Q: BP & Crossing Over Into Schizoaffective?
My boyfriend is Bipolar I and has been hospitalized three times in the last year
for extreme manic episodes, during the last of which he punched a wall and broke
his hand. While he seems to be getting better help than before from a new
hospital and set of doctors, and a change of meds, he still suffers from some
delusions since his last episode (two weeks ago). I know it takes some time to
stabilize, however, a well-educated therapist recently told me that should he
drink alcohol or smoke marijuana he could become permanently delusional and
cross over into schizoaffective disorder. While he's not dual-diagnosis, he
does enjoy drinking and I'm very worried about what this will do to him. I know
you're not a substance abuse expert, but have you ever witnessed this happen
with a patient? The thought of losing him to permanent delusions is completely
terrifying me. Please let me know your thoughts on this.
Dear Kerri --
Number one: bipolar disorder does not "cross over into schizoaffective
disorder". If the bipolar I diagnosis is pretty firm, then this statement is
almost certainly wrong, just on the basis of the fact that we think the
definitions refer to "real things" that are not changed from one to another even
by substance use. However, there is some truth to what she or he is
saying: drinking can (but is not certain to) make bipolar disorder worse. When
bipolar I worsens,
psychosis is common. Delusions are frequently part of psychosis.
So, he could become more prone to psychosis through the
drinking. That much is clear and not controversial. But "permanent", that's
going a bit too far. We can't even say that bipolar disorder is "permanent".
People rather commonly have fewer symptoms as they age, some to the point where
a diagnostic label is probably not warranted anymore. So "permanent" is too
strong. But "worse", that's fair.
If your boyfriend "enjoys drinking" despite the
experiences you describe, then his ability to recognize what the alcohol is very
likely doing (making his risk of relapse much higher -- another
non-controversial statement about alcohol in bipolar disorder) sounds pretty
limited. That means he may have more difficulty getting his bipolar disorder
controlled; which also means that you could see him go through this kind of
thing again (and again, perhaps). That means that you yourself are possibly
having some difficulty recognizing what alcohol means, to him and to you:
basically, a disaster. People who cannot recognize when they are part of the
cause of their own disasters need some specific help for that. So, he might
need to have a very serious AA involvement to get well, or something very close
to that kind of program, which "externalizes" the insight; that is, it lets
other people be the "recognizers", if he'll trust them, which is what AA is all
about. For you, you might want to look at Al-Anon, the AA program for people
who are in a relationship with someone who has a drinking problem. Some such
groups have been very helpful to my patients' family members. They're not
always good, but they can be excellent. Good luck with all that.
Published Jan. 2005