13.4.1  Signs and symptoms of recurrent psychoses

People with recurrent psychoses such as bipolar disorder may suffer from unrealistic or ‘grandiose’ thinking, in which they see themselves as very important people – more important than anyone around them – often with important tasks or ‘missions’ they must complete. During the manic episode, they will tend to have increased energy levels, high moods and difficulty in controlling their impulsive behaviour. They often speak very quickly and tend to jump from one topic to the other (also called ‘flight of ideas’). They also often find themselves unable to sleep and are easily distracted. Because they think they are very important and successful, they may engage in bizarre behaviour like giving away their personal property for no apparent reason. When you see people with mania, they may appear unusually cheerful and make jokes all the time.

Manic episodes can vary in intensity, from mild to extreme forms. Some people will retain sufficient control to function normally, while others will be severely affected and requiring treatment. People with sever bipolar disorder are often unaware of their condition. When considering referral, you should also be wary: during an episode of mania, affected individuals can often be mistaken for having taken drugs or other mind-altering substances.