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crtclms

Do auditory hallucinations = psychosis?

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Hi, I kind of feel like a whiny bitch asking this, but I have been looking all over the internet, and can't find an answer that "satisfies" me, because it isn't really from the most reliable source.

I should preface this by saying I am in the midst of a bad mixed episode, the worst I have had for many years. Also, I am usually considered BP II, so theoretically psychosis is not a symptom. My official diagnosis is BP NOS, but it looks like that will change when the DSM 5 comes out, and I will be BP II "again."

Okay, if you have auditory hallucinations during a mixed episode, are you automatically psychotic? I've had two incidences now, one on Friday/Saturday night (I think it was about 4AM), and then one yesterday.

The one on Friday, I could hear a conversation, but couldn't understand the words. I won't go into the fascinating details that are only of interest to me, but there was only one possible "real" explanation, I checked for it, and it wasn't happening.

And I knew as soon as I heard it it was a hallucination. I don't know why, because there *was* one reasonable, if unusual explanation. But I knew.

The one yesterday I knew right away, too, but I wasn't as scared. I don't know if that is just because I had already experienced it, or what, because logically, I should be more scared, since that is a second incidence.

Both times, after I looked around, and decided it was a hallucination, I was "visited" one last time in a really hugely obvious way, like a "Fuck you, you think we aren't a hallucination? Let us demonstrate that we are." But I already *thought* they were hallucinations.

I know stuff about the people speaking in my first hallucination that I couldn't possibly know, and despite not being able to make out words. I know the man was Jewish and from Brooklyn, I knew how one woman dressed, and that she was an alto, and one was blond and petulant. How does that even make sense? The guy that spoke to me yesterday I know less about.

The thing is, I don't *feel* the way would think I should if I were psychotic. If you ask me, I'm not. But I'm having these hallucinations, and I can't find any other reason on the internet for having them.

I looked up the symptoms for psychosis, and I had almost none of them aside from hallucinations, except personal cleanliness, and some language issues (I can't remember, I'm tired), but both of those could also be explained by a mixed state. I have to admit, my personal cleanliness is crazy bad, the worst ever. I no longer really give a shit how I look, I try to look okay when I go out for DH's sake, but I really couldn't give a fuck. I have to shower tonight, because I have an MRI, but that will be after 8 days. The previous shower to that one was 17 days before (that shower, not today).

So basically, I guess it all boils down to "Whaaaaa?" Any thoughts?

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If you are not exhibiting any signs of loss of contact with reality, I would not assume that you are psychotic at all, but rather are simply having hallucinations and some delusional content and just that. Of course, this is from the point of view that psychosis is essentially synonymous with loss of contact with reality.

(I myself have had both (auditory, visual, and recently olfactory) hallucinations and delusions, but otherwise have not exhibited any other signs of psychosis, even though I seemed scarily close to it at times (e.g. losing the ability to distinguish my hallucinations from reality) when I was on an accidentally doubled dose of mirtazapine. It would seem strange to me to equate hallucinations and delusions with psychosis when I have had none of the other things that tend to go along with psychosis despite having those.)

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When I read the title I was thinking of course, yes. But, the way you are describing it, I'm not sure. With your mixed state are you very anxious or not sleeping well? Do you take an antipsychotic? My hygiene is terrible and I'm not psychotic now.

I would let your pdoc know about the hallucinations. They may want to make a change if they think you are moving towards losing touch with reality.

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I would agree that this is something your pdoc should hear about, regardless of whether they are psychotic or not in nature.

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Don't worry, it is going to be the first thing the pdoc hears about, I see the covering pdoc tomorrow after my MRI.

I was pissed (not at my pdoc) to find that he was out of town until August 20th, because I had specifically asked at the front desk if he was going to be gone in August (which I know is the traditional pdoc "vacation month" from having grown up surrounded by them). They said no, and I delayed calling because I thought he would be there.

But the hallucinations didn't happen until he was already out of town, so whatever.

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Okay, couple of things:

Hearing things for non-organic reasons = psychotic feature. If you have changed your meds at all to deal with this episode, that could be an organic reason. (I went all around my house with a baseball bat looking for the Lamictal Guy. Lamictal Guy wore dress shoes and broke into my fridge to make himself a sandwich. We upped the dose and he went away.)

"Psychotic features" need not rise to the level of full-on loss of contact with reality. I have walked around with strange things (tactile, delusional, imagination-gone-wrong, word salad) while knowing better (mostly), and still being able to get around. For a little while, at least.

