[Victoria'smom]

Okay, I can't find any info on the difference between Bipolar 1 and Bipolar 1 w/ Psychosis but more and more I'm wondering the difference is. I know it's not very much most likely but I figured I'd ask.

[A Red Panda]

Well, isn't it that Mania can still be super intense Mania without having any delusions? (don't really know)

[Mr. Radio]

Bipolar 1 that reaches psychosis is mania gone to the full extent. Imagine your flying a kite and then you let go. That's what psychosis is. You start to think and make the craziest connections and believe them. You're god, you have powers, or you see or hear things. You think that everything is connected to you.

The difference I believe in bipolar 1 and bipolar 1 with psychosis is one mania gets maxed out into a psychotic state and the other only stays at a certain high. The first time I went manic I went psychotic. I would of loved for things to be different.

[Secretum]

Psychosis is a break from reality...you hallucinate, or have delusions (false beliefs). You don't have to be super manic to be psychotic. I had a period where inanimate objects were telling me to kill myself so that I could be one with the universe. I was "enlightened"-I knew exactly what happened after death, knew that the unity one felt with all existence was better than life. I was also talking to dead people telepathically. I wasn't the least bit depressed; I was more manic than I had ever been. But that still wasn't all that manic-i was still sleeping 7 hours a night, didn't have constant racing thoughts, and I didn't do anything impulsive other than suicidal gestures related to my delusion. So, psychosis can happen independent of severe mania. You just have to be at least a little bit manic or depressed. If you're psychotic when you have a normal mood, then you're schizoaffective.

Contrary to popular belief, psychosis has nothing to do with uncontrollable rage. Rage can be a consequence of psychosis, but it is not synonymous.

I hope that this helps! Psychosis comes in many forms. I have a schizophrenic friend (not bipolar) who hears a voice narrating everything that she does. I'd imagine that that would be quite annoying.

[Victoria'smom]

That's what I'm wondering, does the "with psychosis" mean outside episodes or just every episode will have a psychotic break? Wouldn't outside episodes be scizo - affective bipolar type?

[Dylanzmama]

I don't know about schizoaffectve bipolar, but I was just diagnosed "bipolar"... I don't even know if they made a distinction when I was I the hospital. I was definitely manic and psychotic. (Great descriptions above of psychosis!)
All they gave me was lithium, but the delusions didn't stop 'til I took an AP, zyprexa.
I was told that it was caused by a (Dr. supervised)decrease in my antidepressant. Or it was postpartum related.
I take my meds religiously and hope I always do. I never want to go back to that hell!

[ultramar]

My understanding is that the psychosis would definitely be within the context of a manic episode (though I understand you can have depressive episodes with psychosis as well), in which, along with the psychosis (delusions or however it manifests itself) you would also have to exhibit some of the other symptoms of mania (lack of sleep, etc.).

You probably know what psychosis is, its different flavors, Bipolar 1 *with* psychosis, is just one form of bipolar where (I would think usually manic episodes) are accompanied by psychosis. I suspect it doesn't mean, though, that you necessarily become psychotic with every episode.

[ultramar]

From the Mayo Clinic:

To be considered a manic episode:

• The mood disturbance must be severe enough to cause noticeable difficulty at work, at school or in usual social activities or relationships; to require hospitalization to prevent harm to yourself or others; or to trigger a break from reality (psychosis).
• Symptoms do not meet the criteria for a mixed episode (see criteria for mixed episode below).
• Symptoms are not due to the direct effects of something else such as alcohol or drug use, taking a medication, or a having a medical condition such as hyperthyroidism.

My interpretation of "the mood disturbance must be severe enough to ... trigger a break from reality" is that the "mood disturbance" itself must also be present -if this makes sense. The criteria for the 'mood disturbance' that has to be a part of this whole picture would have to include 3 or more of the following, along with the psychosis (also Mayo Clinic):

A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood that lasts at least one week (or less than a week if hospitalization is necessary). During the period of disturbed mood, three or more of the following symptoms must be present (four if the mood is only irritable):

• Inflated self-esteem or grandiosity
• Decreased need for sleep (for example, you feel rested after only three hours of sleep)
• Unusual talkativeness
• Racing thoughts
• Distractibility
• Increased goal-directed activity (either socially, at work or school, or sexually)
• Doing things that have a high potential for painful consequences — for example, unrestrained buying sprees, sexual indiscretions or foolish business investments

[~Christina]

This is what I know .. I deal with psychosis daily with or without an "episode present" .. why you ask ? Because I refuse to take an AP daily. I will use one PRN if I start to question whether my hallucinations visual and auditory are real.

