You may experience psychosis, including hallucinations, delusions, or jumbled thoughts, as a symptom of bipolar disorder. It 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. Thankfully, episodes of psychosis are manageable. If you know you experience 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.
Hallucinations and delusions can 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 affect the brain
- multiple sclerosis (MS)
- a stroke
Many people believe that 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
Symptoms of psychosis in bipolar disorder may include:
- incoherent or irrational thoughts and speech
- lack of awareness
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 have 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 experience paranoid delusions. They might believe someone is out to get them or their property.
Jumbled or irrational thoughts and speech
People with psychosis often experience 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. This means symptoms are either amplifying or reflecting your mood before a manic or depressive episode (congruent), or contradicting your mood (incongruent).
Sometimes, both features can occur during the same episode.
Mood congruent psychosis
Most people with bipolar disorder psychosis experience mood congruent features. This means that the delusions or hallucinations reflect your moods, beliefs, or current bipolar disorder episode (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. Results of an older 2007 study indicated that people with mood incongruent psychosis in bipolar disorder are more likely to need hospitalization.
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: Females with bipolar I disorder have a high risk for 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 those with bipolar disorder.
Some researchsuggests that the frequency of cannabis use increases in proportion to the risk for psychotic disorders.
- Genetic differences: It’s been suggested 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 including:
- 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 whole food 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: Your 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 utilized to “reboot” the brain.
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 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
People with bipolar disorder may experience episodes of psychosis, but thankfully, both psychosis and bipolar disorder are treatable.
With tools, knowledge, and connection with your healthcare team, you can manage your condition and maintain well-being.
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