Bipolar Psychosis
Written by: THE BALANCE
Medically reviewed by Dr. Sarah Boss, MD
Last updated: January 19, 2026
Fact checked
Quick Summary
  • People suffering from psychosis are sometimes unable to distinguish between what is actually happening in reality and what is not.
  • Some physical and mental health problems, notably bipolar disorder, can lead to psychosis.
  • You can be prepped with therapies and coping techniques if you know you have psychosis.
Reading time: 11 min

An absence of connection with reality is a common description of psychosis. People suffering from psychosis are sometimes unable to distinguish between what is actually happening in reality and what is not.

Some physical and mental health problems, notably bipolar disorder, can lead to psychosis. Psychosis bouts are, fortunately, treatable. You can be prepped with therapies and coping techniques if you know you have psychosis.

Psychosis is a sign of a disorder, not a condition. People who are suffering from psychosis may have delusions and hallucinations.

An individual with bipolar disorder may suffer psychotic symptoms at times. During a serious episode of depression or mania, this is common.

While psychosis is frequently linked to mental illnesses such as schizophrenia or bipolar disorder, it can also be caused by a variety of physiological problems.

Delusions and hallucinations can also occur as a result of:

  • A Cyst Or Tumor in the brain
  • Alzheimer’s Disease, for example, is a form of dementia.
  • Parkinson’s Disease, Epilepsy, And Huntington’s Disease are examples of neurological diseases.
  • Other sexually transmitted infections including HIV can harm the brain
  • Malaria
  • A Stroke
  • Multiple Sclerosis (MS)

When a person is suffering from bipolar psychosis, they have episodes of intense depression or mania, as well as hallucinations and psychotic symptoms.

The symptoms usually correspond to a patient’s mood. They may think they have exceptional abilities during a manic phase. This kind of psychosis may result in dangerous or reckless actions.

When bipolar psychosis strikes during a low time or a depressive episode, the person may think that someone is attempting to hurt them or that they may have done something bad themselves. These ideas can make a person feel incredibly enraged, unhappy, or afraid.

Psychosis comes in a variety of forms. In patients with bipolar disorder, there are two kinds of psychosis: mood incongruent and mood-congruent. This means your symptoms are either enhancing or expressing your mood before a manic or depressive episode (congruent), or they are opposing your mood (incongruent).

Both elements can appear at the same moment in the same episode.

Mood Congruent Psychosis

Mood congruent traits are common in patients with bipolar disorder psychosis. This implies your hallucinations or delusions are a reflection of your present beliefs, moods, or bipolar illness episode (depression or mania).

You may experience emotions of incompetence or guilt during a depressed episode, for instance. You may have grandiose fantasies during a manic episode.

Mood Incongruent Psychosis

Mood incongruent signs are in conflict with your current mood. Hearing thoughts or voices, or believing you are being controlled by others, are all symptoms of this sort of psychosis. It’s also possible that you won’t feel guilty or have other unpleasant thoughts during a depressive episode.

Mood inconsistency can be more serious. Individuals with mood incongruent psychosis will most probably require hospitalization, according to the findings of an older 2007 study.

Up to the 1980s, bipolar disorders were referred to as manic-depressive psychosis. It is characterized by mood swings and alterations between depression and hypomania/euphoria/mania. An increase in activity and energy characterizes the hypomanic period. Intense euphoria, psychomotor excitement, no symptoms of weariness, and poor impulse control define the manic phase. Psychotic symptoms might include a lack of touch with reality, as well as delusional thinking with grandeur and hallucinations.

Sadness, lack of pleasure, lack of interest and desire, feelings of worthlessness and guilt, sleep disturbances, decreased appetite, and suicidal thoughts are all symptoms of the depressive phase. Delusions of destruction and hallucinations are common in severe cases. 

When a person with bipolar disorder’s mood returns to normal, he or she understands what he or she has done or said, resulting in feelings of guilt, a profound sense of worthlessness, and a significant amount of social and family misery. Long-term suicide rates are extremely high in this condition.

