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Bipolar Psychosis In Mania/mixed Vs Hypomania

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Interesting topic. It explains, explicitly, how I came to have a Bipolar I diagnosis despite having depression as the symptom 95% of the time.

When I switch over, I may feel good for an hour, but then I enter into a state of an agitated pseudo-schizophrenia, which can last days, despite maximal doses of antipsychotics. I will have auditory hallucinations at my very worst, I will usually have paranoia and think people are tracking me down and weird shit like that. I also go into fits where I spout of incomprehensible strains of words that make sense to me, but are frankly, creepy and disturbing to whoever witnesses it. I also have delusions that MY way of thinking is the RIGHT way. It can be so scary!!

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*Reply posted by ibchupacabra on: Feb 2nd, 2005, 10:36am *

Hey Sbu... I think you sound a lot like me, Mrs. Batshit fucking crazy.....

My doc diagnosed me as rapid cycling BPII w/mixed states. Obviously a few psychotic episodes are thrown in there just to mix things up.

Mixed states cause a tremendous amount of anxiety - think of depression and mania as waves in the ocean hitting each other - just a lotta churn and drama So when you experience both states at the same time - your body and mind process it as Anxiety - and when it's REALLY bad, the delusions (demons & footsteps) start to show up.

Does that make any sense?

That's what my doc diagnosed me as...exactly.

The mixed states can be unreal with some incredibly powerful delusions and psychotic breaks. I don't tend to experience the "they're watching" or "they're out to get me" kind of paranoia but the anxiety can be crippling.

I wish I could be like a friend of mine who is hypomanic almost the time...rarely shifts into a crazed state and rarely dips too deep into a depression.

Me it's cycle cycle cycle and then huge episode and then a lull where I sort of regroup, catch my breath, pick up the pieces and then BAM cycle cycle cycle...they're little cycles that are part of larger cycles that result in an incredible low or an amazing high but both with the same end...some kind of delusional break.

God...it feels so good to talk about this outside of my therapist's office and to people who understand.

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I also rapid cycle with mixed episodes. I have 2 main delusions when I get bad - that the mail people are republican spies, and that people are really parasitic brain aliens and my pills are preparing me for insertion. I hallucinate faeries and spiders and am regularly convinced I understand the crows.

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I also rapid cycle with mixed episodes. I have 2 main delusions when I get bad - that the mail people are republican spies, and that people are really parasitic brain aliens and my pills are preparing me for insertion. I hallucinate faeries and spiders and am regularly convinced I understand the crows.

I never get these sort of delusions when I go into full on mania. My delusions are always more... Idon't know...generic? I get these delusions about how I'm supposed to save humanity, or at least my friends and family...some sort of christ like delusion or I get the opposite where I become convinced that I have become a complete failure...abysmally ruined and broken and as such, need to die in order to protect those that "love" me from any more disapointment.

Regardless...this whole mixed, rapid cycling BP I with psychotic breaks thing is a real bitch.

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My Pdoc has decided I have mixed episodes when I got so much anxiety last time I was manic, and my best friend says I got so psycotic the time before that, that it scared her( that one i don't remember very well). My shrink told me that the bipolar1-mixed is harder to treat, but I wonder if she is just saying that to scare me, to make sure I'm compliant with treatment. use to be I only got truely manic every few years, just hypo-manic most of the time and because I liked the hypo-mania I wouldn't take meds consistantly. Which is likely why things got worse over time. After getting manic twice in 2 months I decided it was time to accept that I was bipolar. My doc doesn't trust me to be complient because of my past, which is why I think she is trying to scare me rather than my being paranoid. I don't think I have any really paranoid ideas, except maybe that miller moths are trying to invade my personal space. I do understand to flight of ideas, even know I'm haveing them as well as pressured speech, I just keep thinking, so what's the big deal about that, other people should just keep up.

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No, mixed/mania type of bp is fairly hard to treat.

i am such a person.

depakote has been my mainstay and lifesaver.

Stay on your meds.

Anna

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No, mixed/mania type of bp is fairly hard to treat.

i am such a person.

depakote has been my mainstay and lifesaver.

Stay on your meds.

