Does BP I or BP II include Delusions or Psychosis?
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Q:  Does BP I or BP II include Delusions or Psychosis?

On your website in speaking about Bipolar II disorder there is a quote that in general says Bipolar II is "more than plain depression but not delusional or psychotic." I have been diagnosed with Bipolar II, but during my depressions experienced delusions and psychosis for a period of time. Could I have another type of mental illness? Or does this occasionally happen with Bipolar II, just not very often? Unfortunately I do not have health insurance, and can't afford it with a Bipolar diagnosis, and am getting free local health care through a state run agency that does not allow the benefit of spending much time with the doctor to discuss these types of concerns or issues.
Thanks for your help!

Dear Joy -
Perhaps the most important part of an answer to your question is that the distinction between bipolar I and bipolar II really doesn’t matter that much.  It does not really determine the kind of treatment you should get.

In your case, if the only time you ever get delusions (loss of contact with reality) is during the depression phases; and when off in the “manic” direction, you only go as far as “hypomania”, which by definition cannot include delusions, and is not supposed to dramatically interfere with your ability to function; then you could indeed have what might rightly be termed Bipolar II (although an unusual version thereof, in the sense that most people with Bipolar II never have psychosis or delusions at all).

More important is to select appropriate treatments for your particular version of bipolar disorder.  We do that by looking at the dominant symptoms which need to be addressed now, or prevented from returning.  In general, the group of medications usually referred to as “mood stabilizers” are the core ingredients in the treatment of bipolar disorder.  We pick among them by looking at your particular needs – and their potential risks and side effects. In your setting, some of the treatment choices may be constrained by cost, but fortunately many of the best ones are now generic and fairly widely available.

Good luck with your efforts to learn more and get or stay a symptom free –

Dr. Phelps


Published February, 2009



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