[MrAbbott]

Hi there, this is my first post, I don't know you guys but hope somebody is or has been at the same point of the journey.

I was diagnosed as bipolar type I in 2016 and yes, I do have psychotic episodes every single time during my (yearly) manic crisis. My doctor hasn't agreed to raise my meds around the crucial dates (10-12 months after crisis) and doesn't think I should carry any medication to administer myself, so here I am... main questions:

a. Can you control your psychosis relatively well?
b. Tips, please, if any.

My psychosis start quite innocently at first, but then a strain of thoughts and delusions kick in till I get in trouble or some family member calls the police/ambulance... well, any help welcome... I'd really like to see next psychosis coming, be prepared and act accordingly but it's proving hard to control. I should know much more about it...

Many thanks for your help and stay well. Regards.

[Soupe du jour]

Hi @MrAbbott. Welcome! I'm glad you joined us. I have bipolar type 1, as well, and during my more severe manic (and mixed manic) episodes I also became psychotic.

I can't know your psychiatrist reasoning, but wonder if s/he doesn't raise your med doses (in precaution) to avoid extra/new side effects. I think "as needed" prescribing is generally better than over-medicating. I assume s/he would raise your medications if/when you become manic? If not, is s/he depending too much on you first being hospitalized? If the latter, I totally agree with you that is too late. Nipping elevation by the bud is better, but see that strategy as best only when there is at least some level of elevation. Not if you are stable, but it's simply the time of year you used to become manic.

Insight into developing mania is possible but I think requires a bit of experience. You, yourself, could do a self check, but also family and good friends could clue you in. Ask them to do so. If you're particularly joyous or agitated/irritable, of course you may have valid justification. Or don't you? If I see my mood/energy is rising, I may "lay low" a bit and avoid known triggers. Early spring is my vulnerable time, as days lengthen with more light. Is my sleep affected? Am I socializing a lot more than usual? How about my physical activity? Perhaps I cut down on overly stimulating things for a bit.

I have been allowed (and even encouraged) to take a prn ("as needed") medication when mood elevation is suspected. My old psychiatrist would make a recommendation on how much and for how long I could use it before needing to call him. I (and my husband) have seen this as an extremely valuable tool that has spared me hospitalizations in the past. It's a shame your doctor won't consider this. Have you discussed "prns" with her/him?

Great topic! I hope you get more suggestions.

[MrAbbott]

Hi Soupe, it's indeed very encouraging to find someone who understands this situation and is able to express it so well. I need to re-check some of your message, for English is not my native language. My shrink is avoiding the matter I just exposed and plainly skipped it from his last mail - I'll insist, but thank you for your valuable input. I'm not even sure he keeps track of the dates of my crisis and I've only recorded the last 3. My parents are growing old and I'm an only son, so I guess from now on I must become more organized and not afraid of asking questions. My psychotic episodes may start while taking a cab or having some lunch at a restaurant... it's funny but turns into scary very quickly, though nobody realizes because I don't verbalize it. Should I? I don't even know how. Maybe a good psychologist would help. My psychiatrist is very good at prescribing the right meds at the right dosage, but fails considerably in the rest of areas that could make my illness more bearable, I hope you've found the right doc for you, Soupe, for it's indeed key to the whole business.

PRN (pro re nata)... does it mean that you carry some meds with you? I believe I should carry risperdal, but maybe my doc doesn't want to risk diagnosing an event that hasn't happened yet. Stay in hospital is hard and to me, most of the time, it looks like they're trying to stop a racing car with a wall of bricks...yep, that's my opinion. It has taken me 2 months to gather all the tiny bits and start being myself again.

As a curio, I'll tell you that the episodes I've recorded happened during a waxing moon, either around spring or summer, so no definite pattern, but that's all I got. It is very interesting to me the fact (and maybe you and others can comment on it) that my first psychosis were easily identifiable after getting stable: I could see my reasoning was wrong afterwards without effort, it was clear. Now they deal with matters that can't be quantifiable and follow a pretty recurrent and steady logic...though they can't be proven (religion, metaphysics, etc).


That's all I got. My doc thinks mutual support among bipolars is not for me, but I'm glad to be here and being able to receive such interesting replies.
May you be well, then. Kind regards from Spain.

