How To Help A Family Member Experiencing Bipolar Psychosis

If you have family experiencing bipolar psychosis, the experience can perhaps feel scary for you as well as for them. You may feel confused and helpless. It can be challenging to understand what they are going through. As such, it can be important that you familiarize yourself with bipolar psychosis and how you can help your family during this time.

Overview of bipolar disorder

Bipolar disorder is a mental health disorder that can cause significant changes in a person’s mood, cognition, and energy levels. A mood disorder, bipolar disorder is characterized by shifts between depressive and manic episodes. During a manic phase, an individual may exhibit signs of an elevated mood, increased energy, and racing thoughts. During a depressive episode, they might experience low mood, fatigue, and feelings of sadness. 

The three most common forms of bipolar disorder are bipolar I disorder, bipolar II disorder, and cyclothymic disorder. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), published by the American Psychiatric Association, for an individual to be diagnosed with bipolar I, they must experience at least one manic episode. Depressive episodes may also occur in bipolar I, but their presence is not necessary for diagnosis. 

For a diagnosis of bipolar II, at least one episode of both major depression and hypomania (a less severe form of mania) must have occurred. Cyclothymic disorder is characterized by mood episodes in which symptoms of hypomania or depression are present but do not meet the criteria for a manic or depressive episode. 

While symptoms of depression and mania typically arise separately, mixed episodes—in which both depressive and manic features are present—can occur. An individual with bipolar disorder may also experience rapid cycling. This specifier is added to diagnoses when four or more manic, hypomanic, or depressive episodes occur in a one-year period. 

What is bipolar psychosis?

Psychosis is a state in which an individual’s perception of reality is altered. It can lead to hallucinations or delusions, but psychosis doesn’t have to involve either to be considered psychosis.

Psychosis is commonly associated with mental health conditions like schizophrenia, schizoaffective disorder, and certain personality disorders. However, it can also be a symptom experienced with other mental health disorders, like bipolar disorders. According to a study published in the journal Current Psychiatry Reports, “More than half of patients with bipolar disorder will experience psychotic symptoms in their lifetime” (Curr Psychiatry Rep, 2000). 

A psychotic episode can present further complications for people with bipolar disorder, potentially causing them to question their reality, withdraw from others, and struggle with everyday tasks. Bipolar psychosis typically happens during a manic episode, but it's also possible during depressive phases.

Psychotic symptoms of bipolar disorder

Psychosis is a set of symptoms that typically develop slowly over time. Symptoms like hallucinations, delusions, and disordered thinking may only become visible after having hidden beneath the surface for an extended period. 

Psychotic symptoms of bipolar disorder can be classified as either mood-congruent or mood-incongruent. Mood-congruent symptoms of psychosis are those that match the individual’s mood episode or emotional state. For example, someone experiencing bipolar depression may have negative delusions regarding the way other people perceive them, which would typically be consistent with depressive symptoms. In this case, a diagnosis of “bipolar disorder with mood-congruent psychotic features” may be provided.

Mood-incongruent symptoms, however, do not match the person’s mood episode or emotional state. For example, someone living with mania may begin hearing voices that have a negative tenor, which would not typically be consistent with manic symptoms. This form of psychosis in bipolar disorder may be denoted by the specifier “with mood-incongruent psychotic features”. Research suggests that bipolar disorder with mood-incongruent psychotic features may be a more severe form of the condition. 

In the early stages of bipolar psychosis, the symptoms may include anxiety, reduced social contact, difficulty concentrating, unwarranted suspicion of others, not paying attention to personal hygiene, and a drop-in performance at work or school.

As the symptoms of psychosis continue to develop over time, they can turn into things like delusions, hallucinations, lack of awareness, incoherent speech, and irrational thoughts.

What are hallucinations?

Many people think of hallucinations as things a person believes they are seeing. While this can be true, people who experience psychosis can also hallucinate things that they hear, smell, or more. In fact, hallucinations can affect all five senses.

What are delusions?

When someone is delusional, they may believe something is happening that is not real. It could be something big like believing that they are invincible or something smaller like becoming overly paranoid. Some people experiencing bipolar psychosis may believe that there are people out to get them, that they have no one who cares about them, or any other number of unreal situations. Many people with psychosis develop somatic delusions, which are beliefs that one is living with a physical illness or defect. 

Lack of awareness, irrational thoughts, and incoherent speech

When people experience episodes of bipolar psychosis, they may have incoherent speech and irrational thoughts. It may be hard to follow what they are saying, and they may lose track of what they're trying to communicate in the middle of a conversation. They might jump from one subject to the next quickly and seem unsure about what they are discussing. Disorganized thinking and speech are common early signs of psychosis in people with bipolar disorder. 

When people are experiencing bipolar psychosis, they are usually unaware that their speech or behavior is out of the ordinary. This can cause them to be confrontational if you question them about their behavior or what they are saying.

What's the outlook on psychosis in bipolar disorder?

The good news is there's a chance that bipolar psychosis is a limited occurrence. It's common for people only to have one episode and then fully recover later. The depressive and manic episodes of bipolar disorder, on the other hand, are often lifelong mental health challenges. However, most people can learn to identify and manage their bipolar symptoms to successfully live a satisfying daily life. 

