Responding to Bipolar Psychotic Symptoms

By Amy Willer | Apr. 17, 2017

 

A first experience with psychosis can be terrifying, exhilarating, disorienting or feel just plain ordinary. Sometimes it can seem ordinary because it was your reality for a while. Your senses and brain colluded to fabricate something that wasn’t actually there. It certainly felt real, though.

For example, during my first psychotic break, it felt as though my cognitive abilities had reduced to that of a toddler. I couldn’t understand what people said to me, and I couldn’t talk. It felt like I had lost my ability to process language. I locked myself in my bedroom for 48 hours and used a coloring book I had; I did this because it comforted me, and it was also the only thing I could focus on or understand. I had no sense of time—many hours would pass, and I thought it had only been a few minutes. I didn’t eat during this time, and it never occurred to me that I should eat or that I was even hungry.

Now that I have more experience managing my illness (bipolar disorder with a psychotic feature), I can look back on this experience and understand it. At the time, though, I didn’t understand anything was wrong, and even if I had, I lacked the language to communicate what I was experiencing. This was because I was not educated about psychosis—even if I understood the situation was odd, I would not have known exactly what it meant. 

Accepting a Complex Condition

The scary part of psychosis is usually the aftermath, when you realize what happened. When you first experience it, you may remember stigmatizing jokes about “crazy people” you’ve heard or news stories of violent, “psychotic” people. But the reality is more complex, and a little more painful than all that. The reality is that you are just a human being—a beautiful one, who also happens to have a mental illness.

This can be painful to accept, and there is a certain grief in admitting we don’t always have control of ourselves. However, effective treatment is available, and over time we may come to recognize the warning signs of an episode. During these signs, we may learn how to intervene for ourselves.

For example, I have many (now) predictable warning signs. I may become clumsy, lack spatial awareness and feel as though I don’t know where I am. I could become lost in a place I have been in hundreds, or even thousands, of times. I can become paranoid someone is in my house, when I know no one is. Even the sensation of sound seems to ebb and flow—seeming at first inaudible, then unbearably loud. It feels like I am drunk, when I am perfectly sober. 

As you learn how to manage your own illness, you might start noticing your set of symptoms. It can be scary to realize that you are headed for a psychotic break, but it is possible to do things that lessen the severity of, or even avert, psychosis. It’s like using an inhaler when your breath becomes heavy, rather than waiting to go to the ER with an asthma attack.

It’s not always that simple, but learning to respond effectively and without fear offers us some of the dignity we sometimes feel we lack. It empowers us to realize that we can confront this medical issue like any other—without shame. Here are some practical ways to incorporate safeguards into your own life: 

  1. Notice your condition’s patterns. How does psychosis manifest in your life?
     
  2. Tell somebody. Develop spaces in your close relationships for the ability to say you are slipping into a psychotic episode or that things don’t seem quite right. If it feels safer, develop a code for talking about it in public.
     
  3. Take medication. Establish in advance with your doctor what medication you can take. You might be able to have an as-needed medication, or agree with your doctor to take a daily, maintenance medication.
     
  4. Call your doctor. They are there to help. If you are afraid of hospitalization, realize that this is not always the outcome of telling your doctor about psychosis. I’ve experienced psychosis as an aspect of my illness for seven years and only been in the hospital once for it; and even then, it was my choice.
     
  5. Absolutely avoid alcohol. This is generally wise with mental illness, but critical in regards to possible psychosis.
     
  6. Know your potential hazards and act accordingly. If you experience “black outs” (dissociative amnesia), try not to drive. Ask a friend for a ride, instead. It is possible to lose total awareness of what you are doing while driving.
     
  7. Get sleep. Sleep deprivation is a trigger for psychosis, and quality sleep can help abate active symptoms.
     
  8. Develop routines around sleep, eating, medications and social time. It may seem overly strict, but it can go a long way towards preventing future episodes. For instance, I don’t answer the phone before nine in the morning, and I limit social time at night to get enough sleep.
     
  9. Watch something that can keep you grounded. Like your favorite movie or television show—even if you watch it on repeat! Something about the familiarity can help if you are having trouble focusing.
     
  10. Have a sense of humor. And finally, if you do hear voices or hide in a parking lot from the police or imagine yourself to be like Winnie the Pooh because you’ve just realized your head is made of fluff (all experiences I’ve had), learn to laugh at yourself! After all, you were Winnie the Pooh for a day.

 

Amy Willer is an advocate, writer, volunteer, friend and community member with bipolar I with psychotic feature and PTSD. She has survived suicide attempts twice and has overcome addictions to self-injury and anorexia. She lives in southern Arizona, and loves hiking and spending time with her friends.

