What is Manic Depressive Psychosis?

Manic depressive psychosis is a serious psychiatric illness characterized by pronounced mood swings and the presence of delusions and hallucinations. Individuals with this presentation of manic depression, also known as bipolar disorder, often have difficulty with everyday functioning, such as maintaining relationships and a job, due to the pronounced nature of their psychosis, which blurs their perception of reality. Treatment for this potentially debilitating condition often necessitates hospitalization and the administration of medications to stabilize mood and long-term treatment, including psychotherapy.

Though there is no known, single cause for the development of manic depression, it has been asserted that several factors may contribute to its gradual development or acute onset. Some studies have suggested that bipolar individuals may possess a genetic predisposition for the disorder due to the presence of biological variance or chemical imbalance. Manic depression presentation does appear to be more prominent in individuals with a familial history of the disorder. Other factors that may trigger disease onset may include environmental factors, chemical dependency and abuse, and trauma.

Bipolar symptom presentation generally varies by the individual and may manifest to varying degrees depending on the severity of the mood swing. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), there are three distinct classifications of bipolar disorder: bipolar I, bipolar II, and cyclothymia, which is considered a milder presentation of the disease. Manic depressive psychosis may be triggered by a severe episode of either depression or mania.

Those who develop manic depressive psychosis develop an altered perception of reality that presents as very real to the symptomatic individual. Essentially, the intensity of a triggering event or cycling from depression to mania causes the affected individual to break from reality. He or she may experience auditory and visual hallucinations, such as hearing voices or seeing people or things that are not present. Some psychotic individuals may hold unrealistic beliefs or harbor feelings of persecution, such as believing they are some religious figure or that they are being watched or hunted. The individual’s psychosis can quickly become a debilitating condition that keeps him or her from being able to function normally and may necessitate hospitalization.

A diagnosis of manic depressive psychosis is generally made with an evaluation of the individual’s psychiatric history and the administration of a variety of diagnostic tests. Manic depression can be difficult to diagnose without a history of patterned, or cyclic, documented behaviors. For a diagnosis of manic depression, an individual must meet established criteria as presented in the DSM for a given period of time.

Criterion includes markers for the depressive and manic ends of the spectrum, as well as those that may manifest in the midst of a mixed episode. The number of required criteria and episode duration for a diagnosis varies by the symptom presentation; meaning, criteria for a major depressive episode will generally be different from that established for a mania-induced psychotic break. Once an evaluation has been made and established criteria is met, a clear diagnosis of bipolar I, II, or cyclothymic disorder may be made. Psychosis itself is categorized as a symptom presentation, not part of the disorder diagnosis.

Individuals experiencing depression may exhibit the trademark signs of a persistently low mood, such as fatigue, loss of interest, and feelings of guilt. Those who are experiencing a depressive episode may also develop suicidal ideas, demonstrate impaired concentration, and avoid social and professional situations. Manic individuals often require little to no sleep, are extremely physically active, and demonstrate impaired judgment. Some may participate in risky behaviors they normally wouldn't pursue, such as promiscuity, substance use and abuse, or situations that may place them at risk for injury or death. In some cases, mania may also trigger an individual to set lofty, unattainable goals that may place him or her at risk for financial, personal, social, or professional ruin.

Manic depressive psychosis generally necessitates hospitalization to prevent the individual from causing harm to himself or herself or others. Hospitalization also allows for the opportunity to ease the individual back to reality with the aid of medication and psychotherapy. Medications such as antidepressants, anticonvulsants, and antipsychotics may be administered individually or in combination to stabilize the affected individual’s mood. Psychotherapy is often considered a necessary part of long-term treatment, incorporating individual, family, and group therapy sessions to promote education, understanding, and healthy coping skills.