Bipolar I disorder with psychotic features is a mood disorder characterized by unusually euphoric or agitated moods, along with depression or a mix of high and low moods. Psychotic symptoms are also part of this disorder, which can severely impact a person’s ability to function. An accurate diagnosis and appropriate treatment plan are vital to the successful management of bipolar I disorder with psychotic features 1.

Diagnosis

To be diagnosed with bipolar I disorder with psychotic features, individuals must have experienced one or more manic or mixed episodes during the course of their illness. A manic episode is a period of unusually elevated, excitable or irritable mood lasting for at least one week. Other symptoms include inflated self-esteem, more talkative or pressured speech and racing thoughts. A mixed episode is diagnosed when a person experiences both a manic episode and a major depressive episode, rapidly alternating with each other. A major depressive episode includes symptoms such as depressed mood, increased restless or decreased physical activity and feelings of worthlessness, among others.

The presence of psychotic symptoms in bipolar disorder places an individual at the severe end of the diagnostic spectrum, meaning that he exhibits more than the number of symptoms required to make the diagnosis. Also, these symptoms significantly interfere with his ability to function in his job, socially or within his relationships.

Psychotic Features Classification

Psychotic symptoms can be congruent or incongruent. Mood-congruent psychotic symptoms are delusions, which are false beliefs, or hallucinations, which are false sensory perceptions, that are consistent with the person’s current or most recent mood episode. For instance, a person who is having a manic episode may have delusions that she has special powers and is invincible.

Mood-incongruent psychotic symptoms are delusions or hallucinations that are inconsistent with a person’s most recent or current mood episode. An example would be a person experiencing a major depressive episode who reports the delusion of special powers. This false belief is inconsistent with the themes of powerlessness and helplessness that are common during depression.

Prognosis

Individuals with bipolar disorder may experience mood episodes throughout their lives, and symptoms may worsen as time goes on, particularly if they do not seek treatment. Individuals with psychotic symptoms typically experience a more severe level of symptoms and may require more intensive intervention. Once a person has had psychotic symptoms during a manic episode, he is more likely to experience them in subsequent episodes. Individuals with mood-incongruent psychotic symptoms have a poorer prognosis than those with mood-congruent symptoms.

Treatment

Appropriate diagnosis and treatment are critical in successfully managing bipolar disorder with psychotic features. Because there is no known cure, treatment plans should focus on managing symptoms and preventing mood episodes. The most common course of treatment is a combination of medication and psychotherapy. Medications for this disorder typically fall into three categories: mood stabilizers, antidepressants or antipsychotics. It is important for a physician to supervise patients to monitor progress and any possible side effects or drug interactions.

Mental health professionals often use cognitive-behavioral therapy, or CBT, to treat bipolar I disorder with psychotic features. CBT can help patients identify negative thoughts and behaviors and learn how to modify them to create positive change. Other mental health services may involve family members, which helps to manage the patient’s symptoms and needs.