Anna

You know, the only time I ever was in real danger in my adult life (I had a bout w/depression in my late teens/early 20s while in engineering school and yes was on prozac w/no prob for a few years until 93) is when I was put on Zoloft last year due to anxiety caused by pain. It made me practically suicidal.

If you are an anxious person you have the following symptoms due to an SSRI like zoloft:

"The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features."

Is it true mania if it's not spontaneous or is medication induced? What happened to me would not have happened w/out the help of Zoloft. I have not really come close to that sort of state in the absence of all medications.

Edited by BustOfPallas

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My Pdoc has decided I have mixed episodes when I got so much anxiety last time I was manic, and my best friend says I got so psycotic the time before that, that it scared her( that one i don't remember very well). My shrink told me that the bipolar1-mixed is harder to treat, but I wonder if she is just saying that to scare me, to make sure I'm compliant with treatment. use to be I only got truely manic every few years, just hypo-manic most of the time and because I liked the hypo-mania I wouldn't take meds consistantly. Which is likely why things got worse over time. After getting manic twice in 2 months I decided it was time to accept that I was bipolar. My doc doesn't trust me to be complient because of my past, which is why I think she is trying to scare me rather than my being paranoid. I don't think I have any really paranoid ideas, except maybe that miller moths are trying to invade my personal space. I do understand to flight of ideas, even know I'm haveing them as well as pressured speech, I just keep thinking, so what's the big deal about that, other people should just keep up.

Ha ha. The pressured speech one makes me laugh. Maybe you were just trying to cram as much information about yourself into the 300 or so dollars an hour he was charging me so you would get your money's worth out of it.

You should have said, "My speech would be a lot less pressured if you were seeing me pro-bono".

Edited by BustOfPallas

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*Reply posted by libertyjones on: Jan 30th, 2005, 4:38pm*

ok i have a first question.... if you "know" you're being delusional is it really delusional? gah. i'll expound when i have time to think more.

If you KNOW you are being delusional, you are NOT. You clearly still have rational though and sounds more like worry/anxiety.

If you were truly delusional you'd have no idea and you wouldn't even consider if you were or not. There is no rational thought like that when delusional.

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This last statement is completely wrong. I have had delusions for three years. When it's the worst I'm unaware of my delusions. That has happened twice. Most of the time I know when I am delusional. I guess you can't understand unless you have gone through that yourself.

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You can be delusional, and know it. There is a long discussion on the boards about this somewhere, but I don't know where. Aren't I helpful?

 

After my evil ex-punched me and tried to strangle me, I was positive he knew where I lived, and was going to find me and hurt me. The fact that he lived 1000 miles away didn't mean I could shake that strong belief. I knew it was wrong, but I kept "seeing" him (no psychotically, just strangers that kind of looked like him).

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Mixed episodes are the worst things that have ever happened to me by far. To me, the suffering of a mixed state is exponentially worse than having one or the other. In it's simplest explanation I am depressed enough to think up some really dark and twisted shit but have enough energy to actually do something about it. Danger. Luckily I haven't had one in a long time. I am on Depakote now which I guess is specifically good for rapid cyclers/mixed staters. I feel the best mentally that I've ever felt but I am as big as a house. The Depakote is not the only reason but it is gasoline on the fire. I'm getting a sleeve gastrectomy in February because my physical health is deteriorating too quickly to do this the slow way. Hopefully if I have and maintain good weight loss from the surgery I won't have to give up the Depakote.

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Mixed episodes are THE WORST. I don't like Dysphoric Mania much more, but I am hoping to have a long break from mixed.

Edited by crtclms

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Oh!  So I see there is a pinned thread for my exact question!  I tend to overlook pinned threads - like I don't see them because they are always there.  <_<  Sorry! 

 

I know that I get mixed.  I know that my depressions have always tended to be "atypical".  But what I am trying to tease out here is if I can check the following boxes:

mania?  delusional?  psychotic?

 

I have seen pdocs and therapists for over half my life but this is the first time I am admitting this stuff so my diagnosis has never been accurate.

 

I adore my current pdoc and am going to come clean with him at my appointment next week.  I have given him the most accurate version I've ever given a pdoc, but it's still the watered down version, which was the same version my husband got until recently.  Lithium is making me feel deliciously stable and normal and somehow that makes me feel brave and in control enough to admit the really crazy stuff.

