Confusion from psychosis or side effect?

I just had my dose of Rexulti increased from 2mg to 3mg 10 days ago. The reason is that, well I was experiencing psychosis again. During the psychosis, I had some serious states of confusion. The very first time I experienced severe confusion during psychosis was back in December. Back then I also was disorganized and had trouble talking where people couldn’t understand me. That was the first time I ever had any confusion or disorganization and I have been living with psychotic BP1 for about 15 years.

In the last day or so I thought I felt myself feeling more normal and less like I was psychotic. However, I have been having bouts of confusion during this time. Simple things that were regular and easy for me required a lot more thought and I struggled to perform them. Also, familiar places and routes seem unfamiliar and things seem to be in a different order than I remember them. It has been so bad that I got lost twice coming back home from the next town that is 20 minutes away, which is a common path that I take. That was within a few days of each other. I am not hearing any voices, I don’t think I am delusional (of course we never know until we aren’t, right?), I can focus, read, write and talk properly and my mind isn’t racing and I am not irritable.

Is this common? Do you think I just am still recovering from the most recent psychotic episode? I don’t think this is a medication side effect because it was worse when I was unmedicated and when I was actively psychotic but just to be sure has anyone felt confused from Rexulti or another antipsychotic? I am starting to get concerned that this might be a form of early-onset dementia since I am 45 and have never had psychosis this bad before that takes this long to recover from.

I swear my health has gotten much worse since I quit smoking and got my second Moderna vaccine (around the same time last year) and that doesn’t seem right at all.

Thanks in advance.


Psychosis is confusion on steroids. I wouldn’t worry about dementia. You are still too young.

It takes a while before meds do the trick. If it doesn’t work out you could always change meds. I changed meds a couple of times before I landed on zyprexa and vraylar.

I have been on just about all the newer APs except the new, new ones (Rexulti is the first of them). Most of them give me severe anxiety or akathisia. Saphris paralyzed my vagus nerve and I vomited anything that went into my stomach except small amounts of water. Zyprexa didn’t keep psychosis away until I was on 15mg and then I was a zombie. It has been a horrible 15 years but luckily my psychosis isn’t chronic so I do get breaks, hence the BP dx and not SZ. No real side effects other than 1 minor 1 that is treatable on Rexulti but worried it might not be working.

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If you are BP then there is other meds you can try besides regular AP’s. From what I know rexulti is a stimulating drug. Not good for BP. Some get adverse effects on stimulating drugs as vraylar, rexulti and abilify.

Have you tried lamictal? It’s the go to drug for BP.

Zyprexa gave me the zombie feeling but I take it before bedtime so the feeling goes away. It took a couple of months before I got used to it.

Why I have a BP diagnosis and not SZ or SZa is complicated. It’s called bipolar because I don’t have chronic psychosis and I never had a permanent functional decline. I have been able to hold down a job for 15 years since my first psychotic break. I don’t have full-blown mania and only milder depression. I have psychosis with mild mood components that aren’t chronic. Essentially cycloid psychosis. It is a thing, rare and classified as bipolar because of remission without meds. I am also on Trileptal. Lamictal is too weak as is lithium. I need an antipsychotic as my psychosis isn’t mood dependent but I technically have a “mood disorder” because I will eventually have some remission (still with non-bizarre delusions) just not when I need it to happen. Yeah, I am a turd in a punch bowl and don’t fit any current diagnosis on paper. This was reconfirmed by 4 psychiatrists over 15 years I need an AP, moos stabilizers help with irritability and somewhat with racing thoughts but not with psychosis. It took me a long time to accept my symptoms aren’t textbook and I really don’t want to unwind the progress of what I have had to go through and undo anything.

The prognosis is good. You don’t suffer from neg’s nor do your positives remain permanent. We all suffer from milder depression from time to time.

Do you have another diagnosis? ADHD maybe? It would explain the racing thoughts.

Try to comply with what the doc’s tell you. If you have issues with psychosis then you need meds for it. I’m sorry I can’t give you further advice on the subject. Your diagnosis seems a bit complicated.

Confusion can be a side effect of meds.

I knew someone who became really confused on just an antidepressant and was fine when they switched to another anti-depressant.

It’s definitely something to bring up with your psychiatrist.

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Thank you I messaged him earlier and asked for a referral to a neurologist just to rule out anything else.

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Remember an MH dx is just a DX so insurance will pay and your Dr. gets paid. In the US at least. Probably why BP dx is so much higher here. You get a lot more choices of meds that can be used. It is basically a universal dx for that reason. It isn’t like a knee injury where there is a difference between a meniscus tear or and ACL tear they just know you have symptoms and fit it into a category to get paid and to help you. There could be 1,000s of different types of SZ and BP but they don’t know and they don’t care.

My daughter and wife (not biologically related) both have BP (daughter 2, wife 1), neither of them has psychosis and my symptoms are somewhat similar but more different in other ways. Yes, I had an ADHD dx as a kid and later in my early 30s and took Adderal but it was a disaster (and how I got my BP dx). My wife and daughter can smoke weed even, I can’t without wanting to poke my eyeballs out from the psychosis. I keep hearing the “good prognosis” thing but I can tell you I once was very intelligent now I am hanging by a thread just trying to get through the day. I was an engineer at one time. No way I could ever do that again. I have an easier job but I have to write. There are times I can’t or my writing looks like Yoda wrote it and it is embarrassing.

I stopped worrying about my dx but I avoid talking about psychosis to other people with a BP dx since their experience is nothing like mine. They all seem to get super manic and get naked and think they are a diety. I just have delusions then weird thoughts, maybe think I need to drive my truck through Walgreens or that I have a dead body in the back then hear voices. Then they go away. Yes, I have had negs. I was actually off meds for 7 years and only had negs during that time. I was told negs can happen in BP but they aren’t prominent. I could still work so they weren’t considered as bad. Zyprexa gave me secondary negs really bad and so did Risperdal. Hence why I come here for help with peer experiences.

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