I’m diagnosed as Bipolar II with Psychotic Features and I have been hearing voices/seeing/feeling things lately but today things got a little worse than they’ve been. I had this strong mental “movie” that I couldn’t control playing in my mind of a person holding my arm, about to stab me with a knife and I was afraid that it was real. A small part of me knew it wasn’t but another part of me was still scared as if it were reality. A little while after that, I saw an image in my mind of the grim reaper standing behind me, about to slit my throat or strangle me with a wire. It felt like it was real and I could kind of sense that it was real even though I knew deep down that it wasn’t. I experienced these types of “episodes” before. So my question is, does this count as psychosis or is it something entirely different?

A. Generally speaking, psychosis is a generic term used to describe a state of mind in which there is a break with reality. Symptoms of psychosis can include hallucinations and delusions. During a break with reality, an individual is unable to tell the difference between what is real and what is not real.

You are specifically inquiring about the “mental movie” playing in your mind. At times, you believe it is real, but you eventually come to realize that it is not real. The question becomes: will there come a time when you are no longer able to make that distinction? This is the concern.

The “mental movie” symptom is concerning, especially given your history of psychotic symptoms. I would characterize it as being abnormal, but without conducting a thorough psychosocial, in-person interview I cannot determine if it rises to the level of psychosis.

My recommendation is to contact your treating mental health professionals and make them aware of your concerns. They can evaluate this situation and determine if intervention is necessary. When it comes to psychosis, it’s best to be proactive. Intervention, particularly medication, could prevent the development of a full-scale psychotic episode. This has been proven time and time again. Please take care.

Dr. Kristina Randle