 

So, without further ado.

 

I tend to have 2 "themes" when I get out there - one theme is a government conspiracy and the other is demonic possession.  I have had people in my house (in front of my children, no less) and paid them hundreds of dollars to speak in tongues and spray holy water all over my house to extract a demon I was sure lived in my basement.  And sometimes my closet, because I couldn't sleep at all and I was convinced it was because the demon was sitting in my closet, staring at me, sucking my soul out of my body while I tried to sleep, taking Benadryl after Benadryl.  Sometimes I thought I could hear him whispering.  I was sure he was sending me messages by moving items in my house and if my children couldn't sleep I thought he was possessing them, too, so I'd sit in their rooms with talismans, ready to fight the demons.  I was also convinced that my oldest child had a past life as a shaman and was speaking tongues to me about it.  And that he could see demons and I had to help him fight them.  Other times I have been convinced the goverment is watching me through my statellite radio and red light cameras.  I shield my children's faces so they aren't recorded on the cameras.  I become afraid of airports and other places with security.  I had an elaborate plan to move to Canada and then Sweden, even bought books on how to do so.  When my husband told me he wasn't coming, I screamed at him for an hour telling him he was crazy and the children and I would leave him behind.  In my youth, my "up" days were more "up" - I formed a business, a party throwing business, and threw the party, spent thousands of dollars on it, did a LOT of drugs, racked up a $15k credit card bill in a couple months, and redecorated my entire apartment, very lavishly and lots of handcrafted stuff for a college student.  I felt sexy and beautiful and funny and I also believed that angels were guiding me so nothing I did - illegal, immoral or otherwise - would ever be wrong or get me into trouble because all of the angels were on my side.

 

I've never been hospitalized.   I've held it together enough so people close to me would think I was anxious, irritable, ebullient or distant but I had enough insight to not share too much with them (ie no angels, etc).  My grades?  All A's then all F's.  It took me 5 and a half years but I eked by in college, despite my intelligence.  Bummer.  My job performance was never that great, and then I was a SAHM.  So to say it affected my work performance?  Wouldn't have been saying much anyway, sadly.  I feel like I've always been kind of an underacheiver. 

 

Manic or hypomanic?  Delusional?  Psychotic?

 

(In your opinion.  Again, I know noobdy here is a doctor, but I am really new to coming to grips with this dx and love everyone's knowledge)

Edited by ray_of_sunshine

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Obviously I'm no professional, but your first description sounded rather delusional (I've been delusional myself) and the second sounded very manic rather than hypomanic. That's just my view without knowing you. For myself, I can't tell if I get manic or hypomanic. I'm happy for you that the Lithium is helping you to be stable! And finding a pdoc you like is great, that can be a hard thing to do, so it's awesome that you have a good one.

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Thank you kindly for your response.  I get nervous asking stuff like that because I don't want to get hit with the "we aren't doctors!  we can't diagnose you!" so thanks for understanding that's not what I'm asking for here.  I agree with you wholeheartedly about all of your response.  I think I keep getting hung up on the fact that I've never been hospitalized.  But, honestly, the more I process the diagnoses and the cluster of adventures and misadventures that my teenage years and adult life has been, the more it's not like "but I've never been hospitalized!" it's more like "but I've never been hospitalized????" if that makes sense.  The line between mania and hypomania is a murky one for me still, but I believe I've crossed over into regular mania.  I am still unclear as to what constitutes being psychotic vs. delusional.  I get that a delusion is an untrue belief - ie the government or a demon is out to harm me and my family and I (and my appointed angels) am the only one who can protect us.  But what, then, is psychosis?  Hallucinations?  But there's more, yes?  Thank you for muddling through this with me, I'm sure if I dug around enough it's been done a zillion times already so you're very kind.

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Mixed episodes are THE WORST. I don't like Dysphoric Mania much more, but I am hoping to have a long break from mixed.

What is the diff between mixed episodes and dysphoric mania?

