Understanding Bipolar I with Psychotic Features

Bipolar Disorder, once called manic depression, is characterized by unusual and out of character shifts in mood, energy and activity levels, concentration, and the ability to complete daily tasks. 

Bipolar I alone affects about 2.8% of the population. In order to meet criteria for Bipolar I, one must have had a manic episode, which may be preceded or followed by a hypomanic or major depressive episode. A manic episode is defined as “abnormally and persistent elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy.” The duration of this episode must last at least one week and be present for most of the day, nearly every, though this is not the case if the individual requires hospitalization. The following are some additional symptoms of a manic episode.

• Inflated self-esteem or grandiosity

• • In a manic episode, one often believes that they may be special or particularly gifted in ways that are not necessarily accurate nor based in reality, such as believing that they are close friends with a celebrity or are the smartest person in the whole world, despite evidence to the contrary.
    
    
• Decreased need for sleep
  • Not to be confused with insomnia, which is when one has difficulty falling or staying asleep. While someone with insomnia may only get 4 hours of sleep and feel dreadful in the morning, someone experiencing mania may get 4 hours of sleep and feel quite rested.
    
    
• More talkative than usual or pressured speech
  • Speech is often rapid and almost compulsive. Meaning that it is difficult to interrupt, even by oneself, at times aimless, and does not take into account the desire the other person to engage in the conversation.
    
    
• Flight of ideas
  • Individuals experiencing a manic episode often describe their thoughts as “racing.” Thoughts move through one’s mind faster than they can be articulated through speech and as a result can be observed as talking continuously and then abruptly shifting topics. At its worst, individuals may be seen as incoherent and disorganized.
    
    
• Distractibility
  • This is not simply having difficulty focusing. Distractibility in this severe form is often a struggle with ignoring anything unrelated to the task or conversation at hand, such as background noise, furniture in the room, or passersby.
    
    
• Increase in goal-related activities or psychomotor agitation
  • Although an increase in goal-related activities may sound beneficial, if is often characterized by planning and acting on multiple activities, including sexual, occupational, social or academic, but without necessarily being succesful in completing any. Furthermore, one may also display restlessness and purposeless activity, and doing multiple things at once or pacing.
    
    
• Poor decision making and risky behavior
  • A person experiencing mania is at-risk for engaging in behaviors with significant consequences, such as reckless driving, spending, poor investment/business choices, or sexual behaviors including infidelity, and indiscriminate encounters without regard to health and interpersonal consequences.

The difference between a manic and a hypomanic episode is the severity of the impairment. A manic episode results in a marked impairment in various domains of functioning and may result in hospitalization to prevent harm to self or others, or may include psychotic features.