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Bipolar With Psychotic Features: Start with this video. The presenter is named Rob Whittaker. The videos, support group and Patreon Community are all under the name Polar Warriors. While I have seen other presenters (I think 2,) Rob makes most of the group's videos. PSYCHOSIS: Signs, Symptoms and Treatment (YouTube video) https://youtu.be/BVywnd9YE4s?si=FmV9aF7VLKRvxG98 Stuff I've learned mixed with personal experiences. I used to think psychosis just had two different sets of symptoms. Hallucinations and delusions. Mostly because that is what I had personally identified in my life. Even in the video above, Rob really only touches on these two. 1. Hallucinations are sensing events that do not exist in reality. The can be any of the five senses: Seeing things is called visual hallucinations. Hearing things is auditory. Feeling things is tactile. Smelling things is called olfactory hallucinations. Tasting things is gustatory. The most common two are visual and auditory. Personal experience: I had sneaky little hallucinations most of my life (until stable on meds.) I just realized they were hallucinations about 5 years ago. (Started when I was 5 years old and I stabilized 10/2004.) I was reading a thread about hallucinations and the light bulb went off! I would hear my name called, or a telephone ring, or a phantom radio, I also would feel (4-6 times a year) being tapped on the back of my left shoulder 3 times “by an angel” (go figure. iDK where that idea came from.) I just thought these little things happened to everyone. My dad used to see things (usually family doing things we just didn’t do) and smelled oranges. 2. The other set of psychosis is delusions. Thinking things that are not based in reality. The movie "A Beautiful Mind" was about a professor with Schizophrenia, but it had the best depiction of a delusion. He consistently, over time, saw and talked with the little girl who never grew up. She wasn't really there. Years later, when he controlled his symptoms better, he did a reality check after being approached by a person he'd never met before. He stopped a student and asked her if she could see the person. Best example of a delusion I've ever seen in a movie. What I do know (again personal experience) is delusions include paranoia, special powers, believing we are gods… I had intense (like hide in my bed with tinfoil over the windows for 6 months at a time) paranoia. I just knew they were “coming to take me away” or everyone was watching me wanted to hurt me. My all-time favorite movie quote was from Mel Gibson in Conspiracy Theory: “Just because I’m paranoid doesn’t mean they’re not out to get me” Psychosis in general also has 3 more sets of behaviors. While these are rare in Bipolar, we are all unique human beings and the differences csn be subtle or profound so any of these are possible. Disorganized thinking Disorganized behavior Negative Symptoms 3. Psychiatrists determine and diagnose Disorganized thoughts by observing disorganized speech. Speech that is not cohesive and coherent. This is different than the rapid, pressured speech of mania. But the concept of identifying thought symptom by speech observation is consistent when doctors are examining mania. Rapid speech originates with "flight of ideas." This is a symptom of bipolar where the thoughts stream by like birds in flight. One might register but vanish when you try to hold onto it and think the way through it while 3 more ideas flash through the mind. A big indicator of disorganized thought is "clang associations." An example of clang associations might be someone trying to say, "The cat has a new bell." When clang associations happen, the idea may sound like, "The cat has well, hell, tell, tail wags, sags, old hag," The saddest part about the idea of clang associations to me is I used to write poetry. Rhyming poetry. Clang associations. I only wrote when I was really high off brain soap. I haven't written any poetry in over 15 years. 4. Disorganized behavior. the first thing people think of and fall back to is "all bipolars have disorganized behavior." That is not necessarily true. The last time you did episodic spending, can you remember justifying your need. Most of the time we have logical thoughts, very fast but logical, driving our behaviors. The disconnect for bipolar people who are accelerated is the most possible repercussions just don't seem to occur. There's no "this is a bad idea because that will probably happen." The same way everything is about "right now." The idea of tomorrow is usually not even contemplated. But for people with schizophrenia, disorganized behavior is incongruent like starting and interrupting activities. An example might be someone talking to you who just starts spinning circles, then in mid-spin, he might just sit down and pull off one shoe. 5. Negative symptoms. Something missing like being unable to carry a conversation or no apparent goal-driven behavior. Actually, increased goal-driven behavior is one of our hypo/manic symptoms. So the absence of not only increased but also all goal-driven behavior would be a negative symptom. Something would be missing. This video by Dr. Tracey Marks does an excellent job of explaining what I just mangled by filtering through my experiences and thoughts. Depression vs Negative Symptoms of Schizophrenia - How to Tell the Difference https://youtu.be/rdFF1_tPyGA?si=FxWxhbG5zvn9-yYZ Ok , so the BIG question: How do I handle this when it happens? The best I can tell you is if you can determine that something is happening that’s not real (like seeing shadow people - real common) or if you feel like you are special or paranoid, it’s time to call your doctor’s office (especially if you feel the need to tell someone how very special you are.) Don’t wait for an appointment or ask for one. Call right away and ask to speak to the nurse. Psych nurses are awesome. They really listen, ask the right questions, consult the doctor and call back with prescription changes and/or instructions. (Usually the same day!) The psychiatrist can prescribe an antipsychotic or increase one. It does not have to be a permanent change and he, or she, can change it again after you are not in distress. The crippling paranoia and the belief that I had touch healing would go away on their own but, in my case (remember, YMMV) that could take 6-8 months before it did. A temporary med adjustment might have stopped it and stop my long-term suffering.