Some gothic hallucinations don't get reported because the psychotic person doesn't realize they're not true. That's never happened to me other than in or almost in the hospital. In other words, by that point, there was plenty of behavior to go with them.

BPII label doesn't rule it out. BPII is consistent with psychotic depression, though that is often delusional (I did have a depressive hallucination but I was on an AD). In a mixed state it's their call. If the psychotic feature is part of the manic component, then, hello BP1. If part of the depression, then no change. Angels dancing on the head of a pin.

I am very, very sorry you feel so awful. I hope someone gives you something to zap it ASAP. For me, a short course of Zyprexa does wonders for this stuff, and Depakote is better than nothing. I am also sorry about the MRI. I hope it helps.

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Oh, confused, sorry, I spaced. I am very anxious and not sleeping well, and it isn't helping my headaches. I have GAD, but last week sent my anxiety through the roof (a lot of shit went down last week). I feel like on Thursday, a switch flipped in my head, almost a physical sensation. My mood got agitated at that point (as in, switched from depression to agitated depression). From that point on, I have been a fucking mess.

Showering sucks.

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I haven't changed anything recently, recently, but within the last 6 months I added lithium. But I have discovered I know absolutely nothing about lithium, which is kind of funny if you knew how much I heard about lithium growing up.

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Anxiety and not enough sleep can lead to hallucinations. I don't think in that context it's considered psychosis. I hope you feel better soon.

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Technically, the occurrence of a mixed state (unless perhaps it's too short to be a mixed state as DSM-IV-TR defines it, or perhaps if it's more like "just" an agitated depression or "only" hypomania-grade) would put you in the bipolar I camp.

If you are not exhibiting any signs of loss of contact with reality, I would not assume that you are psychotic at all, but rather are simply having hallucinations and some delusional content and just that. Of course, this is from the point of view that psychosis is essentially synonymous with loss of contact with reality.

Many people who experience psychosis learn that if they're hearing something that's highly unlikely (or if it's a voice they know from the past to be due to AH, etc.), they assume it's a hallucination, and try to get on with their lives. In that way, you could argue that they aren't "losing contact with reality" either. This doesn't mean that their psychosis is cured, though...

P.S. Could your hallucinations be related to your migraines? Sleep deprivation? If there isn't a general medical or pharmacological cause, then you can definitely technically count them as psychotic symptoms

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I think if you are not sleeping well right now then that could be a possible explanation. I don't think hallucinations are always psychosis.

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Technically, the occurrence of a mixed state (unless perhaps it's too short to be a mixed state as DSM-IV-TR defines it, or perhaps if it's more like "just" an agitated depression or "only" hypomania-grade) would put you in the bipolar I camp.

This of course is more an artifact of some of the criteria for DSM-IV-TR being obsolete than anything, namely that it does not recognize mixed states except ones with a fully manic component, hence meaning that any mixed states as it recognizes them automatically mean bipolar I. This is something that, IIRC, is going to be fixed in the DSM 5.

If you are not exhibiting any signs of loss of contact with reality, I would not assume that you are psychotic at all, but rather are simply having hallucinations and some delusional content and just that. Of course, this is from the point of view that psychosis is essentially synonymous with loss of contact with reality.

Many people who experience psychosis learn that if they're hearing something that's highly unlikely (or if it's a voice they know from the past to be due to AH, etc.), they assume it's a hallucination, and try to get on with their lives. In that way, you could argue that they aren't "losing contact with reality" either. This doesn't mean that their psychosis is cured, though...

P.S. Could your hallucinations be related to your migraines? Sleep deprivation? If there isn't a general medical or pharmacological cause, then you can definitely technically count them as psychotic symptoms

This seems to be more from the point of view of judging things as being along a continuum that includes psychotic features, rather than dividing things into simply non-psychotic and psychotic, with psychosis automatically meaning thought disorder and loss of contact with reality.

Personally this is interesting because I do get and have gotten hallucinations without any signs of thought disorder or, other than on the extra mirtazapine, believing anything other than that my hallucinations are in my own head, along with delusions, which I did believe to be real at the time but otherwise stayed in contact with reality and had no thought disorder. From this point of view, these are still psychotic features, when I have been used to believing that I have not been psychotic with these.

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Hmm. I am definitely not sleeping well, but I am sleeping. I have had hallucinations from lack of sleep, but they were just kind of amoeba-like stuff floating through the air. And at that point, I had had maybe 6 hours of sleep in 3 days. Now it is more like getting 4 or 5 hours of sleep (not the hypo "all I need," I need more. I just can't sleep more).