Comments
Jose Barrios Vanegas
Very useful, specially when you don't know how to react. Thanks,
9/21/2017 11:57:26 PM

Julia
Hi Amy,
Looks like I'm late to the party, but that's ok. Thanks for your article.

I don't really know if I've experienced psychosis, but I've been told I have exhibited signs noticeable to other people. I always like to read what others say about their psychosis because I know it is different for everyone and when I read about others' experiences, I can identify with bits and pieces of what I see. It is all very confusing to me. I am confusing to me. :)

I've had, on occasion (like I can count it on one hand), short periods where I kind of freeze, but I watch everything going on around me. It looks like an absence seizure,but it's not that. It's almost always happened when I've been hospitalized and it's hard to think if there's a trigger. When the nurses have noticed, they do their thing (some, sadly, ignore you and think you just want attention), but I'm frozen. I can hear and understand all the words, but I can't speak at all or move. My eyes are always the way to come back out of it, whatever it is. So now I know that if I can keep my eyes moving, it'll end faster and be easier. It just takes time. I know once, it seemed to take hours. Another time, maybe 30 minutes. The 30 minutes time, I think they might have given me a small dose ativan but I'm not certain. I do remember that nurse and the eye contact we made that was the start of it ending. She said they all thought mimicked as a mini-catatonia.

I live in AZ too; it would be neat to connect with you. I'm sure you have so many more experiences and wisdom to impart!
9/10/2017 12:05:23 AM

Catherine Ryan
Thanks so much I have borderline along with severe anxiety and depression.. these out of body unable to function situations are scary and have always made me second guess myself. Now I know why , it's my borderline...! Thankyou for your honesty and humour much needed at this very upsetting time!!! You're amazing xx
5/19/2017 8:06:52 AM

Jerry
Extremely helpful information for our family. Thanks Amy.
5/17/2017 1:35:02 PM

Juliette Hirt
Amy, this is such a wonderful article! Thank you so much for sharing your insights. I will keep them in mind next time I turn into an angel. LOL!
5/10/2017 1:37:48 AM

Amanda
I was diagnosed with bipolar disorder 1 after my mother passed away in my early twenties At that time I started to have bipolar disorder psychosis I heard things and saw things that weren't there.It was a very scary time in my life.I was hospitalized at the best hospitals and received treatment. Now I know my symptoms and triggers.This blog was helpful because it explained what happened when someone suffered from bipolar disorder psychosis.This was very useful information. It was well written and educating. I appreciate the time that spent on writing this blog.Thank you Amy Willer , I enjoyed reading your blogs on Nami website.
5/9/2017 10:36:22 AM

Rebecca
Add me to this list of resounding thanks for your article. Really helpful.
5/6/2017 6:51:57 PM

Shannon Vassiliki Iliadis
Amy, you are not alone. It is very impressive you have only been hospitalized once. You are stronger and have more depth and beauty than you ever imagined was possible. Please realize you make the world a better place with you in it. It's very important to not act on ideation. I want Matthew Nock to help you and I will help you too when I when sue the MacArthur Genius Grant foundation. Your story deeply moved me. I struggle myself at times. I have "A beautiful Mind." Whatever you desire I have just adopted you in my heart and I will help you with everything you need in this life. I promise you.
5/2/2017 1:46:25 PM

Steven
Thank you. I have the same symptoms as you do along with schizoaffective disorder. Thanks to you and nami.org for the information. Its nice to know we are not alone.
4/30/2017 11:12:38 PM

Vierna
Great article. Thanks so much for your support and insight!!
4/29/2017 8:10:43 PM

Tess
Thank you, Amy, for telling your story. My teenage daughter has bipolar I disorder, and her brain just shuts down when she has an episode. She can't think, has trouble talking, and can't retrieve information from her memory, although she knows it's there, she just can't find it. I am going to have her read your article. It is always good to know you are not alone!
4/28/2017 4:20:53 PM

Anthony Hopkins
I can relate well with this blog because I suffer from Schizoaffective Disorder. I have problems sleeping at night. It is also my fault because I drink caffeinated drinks throughout the day. I sometimes take my medication with coffee and other energy drinks. Therefore, I am not able to sleep well at night. It is my fault sometimes because I have been having problems drinking water. The water inside of my apartment is very nasty. It taste very nasty. Thanks!!
4/27/2017 11:02:47 PM

rhonda
Great Article Amy,
Thanks so much for sharing. I look forward to the day, our son will have the clarity, will and skills (like you do) to managing his Bipolar 1 with psychotic features.
4/27/2017 4:41:42 PM

Dawn
Thank you so much for these facts and the help NAMI GIVES US.
4/27/2017 12:52:42 PM

