Bipolar disorder is a mood disorder that features extreme shifts in mood, during which psychosis can occur. People with psychosis experience a disconnected view of reality. It can involve hallucinations and delusions.

Bipolar disorder can affect energy, activity levels, sleep, communication, and the ability to perform daily tasks.

A person with bipolar disorder may experience manic and depressive episodes. Manic episodes include periods of extreme elation and energy. During depressive episodes, a person may feel so low that they cannot function or take any action.

Psychosis can happen at different stages of bipolar disorder. However, it is not always present, and not everyone with bipolar disorder will experience it.

It can be a frightening experience for the person and those around them, but a mental health care professional can offer treatment to help manage and relieve the symptoms.

If a person has bipolar disorder and shows signs of psychosis, it is best to speak with a doctor, if possible, as there is a risk of complications.

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Psychosis can occur with bipolar disorder, schizophrenia, some types of dementia, and other conditions.

With psychosis, the person’s thinking becomes disconnected from reality, and they may have issues recognizing what is real and what is not.

A psychotic episode can involve:

The pattern of symptoms will vary among individuals and according to the situation.

A person may also show signs before a psychotic episode. These can include:

  • suspiciousness
  • difficulty organizing thoughts
  • withdrawal from social interactions
  • unusual or intense feelings or ideas
  • decline in personal hygiene
  • insomnia
  • trouble communicating
  • sudden drop in work performance

Bipolar psychosis happens when a person experiences an episode of severe mania or depression along with psychotic symptoms and hallucinations.

The symptoms tend to match a person’s mood. During a manic phase, they may have grandiose thoughts, such as believing they have special powers or are famous. This type of psychosis can lead to potentially harmful behavior.

If bipolar psychosis occurs during a low period or a depressive episode, the individual may believe that someone is trying to harm them or that they have done something wrong. These beliefs can trigger extreme anger, sadness, or fear.

Bipolar psychosis generally lasts for brief periods. A person experiencing an episode of bipolar psychosis is likely to return to a lucid state with treatment.

Psychosis in bipolar disorder and schizophrenia

Bipolar disorder shares some symptoms with schizophrenia, another chronic psychiatric disorder. Psychosis can occur in both conditions.

Either condition can disrupt a person’s life enough to interfere with daily activities and their ability to maintain close relationships or hold a job.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) lists the same symptoms of bipolar disorder for children and adults. Bipolar disorder may include psychotic features.

Bipolar disorder and psychosis are challenging to diagnose, particularly in children and teens. A psychiatrist needs to confirm that the behaviors they are exhibiting are not due to other factors.

Other causes of symptoms could include:

  • everyday highs and lows that are common among teens
  • acute trauma
  • another mental health disorder
  • substance misuse

If a child or a teen shows signs of psychosis or experiences mood changes that are more severe than usual for their age group, it is important to consult a doctor.

A person may experience the following:

  • Visual and other hallucinations: The person may see, hear, smell, taste, or feel things that are not there.
  • Delusions: The person may be sure that something is true when it is not. They may believe that they are important, have contacts in high places, have a lot of money, or are related to royalty, when in fact they are not.
  • Paranoia and fear: The individual may believe that they have done something wrong or that someone wants to cause them harm.
  • Unusual or racing thought patterns: This can lead to rapid, constant, confused, or disjointed speech with frequent changes of topic. The person may forget what they were talking about.
  • Lack of insight: The person is unable to recognize unusual behavior in themselves, though they may recognize it when they see it in others, whether it exists or not.

These symptoms can occur during episodes of mania or depression, or during a mixed episode — when a person with bipolar disorder shows signs of both a low and high mood.

They can cause the person to behave unusually, affecting their relationships with others in their personal life, at work, or in other situations.

If the person believes they are very important, they may behave in ways that are outside the law.

An individual who believes they have committed a crime or that someone is coming after them may become defensive or talk about suicide. In this case, they may need emergency medical attention.

A doctor will ask about the person’s symptoms, medical history, and any recent events — such as a trauma — that they may have experienced. They will also ask about the use of prescription or other drugs.

To receive a diagnosis of bipolar disorder, a person needs to display some or all of the symptoms listed in the DSM-5-TR.

Psychosis can be difficult to diagnose because it can share symptoms with depression and other mental health disorders.