My Pdoc and T and I have discussed and discussed whether its this or that. The decision was made jointly that I am just fine and dandy with a Bipolar I diagnosis., I mean, does it really matter ? and the answer for me is ... No it really doesnt.

I don't give a damn about who does what studies and whatever there criteria shows , They are just too busy arguing who is more right than the other.

Anyway , just my opinion as always.

[Victoria'smom]

Are our pdoc & t the same christina? I'm asking because it's been ask of me to clarify several times when dr.s are dealing with Miguel. His record still has adhd and AS on it and I'm always getting "lamictal isn't for adhd and/or he's to social for AS". So they extra scrutinize the rest of our family history including the bipolar. I was also wondering if the "with psychosis" was just a less stigmatized way of saying scizo-affective. Also because Miguel is re-evaluated every 2 yrs. By a different pdoc (that don't have access to our recoreds), he's other medical issues & his Gp he sees a lot of drs. So from now on I guess I'll just leave the "with psychosis" out.

[Victoria'smom]

And one can still be manic with out psychosis?

[~Christina]

I think it's too early in my opinion for pdocs to put more labels on him. All these "diagnosis will follow him around possibly for life, it could effect school, college, loan applications, health insurance of course , life insurance policies .. oh the list goes on .... I am really happy my Pdoc isn't all about tossing label after label after label at me . If he was that type I would fire him and find a new one.

I think most people can have episodes of Mania with out it going into Psychosis.

[bluewind]

In order to get a Pdoc at a clinic that offers a sliding scale for uninsured and unemployed people like myself, I have been told I need to get a determination or proof of a severe mental illness! I have been dealing with this for 15 years! I have a file 3inches thick. But we moved to a new state and that is the requirement.

I have bipolar 1 with psychosis and mixed state, gad and panic disorder. I have been psychotic without being manic but by forgetting to take my geodon on an overnight trip. Was I a little depressed or manic...I don't think so but perhaps. I certainly got psychotic. Thank goodness we were only gone two days. After I took my geodon I was A-OK.

That's just my experience. However, the first time I was psychotic I was highly manic.

[Victoria'smom]

Christina his pdoc has him solely labled as ADHD on paper. She will be switching it to solely aspergers to get the services (with out going through insurence or the school system): Drama classes, Occupational therapy, physical therapy, and social classes because he does meet the aspergers criteria.

With us having to "rip him off the walls" and "someones in my bedroom and he's waiting until I'm sleeping to kill me to take my toys" or like things whenever trying adhd meds, and his increasing Self injury and suicide attempts, she's pretty sure it's bipolar. As long as he's getting services it will stay as aspergers, even if he has to go inpatient but she's using bipolar meds to help. However she doesn't want us to be shocked with the bipolar label when he has intake when moving to adult services at 18. However with aspergers she can fight that a change in pdoc's would be more damaging to mental health and he could stay in the children's services until he is ready to move.

I'm sorry I wasn't clear on that, it's the non-psy doc.'s and the nurses that are annoying. He does do testing every 2 yrs but because she's his residing pdoc the testing are suggestions.

[ultramar]

Originally Posted by ~Christina

This is what I know .. I deal with psychosis daily with or without an "episode present" .. why you ask ? Because I refuse to take an AP daily. I will use one PRN if I start to question whether my hallucinations visual and auditory are real.

My Pdoc and T and I have discussed and discussed whether its this or that. The decision was made jointly that I am just fine and dandy with a Bipolar I diagnosis., I mean, does it really matter ? and the answer for me is ... No it really doesnt.

I don't give a damn about who does what studies and whatever there criteria shows , They are just too busy arguing who is more right than the other.

Anyway , just my opinion as always.

For the record and for what it's worth -my personal, not-a-doctor opinion- there can be all kinds of co-morbid/additional stuff going on, which complicates things considerably, and which does not negate any bipolar diagnosis, just more/other crap to deal with. It's not like we're pure new-born babies who happen to have bipolar. We're complicated. I have my own issues, unrelated, but everything ends up affecting everything else to some extent or other, imo.