Joshua Sinclair
very helpful. Thank you!
4/27/2017 12:41:15 PM

Francine Farina
I did have psychotic breaks during hospitalizations which did not help. I did not respond well to Risperdal! It was horrible. I need to read more articles like yours. Thank You.
4/27/2017 10:11:02 AM

QueenP
I can relate to a lot of this. Thank you!
4/26/2017 7:36:47 PM

Elliot
Having Bipolar 2 for so many years-different meds. finally in retirement at 65-I take much less meds-small xanax down alot -and an Viibrid which does the job at 40mgs. so much in life has lightened up-still have symptoms at waking and sometimes during the day but real improvement
4/26/2017 7:12:16 PM

Jennifer Newhouse
Thank you for being so candid and so detailed in your descriptions. I think it really helps to be able to understand my daughters disorder more clearly. You are the only other person I have heard from besides my daughter that lost the ability to speak, lost personal information, like how old they were etc and needed to be fed. All these happened with her first very major break. She hasn't had one for about 15 years now. Some small reversals but none that were difficult to catch and manage. Thanks for being so open!
4/26/2017 6:10:36 PM

P.S.
I really enjoyed reading part of your story Amy. I believe I have had psychotic breaks throughout my childhood. One of those times I was in play yard of my elementary school and had been going through a lot of stress from verbal and physical abuse from my mom at home and bullying from my classmates at school. One day I remember walking in the play yard and standing just looking forward for I don't know how long, not knowing where I was or who I was. I tend to have had something like this over the years when I became severely stressed. At times I have gotten so frustrated I would feel anger clench my teeth and start to yell at whoever is close to me and say things I may or may not remember and I would regret it later. After the episode I would have a huge high of happiness that would be exhilarating. After having studied about brain disorders and trauma I believe I may have Bipolar Disorder, PTSD, Moderate Anxiety disorder, and Depression. Non of these have been officially diagnosed. I have reached out for help several times through mental health, but I always am told I keep it together very well and I should just work through it. That's just it I have tried to work through it and have suffered through, addictions, loss of close relationships, family, friends. The worst feeling over all is the pain from being misunderstood.Most people really do not understand me. Even those closest to me. It has hurt so much. I have managed to get through life, but I am so tired of the anxiety and not being able to accept change and allow myself to be in close relationship, by putting up strong boundaries. Thanks so much for your informative and supportive story Amy. I look forward to reading more about your journey. Your story was very helpful.
4/26/2017 6:03:14 PM

Rachael
Great info, however for people who are experiencing this for the first time and are scared to talk with someone what do you suggest?
4/26/2017 11:34:28 AM

Elisa Waggoner
Thanks to Ms. Willer for solid recommendations and for sharing some of the specific things she has experienced. Personal experiences are educational and enlightening, and I identified with many of them. They also give more shades of meaning to words, such as diagnoses, that are otherwise vague and misunderstood by a lot of people.
4/20/2017 5:49:01 PM

Marilee Eaves
Amy, I love the clarity of your descriptions of the way things have been and what you have learned. I've managed to avoid episodes through medication for 30 years, but I never associated some clumsiness with the bp disorder. Thank you! one more mystery resolved. Keep writing!
4/20/2017 2:30:41 PM

Josh
I can't seem to leave my house to make friends how can I get through it.
4/20/2017 12:02:47 PM

ann kurian
good Information. It's really useful information for daily living with a Bipolar patient.
4/19/2017 2:10:38 PM

ann kurian
it's really informative. Good information.
4/19/2017 2:09:10 PM

ann kurian
Good information. it's really informative.
4/19/2017 2:07:52 PM

P-S
This article was so helpful . Thank you for being candid. I just got out of the hospital today for the second time in a month and I had a lot of similar issues but no one seems to listen☹️ Hopefully my therapist can help tomorrow. I have had psychotic breaks before but they were very extreme and obvious. Thank you for letting people know that they are not always obvious. God bless you and keep you safe!
4/18/2017 4:03:14 PM

Adrienne
Amy's description of learning to recognize symptoms of psychosis and her recommendations are truly a gift to anyone wanting to learn about recovery and what it takes! Thanks, Amy!!
4/18/2017 9:47:45 AM

Adrienne
Thanks, Amy, for your very special and thoughtful account. Such a gift for others working to understand symptoms!
4/18/2017 9:42:41 AM

Carole hart
Thank you for sharing. That helped me better understand psychosis.
4/18/2017 6:40:58 AM

Justin Carroll
Thank you. He's finally tired now and every word is a heavy burden. But thank you. I'd like to talk one day7
4/18/2017 5:41:40 AM

Paige
Thank you for sharing your story and offering tips to manage! It helps knowing me and my son are not alone!
4/17/2017 9:13:38 PM

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