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Table of Contents

Symptoms

Diagnosis

Causes

Types

Treatment

Coping

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Bipolar psychosis is the loss of contact with reality in which the person cannot distinguish between real and imagined. Symptoms include delusions (believing something that is not real) and/or hallucinations (seeing, hearing, touching, smelling, or tasting something that is not real).

Psychosis usually accompanies episodes of extreme mania in people with bipolar I disorder (the more severe form of the disease). While less common, it can also happen to people withbipolar II disorder.

Psychosis is also a feature of other types of mental illness, includingschizophreniaandschizoaffective disorder. Certain physical illnesses such as Parkinson’s disease, Alzheimer’s disease, brain tumors, and stroke can also trigger a psychotic episode and can even be an extreme feature ofpostpartum depression.

More than half of peopleliving with bipolar disorderwill experience at least one symptom ofpsychosisover the course of their lives.

This article discusses the symptoms, diagnosis, and causes of bipolar psychosis. It also explores the treatment options and coping strategies that can help.

Symptoms of Bipolar Psychosis

While people will often refer to it as a “psychotic break,” the reality is that a psychotic episode usually develops slowly over time.

Early Warning Signs of PsychosisSome early warning signs of psychosis include:Consistently worrying about grades or job performanceExperiencing strong, inappropriate feelings or no feelings at allFailure to keep up with personal hygieneHaving unwarranted suspiciousness of othersStruggling to concentrate or think clearlyWithdrawing from friends and family

Early Warning Signs of Psychosis

Some early warning signs of psychosis include:Consistently worrying about grades or job performanceExperiencing strong, inappropriate feelings or no feelings at allFailure to keep up with personal hygieneHaving unwarranted suspiciousness of othersStruggling to concentrate or think clearlyWithdrawing from friends and family

Some early warning signs of psychosis include:

Getting help for psychosis sooner rather than later can make the recovery process faster and easier, so early indicators should not be ignored. That said, people close to the person experiencing psychosis are usually the ones to detect these symptoms.

Delusions

Psychotic delusions are typically clustered around one or several of the following themes:

Delusions Occurring in Bipolar Disorder

Hallucinations

Hallucinations don’t just involve perceptions but actual sensations involving one or more of the five senses. They can be classified as:

What Are Hallucinations?

Diagnosis of Bipolar Psychosis

To diagnose psychosis in bipolar disorder, a doctor will ask questions about the symptoms you have been experiencing. They will want to learn more about your medical history, recent stressors you might have experienced, and any medications or substances you are taking.

A doctor or mental health professional will utilize the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR) to help make a diagnosis. The DSM is a tool that categorizes different types of mental disorders and describes their diagnostic criteria.

Because psychosis can also be a symptom of other conditions, your doctor will rule out other causes. To do this, they might perform a physical exam, order lab tests, and conduct psychological assessments.

Causes of Bipolar Psychosis

The causes of bipolar psychosis are not fully known, but it is believed that a few different factors can increase the risk. These include:

Types of Bipolar Psychosis

People experiencing psychosis will typically appear incoherent and completely unaware of how extreme their behavior has become. In terms of symptoms, they are typically classified as being eithermood-congruent or mood-incongruent.

The hallucinations and/or delusions match the person’s mood.

The underlying belief that you’re being spied on can manifest with imagined sounds or voices from the next room.

A person’s mood does not match the hallucination and/or delusion.

The episodes are considered serious and will more often than not require hospitalization.

Treatment for Bipolar Psychosis

Treatment for bipolar psychosis typically involves:

While there is no cure for bipolar disorder, treatment can help people manage symptoms and improve their quality of life.Adhering to your treatmentcan significantly improve symptoms and reduce your risk of having future psychotic or severe mood episodes.

Coping With Bipolar Psychosis

If you have bipolar disorder, there are also strategies you can use to monitor and manage your symptoms. Lifestyle modifications that can help include:

Safety Considerations

The word “psychosis” can be scary for some people, suggesting the affected person is likely toinflict self-harmor cause harm to others. While this is possible, particularly in cases of severe mood-incongruent psychosis, episodes are usually more troubling than dangerous, but they still require treatment.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see ourNational Helpline Database.

A Word From Verywell

With a holistic approach to the treatment of bipolar psychosis—including psychotherapy, medication, and social support—most people can fully recover and return to their normal life without further incident. While bipolar disorder cannot be “cured” in the traditional sense, with proper diagnosis and treatment,symptoms of the disordercan be successfully controlled over the long term.

