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insight into bipolar episodes


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I was dx'ed almost a year ago and in my first severely manic, psychotic episode I knew something was wrong but I didn't know what it was until my parents took me to the doctor...still I didn't realize that I was completely out of touch with reality. I crashed into a psychotic depression a few months later and it took me like 3 months to realize I was psychotic and out of touch with reality so I was able to tell myself like "this isn't real, calm down" and I went to the doctor shortly afterward...but it took me such a long time to realize it and I didn't tell my doctor (stupid of me), I think I might have just been in denial or I just didn't have "insight" to realize all of my beliefs were completely false, I almost made some extremely bad decisions ... 

 

I am tired of embarrassing myself or making horrible decisions, is there a way to learn to recognize you're having a severe episode or is your brain just too impaired at that point....it is really scary 

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sometimes it seems like the sicker one is, the less their insight

 

you can gain insight - I have and a lot of people here have increased their insight

it is probably more challening for people who have a lot of psychosis, but it can be done

 

here are my suggestions

 

 

100% compliant with medication, if you don't like a med talk with your doctor, don't just drop it

 

keep a mood chart every day for a year, you will learn a lot about your illness

 

get sleep, when you start to lose sleep, or have pressured speech look out!  mania is on the way

 

develop relationships with family, spouse, or friend where you can listen to them and not be defensive

 

do some therapy, it will help - especially evidence based therapy like CBT

Edited by bpladybug
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I've had psychotic episodes that i didn't realize were happening.  It helps to be aware of any symptoms you have early on.  I get irritable and paranoid first.  So if I start snapping at people I keep a closer eye on my thoughts/behavior.  But, the good thing is, I haven't had psychosis for about 6 years.  I'm on a good med combo, I go to therapy and time has helped me get over the last episode.  I still have some doubts about what was real in the past, but I'm not psychotic in the present.

 

You may want to check out the board for schizophrenia and psychotic disorders, too.  You are in the right place, just another option.

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Sometimes I have insight about one thing but not another. I'll recognize that one set of thoughts is creeping into delusional territory while being completely oblivious to another delusional thought in which I firmly believe. For example, I may feel scared and paranoid that people can read my thoughts, and know that it is a completely stupid notion (while still being bothered by it and altering my behavior out of fear that I could still be wrong) - but at the same time, I may be firmly convinced that I am going to live forever and absolutely nothing can harm me.

 

I may realize that something I'm doing is really destructive and still be hell bent on carrying it out, all the while still being confused about why I am so determined to do so, i.e., I am working on a project and I desperately need to stop and sleep/eat/bathe but I don't care and will ignore everything until the situation becomes critical and I pass out.

 

There have been times I didn't realize that I was having an episode, except in hind-sight... once I pulled myself out of the wreckage I'd created. Sometimes it seems like in the middle of one of my episodes, I just want to watch the world burn. It isn;t directed at other people - just myself - but it's still scary, in hindsight, to see how willfully destructive some of the stuff I've done has been. There were times I should have been hospitalized, but my mom thought psychiatrists were evil.

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Everyone's bipolar is different.  The best thing you can do for yourself, in my opinion, is learn your early warning signs.  Mood charting can help with this.  Therapy can also help with this.  If you're able to look at cycles of behavior over a period of time, you might realize that there are some commonalities in things you do that can indicate an episode may be coming on.  It's not perfect.  You're still likely to have episodes that you may only recognize in hindsight.  You're also likely to try to justify your behavior in terms of external circumstances.  Be as honest with yourself and your medical team as you can be.

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Yeah, I agree wth Megan on that one. If you have a good family member, significant other, or friend who is vigilant, they can be a good second line of defense. Your therapist and psychiatrist are another set of people who can catch your symptoms before they start to become a serious problem. Keeping your illness in check is a team effort.

 

But your first line of defense is data you gather yourself. I can still have a window of clarity where symptoms are ramping up but I haven't boarded the crazy train yet. So, Confused is right in that mood charting is very useful. I don't do it enough. Sleep is super important, I cannot stress how important it is and I didn't even begin to understand that properly for years. I have learned to consider being unable to sleep or being up for more than 24 hours an emergency. It means that I have a window of time where I can do something about the oncoming train, so to speak.

 

Being proactive about things can be tough. Sometimes, I just want to stick my head in the sand. But it's far better to have a false alarm and begin taking steps to manage a potential episode, than it is to have to pick up the pieces after it's over.

Edited by Bubble
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I've had psychotic episodes that i didn't realize were happening.  It helps to be aware of any symptoms you have early on.  I get irritable and paranoid first.  So if I start snapping at people I keep a closer eye on my thoughts/behavior.  But, the good thing is, I haven't had psychosis for about 6 years.  I'm on a good med combo, I go to therapy and time has helped me get over the last episode.  I still have some doubts about what was real in the past, but I'm not psychotic in the present.

