Let’s talk Psychosis, Cognition and Bipolar Disorder.
Ok, first the basics: what is psychosis exactly? It can be a symptom of a mental health condition (e.g., Bipolar disorder), or an entire disorder of its own (e.g., a ‘primary’ psychotic disorder such as schizophrenia). To further complicate things, psychosis can also be induced when things like sleep deprivation, alcohol abuse, or even brain infections and strokes come into the picture. [1]
Now that we understand where it can originate, what can psychosis look like? Psychosis affects the mind in ways that may disrupt the five senses (e.g., hearing) as well as thoughts and emotions. During psychosis there is some loss of contact with reality—it can be difficult to tell what is real and what is not. There is great variety in this experience. Some people experience hallucinations, meaning they see or hear something others do not, or delusions which involve holding false beliefs (most common, feelings of paranoia). In the case of Bipolar disorder, delusions are the more commonly experienced symptom of psychosis. Have you had a manic episode? Maybe you can relate to an experience called ‘delusions of grandeur’ where there is a false belief of being “rich and famous” or being chosen for a special purpose. Or maybe in a state of depression you’ve believed that you did something terrible, which is completely fictitious, like have been the reason Trump was elected.
Another common symptom of psychosis might include streamlined speech that is not comprehensible to others, or behavior that is unintentionally and wildly inappropriate for the situation.
Some people who experience an episode of psychosis, and get treatment early on, never experience another episode. Others learn to manage it and to make their way through life, psychosis included.
So that’s our focus—symptom management.
Of course, not everyone responds to treatments in the same way. Some people who experience psychosis need only medication, while some need medication and therapy. If you have Bipolar disorder, you are familiar with this reality. So for those of you who experience , or have loved ones who experience, symptoms of psychosis that do not 100% respond to medication, THERE ARE OPTIONS. In fact, there is help available-from a friend!
He (Dr. Mahesh Menon) has something exciting to share about this field of effort:
“My colleagues and I have developed a psychotherapeutic approach specifically designed to target persistent delusions that we call Metacognitive* Training (MCT). MCT is group-based intervention that targets a number of the specific thinking patterns that underlie delusions, such as paranoia. It has been shown to be effective in reducing delusional severity in individuals with schizophrenia. “
If you aren’t pumped yet, maybe it will help to understand that almost all studies focused on MCT or other psychotherapy specific to psychosis have been focused on people with a schizophrenia spectrum diagnosis. But other people experience psychosis—some of you out there with Bipolar disorder and delusions during your mood episodes for example! So there is good reason to take a look at how people with Bipolar disorder-psychosis respond to a psychotherapy such as MCT.
But wait, there is more! Many people who experience psychosis also find that they struggle with aspects of cognition such as memory, attention, or planning. For these difficulties, there is a specialised treatment known as Cognitive Remediation Training (CRT). This training involves the use of ‘brain games’ and strategies for daily life to improve in these areas of cognition.
Cognitive struggles can appear during an experience of psychosis, during a psychosis-free mood episode, or can continue to persist even when you are not experiencing symptoms.[3] We all have something to work on in relation to cognition, whether we have Bipolar disorder or not. If you notice that your challenges are impairing your ability to do what you have to, or want to do, we do recommend you seek out resources (like CRT if it is a good fit for you) to discover how to best address your cognitive barriers.
For more information on the Bipolar & Cognition relationship, or how to take independent action to address our cognition, check out the dedicated page on our Bipolar Wellness Centre!
Lastly, but arguably most importantly, the Cognitive Neuroscience of Schizophrenia (CNOS) Lab is currently running a study on Bipolar disorder, Psychosis, & Cognition – and would LOVE your help if you feel this is relevant to you. So if you think you have experienced psychosis in the context of Bipolar disorder (currently, or within the last 6 months), and are interested in engaging in Metacognitive Training OR Cognitive Remediation Training, please refer to our brochure below and do let us know!
You can do this most efficiently by emailing Julia at cnos.lab@ubc.ca
Parting Note: We hope you feel more supported now, with another option in your pocket. As always we thank you for your partnership in our interdependent approach to improving the Quality of Life of those living with Bipolar disorder today and tomorrow! We 100% could not do it without you.
*Metacognition can be explained as “thinking about one’s own thinking” and involves the ability to select appropriate responses. It also includes the way we look at and consider information, and how we deal with cognitive limitations”[4]
[1] “RAISE Questions and Answers.” National Institute of Mental Health, U.S. Department of Health and Human Services, www.nimh.nih.gov/health/topics/schizophrenia/raise/raise-questions-and-answers.shtml#1.
[2] Fletcher, Jenna. “Bipolar Psychosis: Symptoms, Treatment, and Outlook.” Medical News Today, MediLexicon International, www.medicalnewstoday.com/articles/314450.php.
[3] http://www.bdwellness.com/Quality-of-Life-Areas/Cognition
[4]University Medical Center Hamburg-Eppendorf. https://clinical-neuropsychology.de/metacognitive_training-psychosis.html
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VICTORY FROM 23YEARS SHIZOPHRENIA
To everyone of you reading this, I pray to God you find breakthrough someday like I did. It’s not longer news that the stigma and discrimination attached to having a mental illness is harder to cope with than the illness itself. Yes, when I had Schizophrenia for 23years, there is never a time I was perceived as being a gentle caring person. I developed schizophrenia so early and the changes were difficult to measure. Horrible Voices, mood swings and delusions and hallucinations play out their effect on me so constantly that they became part of the essence of who I am. I felt something I could not publicly air, it’s nothing anyway; we all have overt or latent prejudices. I spent so much time in and out of psychiatric wards. It was not easy I must confess. I can’t think of a time when I wasn’t plagued with hallucinations, delusions, and paranoia. At times, I feel like the operator in my brain just doesn’t get the message to the right people. It can be very confusing to have to deal with different people in my head. When I become fragmented in my thinking, I start to have my worst problems. I was hospitalized because of this illness many times, sometimes for as long as 3 to 5 months. I began wearing the same clothes each day and seldom bathed. I remember telling my colleagues at my work place that the world is coming to an end; we should take some months off so we can bring it back. Any contribution they have, it should be in writing because there are cameras everywhere. It was funny how no other person knows this except me, yet no one seems to look at things from my point. I was in this lake for years; I thought I was never going to live happy again because I scared almost everyone close to me away. To surmount the whole story, I came across a testimony of someone who had similar symptoms, she understood so well that she made me find reasons to get rid of it by using Herbal medicine, she also promise to refund my money if it doesn’t work. Surprisingly, the amount I was charged isn’t half the money I have spent on drugs most especially, Clozaril which I was told never to take a day off without. I placed my order for HIPPOSSIMA, from my finding that is the name of the Herbal medicine. It was a miracle how the symptoms drastically reduced just after 5weeks of use. Today, my schizophrenic story is now history. For inquiries, you can reach the doctor via: gregoryalhodgson@gmail.com. Or visit: curefromschizophrenia.blogspot.com. I made it thru and so can you! Though it is not easy, but it’s worth fighting for.