High self- esteem, too many ideas to be realised at a short period of time, having lots of energy despite a few hours of sleep (less than 5 hours) and thinking that you were in fact, Jesus, which has been saved from cruxification are some of the symptoms which indicates you were in a manic phase, part of symptoms which can be found in people who were diagnosed with bipolar disorder, mostly. Why mostly? As most of the symptoms only can be accessed through clinical experiences, sometimes, we mistook it for bipolar when they supposed to have something else.
Even though I'm quite interested in psychiatry, honestly, patients associated with that field are quite scary, at least to me. One of the reasons why psychiatry will not be my future specialisation if eventually, I pass my professional exam sometimes around September next year. Pray for me guys, I really need it.
Now, before it was called the bipolar disorder, having these symptoms could have been the first step for you to be diagnosed with having a condition called Manic-Depressive Psychosis (MDP). I know, they just arranged three kinds of major symptoms to make it a diagnosis and it is valid until they found that some people might have only manic without depression or psychosis. People with bipolar with depression as the major presenting complaint can be quite tricky by eventually, with a good patient's history, you will know that they were having either manic or hypomanic symptoms which I would discuss later.
So, what about being a Jesus? Most of the people who are having this kind of delusion associated with being some of the most popular figures are quite religious. I'm not blaming religion for that matter but according to a study which was published in 2013, people who were having delusion associated with religion will most likely have a delusion of grandiose accompanied by significant positive symptoms such as hallucination, other forms of delusions and maybe some illusions.
One of the most intriguing things about being delusional is that patients usually misinterpreted normal stimuli, perceiving them in the most pathological way. This form of delusion is called as the delusion of perception. You look around (as Jesus, Muhammad etc.) you saw a normal stimulus (maybe a tree, pen, car) but the interpretation can be quite bizarre. For example, you saw a black cat and quickly predicted that tomorrow would be the end of the world or you saw a red car and thought any seconds now, you will be given some kind of revelation from the higher order to guide your people.
It's difficult to discern between what can be thought as bizarre and what are things that were accepted culturally so to put it in the simplest explanation if the information came in from patients are quite bizarre and not recognised within a social structure, then, they were regarded as pathological and could be a subset of psychotic presentation. It's important for a clinician to know and understand what sort of things which are accepted in the culture of people in a specified location. It'll be subjective and difficult in some situations.
Hypomanic VS Manic
We can say that the difference between those two symptoms are how impaired their social interaction in the community and how long they were having symptoms. In the current guideline, if patients were having symptoms related to the mania phase for at least 4 days but less than 7, hypomania can be the major presentation. This thing, however, would not depend solely on the duration of symptoms. It can be how bizarre the symptoms are.
Honestly, most of the times, when we are taking history, the thing that we rely on, particularly for psychiatry, is the ability for patients or their caregiver to recall a specific event. They might have said it last for less than 7 days but they could have been manic for more than 7. The treatment is not really different once you were diagnosed with either of the bipolar types but the dosage of the medication or any kind of alternatives to make you function again in the society can be quite different.
Insight is the most important thing that would determine the future outcome of the patient who was seeking treatment for a specific condition. If you think, you were having some kind of problems, you will try your best to treat it or find a way to make it go away. What if you think you weren't having any kind of problem when in fact you do? How does a clinician confirm whether or not the information given by the patient is actually true? Well, that's why it is important for us to take the patient's history from other people who knew her well; parents for example. It's called as the collaborative history taking.
There are 7 items which are described in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM) to describe people who were manic:
- Grandiosity and overconfidence
- Energetic despite few hours of sleep (the duration can be somewhat variable but according to DSM, the duration is less than 3 hours)
- Talkative or they seem to force themselves to talk more
- Racing thoughts or a situation whereby you were having lots of ideas (flight of ideas)
- Can't really concentrate to perform normal daily activities (this symptom might be apparent among students)
- Psychomotor agitation
- Involvement in activities which are deemed as risky by others (even if the outcome of such activities are apparent)
In an article written by Wynne Parry published in Livescience website has found that people who were having a set of symptoms related to bipolar sometimes felt they were given a set of advantage compared to others to accomplish a certain goal. For example, you want to pursue your idea, opening a bakery shop but you were too afraid to do it. Well, since people who were bipolar tend to behave like risks are nothing, then success to the opening of the bakery shop can be attributed to the mania. The world seems colourful and more vivid compared to its counterpart, depression, in which people feel like they were living in the monochromatic world.
Religious Delusion And Delusion of Grandeur
Diagnosing religious delusion can be tricky especially if the rapport between the doctor and the patient or between the doctor and the caregiver is not good. Psychiatric illnesses are usually and constantly challenged with stigmas by the surrounding community and it would be bad if the patient doesn't have a strong social support especially from their parents.
Sometimes, even without severe symptoms related to the mania, the thought of being a significant religious figure did cross someone's mind and this kind of revelation often misinterpreted by people who were having poor insight; whether or not they sell the idea to the other people would depend on the severity of said, symptoms. That's why, for the first few minutes or sessions of psychiatric interviews, clinicians would focus on connecting with patients rather than straight away dig in the presenting symptoms.
Are you going to tell the doctor that your children were having some kind of religious thought so that they can be diagnosed accordingly? It sounds simple but in reality, it is difficult. If you are the caregiver, it's like exposing your child weaknesses to the public which will make them prone to having stigmatised by others. If you think stigma came only in the form of social isolation, then you were mistaken.
It's difficult to employ people with psychiatric illnesses, even more so if they were once, Jesus. It's difficult to determine where you are in the religious delusion scale where we have a scale from one to ten with one being normal religious belief and ten being bizarre religious beliefs. It will be more difficult if you are not from the area or you are interviewing someone from different religions.
In the past 2/3 weeks, I've interviewed someone who claimed that he is a prophet after Muhammad (the last prophet in Islam). Now, the general consensus among Muslims is there is no prophet after Muhammad so whatever described by him is quite bizarre. He was having a few dreams which he claimed that the god talks to him (not sure whether he was dreaming or having some kind of auditory hallucination) and there are a few events in his life which make him confident that he was the chosen one.
It's important for a clinician to act as interested as possible to hear the patient's thought so that we can determine how severe the patient's condition is. Treating them to give them the opportunity to lead a relatively normal life can be quite difficult but I have seen a few who successfully control their urges, submitting to the idea encircling their head.
References: [1], [2], [3], [4]
All images were taken from Pixabay
References: [1], [2], [3], [4], [5], [6]
