Expert: Ivan Goldberg, M.D. - 3/27/2006

Question
-------------------------
Followup To
Question -
Dear Dr Goldberg
My 20 year old son was diagnosed with bipolar1 mania with psychotic features. He was also a chronic pot user smoking copious amounts for the past 5 years. He goes to some NA meetings, hes very addicted.
He is very bright creative and talented. He is very social and has a girl friend.
He went undiagnosed for over a year, his Pdoc says hes had one long manic episode. So far he has not been depressed. My son was hospitalized for 3 weeks, had an aborted trial of 15 mg abilify at the hospital, and is now attending a psycho-social outpatient program.
However he still exhibits psychotic features such as a belief that he has esp, belief the govt is watching, and is still a bit paranoid at times.
At his core he is in denial about his illness, although he is being med compliant. He is on 3mg risperdol and 1250 depakote. He complains that the meds are making him slow minded and stupid. He is always talking about stopping his meds and that he really doesnt need them. To be fair there are days when his insight is pretty good but other days when he just reverts and is in total denial.
His short term memory is not great. I am not sure if this is due to his illness, the meds or his long term pot abuse.
Schizo affective disorder has been ruled out by his Pdoc who has 30 plus years experience, he is very sure about this. Sometimes i wonder....
My question is how much longer will my son be residually psychotic. Its been at least two months now. His Pdoc says that he was out there for such a long time that it is going to take some time to heal, but is not specific about when the psychosis will resolve. I know that the criteria for schizo affective disorder is psychotic without mood for a period of at least two weeks.
Emotionally he is about 15, with the life experience of a very active idependent 20 year old.  
Answer -
Unfortunately there is no way I can predict how long your son will remain psychotic. As you mention, psychosis without mood symptoms will eventually cause the diagnosis to be changed to schizo-affective disorder.

While antipsychotic medications are necessary, it is not unusual for people taking them to complain about their effects on thinking.

Best regards . . .

Ivan
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Dear Dr Goldberg

Is there any evidence out there, or in your experience where there might be some average time to resolution of psychotic features in Bipolar mania 1, or is each consumer different?
He is getting better, he is still quick to laugh and smile. He emotes. Hes witty etc. He can still be quite irritable at times too depending on his mood.
It was explained to me that with the hightened senses of mania,that it is difficult for him to filter out extraneous background noise and focus his attention for long periods of time. Although he has learned some amazing coping techniques for this, i can see his attention improving, and he does bring himself back into the moment. He told me that when he is in a crowded restaurant or situation, he will have a thought race thru his mind, it could be anything, and then sometimes, but not all the time, he will hear someone in the crowd repeat a word or two that was in his thoughts. Thats why he believed he had esp. now hes learned that this isnt so.  Its never malevolent, and mostly just unfiltered background noise. He was taught to close his eyes when over stimulated, one less sensory imput. Hes been taught to meditate, or walk away to less active area when possible and breath, regroup so to speak. I havent seen him need to do this yet. His most stubborn delusion is his desire to quit his meds, but hes learned enought to resist this ( so far) yet is that a delusion? He is quite articule in his discription of how crappy the meds make him feel. Is this the trade off? Dull minded lethargy vs manic psychosis? I hope not.
Is there an (average) time to resolution with psychosis? I understand that you can not predict when it will stop totally. I was just wondering if there was any thing out there at all in terms of research or literature relating to average time to resolution?  

Answer
Hi . . .

While there may be data on the average time for the resolution of the psychosis accompanying a manic episode I am not aware of such data. While some patients are psychosis-free in weeks, other take months, and a few never cease to be psychotic.

I'm sorry I cannot be more specific.

Best regards . . .

Ivan
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%