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I think I might be entering one of these episodes

 

Thank you kindly for your response.  I get nervous asking stuff like that because I don't want to get hit with the "we aren't doctors!  we can't diagnose you!" so thanks for understanding that's not what I'm asking for here.  I agree with you wholeheartedly about all of your response.  I think I keep getting hung up on the fact that I've never been hospitalized.  But, honestly, the more I process the diagnoses and the cluster of adventures and misadventures that my teenage years and adult life has been, the more it's not like "but I've never been hospitalized!" it's more like "but I've never been hospitalized????" if that makes sense.  The line between mania and hypomania is a murky one for me still, but I believe I've crossed over into regular mania.  I am still unclear as to what constitutes being psychotic vs. delusional.  I get that a delusion is an untrue belief - ie the government or a demon is out to harm me and my family and I (and my appointed angels) am the only one who can protect us.  But what, then, is psychosis?  Hallucinations?  But there's more, yes?  Thank you for muddling through this with me, I'm sure if I dug around enough it's been done a zillion times already so you're very kind.

Delusions are a very frequent symptom of psychotic disorders, the most frequent symptom actually along with hallucinations. Being delusional or hallucinating alone is not sufficient for diagnosing someone as psychotic. Many people who are considered perfectly healthy suffer of delusions (e.g. people being convinced someone else is meant to be with them romantically while there is clear evidence that that is simply not the case).

 

There is usually severe impairment of one or more cognitive functions while a person is in a psychotic state, e.g. speech can be severely impaired to the point where someone is completely incomprehensible. Catatonia is also sometimes present in schizophrenia and very rarely in bipolar disorder (I am one of those lucky people who suffered episodes of catatonia during mania).

 

On the other hand, if delusions are chemically induced (by single/prolonged administration of certain chemicals or by withdrawl), it does qualify as a psychosis. There really is no single diagnosis of a psychotic state in DSM IV, but instead there are various illnesses which are grouped as psychotic disorders.

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Just wanted to say thanks to OP for writing all of that. My brain's been dragging me feet first through mixed-episode hell for about a month and a half now.   :wall:   Still trying to keep shit together.

Edited by Verdant_CHaos

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Mixed episodes are the worst things that have ever happened to me by far. To me, the suffering of a mixed state is exponentially worse than having one or the other. In it's simplest explanation I am depressed enough to think up some really dark and twisted shit but have enough energy to actually do something about it. Danger. Luckily I haven't had one in a long time. I am on Depakote now which I guess is specifically good for rapid cyclers/mixed staters. I feel the best mentally that I've ever felt but I am as big as a house. The Depakote is not the only reason but it is gasoline on the fire. I'm getting a sleeve gastrectomy in February because my physical health is deteriorating too quickly to do this the slow way. Hopefully if I have and maintain good weight loss from the surgery I won't have to give up the Depakote.

I agree when I feel like this I have a lot of agitation for no reason and everything annoys me-the tone of someone's voice to tapping nails. And I feel like I'm not doing enough like I have cabin fever, everything is way too boring. I turn into a dare devil I'll do anything and have terrible tunnel vision. Then I get horrible depressed because I regret everything I did and I just stay in my room all day. Thank God for meds

I use to have horrible depression a and took different anti depressants then when I was 20 and taking Zoloft I started having horrible mixed episodes and hypo mania but I didn't know until my family started saying stuff about it.

It seemed like the Zoloft induced it, but if that were the case then once I stopped the episodes would stop but they didn't. Weird that it just happened out of the blue and I took paxil and celexa when I was 18/19yrs old and was fine.... Anyone else experienced something similar?

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Just wanted to say thanks to OP for writing all of that. My brain's been dragging me feet first through mixed-episode hell for about a month and a half now.   :wall:   Still trying to keep shit together.

 

[thanks]

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"Other psychotic symptoms can include disorganized speech and thought. An observer of this will likely not be able to understand or make any connection between one topic and the next."

This 'symptom' perfectly describes the frustrations I had while trying to communicate during the final stages of the last (and 2nd) manic episode I had...as the person experiencing the mania...my thoughts seemed in no way to be disorganized...In fact, quite the opposite. I experienced it as an extremely organized thought process that was simply so rapid that I was unable to speak as fast as my brain was working. By the time I was able to utter the next sentance...tens of connections had been made in my mind that the listeners werent aware of. Of course they couldn't understand to make the connections.

 

I know this is super-old, but I just wanted to comment on it because I've never read anything like this, and it is vey similar to something I got when manic.

