Bipolar Disorder Community
Which comes first?
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Bipolar Disorder is also known as "Manic Depressive Disorder". This forum is for questions and support for people with, or for loved ones of people with Bipolar Disorder. The forum covers topics ranging from Aggressive Behavior, Affect on friends and Family, Alcohol and Drug Abuse, Appetite Changes, Chronic Pain, Denial, Depression, Difficulty Concentrating, Euphoria, Guilt, Manic Depression, Medications, Mood Swings, Poor Judgment, and Sleep Disorders

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Which comes first?

which comes first: bipolar diagnosis then psychosis or the other way around? is this the same for all the other disorders that partner bipolar disorder?
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2010625_tn?1329375656
I think that bipolar disorder can be with or without psychotic features. Since you seem to be having some psychosis then I would say you have it with. I think they have to observe you over time to get an acurate diagnosis. Therefor you would have to meet the diagnostic creiteria outlined in the DSM IV to recieve a diagnosis.
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Avatar_f_tn
Psychosis is a symptom and symptoms lead to diagnosis. So usually the psychosis would have to come before the diagnosis. However you can be diagnosed without being psychotic, and then develop psychosis.

Psychosis also does not necessarily mean you have bipolar disorder. It is a symptom but you also have to have numerous other symptoms like hypomania or mania, and depression. People can have one psychotic episode and be just fine after that.
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2010625_tn?1329375656
I wish this was like face book so I could like your comment, lol.
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Avatar_m_tn
As others here have commented, a real psychotic episode, which is a very serious event, must occur in order for their to be a true 'bipolar I' diagnosis.
The diagnostic 'bar' for labling someone as 'manic depressive' must be high, because of the risks of the medications that are needed to control this illness, among other factors.
For example:  someone can struggle his/her entire life with significant depression and mood fluctuations, but still be 'high-functioning' and involved in life.  Many people who have gone through a diagnosed 'major depressive' episode (sometimes requiring hospitalization) many years later get a full 'bipolar' diagnosis when they experience another 'episode' of 'psychotic depression', which is really a 'manic episode'.  
Many people who were first told that they had 'severe depression' with 'psychotic episodes', sometimes called 'bipolar II', have manic depression.
Treating the underlying illness with a mood stabilizer is very important, because the reality is that if a person experiences a full manic episode, even once, in life, the likelihood of this happening again becomes higher if the condition goes untreated.
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Avatar_f_tn
I hate to disagree with you but if you look up bipolar I in the DSM you will see that it can be with or without psychosis.

Here are the diagnostic codes for bipolar I, and you can see that not every one requires psychosis.

Bipolar - Single Manic

    296 Bipolar I Disorder, Single Manic Episode, Unspecified
    296.01 Bipolar I Disorder, Single Manic Episode, Mild
    296.02 Bipolar I Disorder, Single Manic Episode, Moderate
    296.03 Bipolar I Disorder, Single Manic Episode, Severe Without Psychotic Features
    296.04 Bipolar I Disorder, Single Manic Episode, Severe With Psychotic Features
    296.05 Bipolar I Disorder, Single Manic Episode, In Partial Remission
    296.06 Bipolar I Disorder, Single Manic Episode, In Full Remission

The difference between bipolar I and bipolar II is that bipolar one may require hospitalization with or without psychosis, while you don't need hospitalization for hypomania of bipolar II.

From ************.com - Hypomanic episodes have the same symptoms as manic episodes with two important differences: (1) the mood usually isn't severe enough to cause problems with the person working or socializing with others (e.g., they don't have to take time off work during the episode), or to require hospitalization; and (2) there are never any psychotic features present in a hypomanic episode.

I hope this clears up some questions. Bipolar can get worse. You could have bipolar II and worsen to Bipolar I and perhaps get psychosis.
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