 

You may want to check out the board for schizophrenia and psychotic disorders, too.  You are in the right place, just another option.

 

Yeah, it is so scary when you don't even know what happened in the past :(

 

I guess I have to be a lot more vigilant, this whole time I was trying to pretend I'm fine and ignore my "symptoms" but I guess I just can't do that anymore because it wound up getting completely out of control ... 

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Prevention is key for me, by staying on all meds, keeping as little stress as possible in life, and getting enough sleep in every day.  Especially enough sleep ... when I don't get enough sleep I tend to become more psychotic, even if I am taking meds compliantly.

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Being honest with yourself and especially your doctor. Chart or journal your moods so you have a record, and report even what seem like 'nothing' little changes - let your doctor decide if it's nothing to worry about or something more concerning.

I did up a 'health care action plan' with my former tdoc. This included making a list of possible symptoms, learning to recognise your early ones is important. Feedback from others is also a good idea, I live alone but keep frequent contact with my mother and sister, not to mention my employees at work.

I have reported potential 'red flag' symptoms to my pdoc before, and she told me those were likely a regular mood shift unrelated to my disorder, but of course keep an eye on it. She was right. Most recently I recognised warning signs of an impending mixed episode, and she instructed me to check myself IP, which I did - and my Sx definitely got worse before they started aggressively treating my hypomania. So I was glad to have caught it so early.

Trust between you and your medical team is key, and between you and your external support people too, like family, friends, trusted co-workers, etc.

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Honesty and feedback. The best thing I've found is to have an individual who I can trust who can tell when my moods move outside of "normal/average) ranges. It's really hard to accept that I am indeed acting this way, but it acts as a reality check. I sure don't like it sometimes, especially when it's not what I think, but my prior pdoc says you can always get a better gauge of your behavior through others. Self-reflection can be your own worst enemy. I rationalized my feelings as "normal" or "ok" until I started voicing them to others.

I also do a mood tracker and constantly analyze my mood cycles. I cycle regularly (complete cycle every 5 weeks) so I like to see how/where I should be. I don't always need to know how I felt last Tuesday, but it helps to know how long I've been depressed.

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My best friend told me just last night that based on our email exchanges alone she could tell something wrong. I realize she is right. My husband isn't great at insight into others *at all,* I think it might be a deficit from the epilepsy.

 

But when I asked him if I had been behaving differently, he said yes, but he couldn't decide if it was the move or my mood. I had thought (hoped?) it was the  move, to).

 

I don't know if it was 100% lack of insight, or pure denial. The timing of this episode is going to be a catastrophic.

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I am in the same boat with you, I have no idea when I am slipping into an episode. I can usually tell better when I am depressed because I notice that I tend to sleep more and not want to do anything (at all), but hypomania/mixed episodes I have no clue about until they are over. My girlfriend bless her heart, is the only person I see or talk to on a regular basis who can be objective and let me know when I am starting to behave differently, but she is overly-hyper vigilant to the point where if I have a really good day she thinks I am getting manic, and when I have a bad day she thinks I am getting depressed... and I can't fully trust that as a result. 

 

So I really have no clue. I do a mood chart but I don't know how I feel half the time so I just put down a "5" or a "6" in the middle, regardless of anything else. 

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sometimes it seems like the sicker one is, the less their insight

 

you can gain insight - I have and a lot of people here have increased their insight

it is probably more challening for people who have a lot of psychosis, but it can be done

 

here are my suggestions

 

 

100% compliant with medication, if you don't like a med talk with your doctor, don't just drop it

 

keep a mood chart every day for a year, you will learn a lot about your illness

 

get sleep, when you start to lose sleep, or have pressured speech look out!  mania is on the way

 

develop relationships with family, spouse, or friend where you can listen to them and not be defensive

 

do some therapy, it will help - especially evidence based therapy like CBT

 

This is a good summary of many of the suggestions made.

 

My last therapist also sat me down after I went manic and had us brainstorm all the signs that I did not see at the time. We did this while it was all fairly fresh and somewhat recallable. Over time, I've always forgotten the signs. But they are definitely there. When I start getting really irritated with other drivers, it's a maybe sign. When I'm yelling at them, near certain. When I get argumentative at work, I'm heading for trouble. Not sleeping normally, a big clue, and an easy one to notice. Work with a good therapist, chart your moods for a year, learn the first signs of your illness and then act quickly instead of ignoring them. Of course, this sounds easy to people who don't go nuts.

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