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Psychosis is often described as a loss of contact with reality. People experiencing episodes of psychosis are often unable to recognize what is real in the world around them.

Psychosis is a legitimate reality for some medical and mental health conditions, including bipolar disorder. Fortunately, episodes of psychosis are manageable. If you know you are experiencing psychosis, you can be prepared with treatments and coping tools.

Psychosis is a symptom of a condition, not a disorder. People experiencing psychosis may have hallucinations or delusions.

Sometimes a person with bipolar disorder may experience symptoms of psychosis. This often occurs during a severe episode of mania or depression.

Although psychosis is often associated with mental health conditions such as bipolar disorder or schizophrenia, it can occur due to other medical conditions and causes.

Hallucinations and delusions may also be experienced as a result of:

  • a brain tumor or cyst
  • dementia, including Alzheimer’s disease
  • neurological conditions such as epilepsy, Parkinson’s disease, and Huntington’s disease
  • HIV and other sexually transmitted infections that can affect the brain
  • malaria
  • multiple sclerosis (MS)
  • a hit

Psychosis in bipolar disorder can occur during manic or depressive episodes. But it is more common during manic episodes.

Many people believe that psychosis is a sudden and severe break with reality. But psychosis usually develops slowly.

Early symptoms of psychosis include:

  • decreased performance at work or school
  • less than normal attention to personal hygiene
  • difficulty communicating
  • difficult to focus
  • reduced social contact
  • unjustified suspicion of others
  • less emotional expression
  • anxiety

Symptoms of psychosis in bipolar disorder may include:

  • hallucinations
  • hallucinations
  • incoherent or irrational thoughts and speech
  • lack of awareness


When people hallucinate, they experience things that are not real to anyone but themselves. They may hear voices, see things that aren’t there, or have unexplained sensations.

Hallucinations can involve all the senses.


Delusions are an unshakable belief in something that is not real, true, or likely to happen.

People can have delusions of grandeur. This means that they believe they are invincible or that they have special powers or talents. In bipolar disorder, delusions of grandeur are common during manic episodes.

If a person with bipolar disorder experiences depressive episodes, they may experience paranoid delusions. They may believe that someone wants to take them or their property.

Confused or irrational thoughts and speech

People with psychosis often experience irrational thoughts. Your speech may be rapid, incoherent, or difficult to follow. They can jump from one topic to another, losing track of their train of thought.

Lack of awareness

Many people experiencing psychosis may not realize that their behavior is not consistent with what is really happening.

They may not recognize that their hallucinations or delusions are not real, or realize that other people are not experiencing them.

There are two types (or characteristics) of psychosis in people with bipolar disorder: mood congruent and mood incongruent. This means that the symptoms either amplify or reflect your mood before a manic or depressive episode (congruent) or contradict your mood (incongruent).

Sometimes both features can occur during the same episode.

Mood-congruent psychosis

Most people with the psychosis of bipolar disorder experience mood-congruent features. This means that the delusions or hallucinations reflect your mood, beliefs, or current episode of bipolar disorder (mania or depression).

For example, in a depressive episode, you may have feelings of guilt or inadequacy. In a manic episode, you may experience delusions of grandeur.

mood-incongruent psychosis

Mood-incongruent symptoms oppose your current mood.

This type of psychosis may involve hearing voices or thoughts, or believing that others control you. During a depressive episode, you may also not feel guilt or other negative thoughts that are typical during depression.

Mood incongruity can be more serious. Results of a previous study from 2007 indicated that people with mood-incongruent psychosis in bipolar disorder are more likely to require hospitalization.

The exact cause of psychosis in bipolar disorder is not well understood. But we do know of some factors that may play a role in the development of psychosis:

  • Sleep deprivation. Sleep disturbances have been associated with a lower quality of life overall for people with bipolar disorder and can lead to worse symptoms.
  • Sex. Women with bipolar I disorder are at high risk for mania and postpartum psychosis.
  • hormones Since psychosis has been associated with both childbirth and the first signs that occur during puberty, hormones may play a role in the development of bipolar disorder psychosis.
  • Cannabis. Cannabis is the most commonly used drug among people diagnosed with bipolar disorder. And what is more, some research suggests that the frequency of cannabis use increases in proportion to the risk of psychotic disorders.
  • Genetic differences. It has been suggested that there may be some genetic differences present in both people with schizophrenia and bipolar disorder.

People who have experienced the psychosis of bipolar disorder report that a holistic approach is the most effective.

This means your treatment could benefit from including:

  1. Monitor the psychosis in a planner or calendar and note your environment, diet, and events before and after the episode.
  2. Have a responsible partner or support group to advise you if you are at the beginning of an episode or think you may be in the middle of one. Keep your treatment team in this loop as well.
  3. Avoid alcohol, which is known to intensify everyday symptoms of bipolar disorder and possibly be a trigger for mania and psychosis.
  4. Develop a routine for wellness that includes consistent sleep, taking medications as prescribed, a whole foods diet, and healthy social time.
  5. Make room for your favorite activities that help you stay grounded, like a custom playlist, a movie, exercise, or whatever generally makes you laugh.

These strategies are recommended along with the following formal treatments:

  • Recipes: Your doctor may prescribe mood stabilizers, antidepressants, or antipsychotic medications.
  • Psychotherapy: Therapy may include individual counseling, family therapy and education, group therapy, or peer support.
  • Electroconvulsive therapy (ECT): You may be offered ECT when medication and psychotherapy do not lessen the psychosis. It is an outpatient procedure used to “reset” the brain.

It is not uncommon for people to have a single episode of psychosis and recover with treatment. Early diagnosis and creating a treatment plan are important to control your symptoms and improve quality of life.

Bipolar disorder and psychosis are not yet curable, but both are treatable. For many people, the symptoms can be successfully managed so that they can live well and fully.

If a friend or loved one is experiencing psychosis, there are also ways to help them and communicate effectively when they are having an episode.

How to communicate with someone experiencing psychosis

People with bipolar disorder may experience episodes of psychosis, but fortunately, both psychosis and bipolar disorder are treatable.

With tools, knowledge, and working with your health care team, you can manage your condition and maintain your well-being.

The Healthline FindCare tool can give you options in your area if you need help finding a therapist.