Psychotic Breaks in Bipolar Children

Children and adolescents who are diagnosed with bipolar disorder have mood swings---cycling between mania and depression---but they often exhibit "rapid cycling" where they go through more frequent episodes than the typical pattern for adults with bipolar disorder. When these swings become severe, when the manic or depressive symptoms are extreme, they can trigger a psychotic break.

Bipolar Psychosis versus Schizophrenia

• For many years, people with psychotic symptoms were automatically diagnosed with schizophrenia. In 1977, though, Dr. Harrison Pope and Dr. Joseph Lipinski wrote an article presenting evidence that psychosis and schizophrenia are not always synonymous. They argued that family history, the patient's symptoms and response to treatment needed to be carefully assessed to differentiate patients with a primary diagnosis of bipolar disorder from those whose symptoms were consistent with schizophrenia. Today the Diagnostic and Statistical Manual of Mental Disorders, which defines approved psychiatric guidelines for all mental health disorders, recognizes bipolar disorder with psychotic features.

Psychosis in Bipolar Disorder

• While psychosis can result from intense depression or mania, it happens more often during a manic episode. Psychotic symptoms include delusions, paranoia and hallucinations. Delusions are thoughts that are not grounded in reality. They range from believing that thoughts and behaviors are being controlled by others, to delusions of grandeur in which the person believes they have great wealth, intellect, or power, to a false belief that they are being persecuted. Paranoia is the irrational belief that one is being followed or harmed---that someone is out to get one. Hallucinations can be visual, auditory or even tactile---they see, hear or feel things that no one else experiences. The actual psychotic symptoms may vary to reflect the mood state.

Hallucinations

• Voices may tell them to fly from the top of the building or to attempt a flying leap down the stairs. If they are depressed, the voices may be more threatening, telling them their teacher wants to kill them. Visual hallucinations may be interesting or frightening. Their favorite action figure may come to life or they may see their most feared creature crawling all over the room. Children experiencing hallucination are not capable of reasoning their way back to reality.

Delusions

• During a manic phase delusions tend to be grandiose. Children may feel they can do homework better than anyone or they may believe they can outperform the competition in their chosen activity. They could think they actually have the special power that their favorite cartoon character possesses. If they believe someone is out to get them they may take action to protect themselves. During depression, the delusions may be more morbid or express the child's feeling that they are the center of all external events. Children believe their delusions are real and their false beliefs become firmly entrenched to the point where they are unshakable.

Treatment

• A psychotic break causes bizarre, irrational, and potentially harmful behavior such as violence. Antipsychotic medications may be necessary to help stabilize immediate symptoms and to prevent future psychosis. The group of medications called atypical antipsychotics are the first choice because they treat two chemicals in the brain---one that stabilizes psychosis and another that controls mood symptoms. In fact, these medications are often used to treat the mood swings even if psychosis is not evident. The atypical antipsychotics include Risperdal, Zyprexa, Abilify, and Seroquel.