility, anxiousness, and psychomotor agitation. A euphoric or expansive mood, mood impulsivity, irritability, and a sense of grandiosity may also accompany mania.
It is also possible to have mixed features of depression and mania at the same time. When a person experiences four or more episodes of depression or mania in one year, this is normally referred to as rapid cycling.
Bipolar II disorder
With bipolar II, a person has generally had at least one hypomanic episode and a period of depression, but not a manic episode. Hypomania may be seen as a milder form of mania in which delusions and hallucinations are not present. The American Psychological Association (APA) defines it as "a state of enhanced mood and increased energy and activity that resembles mania but is milder."
Another distinguishing characteristic between mania and hypomania may be the duration of episodes. Whereas manic episodes tend to last at least a week, hypomanic episodes usually last for a minimum of four consecutive days.
Cyclothymic disorder
Cyclothymic disorder can be defined as a mood disorder involving periods of depressive and hypomanic symptoms that occur over a period of at least two years. Considered a milder form of bipolar disorder, it does not meet the full criteria for a major depressive episode or hypomanic episode.
A person with cyclothymic disorder may experience fluctuations of hypomania and a milder form of depression.
Mixed features
Mixed features can refer to experiencing depressive and manic symptoms at the same time. Findings indicate that people with manic/hypomanic or depressive episodes with mixed features may have a more severe form of bipolar disorder. Mixed features may also correlate with a higher rate of coexisting mental health disorders.
Manic symptoms and psychosis
According to an article in the World Journal of Psychiatry, ''lifetime psychotic symptoms are present in over half of the patients with bipolar disorder (BD) and can have an adverse effect on its course, outcome, and treatment." However, some studies indicate that psychotic symptoms don’t necessarily have a negative impact on bipolar disorder.
When connected to bipolar disorder, psychosis can also be associated with hallucinations, delusions, or both, and these symptoms tend to be more frequent during manic episodes.
Similarities between bipolar disorder and schizophrenia
The similarities of the psychotic features associated with bipolar disorder and schizophrenia have led researchers to speculate that bipolar disorder may "lie in an intermediate position between psychotic and non-psychotic disorders," along "a continuum of psychosis stretching from major depressive disorders with psychosis to psychotic BD and schizophrenia."
Other forms of bipolar disorder
Some forms of bipolar disorder, such as mood-incongruent psychotic bipolar disorder, which can be considered a severe form of the disorder, are thought to overlap with schizophrenia. Bipolar disorder may also be classified as falling between unipolar depression and schizophrenia.
Psychotic symptoms can influence the way bipolar disorder is diagnosed and treated, sometimes leading to a misdiagnosis of schizophrenia.
Treating bipolar disorder with manic depressive psychosis features
A person with bipolar disorder may require treatment throughout their life to relieve symptoms and improve overall function. Early diagnosis tends to be associated with a better prognosis. However, many people experience a delay in appropriate treatment following an initial depressive episode.
Treatment may include the use of mood stabilizers and antipsychotic medication, which must be prescribed and closely monitored by a doctor or psychiatrist.
Manic depressive psychosis features: Treatment for bipolar disorder
As stress can be a major trigger for episodes of depression and mania, it can also be important to seek psychotherapy. The National Alliance on Mental Illness (NAMI) generally suggests that those with bipolar disorder should engage in medication management with a psychiatrist, as well as weekly or biweekly therapy sessions.
Therapy can help individuals manage symptoms and cope with stress. Therapeutic modalities that may be especially helpful for individuals with bipolar disorder can include interpersonal and social rhythm therapy, family-focused therapy, dialectical behavior therapy (DBT), cognitive behavioral therapy (CBT), and group psychoeducation.
Seeking mental health support for bipolar disorder
Therapy can be invaluable when you're struggling to balance your emotions and keep symptoms of mania and depression at bay. A therapist can also introduce helpful ways to manage stress, such as mindfulness meditation. Online therapy through platforms like BetterHelp can be convenient for many people who prefer to speak to a therapist by phone, video, or online chat.
Mental health treatment of a manic-depressive psychosis episode
According to a 2021 randomized comparative effectiveness trial, online and in-person therapy appear to produce the same results when used to treat individuals with bipolar disorder. While in-person care may be necessary for acute psychotic symptoms, online therapy may be a helpful form of treatment outside of psychotic episodes.
Takeaway
Treatment for bipolar disorder may include the use of mood stabilizers, antipsychotic medication, and psychotherapy. Since stress can trigger episodes of depression and mania, it's generally recommended to attend regular therapy sessions. Online therapy may offer a convenient and flexible way to seek professional support.
What does a bipolar disorder manic episode look like?
Bipolar disorder (formerly called manic depression) is characterized by manic and hypomanic episodes. In a severe manic episode, there is a steep increase in physical and mental activity. People will often behave impulsively and irrationally, sometimes engaging in drug and alcohol misuse and/or making decisions that lead to financial problems during these types of mood episodes. Hypomania symptoms share similarities with mania, but they are less severe and don’t usually cause extreme changes in a person’s mood or behavior.