In addition, people with bipolar disorder often do not see their actions as unusual. They may think their challenges stem from the people around them rather than themselves.

Effects of not using medication for bipolar disorder

As a manic phase makes a person feel good, they may not want to change or see any need to seek help. As a result, they may not seek help and remain without a diagnosis.

People who have received a diagnosis in the past — often during a low period — may stop taking their medications. If this leads to a manic episode, they may not want to seek help.

Effect of antidepressants

Sometimes, a person who has never had a diagnosis of bipolar disorder shows signs of depression. At this stage, they may receive antidepressants from a doctor.

If the person has underlying features that make them susceptible to bipolar disorder, some antidepressants can trigger a manic episode.

Friends and family who are aware of bipolar disorder and its symptoms can help a person who is experiencing psychosis by encouraging them to seek help.

If a person experiences severe episodes of depression or mania, they should seek help from a doctor or a mental health professional. Friends or loved ones may consider encouraging them to do so.

If a person talks about or attempts suicide, someone should seek emergency treatment immediately.

People with bipolar disorder are often unaware of their symptoms or reluctant to seek help. Family and friends may need to encourage the person to talk with someone about what is going on.

Treatments for bipolar disorder will include treatment for psychosis, if necessary. It usually combines counseling services and medication. In cases of severe mania, a person may need hospitalization.


Several medications are available for treating psychosis in bipolar disorder.

Doctors typically prescribe antipsychotics for psychotic symptoms. The treatment can depend on whether a person is experiencing psychosis with bipolar mania or depression.

Antipschyotics for bipolar mania can include:

  • olanzapine (Zyprexa)
  • risperidone (Risperdal)
  • quetiapine fumarate (Seroquel)
  • asenapine (Saphris)
  • aripiprazole (Abilify)
  • ziprasidone (Geodon)
  • iloperidone (Fanapt)
  • olanzapine/fluoxetine (Symbyax)
  • paliperidone (Invega)

Antipsychotics for bipolar depression can include:

  • quetiapine (Seroquel XR)
  • lurasidone HCl (Latuda)
  • olanzapine/fluoxetine (Symbyax)
  • cariprazine (Vraylar)

A doctor may prescribe antipsychotics that a person takes regularly, even when they are not experiencing a manic or depressive episode.

A person will use these medications in addition to mood stabilizers and appropriate antidepressants.

Finding a suitable drug and dosage may take time — sometimes years.

Side effects

Antipsychotic medications can also have adverse effects.

Some medications, especially older ones, may cause unwanted and uncontrollable muscle movements. These often go away after the person stops taking the drug, but they can sometimes be permanent.

In very rare cases, they may lead to neuroleptic malignant syndrome. This life threatening condition involves a high fever and sweating, muscle stiffness, and changes in blood pressure.

During pregnancy, a doctor may advise against antipsychotic medication, as the effect on a fetus remains unclear. If stopping the drug may increase the risk of harm to the pregnant person or baby, they may advise taking it or may recommend another treatment.

Treatment team

A psychiatrist is usually the best guide for treatment, but a treatment team may include:

  • social workers
  • therapeutic support staff
  • counselors
  • family or primary doctor
  • other specialists

Bipolar disorder often affects family members and friends in addition to the person who has the condition.

Caregivers may need to seek help to manage situations.

Some tips include:

  • learning as much about bipolar disorder as possible to try to understand what it means to have the condition, how the individual feels, and how to respond to it
  • finding ways to manage stress, which applies to both the person with bipolar disorder and their loved ones
  • joining a support group for family members or friends of people with bipolar disorder
  • helping the person set goals, join support groups, get involved in the community, and follow treatment plans
  • setting boundaries and limits, and seeking support to stick with them if needed

Psychosis can be a feature of bipolar disorder. Scientists believe it happens because of changes in the brain, but there is still not enough information to explain it fully.

Not everyone with bipolar disorder will experience psychosis, and it does not happen all the time.

When it happens, it can be difficult for the one who experiences it and for those around them.

How people react to psychosis can also put them at risk of physical, social, or other harm. For this reason, it is important to seek help if someone experiences psychosis.

Medication can help manage psychosis. It is not always easy to diagnose or treat, but with a doctor’s help, it is usually possible to bring symptoms under control.

As scientists learn more about changes in the brain that occur with psychosis, more effective, targeted treatments may become available.