Those experiencing bipolar psychosis must receive early diagnosis and treatment. This can be key to controlling the condition and regaining the quality of life that they once had.

Treatment for bipolar disorder psychosis

If you have someone in the family who is experiencing bipolar psychosis, you can help them receive the treatment that they need. There are both traditional and holistic treatment options available. Many people can control bipolar psychosis through only holistic measures. These include things like making lifestyle changes, practicing self-care, and maintaining healthy personal relationships.

The traditional forms of treatment for bipolar psychosis include medication, psychotherapy, and electroconvulsive therapy (ECT). The medications that may be prescribed include drugs like antidepressants, mood stabilizers, and antipsychotic medications. Antipsychotic medication can help alleviate the severity of psychotic episodes in people with bipolar disorder. According to a medically reviewed American Psychiatric Association article, antipsychotics are thought to work by influencing neurotransmitter function in the brain. We mention this for educational purposes but note that advice regarding medications can only come from a certified healthcare professional. Never stop or start taking medication without first consulting your doctor.

For those who want help managing bipolar disorder symptoms and unpacking psychosis episodes, there are many different forms of therapy options available as well. This can include one-on-one counseling, group therapy, peer support, family therapy, and more. 

If your family does not see improvement through medication and psychotherapy, they may be offered electroconvulsive therapy as a form of treatment. ECT is a form of electric therapy where an electric current is used on the brain that causes a temporary seizure. The belief is that this can help to “reset” the brain. This treatment has come a long way over the decades and has been effective for many people with severe mood disorders, in some cases allowing them to see rapid improvement.

How you can help your family

1. Help keep track of their experiences and symptoms

Keep a journal of the experiences that someone in your family is having. It can help you to look for patterns when the psychosis manifests. This could be important information to have when your loved one sees a doctor or therapist.

2. Schedule an appointment with a doctor

Bipolar psychosis is not something to treat at home without the help of a medical professional. It is recommended that you see both a physician and a therapist to get the best care possible. If your family is resistant to going to a therapist’s office, BetterHelp has online therapists available to help them get the help and treatment they need from the comfort of their home.

3. Help them keep on track with their medication

There are many different forms of medication to help people with bipolar psychosis, but the medication can only help if they take it. Help your loved one keep track of how much and what time they should be taking their medication, and then remind them to do so. Again, remember to only take official medication advice from a certified medical professional.

4. Help them get the rest that they need

Sleep deprivation is a common trigger for bipolar psychosis. Help your loved one get the rest and sleep they need regularly. If they have difficulty sleeping, talk to a physician about the available options.

5. Create routines

Often, individuals with bipolar psychosis have a hard time tending to personal hygiene, difficulty maintaining a healthy sleep regimen, and trouble managing their schedule. Creating daily routines can help to reduce or eliminate psychosis episodes. It may be something your loved one is resistant to because they find it restricting, but in the long run, it can benefit them. Try to set a schedule of routines they can follow for things like eating, sleeping, and socializing. Even watching a familiar TV show can help them keep their focus away from troubling things.

6. Speak clearly

When talking with someone with bipolar psychosis, you should be direct and honest. They may have a difficult time understanding things like analogies, sarcasm, and exaggerations. Match their eye level and never talk about them like they are not there.

7. Remain positive

The situation can seem overwhelming, negative, and stressful for every person involved. But in front of your family, remain positive and encouraging. Comfort them when they allow it and look for ways to encourage and motivate them.

8. Ask questions and don't make assumptions

Don't assume that you know what they want. Ask them how they would like to be helped. There may be times when they cannot answer you or provide helpful information, but they also might surprise you.

9. Don't make threats of consequences 

If you are the parent of a child experiencing episodes of bipolar psychosis, it can be challenging to understand what they are going through. But acknowledge that they are not faking their behavior or choosing to act that way. Threatening consequences if they don't change their behavior will likely not help them and may further frustrate the situation.

10. Don't make it all about the diagnosis

Don't forget that your family is a person, no matter how difficult the situation becomes. It can be easy to shift to thinking more about the diagnosis of bipolar disorder or psychosis and less about the individual. When this happens, the conversation might shift to be all about diagnosis, medication, and treatment.

For your loved one, the things they are experiencing are very real, even if they aren't genuinely happening. When they are in a psychotic state, they likely aren't going to want to hear about the diagnosis or treatment options. This can frustrate them further.

Get support from an online therapist

And if you, as a caregiver, or someone in your life with bipolar disorder or bipolar psychosis wants to talk to a certified therapist, you can do so through BetterHelp or any platform they are comfortable with. BetterHelp offers online therapy, a discreet and comfortable alternative to in-person therapy. And if you’re reluctant about online therapy models, rest assured that studies show that online therapy is just as effective and sometimes even more effective as in-person therapy when treating a wide array of mental illnesses. While online therapists cannot prescribe medication, they can work in tandem with an in-person doctor to ensure cohesive and thorough treatment.