Expert: Ivan Goldberg, M.D. - 3/22/2009

Question
I am Bipolar and when I relapse into a major manic episode, I often find myself talking to myself for hours on end.  Often people standing by will come to me and say Art, are you ok? because I am not even conscious of the fact that I am talking to myself.  This especially happens when I get very stressful.  IS THIS TYPE OF BEHAVIOR CONSIDERED PERHAPS THE FIRST STEPS OF A PSYCHOTIC BREAK AND WHAT CAN BE DONE TO CATCH THIS TYPE OF BEHAVIOR BEFORE IT EVOLVES INTO SOMETHING MORE PROFOUND.

Answer
Hi Art . . .

Psychotic episodes usually develop similarly. If you have had psychotic episodes that were preceded by you talking to yourself for hours, then the behavior you describe should be brought to your attention immediately so you can contact your doctor.

Of course, many people who do not have bipolar disorder, and who have never been psychotic talk tot themselves. And, if there is no clear cut relationship between your talking to yourself and the onset of psychosis, the behavior then could be considered to be "just" stress-related behavior.

Best regards . . .

Ivan
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