 

Instead of talking at a million miles a second, I got past that, to the point where I couldn't talk at all. The reason for this is that I knew so much abut everything that existed, I was the all-seer, to the point that I couldn't even use words to communicate as they were below my level of god-like knowledge and communication. I just was. I was everything, I was a god. I was beyond speech. I was just a beam of light.

 

I couldn't even describe this at the time, as I was truly unable to communicate due to the delusion. This seemed highly logical at the time, as I was 'just being a god' but now I can see how this was a manifestation of thought disorder, causing me to think I was communicating through just being, and that I was actually unable to speak. 

 

Quite creepy now I'm thinking about it.

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While I still have doubts regarding my Dx(the label not the meds), I found this mania subtype description published in 2001 insightful.

(it is more than a decade old so it might not be useful to others)

 

Subtypes of Mania Determined by Grade of Membership Analysis
http://www.nature.com/npp/journal/v25/n3/full/1395666a.html

It pertains to DSM III-R’s criteria of mixed episode.
It subdivides hospitalized bipolar mania/mixed (DSM III-R criteria) patients into 5 types.

Pure type 1: what Kraepelin called “hypomania.”
Pure type 2: what Kraepelin called “acute mania.”
Pure type 3: what Kraepelin called “delusional mania.”
Pure type 4: what Kraepelin called “depressive or anxious mania.”
Pure type 5: “puzzling admixture of depressed and classical manic symptoms.”

Pure type 4 and 5 had “considerable mood lability.”

What is interesting is that only about one third of pure type 4 and 5 patients met DSMII-R criteria for mixed episode, mostly being pure type 4. Half of pure type 4 and 90% of pure type 5 didn’t meet DSM III-R’s criteria for mixed episode.

When I read the description of pure type 4, it was closer to what I had experienced prior to hospitalization than any description of hypomania or mania that I read.
 

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A GLANCE OF MY STORY WITH MIXED TYPE BIPOLAR AND ALCOHOLISM 

     I am new to the forum but I am glad I found it. With sharing my most recent and severe episode i hope to gain friendships with people who have similar diagnosis/conditions/addictions as i do.I  am 26 and I just got out of the hospital after spending five days in the ICU and give days in the psych ward. I attempted suicide and was within minutes of death. I happy to be alive, but I wish there was a wand for mixed type bipolar/bipolar type 3. My doc has me on only 25mg of lamictal  and 100 mg of trazAdone. I don't feel like myself. What I did to get meverything on this pathetic regiment was I od'd on 26 days worth of my medication cocktail at the time. My daily regiment consisted of 450mg of lithium, 50 mg of seroquel, 40 mg of vyvance, and 40 mg of prozac. I know a crazy high low combination. I was enjoying it until that one day. I have severe mood swing and very frequent intervals. I am happy laughing one moment and the next I am guzzling 26 days worth of 4 separate medication along with a liter of vodka. Not to menation this was my second attempt in 6 years. I am an alcohlic, drug addict, severe mixed type bipolar(that is being poorly treated because my pdoc doesn't trust me with potentially  lethal medications), ADHD, paranoia, eating disorder, and hypersexual tendencies. I very recently came to terms and accepted that I am bipolar. I don't know what it is like to sober for long periods of time. I don't know why my doctor wont build up the lamictal in my system becahse sucks because I don't like these severe mood swings. I can't function  properly and I feel useless, unwanted, In the way, like a zombie, exhausted, disconnected with my loved ones, suicidal, in a rut... but other times I am over the hills happy, fearless, daring, life of the party, confident, hyper, risk taking, sex crazed, adrenaline junky and these all come in very frequenthe intervals. I didn't realize that these weren't  normal behaviors  until my stint in the hospital. I was reminiscing on all the the times I should have died, or friends could've died at my hands, all my bad decusions , including shop lifting and extreme drug and alcohol abuse, and the 4 near death experiences, illegal behavior that ended me in jail,  etc. It was all because of my manic and depressive episodes. I know I am not alone here. So if any one can relate or wants to share their stories with mixed type. I am eagerly waiting for someone to shine the light on me. 

I know my story is all jumbled up, but my p.doc won't treat my ADHD.

Your Friend,

Kelsey

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