10 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dunayevich E, Keck PE.Prevalence and description of psychotic features in bipolar mania.Curr Psychiatry Rep.2000;2(4):286-290. doi:10.1007/s11920-000-0069-4Burton CZ, Ryan KA, Kamali M, et al.Psychosis in bipolar disorder: Does it represent a more “severe” illness?Bipolar Disord. 2018;20(1):18-26. doi:10.1111/bdi.12527Picardi A, Fonzi L, Pallagrosi M, Gigantesco A, Biondi M.Delusional themes across affective and non-affective psychoses.Front Psychiatry. 2018;9:132. doi:10.3389/fpsyt.2018.00132Neves Mde C, Duarte DG, Albuquerque MR, et al.Neural correlates of hallucinations in bipolar disorder.Braz J Psychiatry. 2016;38(1):1-5. doi:10.1590/1516-4446-2014-1640Chaudhury S.Hallucinations: Clinical aspects and management.Ind Psychiatry J. 2010;19(1):5-12. doi:10.4103/0972-6748.77625Gandal MJ, Haney JR, Parikshak NN, et al.Shared molecular neuropathology across major psychiatric disorders parallels polygenic overlap.Science. 2018;359(6376):693-697. doi:10.1126/science.aad6469Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJ, Kushner SA, Bergink V.Risk of postpartum relapse in bipolar disorder and postpartum psychosis: A systematic review and meta-analysis.Am J Psychiatry. 2016;173(2):117-127. doi:10.1176/appi.ajp.2015.15010124Miller NS, Ipeku R, Oberbarnscheidt T.A review of cases of marijuana and violence.Int J Environ Res Public Health. 2020;17(5):1578. doi:10.3390/ijerph17051578Okkels N, Trabjerg B, Arendt M, Pedersen CB.Traumatic stress disorders and risk of subsequent schizophrenia spectrum disorder or bipolar disorder: A nationwide cohort study.Schizophr Bull. 2017;43(1):180-186. doi:10.1093/schbul/sbw082Waters F, Chiu V, Atkinson A, Blom JD.Severe sleep deprivation causes hallucinations and a gradual progression toward psychosis with increasing time awake.Front Psychiatry. 2018;9:303. doi:10.3389/fpsyt.2018.00303

10 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dunayevich E, Keck PE.Prevalence and description of psychotic features in bipolar mania.Curr Psychiatry Rep.2000;2(4):286-290. doi:10.1007/s11920-000-0069-4Burton CZ, Ryan KA, Kamali M, et al.Psychosis in bipolar disorder: Does it represent a more “severe” illness?Bipolar Disord. 2018;20(1):18-26. doi:10.1111/bdi.12527Picardi A, Fonzi L, Pallagrosi M, Gigantesco A, Biondi M.Delusional themes across affective and non-affective psychoses.Front Psychiatry. 2018;9:132. doi:10.3389/fpsyt.2018.00132Neves Mde C, Duarte DG, Albuquerque MR, et al.Neural correlates of hallucinations in bipolar disorder.Braz J Psychiatry. 2016;38(1):1-5. doi:10.1590/1516-4446-2014-1640Chaudhury S.Hallucinations: Clinical aspects and management.Ind Psychiatry J. 2010;19(1):5-12. doi:10.4103/0972-6748.77625Gandal MJ, Haney JR, Parikshak NN, et al.Shared molecular neuropathology across major psychiatric disorders parallels polygenic overlap.Science. 2018;359(6376):693-697. doi:10.1126/science.aad6469Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJ, Kushner SA, Bergink V.Risk of postpartum relapse in bipolar disorder and postpartum psychosis: A systematic review and meta-analysis.Am J Psychiatry. 2016;173(2):117-127. doi:10.1176/appi.ajp.2015.15010124Miller NS, Ipeku R, Oberbarnscheidt T.A review of cases of marijuana and violence.Int J Environ Res Public Health. 2020;17(5):1578. doi:10.3390/ijerph17051578Okkels N, Trabjerg B, Arendt M, Pedersen CB.Traumatic stress disorders and risk of subsequent schizophrenia spectrum disorder or bipolar disorder: A nationwide cohort study.Schizophr Bull. 2017;43(1):180-186. doi:10.1093/schbul/sbw082Waters F, Chiu V, Atkinson A, Blom JD.Severe sleep deprivation causes hallucinations and a gradual progression toward psychosis with increasing time awake.Front Psychiatry. 2018;9:303. doi:10.3389/fpsyt.2018.00303