Mixed features will also fall under BP II when the DSM 5 comes out, unless something happens to the current text. The mixed episodes are actually why I am "NOS."

My migraine auras aren't voices, or haven't been, at least. I think I am getting enough sleep to preclude hallucinations of that sort.

If I am put on an AAP, it will probably be Risperidone, that is the one that I used in the past. I tried Geodon first (sorry Vape), but it didn't work. I loved risperidone when I needed it, and when I calmed down, the side effects became annoying, and my pdoc stopped it.

Okay, this looks like it is going to come down to what the pdoc has to say.

Thanks, and I would of course like to hear anything anyone can add. I could see it fitting a "psychotic feature," but I still don't get how that could be happening (unless it *is* the lack of sleep and anxiety; I just feel like they aren't super bad for being in the midst of an episode). You never know when someone might come across a post and say, "This exact thing happened to me, and this is what my pdoc and I discussed."

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Yeah, but Closure, isn't my being able to tell you details about the "people" behind voices a thought disorder? These aren't voices I know in real life. And if I were going to conjure up a Brooklyn accent, I would have thought it would sound like my ethnic Jewish relatives, not the more upper-middle class version.

And ask me how I knew his accent when I couldn't hear any of the words he was saying? I don't now. Maybe a cadence. But still.

I am a little afraid I am sounding like I want it to be worse than it is, but the way I handle new symptoms is to catastrophize until even I know I am out of control, and for some reason am then able to pull back and not be so panicky. Maybe because I realize the worst case scenario is extremely unpleasant, but actually not a catastrophe..

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You aren't a whiny bitch and you don't sound like you want it to be worse.

Let us know what you find out from your pdoc

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Yeah, but Closure, isn't my being able to tell you details about the "people" behind voices a thought disorder? These aren't voices I know in real life. And if I were going to conjure up a Brooklyn accent, I would have thought it would sound like my ethnic Jewish relatives, not the more upper-middle class version.

And ask me how I knew his accent when I couldn't hear any of the words he was saying? I don't now. Maybe a cadence. But still.

That is why it seemed to me like you probably have some delusional content to this as well, that you believe these things about the people you hear talking without being able to know this from what you hear. I just did not associate this with the term thought disorder, which I tended to associate with a more fundamental breakdown of one's thought processes, e.g. loose association or clanging. (I do remember you comment that you had gotten clanging recently, though...)

Edited by Closure

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To be honest, crtclms, you don't absolutely have to medicate these away if they don't interfere with your life or bother you (although they seem to increase your anxiety, so it may be worth it to try to stop them.)

You should definitely tell you pdoc about them and about the anxiety they cause.

P.S. The mixed episode thing is something that probably should get fixed in DSM V.

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I have had hallucinations similar to those after simply not getting enough sleep, although I didn't feel particularly tired. I didnt think it was psychosis. I wish I had something of real worth to add, as you are obviously distressed. I just wanted to say that I hope everything with the pdoc goes well and you get some answers.

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I had one auditory hallucination out of the blue--as in I was otherwise completely fine, no mood episode. My psychiatrist described it as a psychotic symptom, but that I wasn't in a psychotic state. I don't know if that was to make me feel better or if the distinction does in fact exist...but it might explain the divergent views on what all is necessary to constitute a psychotic state.

To my psychiatrist, seeing things/hearing things that aren't there=psychosis (if no organic/pharmacological cause), but he stated that when you're only mildly experiencing them, you frequently keep the ability to reality check it on your own (test it for yourself and see that it's not in fact happening/that it is a hallucination. When you lose the ability to reality-check, you're more likely to be in a full-blown psychotic state.

Obviously only one psychiatrist's perspective...but I like him a lot and he really seems to know what he's doing. So I trust him fairly well.

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My pdoc feels that I've had two episodes of psychosis: the first was when I got dx'd, and had delusions of persecution, paranoia, hallucinations. The second was about two years ago when I was having multiple visual and auditory hallucinations despite being on lithium and risperdal and Zoloft. In the last case, pdoc simply upped my risperdal from 3mg to 6 mg and the hallucinations went away. From time to time, like once every couple of days, I see shadows and movements out of the corners of my eyes (mainly out of my living room window) but my pdoc isn't concerned about them, as they are very minor and don't interfere with my life. Like, say, a life-size cartoon character running across my back yard did.

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