Bipolar psychosis symptoms
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Bipolar Psychosis Symptoms: An Overview
Prevalence of Psychotic Symptoms in Bipolar Disorder
Psychotic symptoms are a significant aspect of bipolar disorder (BD), affecting a substantial portion of patients. Research indicates that lifetime psychotic symptoms are present in over half of BD patients, with current psychosis observed in nearly half of them . Specifically, psychosis is more prevalent in bipolar type I compared to bipolar type II disorder and is more common during manic or mixed episodes than during depressive episodes .
Common Psychotic Symptoms in Bipolar Disorder
The most frequently reported psychotic symptoms in BD include delusions and hallucinations, with delusions being more common across all phases of the disorder . During manic episodes, grandiosity, delusions, lack of judgment/insight, excitement, suspiciousness/persecution, and hostility are prominent . Mood-congruent delusions, particularly grandiose delusions, are the most common psychotic features in pediatric bipolar disorder .
Impact on Illness Severity and Course
Psychotic symptoms in BD are associated with a more severe course of illness. Patients with psychotic features tend to have poorer insight, higher levels of agitation, anxiety, and hostility, and increased rates and duration of hospitalizations . Additionally, psychosis in BD is linked to a higher frequency of switching among patients with depression and poorer outcomes with mood-incongruent symptoms . However, psychosis is less likely to be associated with a rapid-cycling course, longer illness duration, and heightened suicidal risk .
Neurocognitive and Functional Impairments
Psychotic bipolar disorder is associated with specific neurocognitive impairments. Patients with a history of psychosis exhibit deficits in executive functioning and spatial working memory compared to those without psychosis . Despite these impairments, general intellectual function remains preserved. Furthermore, psychotic symptoms in BD are linked to less favorable socio-demographic profiles, including earlier age at onset, higher rates of comorbid substance use disorders, and more frequent hospitalizations and involuntary commitments .
Comparison with Schizophrenia
The psychotic symptom domains in bipolar mania, as measured by the Positive and Negative Syndrome Scale (PANSS), show similarities to those in schizophrenia. Both disorders exhibit factors such as anxiety, negative symptoms, depression, excitement, and positive symptoms, although bipolar patients may present fewer cognitive symptoms . This overlap suggests that while there are distinct features, there are also shared dimensions of psychosis between the two disorders.
Conclusion
Psychotic symptoms are a prevalent and impactful component of bipolar disorder, contributing to the severity and complexity of the illness. These symptoms manifest in various forms, predominantly as delusions and hallucinations, and are associated with significant neurocognitive and functional impairments. Understanding the prevalence, common symptoms, and impact of psychosis in BD is crucial for effective diagnosis, treatment, and management of the disorder.
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