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Dunayevich E, Keck PE.Prevalence and description of psychotic features in bipolar mania.Curr Psychiatry Rep.2000;2(4):286-290. doi:10.1007/s11920-000-0069-4Burton CZ, Ryan KA, Kamali M, et al.Psychosis in bipolar disorder: Does it represent a more “severe” illness?Bipolar Disord. 2018;20(1):18-26. doi:10.1111/bdi.12527Picardi A, Fonzi L, Pallagrosi M, Gigantesco A, Biondi M.Delusional themes across affective and non-affective psychoses.Front Psychiatry. 2018;9:132. doi:10.3389/fpsyt.2018.00132Neves Mde C, Duarte DG, Albuquerque MR, et al.Neural correlates of hallucinations in bipolar disorder.Braz J Psychiatry. 2016;38(1):1-5. doi:10.1590/1516-4446-2014-1640Chaudhury S.Hallucinations: Clinical aspects and management.Ind Psychiatry J. 2010;19(1):5-12. doi:10.4103/0972-6748.77625Gandal MJ, Haney JR, Parikshak NN, et al.Shared molecular neuropathology across major psychiatric disorders parallels polygenic overlap.Science. 2018;359(6376):693-697. doi:10.1126/science.aad6469Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJ, Kushner SA, Bergink V.Risk of postpartum relapse in bipolar disorder and postpartum psychosis: A systematic review and meta-analysis.Am J Psychiatry. 2016;173(2):117-127. doi:10.1176/appi.ajp.2015.15010124Miller NS, Ipeku R, Oberbarnscheidt T.A review of cases of marijuana and violence.Int J Environ Res Public Health. 2020;17(5):1578. doi:10.3390/ijerph17051578Okkels N, Trabjerg B, Arendt M, Pedersen CB.Traumatic stress disorders and risk of subsequent schizophrenia spectrum disorder or bipolar disorder: A nationwide cohort study.Schizophr Bull. 2017;43(1):180-186. doi:10.1093/schbul/sbw082Waters F, Chiu V, Atkinson A, Blom JD.Severe sleep deprivation causes hallucinations and a gradual progression toward psychosis with increasing time awake.Front Psychiatry. 2018;9:303. doi:10.3389/fpsyt.2018.00303

Dunayevich E, Keck PE.Prevalence and description of psychotic features in bipolar mania.Curr Psychiatry Rep.2000;2(4):286-290. doi:10.1007/s11920-000-0069-4

Burton CZ, Ryan KA, Kamali M, et al.Psychosis in bipolar disorder: Does it represent a more “severe” illness?Bipolar Disord. 2018;20(1):18-26. doi:10.1111/bdi.12527

Picardi A, Fonzi L, Pallagrosi M, Gigantesco A, Biondi M.Delusional themes across affective and non-affective psychoses.Front Psychiatry. 2018;9:132. doi:10.3389/fpsyt.2018.00132

Neves Mde C, Duarte DG, Albuquerque MR, et al.Neural correlates of hallucinations in bipolar disorder.Braz J Psychiatry. 2016;38(1):1-5. doi:10.1590/1516-4446-2014-1640

Chaudhury S.Hallucinations: Clinical aspects and management.Ind Psychiatry J. 2010;19(1):5-12. doi:10.4103/0972-6748.77625

Gandal MJ, Haney JR, Parikshak NN, et al.Shared molecular neuropathology across major psychiatric disorders parallels polygenic overlap.Science. 2018;359(6376):693-697. doi:10.1126/science.aad6469

Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJ, Kushner SA, Bergink V.Risk of postpartum relapse in bipolar disorder and postpartum psychosis: A systematic review and meta-analysis.Am J Psychiatry. 2016;173(2):117-127. doi:10.1176/appi.ajp.2015.15010124

Miller NS, Ipeku R, Oberbarnscheidt T.A review of cases of marijuana and violence.Int J Environ Res Public Health. 2020;17(5):1578. doi:10.3390/ijerph17051578

Okkels N, Trabjerg B, Arendt M, Pedersen CB.Traumatic stress disorders and risk of subsequent schizophrenia spectrum disorder or bipolar disorder: A nationwide cohort study.Schizophr Bull. 2017;43(1):180-186. doi:10.1093/schbul/sbw082

Waters F, Chiu V, Atkinson A, Blom JD.Severe sleep deprivation causes hallucinations and a gradual progression toward psychosis with increasing time awake.Front Psychiatry. 2018;9:303. doi:10.3389/fpsyt.2018.00303

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