When experiencing psychotic symptoms during a manic or depressive episode, each individual’s experience is unique. Psychotic symptoms, on the other hand, can be divided into a few groups:

Hallucinations. A hallucination is a feeling or sensation that is perceived as real yet is not. It might be heard, felt, seen, tasted, or scented. Seeing objects that aren’t there or hearing things that aren’t there are examples of hallucinations.

Delusions. A delusion is an erroneous notion that persists despite evidence to the contrary. Paranoid, persecutory, grandiose, jealous, or a combination of these sorts of delusions is all possible.

Confused thinking. Disordered, rapid, and nonsensical thoughts are symptoms of psychosis. To the untrained eye, such an individual appears to speak quickly, move from one subject to the next, and make little sense.

Self-awareness is lacking. An individual will not be conscious that his or her thoughts or hallucinations are untrue while experiencing a psychotic episode. This might cause a lot of anxiety and distress.

In bipolar disorder, psychosis seems to mirror a person’s current mood. As an example, a person suffering from mania may have grandiose illusions, feeling that he or she is more skilled and capable of accomplishing something, or even famous and wealthy. These delusions will intensify during a depressive episode and may involve paranoid beliefs that someone is trying to get them.

Bipolar disorder is sometimes accompanied by psychotic symptoms. Psychosis is defined as a lack of awareness of reality. Certain medicines, illegal substances, and other mental conditions, such as schizophrenia, can all produce psychosis. Bipolar disorder with psychotic symptoms can be difficult to diagnose since psychosis is so multifaceted and can be caused by a variety of factors.

Delusions, or incorrect ideas that contradict or clash with reality, are common psychotic symptoms. The following are some examples of common delusions found in people with bipolar disorder:

Delusions of grandeur. This type of hallucination involves believing that you are exceptionally powerful, well-known, or knowledgeable. Because you feel invincible, you may indulge in the unsafe activity.

Paranoid delusions. Conspiracy theories, thoughts of imminent doom, or the belief that people or groups are out to get you are all examples of this. If a person believes there is a huge threat that only they can defeat or solve, this can arise alongside delusions of grandeur.

Somatic delusions. A type of hallucination similar to Hypochondria. It’s the self-created notion that you have an illness or physical flaw despite the fact that doctors can’t detect anything wrong with you.

Delusions of reference. This is the sensation that the world surrounding you contains codes or secret means. For example, you might assume that the weather guy on the news is talking with you in code or that what they’re saying has a hidden meaning.

Delusional jealousy. This is when you’re envious of your spouse or partner because you think they’re being unfaithful. These misconceptions may remain despite your partner’s assurances that they are false.

Hallucinations, or hearing or seeing things that aren’t really there, are another symptom of psychosis. Auditory, visual, and tactile hallucinations are the three types of hallucinations. Visual hallucinations might include shadows in the corners of your eyes, as well as clearly apparent people, objects, or animals that others cannot see.

People suffering from paranoid delusions may notice shadows or movements in the corner of their eyes. Hearing sounds or voices that other people can’t hear is known as auditory hallucinations. Hearing voices that give you commands or insult you are examples of this.

Around half of bipolar 1 disorder, patients will have mood-congruent psychotic symptoms.

Individuals suffering from mood-congruent psychotic features will have delusions and hallucinations that match their present mood.

For example, a patient experiencing a manic episode may feel they are acquainted with the British Royal Family and had tea with them numerous times when they have not.

Physicians and scientists are still baffled as to what causes psychotic symptoms. When a patient with bipolar 1 disorder is going through a depressed episode, on the other hand, they may feel deeply guilty about something that was absolutely beyond their control.

The elevated mood might present either as irritability or euphoria (feeling “high”) during a hypomanic episode.