Manic episode bipolar symptoms may share similarities with attention-deficit hyperactivity disorder. The underlying causes of these two mental health disorders are different. Further, bipolar disorder symptoms can be characterized by mood swings (i.e., depression and manic or hypomanic episodes), while symptoms of ADHD tend to be more consistent.
What are the mental health effects of a manic depressive episode?
Bipolar disorder is one of many mental disorders listed in the Diagnostic and Statistical Manual, which explains its diagnostic criteria. It’s mainly characterized by mood symptoms, with mood changes based on at least one manic or depressive episode. People with bipolar disorder experience depressive symptoms and at least one hypomanic period, although it’s important to note that there are a few different types of bipolar disorder. Some people experience mixed episodes of mania and depression, and others have rapid cycling bipolar disorder, in which they cycle through both a manic and depressive mood state for brief periods, sometimes lasting a few months. There is no way to prevent bipolar disorder; however, this mental illness is entirely possible to treat, and people with bipolar disorder can live a normal life.
Both depression and mania can have mental health side effects aside from mood changes. Mania can often lead to further comorbid complications as a result of substance use. Some people resort to drinking alcohol, often leading to alcohol misuse. Mental health effects can also result from difficulties at home, school, and work. It is important to seek treatment, which usually consists of talk therapy and medication. Education of family members can also be key.
What are the manic depressive psychosis (bipolar disorder) features?
With bipolar psychosis, a person can have psychotic symptoms in either a manic phase or a depressed phase. Such symptoms may include hallucinations, delusions, social withdrawal, and confused speech or thinking. Other symptoms can include thoughts of self-harm or suicide attempts. In such instances, call the 988 Suicide & Crisis Lifeline. Bipolar disorder may be a challenging lifelong condition, but there are ways to manage bipolar episodes. Typically, mental health professionals use psychotherapy and pharmacological treatment to treat the symptoms.
Bipolar disorder may also co-occur with anxiety disorders, substance misuse, and other mental disorders, which can make symptoms worse. If you need resources for bipolar disorder, substance use disorder, or other related disorders, you can contact the Substance Abuse and Mental Health Services Administration helpline. You may also seek mental health support through online therapy, such as BetterHelp.
What is a major depressive disorder with psychotic features and depressive episodes?
Other mental health conditions can complicate the effects of severe depression. Major depressive disorder with psychotic features is when someone who is experiencing major depression also has psychotic episodes. These individuals typically go through intense depressive episodes marked by deep sadness, hopelessness, and a loss of interest, along with hallucinations or delusions.
What is the difference between depressive psychosis and manic psychosis in mental health conditions?
In mental health conditions like bipolar disorder or depressive psychosis, the psychotic features are related to the person’s depression; for instance, they may have paranoid delusions that someone is out to get them, so they stay at home and withdraw socially, which perpetuates the depression. In manic psychosis, the psychotic features are related to the mania; for instance, the person might have grandiose delusions that they have a mission to save the world.
Depressive psychosis and manic psychosis are clinical features commonly associated with bipolar disorder. A first-degree relative with the condition, traumatic events, and substance misuse are possible factors that may cause the onset of the first episode. According to the National Institute on Mental Health, the symptoms of bipolar disorder may cause serious challenges to a person’s mental and physical health. Although bipolar disorder is not currently curable, treatment options such as psychotherapy and medications may help manage symptoms of depressive psychosis, manic psychosis, and other related disorders that may co-occur with bipolar disorder.
Is depression with psychotic features and depressive episodes rare?
Psychosis with the comorbid mood disorder of depression is somewhat prevalent, with one study citing that 10–19% of people experiencing depressive episodes also experience psychosis.
What are the five key features that define psychotic disorders and other mental health conditions?
Psychosis is primarily a thought disorder, as described by the American Psychiatric Association. The five key features of a psychotic disorder are hallucinations, delusions, disorganized speech and/or thoughts, unusual behavior, and negative symptoms (loss of ability to function as usual).
If you or someone you know experiences any type of psychotic episode, it’s important to reach out to your doctor and a mental health professional. Getting medical care and treating psychosis and related mental health conditions and disorders early on can make a big difference in clinical outcomes. Medical professionals can administer a physical exam, take a medical history, and assess a person's symptoms. From there, they can arrive at a diagnosis and create a treatment plan. For some, ongoing treatment is necessary, and electroconvulsive therapy can be used in severe episodes.
What can be mistaken for psychosis?
A number of medical conditions can create symptoms that can be mistaken for psychosis. These include toxicity, vitamin deficiency, head trauma, stroke, seizure, Alzheimer’s, and encephalitis, among others.
What is the chief distinguishing feature of psychotic disorders?
The chief distinguishing feature of psychotic disorders is that a person loses touch with reality, when they are not able to recognize the difference between their imaginings and what is real. If you observe a loved one showing warning signs of psychosis, seeking professional help for early diagnosis and treatment may prevent long periods of illness or worsening of symptoms.
What personality disorder has psychotic features?
Other disorders aside from schizophrenia can cause psychosis. A few personality disorders have psychotic features, including borderline personality disorder and schizotypal personality disorder. While they do not have exactly the same symptoms, both are characterized by some degree of disconnection from reality.
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