Bipolar Psychosis: The Basics

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What is psychosis?

  • Psychosis: a distorted or nonexistent connection with reality; the inability to distinguish between the “real” world and subjective perceptions (delusions and/or hallucinations)


When does it occur?

  • In bipolar disorder, psychosis can occur during extreme mania (Bipolar Type 1). It can also occur during bipolar depression (less common).


How common is it?

  • Approximately 2/3 of bipolar patients will experience at least 1 psychotic symptom over a lifetime.
  • It occurs equally among all genders, races, and age groups.




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  • Fixed, false, irrational or illogical beliefs
  • Seen in Bipolar I mania
  • More common than hallucinations in bipolar patients
  • Most bipolar delusions are grandiose (exaggerated feelings of power, wealth, sexual attractiveness, luck or insight)
  • Inflated beliefs in ability, situation or prospects can be dangerous, leading to reckless financial or sexual behavior i.e. crazy business ventures, gambling, physical recklessness, sexual promiscuity. These can be destructive and lead to a downward spiral.

Types of delusions:

Grandiose delusions:

  • The person believes that they possess special gifts or powers that others don’t have or that they have access to information that is hidden from  others. This type of delusion is most characteristic of mania.
  • Ex.: belief that they are a king

Persecutory delusions:

  • The person believes that people are after him/her or that something really bad is about to happen to them or someone they know.
  • Can occur in mania but can also be seen in other psychotic illnesses
  • Ex: believing that someone is out to hurt them



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  • Hearing, seeing or sensing things without there being a stimulus to cause them
  • Can be seen in mania, occurring in any sense organ
  • most common in mania are auditory and visual
  • Bipolar hallucinations tend to be brief, grandiose, often related to delusional beliefs, and often religious/mystical in nature (i.e. seeing the face of God)
  • Can be psychedelic, frequently pleasurable or ecstatic

Auditory Hallucinations

  • Hearing things i.e. sounds of voices
  • Hallucinations are normally perceived as coming from outside the person’s head

Olfactory Hallucinations

  • Smelling things

Gustatory Hallucinations

  • having unusual tastes in the mouth

Tactile Hallucinations

  • Feeling sensations on the skin (i.e. something crawling over them)

Somatic Hallucinations

  • feeling sensations deep within the body; can be very unpleasant

Visual Hallucinations

  • Seeing things that aren’t really there (i.e. shadows)
  • Are uncommon in pure mania



  • Psychotic symptoms (hallucinations/delusions) indicate a serious episode and the need for hospitalization for close monitoring/urgent treatment.
  • Need a quiet, calm and controlled environment



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Bipolar vs Other Diagnosises

  • Those experiencing bipolar depression may be misdiagnosed as depressed (unipolar), especially women.
  • Those experiencing bipolar mania may be misdiagnosed as schizophrenic, especially men.
    • Schizophrenic delusions continue for longer periods of time (i.e. months, years). Bipolar delusions are more transitory.
    • Schizophrenic delusions tend to be a more negative experience, such as the belief that they are being persecuted. In bipolar disorder, delusions are more optimistic, reflecting great expectations (although unlikely/ill-founded). Bipolar delusions may involve extreme sharing, intimacy, or sense of connection.







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