Bipolar Psychosis: A Troubling Feature of Bipolar Disorder

Learn about Bipolar psychosis. Includes examples of bipolar psychosis along with symptoms and treatments of psychosis in Bipolar Disorder.

Psychosis is thinking in which there is a break with reality. Common types of psychotic thinking include:

  • thoughts which are not consistent with reality called delusions
  • sensory experiences that are not real such as hearing, seeing or smelling things that are not there called hallucinations
  • misinterpretations of reality, such as imagining that the announcer on TV is directly talking to the person suffering the psychosis called illusion

Psychosis can be present in those with schizophrenia, depression, or bipolar mania.

Psychosis in Bipolar Disorder

We usually think of a person suffering from bipolar disorder as having:

  • distractibility
  • rapid thought or speech
  • not needing sleep
  • being grandiose or irritable
  • often taking unnecessary risks or being reckless (spending too much money, driving too fast, having reckless sex)

Most patients suffering from manic episodes will have several of these symptoms at the same time, and for a prolonged period of time. But some with bipolar mania can also suffer from psychotic thinking. In bipolar mania, these psychotic thoughts are usually related to the person's manic state.

Examples of Bipolar Psychosis

Some, during their mania, believe they are more important, gifted or capable than they really are. As a result of their inflated thoughts, they often behave in ways that are not usual for them, and represent a severe change from the non-psychotic state. For example, people during a manic psychosis might believe:

  • they are capable of superhuman feats (can fly, drive at excessive speeds, gamble excessively though they are broke).
  • they have God-like qualities, and begin to "preach" to others.
  • they are about to receive large amounts of money (eg, will win tonight's lottery) and so begin to spend excessively.

In depression, the psychosis is usually consistent with their depressed state (eg, thinking they have a terminal disease and are about to die). In schizophrenia, these thoughts are more bizarre and disorganized or paranoid. In mania, however, the psychotic thinking is usually grandiose, reckless, or about hyperactive or pleasurable or angry events.

Psychosis during a manic episode is a very severe symptom and needs to be treated. Today, we use drugs called atypical antipsychotics to treat manic episodes with and without psychosis. Some of these medicines are: Zyprexa (olanzipene). Risperdal (risperidone), Seroquel (quetiapine), Abilify (aripiprazole) and Geodon (ziprazedone). Other older antipsychotics (such as thorazine, haloperidol, thioridazine, perphenazine and others) can be used for the psychotic thinking but are not as effective for use in longer term prevention of bipolar symptoms.

Watch HealthyPlace TV Show on Bipolar Psychosis

Psychotic thinking during a manic episode is usually an indicator of the need for hospitalization to protect the patient as well as to get more rapid control of the manic state. On the HealthyPlace TV show, we will talk with author (and bipolar sufferer), Julie Fast, about this unusual symptom. You can read her special section on Psychosis in Bipolar Disorder written exclusively for She also discusses bipolar psychosis in videos (numbers 9 and 10).

Join us this Tuesday, September 15. You can watch the HealthyPlace Mental Health TV Show live (5:30p PT, 7:30 CT, 8:30 ET) and on-demand on our website.

Dr. Harry Croft is a Board-Certified Psychiatrist and Medical Director of Dr. Croft is also the co-host of the HealthyPlace TV Show.

next: Living with Dissociative Identity Disorder
~ other mental health articles by Dr. Croft

APA Reference
(2009, August 2). Bipolar Psychosis: A Troubling Feature of Bipolar Disorder, HealthyPlace. Retrieved on 2024, July 20 from

Last Updated: April 11, 2017

Medically reviewed by Harry Croft, MD

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