[ultramar]

Originally Posted by Miguel'smom

And one can still be manic with out psychosis?

Yes, per DSM anyway. There's a list of criteria, a certain number of them have to be met, psychosis is one (but you don't have to meet all of the criteria, thus psychosis is not a deal-breaker, so to speak).

[ultramar]

Originally Posted by ~Christina

I think it's too early in my opinion for pdocs to put more labels on him. All these "diagnosis will follow him around possibly for life, it could effect school, college, loan applications, health insurance of course , life insurance policies .. oh the list goes on .... I am really happy my Pdoc isn't all about tossing label after label after label at me . If he was that type I would fire him and find a new one.

I think most people can have episodes of Mania with out it going into Psychosis.

I agree, and I'm glad my pdoc isn't like that either. I feel like the more the diagnoses, the more every thought, emotion and action is going to be attributed to one diagnosis or another, without leaving much room for just being a kid/person/human being outside of all of these labels.

Can he get a full neuropsych exam, to try to definitively narrow things down? Why do the new pdocs not get the old records? I think seeing a series of pdocs (and I'm not saying this is anyone's fault) kind of lends itself to getting lots of diagnoses. Because some may disagree with each other, but instead of getting rid of and replacing, what ends up happening sometimes -as I've seen in some cases- is that they just stack up, one added to another, even if there ends up being contradiction and/or overlap.

Is there any way he can get one of these 3-4 hr neuropsych exams and then be able to stay with the same pdoc after that for an extended period of time (assuming you find a pdoc who agrees with the exam, as no agreeing would just muddy things further)?

I can't imagine going through what you do, and with all that you and your husband also struggle with. My 2 cents (and it's mostly my gut speaking) is that there really can be too many diagnoses. How do you medicate, for example, co-existing conditions with completely different symptoms? It seems to me that meds for one thing, may -in theory- make something else worse.

[Victoria'smom]

Okay I guess I complicated thing. It's his non mental health doctors/nurses that give me trouble about his diagnosis and mine "because lamictal isn't an ADHD/AS drug", "he's to social to have AS" and "what is bipolar 1 with psychosis?" "are you sure he does have that"... So I started to wonder the difference between with or without psychosis.

A= primary pdoc that he sees monthly
Z= re-evaluation pdoc
T= child's therapist that he sees 2x a month

He's been with A for 2 ish years. Children grow, behaviors change, therapy helps, so the children re-evaluate every 2-3 years. So the re-evaluation can not be done by the Child's A. I guess it's kinda a review of A's work also.

The Z gets all A's notes and T's note along with the 2 packets about his functionality (can he do this?, 1-5 do you strongly agree - strongly disagree that he does X (ie. daily tantrums, refuses to shower), family medical history and questions about his home life (ie. how many times has he been hit, slapped, spanked w. an object, punched, strangled or other wise harmed in the last month, Is he exposed to illegal drugs including pot, prescription abuse, cocaine with in the last month...)

While 2 family members fill out the separate packets (= 2 packets) with the same questions. The child takes a 3+ hour test. All that information is collected and reviewed by Z. Z suggests Dx and possible med changes if needed, this letter is also sent directly to the home as well as given to A.

Between the parent's, child's T and child's Pdoc a decision is made with the least restrictive diagnosis possible. Miguel's primary pdoc told us not to be surprised when we get his re-evaluation letter and it says bipolar, given his history, our history and his medication reactions. I think she's already seen the letter. His primary doctor does have to change Miguel's dx. (currently officially adhd) because of his reactions to the adhd meds and how he has done with lamictal. However she will not put in his file that Miguel as bipolar because his ocd behavior and mood swings can fall under AS.

Once Miguel phases out of the child's department or moves we will likely be staring at a bipolar dx the new pdoc according to Miguel's T and Pdoc. He will have a re-evaluation in 3 years unless he is in IOP, or child crisis then when entering he will get re-evaluated.

Umm... I hope that's a bit more understandable. He see's 1 pdoc, and 1 T but he's re-evaluated every 2-3 years. His pdoc try's to keep kids on 1 or 2 meds because kids have a harder time taking meds. Miguel's lamictal is dissoluble and he's 11.