Can Delusions Be Part of BP
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Q:  Can Delusions Be Part of BP

I have ongoing delusions about being the subject of a 24-hour/day television show. Also, I hear voices, which anti-psychotic medication has taken care of.  While having mood swings attributable to my bipolar, these other delusions and hallucinations seem to be psychotic symptoms.  Can you tell me if these are sometimes symptoms of manic depression, and if there are resources for those with these psychotic symptoms?

Thank you.

Dear Bob -- 
Hearing voices and having delusions such as you describe are definitely, clearly part of bipolar disorder for some people.  Treatment should focus on mood stabilizers, which are the backbone of treatment for bipolar disorder; but might include, at least temporarily, an antipsychotic for the psychotic symptoms.  The old-generation antipsychotics such as Haldol and Thorazine will work; and there is a family of new-generation "atypical" antipsychotics that generally seem less bothersome in terms of how people feel while taking them.  However, among those, Zyprexa clearly has mood stabilizing properties itself.  It would be ideal for symptoms like yours except that it is associated with such extreme weight gain as to be able to cause diabetes in some folks; so I regard it as a temporary solution also.  The other newer ones have less weight gain but can still do it.  A few of the mood stabilizer options do not produce weight gain routinely, such as Trileptal, so are worth considering; or Depakote using the ER version and keeping the dose below the appetite-increase threshold, which is fairly obvious when you step over it.  

That's the basics, in my view.  As you can gather I'd focus on the whole picture of the bipolar disorder (sleep, mood swings and mood lability like irritability and easy tearfulness, difficulty concentrating) as much or even more than on the psychotic symptoms.  Thus no "resources" are specially necessary for those with psychotic symptoms -- just routine but aggressive-short-of-severe-side-effects treatment, including temporary use of antipsychotics if necessary.  For more on the routine treatment and options, you could have look at the treatment section of my website material on bipolar II, even though BPII doesn't have psychotic symptoms. 

Dr. Phelps

Published January, 2002

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