Bipolar disorder can cause symptoms such as psychosis, including hallucinations, delusions, or jumbled thoughts. These symptoms may occur during manic or depressive episodes.

Psychosis is often described as a loss of contact with reality. People who experience episodes of psychosis often aren’t able to recognize what’s real in the world around them.

Psychosis is a legitimate reality for some medical and mental health conditions, including bipolar disorder. However, treatment and coping tools can help manage episodes of psychosis.

Psychosis is a symptom of a condition, not a disorder itself. 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.

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

Hallucinations and delusions can also result from:

Psychosis in bipolar disorder can happen during manic or depressive episodes. It’s more common during episodes of mania.

Many people believe psychosis is a sudden, severe break from reality. But psychosis usually develops slowly.

The initial symptoms of psychosis include:

  • decreased performance at work or in school
  • less than usual attention to personal hygiene
  • difficulty communicating
  • difficulty concentrating
  • reduced social contact
  • unwarranted suspicion of others
  • less emotional expression
  • anxiety

Symptoms of psychosis in bipolar disorder may include:


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

Hallucinations can encompass all the senses.


Delusions are an unshakable belief in something that isn’t real, true, or likely to happen.

People may have grandiose delusions. This means they believe they’re invincible or have special powers or talents. In bipolar disorder, delusions of grandeur are common during episodes of mania.

If a person with bipolar disorder experiences depressive episodes, they may have paranoid delusions. For example, they might believe someone is out to get them or their property.

Jumbled or irrational thoughts and speech

People experiencing psychosis often have irrational thoughts. Their speech may be fast, rambling, or hard to follow. They may move from subject to subject, losing track of their train of thought.

Lack of awareness

Many people experiencing psychosis may not be aware that their behavior isn’t consistent with what’s really happening.

They may not recognize that their hallucinations or delusions aren’t real or notice that other people aren’t experiencing them.

There are two types, or features, of psychosis in people with bipolar disorder: mood congruent and mood incongruent.

In mood congruent psychosis, symptoms either amplify or reflect your mood before a manic or depressive episode. In mood incongruent psychosis, symptoms can contradict your mood.

Sometimes, both features can occur during the same episode.

Mood congruent psychosis

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

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

Mood incongruent psychosis

Mood incongruent symptoms are in opposition to your current mood.

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

Mood incongruence may be more severe. A 2022 review of research indicated that mood incongruent psychosis is a marker of bipolar severity.

The exact cause of psychosis in bipolar disorder isn’t well understood. But we do know some factors that may play a role in developing psychosis:

  • Sleep deprivation: Sleep disturbances have been associated with lower quality of life for people with bipolar disorder and may trigger worse symptoms.
  • Sex: People with bipolar I disorder who give birth have a high risk of postpartum mania and psychosis.
  • Hormones: Since psychosis has been associated with childbirth and early signs occurring during puberty, hormones may play a role in developing bipolar disorder psychosis.
  • Cannabis: Cannabis is the most frequently used drug among people with bipolar disorder. Some research suggests the frequency of cannabis use increases in proportion to the risk of psychotic disorders.
  • Genetic differences: Some research suggests there may be some genetic differences in people with schizophrenia and bipolar disorder.

People who have experienced bipolar disorder psychosis report a holistic approach as the most effective.

This means your treatment might benefit from:

  • monitoring psychosis on a planner or calendar and noting your setting, diet, and events before and after the episode
  • having an accountability partner, treatment team, or support group to advise if you’re at the onset of an episode or think you may be in the middle of one
  • avoiding alcohol, which is known to intensify everyday bipolar disorder symptoms and possibly be a trigger for mania and psychosis
  • developing a routine for wellness that includes consistent sleep, taking medications as prescribed, a balanced and nutritious diet, and healthy social time
  • keeping space for your favorite activities that help you stay grounded, like a custom playlist, movie, exercise, or what usually gets you laughing

These strategies are recommended alongside the following formal treatments:

  • Prescriptions: A doctor may prescribe mood stabilizers, antidepressants, or antipsychotic medications.
  • Psychotherapy: Therapy may include one-on-one counseling, family therapy and education, group therapy, or peer support.
  • Electroconvulsive therapy (ECT): You may be offered ECT when medication and psychotherapy don’t lessen psychosis. It’s an outpatient procedure used to “reboot” the brain.

What is bipolar disorder psychosis?

Bipolar disorder psychosis is a symptom of bipolar disorder that can present as hallucinations or delusions. Psychosis can occur during mania or depressive episodes.

How long does an episode of psychosis last with bipolar disorder?

Bipolar disorders can present with episodes of psychosis that last a week or longer.

Can you recover from bipolar disorder psychosis?

An episode of psychosis is a symptom that can occur during a period of mania or depression in people with bipolar disorder. Medications and other treatments may help reduce the number of episodes or the severity of symptoms.

How do you deal with someone with bipolar disorder during an episode of psychosis?

If someone with bipolar disorder is experiencing psychosis, it’s best to speak clearly without distractions and use shorter sentences. It may also help to use the same language they use to describe what they’re feeling.

They may not want to talk with you, but it may help to make yourself available in case they change their mind.

It’s not unusual for people to have only one episode of psychosis and recover with treatment. Early diagnosis and creating a treatment plan are important to manage your symptoms and improve your quality of life.

Bipolar disorder and psychosis aren’t yet curable, but they’re both treatable. Many people manage symptoms successfully and live well and fully.

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

How to communicate with someone experiencing psychosis


  • mirror the same language they use to describe their experience
  • speak clearly and in short sentences
  • actively listen to validate their experience, but aim to redirect the conversation
  • speak privately, without distractions, if possible
  • accept if they don’t want to talk with you, but be available in case they change their mind
  • be mindful if they’re distressed by the experience


  • talk down to the person, challenge, or “egg on” a delusion or hallucination
  • verbally or nonverbally judge, disapprove, or argue
  • label with combative stereotypes like “crazy,” “psychotic,” “postal,” or “raging”
  • try to touch or physically move the person
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With tools, knowledge, and connection with your healthcare team, you can manage your condition and maintain your well-being.