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Q: Psychotic Bipolar Depression
Hi Dr. Phelps,
Can you tell me about your observations of Bipolar patients that get psychotic
while depressed instead of manic. I just read a Bipolar Clinical Management
Medscape article that said that 30 percent or so of people with Bipolar
Depression get psychotic. Do you see it often? Do you handle meds differently in
those cases? My son is psychotic again and I was hoping to gain some insight.
The main Bipolar books haven't mentioned it.Thanks so much.....
http://www.medscape.com/viewprogram/135
Dear Ms. B' --
Yes, I do see that combination of depression and psychosis quite often in
bipolar disorder. For an official, if technical discussion of this
topic, try this article on
psychotic
bipolar depression. Admittedly there is an emphasis on psychosis as
part of "mania". Admittedly, there is a tendency to see
psychosis as linked with mania, such that when psychosis is seen in bipolar
depression, it's called "bipolar mixed state"; as opposed to a
depression with psychotic features. Interestingly, as you've probably
learned, psychotic depression is a well-recognized phenomenon, though it is
not technically a bipolar variation (some authors think it is...). The
important thing, obviously, is to keep one's eyes on the symptoms and not get
too confused with the lingo.
Dr. Phelps
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