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    Includes Expert Content
    Psychosis and mania (Dr. G question)
    reneegigliotti posted:
    Hi Dr. G,

    I'm curious why some people experience mania but don't have the severe delusions and sensory distortions and other people (like me) do. Are psychotic symptoms common in severe mania or is just a subset of patients who experience them on a regular basis? There is for me a point in time where mania ceases to be fun and starts to become disorientating and a serious safety problem. I can't see the cross-over but my psychiatrist and psychologist can. As they are fond of saying "I have no insight" at those times. Is this experience common?
    Joseph F Goldberg, MD responded:
    Dear Renee, About half of people with bipolar I disorder at some point may have delusions or hallucinations while they're manic. Hypomania, in bipolar II disorder, by definition means no psychosis (otherwise it would be called bipolar I mania). Some people may be more psychosis-prone than others, and in fact those who develop psychosis when neither manic or depressed would likely be said to have schizoaffective disorder. Dr G
    reneegigliotti replied to Joseph F Goldberg, MD's response:
    My Dr. G and I have discussed whether my psychotic symptoms linger past the resolution of the manic episodes. What I told him is that it is very hard, even after an episode, for me to hold on to the reality that what I believed, saw or heard during mania wasn't in fact real. I can sort of intellectually entertain the idea but I'm not convinced that it's true. For example, I remain afraid that what I hallucinate will appear at any second and that they are just laying in wait for me. However, I kinda of know on some level that's not real. My psychiatrist says as long as I can keep room in my brain for the idea that these things aren't real, we are ok. I cannot hold that in my brain at all while manic, however.

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