[Nammu]

I also have bipolar 1, but usually don’t have psychosis except when I’m on a antidepressant. Psychosis is very difficult to get in front of, it’s very very hard for the person who has it to realize they are I’ll once they’re in that state. If you’re on meds and they are not stopping the episodes I’d say the whole med regimen needs another look. And definitely you need an increase in meds around the time of psychosis. Surely they have records of your hospitalizations and can see a pattern? It’s a very valid desire to increase meds prior to an episode. Perhaps you can ask your doctor to review the records and see for themselves the pattern?

[Soupe du jour]

Hi MrAbbott. I do have my prn meds on hand, including when I travel. When my issue is more on the anxiety side, I take a lorazepam (a benzodiazepine), though it's not prescribed in the country I live in now. My former doctor in the US and my new doctor in Czech Republic prefer I rather take prn quetiapine aka Seroquel (Kventiax in Czech Rep). It does help, I'll admit.

I understand sudden onsets of mania well. Though I've had many, I've also experienced more gradual ones. I agree with Nammu (above) that the former are hard to catch by yourself, but the latter can be. In the case of certain triggers, I have taken precautionary prns. For example, international air travel has always been a huge trigger of mine. Such experiences have brought on sudden manic psychosis.

I try hard not to depend on prn medications unless truly necessary. I know they shouldn't be a constant crutch. Other coping tools are best. Do you have any you use? If not, I encourage you to find and practice some. A therapist can help with that.

[MrAbbott]

Hi @Nammu, thanks for your message... well, it's hard to argue with my doc when he'll give no reasons at all. I also find raising the meds very advisable around key dates...but...I'll keep digging or else I'll face another visit to hospital by ambulance . I truly don't know what to expect because "a plan" or strategy has not been clearly explained to me. He wants, I believe, to be alerted by my family and then decide what to do, but...this strategy has failed 6 times out of 7, more or less... what else do you (or others) do to prevent manic states and psychosis? 1.nutrition? 2.sport? 3.spirituality? 4.mutual help among sufferers? Here, where I live, only the medication factor has been stressed, the rest I must find out on my own.

I'll go jogging now. See you guys around. Cheers.

[MrAbbott]

Hello @soup. Ok yeah I took yoga some time ago, but it's time consuming and I've got children, so some jogging for me when I can to keep morale up. I attended a local bipolar association but surprisingly enough I left the meeting more depressed than ever... XD. I don't like being tagged and caged but I understand some people that know me would raise their guard when finding out I'm bipolar - lost some friends along the way, that's for sure.

I've managed to stabilize my manic episodes to once per year and that I have my doctor to thank for... going beyond that limit is now my purpose. How often you said your mania appears? Take care.

[*Beth*]

Hello MrAbbott, I want to welcome you to the forum and to the Bipolar Disorders board.

I believe that, in addition to medication, therapy may be something you could benefit from. Is that something you might do, or is it not for you?

[MrAbbott]

Hi @Beth. Yes I'd try therapy but I'm very skeptical due to past experiences with local psychologists. It's hard to find the real deal. Thanks for your post. Stay well

[*Beth*]

Originally Posted by MrAbbott

Hi @Beth. Yes I'd try therapy but I'm very skeptical due to past experiences with local psychologists. It's hard to find the real deal. Thanks for your post. Stay well

Thank you

I completely understand your skepticism. Finding the real deal is often very difficult. I, too, struggle with that.

[Nammu]

The last time I was in therapy I was up front with my T that part of her job was to get a early read on my moods and help me be aware. I was with her for 12 years and she did help me see the ups and down more clearly. When I started I was still having a hard time believing I was bipolar. For most of the time I saw her I was un medicated so it was vital that I be aware. She helped document too exactly why I wasn’t to be on ADs. There was the time I was manic and she thought meds would be good. But I sort of handicapped the pdoc by saying no to most things. So he gave me trazadone for sleep and I got much worse. Then I found out that was an AD! So the next episode I had I gave the pdoc more leeway and did go on an AP. Plus mood stabilizer and it worked very well. But learning from my T my moods was invaluable. There were times we just talked about our interests to pass time because I was stable because it wasn’t therapy so much as it was a sounding board and mood evaluation for me.

[Fuzzybear]

How are things now? Thinking of you!