During hypomanic episodes, you may experience the following symptoms:

  • Changing gears quickly from one thought or idea to the next
  • Having an overabundance of self-assurance
  • Speech that is loud and “pressured” (uninterruptible).
  • Extra energy levels, as well as hyperactivity and a lower desire for sleep

People that are going through hypomanic episodes are usually very pleasant to be around. They can frequently appear to be the “life of the party,” cracking jokes, showing a keen interest in unrelated activities and other people, and influencing others with their cheerful disposition.

What’s the big deal about that, you might wonder? Hypomania can sometimes result in chaotic and harmful conduct. Hypomanic episodes can evolve to full manias, which can impair a person’s capacity to operate (bipolar I disorder). People with mania may spend the money they will not have, seek sexual relationships with people they wouldn’t generally have sex with, and start engaging in other risky or impulsive behaviors that have the potential to be dangerous.

The great majority of patients with bipolar II disorder spend more time dealing with depressive symptoms than hypomanic ones. Depression might set in right after hypomania has passed, or it can take a long time. Some people go through cycles of depression and hypomania, while others have extended spells of normal mood in between.

Hypomania can continue anywhere between a few days to several weeks or months if left untreated. Symptoms usually last anywhere from a few weeks to several months.

Episodes of depression in bipolar II disorder are comparable to “usual” clinical depression, characterized by low activity and energy, feelings of worthlessness or guilt, and suicidal thoughts. Bipolar disorder depressive symptoms might endure weeks, months, or even years.

People who have suffered bipolar psychosis believe the most effective treatment is a holistic approach.

As a result, you might want to include the following in your treatment:

  • Keep track of your psychosis in a diary or calendar, recording where you were, what you ate, and what happened before and after the event.
  • Having an accountable companion or support network who can tell you if you’re on the verge of an episode or suspect you’re in the midst of one. Keep your medical team updated on the situation as well.
  • Avoiding consumption of alcohol, which has been shown to exacerbate bipolar illness symptoms and may be a cause of mania and psychosis.
  • Creating a wellness regimen that includes regular sleep, taking medicines as recommended, eating a whole food diet, and engaging in healthy social activities.
  • Leaving room for your favorite hobbies that help you stay grounded, such as a personal music playlist, a movie, workout, or whatever makes you happy.

These tactics should be used in conjunction with the following proper treatments:

  • Mood stabilizers, antipsychotic and antidepressant medications may be prescribed by your doctor.
  • One-on-one counseling, education, family therapy, group therapy, and peer support are all examples of psychotherapy.
  • When psychotherapy and medication fail to relieve your psychosis, you may be provided electroconvulsive therapy (ECT). It’s a non-invasive procedure that “reboots” the brain.

FAQs

Why Is Therapy An Important Aspect Of The Treatment For Bipolar Disorder?
Mood-stabilizing medications are a key part of controlling the symptoms of bipolar disorder. Some patients, on the other hand, may have difficulty recalling to take medicine daily or refuse to take the medicine altogether. That’s why it’s equally crucial to recognize patterns of conduct. This can make you feel more prepared for a future manic or depressed episode and in control of what to expect. Therapy empowers individuals by providing support that drugs cannot provide.
What Factors Contribute To The Development Of Bipolar Disorder?
An abnormality in levels of neurotransmitters is regarded to be the main cause of Bipolar Disorder. Neurotransmitters are neurochemicals that appear to play a role in a variety of mood disorders. Other variables, however, may contribute to the formation of Bipolar Disorder. Physiological differences in the brain, levels of the hormone in the blood, heredity, and substantial stress, trauma, or abuse are all possible causes.
How Long Does Bipolar Psychosis Last?
The duration of psychosis is determined by the cause and type of the psychotic episode. The duration of psychotic episodes caused by a mental health issue, for example, differs from that of drug-induced psychosis. In addition, the duration of psychosis varies depending on the mental health issue.
The length of bipolar psychosis has not been specified by medical sources. During the manic phase of bipolar disorder, a patient may experience psychosis, which can last weeks or months.

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