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Bipolar Psychosis: What You Should Know

Bipolar Psychosis: What You Should Know

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Bipolar Psychosis: What You Should Know

Navigating bipolar disorder can involve more than just managing depressive and manic episodes; it also might include the potential challenge of psychosis.

This helpful guide explains how to recognize bipolar psychosis, outlines common questions, highlights risk factors that may lead to psychosis, and provides some examples of the types of support commonly offered to those who have been diagnosed with psychosis.

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What is bipolar psychosis?

Bipolar disorder affects roughly 3 out of every 100 U.S. adults, with psychosis being an occurrence that can arise during a mood episode for some individuals.

Psychosis, more formally known as psychotic symptoms or psychotic experiences, refers to times when a person perceives or interprets things differently from those around them — essentially, a loss of contact with or change in beliefs about reality. It’s a feature that can manifest in both the manic and depressive phases of bipolar disorder. 

What happens during a psychotic episode?

Understanding what happens during a psychotic episode is pivotal to recognizing and managing it effectively. The experience can be disruptive, confusing, distressing, or even frightening. Here is a breakdown of key occurrences:

  • Early warning signs that an episode is approaching can include heightened sensitivity, difficulty concentrating, withdrawal, and changes in sleep and eating patterns.
  • Hallucinations are sensations that seem real to the person experiencing them despite lacking any actual external source. Examples include hearing voices, seeing things, or feeling sensations that aren't there.
  • Delusions can occur when someone is experiencing a psychotic episode. These irrational and unfounded yet strong beliefs can range from feelings of persecution to grandiose ideas about one’s abilities and significance.
  • Paranoia during psychosis can lead to an intensified distrust of others and feelings of threat that aren't based in reality. This can cause severe anxiety and alter a person's usual behavior.
  • A cognitive fog that causes confusion and changes in thinking can happen during psychotic states. Typical thought processes can be disrupted, sometimes making it challenging for the individual to look after themself or make decisions.
  • Jumbled thoughts and fragmented speech can occur. Irrational thought patterns may also be experienced.
  • A lack of awareness of the change in one’s behavior and perceptions can lead to poor judgment, impulsivity, and risky behavior.
  • Other common symptoms may include a lack of motivation, declining personal hygiene, and social withdrawal.

Safety should be a primary concern during a psychotic episode. The altered perception of reality can lead to increased risk including dangerous behaviors, self-harm, or harm to others. In such instances, immediate professional intervention is necessary.

  • Call 911 if you’re having a mental health emergency.
  • Text HOME to 741-741 if you're emotionally distressed and need immediate support.
  • Call 988 for the National Suicide Prevention Hotline.

Types of bipolar psychosis

There are two primary types of psychosis. These classifications help licensed prescribers and therapists tailor treatment approaches to the symptoms of bipolar psychosis. 

Mood-Congruent Psychosis

This type of psychosis involves behaviors or thoughts that are consistent with depressive or manic mood states. For instance, during a depressive episode, someone may believe they committed an unforgivable sin.

Mood-Incongruent Psychosis

On the other hand, mood-incongruent psychosis involves beliefs or experiences that don’t line up with the presented mood state. During depression, for example, someone may feel that they have supernatural abilities.

Commonly asked questions about psychosis

What’s the difference between psychosis and schizophrenia?

While both bipolar disorder and schizophrenia can involve psychosis, the experiences are different. Bipolar psychosis tends to be shorter and often related to severe mood symptoms. Schizophrenic psychosis is typically longer-lasting, with more severe disorganization in thoughts and behaviors, and often occurs outside of mood episodes.

How long does psychosis last?

The length of a psychotic episode can vary in those with bipolar disorder. Psychosis can last for as little as a day or several weeks. Understanding the typical length of an episode can help individuals prepare for the recovery period and take steps to prevent or lessen the impact of future episodes.

How is bipolar psychosis diagnosed?

Diagnosing bipolar psychosis requires a thorough evaluation by a mental health professional. This assessment involves discussing symptoms, reviewing medical history, and, at times, conducting physical exams and lab tests to rule out underlying medical conditions that could be causing symptoms.

Asian woman up late at night

The causes of psychosis

Understanding the triggers of a psychotic episode is crucial for management and prevention. What triggers bipolar psychosis? These are some of the common causes:

  • A lack of sleep can be a serious trigger for a bipolar episode, including psychosis. 
  • Hormonal changes can impact mood stability and be linked to the onset of psychosis.
  • High levels of stress or traumatic events could cause the onset of psychosis.
  • Drug or alcohol use could have an effect, and substance abuse can be a strong trigger for psychosis.
  • Genetics can also be a factor, as family history can play a role in bipolar disorder and psychosis.

Treatment for psychosis

Managing bipolar disorder’s psychotic episodes typically involves a combination of medication, therapy, support, and self-care.

During a psychotic episode, medications may need to be adjusted or added, and one may need to check in with or see their prescriber often. Antipsychotic medications are often used to manage the symptoms of psychosis. Like all medications, these have risks and benefits, and it's important that you consider those with a healthcare provider.

Cognitive behavioral therapy (CBT) can also be effective in helping individuals manage and prevent psychotic symptoms by providing tools to challenge and reframe irrational beliefs.

Having a strong support group is really important for people who experience psychosis — those trusted individuals can help distinguish reality from imagined perceptions. Support and education programs for loved ones can also be a valuable resource to help them become more informed and prepared to provide help through the recovery process.


Maintaining a balanced lifestyle that includes regular exercise, a healthy diet, and adequate sleep can help stabilize mood and reduce the risk of psychotic episodes. Additionally, identifying and avoiding personal triggers such as stressful situations or substance use is crucial.

Be prepared: Fill out this free mental health emergency plan so you have a roadmap for action if your symptoms escalate. 

What to do after a psychotic episode

After experiencing bipolar psychosis, it’s crucial to regroup and reestablish a sense of stability. Many of the same interventions that are recommended during an episode apply in the recovery process, which may also involve adjusting treatment, seeking support, and focusing on self-care. It’s also essential to have open and honest communication with a trusted mental health professional.

Following a psychotic episode, it may be beneficial to:

  • Schedule a check-in with a licensed prescriber. Medications may need adjustments to ensure their effectiveness and minimize side effects. 
  • See your therapist. Continued therapy can provide a safe space to explore feelings, address challenges, and develop strategies for managing symptoms and preventing relapse.
  • Prioritize self-care. Engage in physical activity, maintain a nutritious diet, and do what you can to get adequate sleep.
  • Connect with your support system. Leaning on the support of friends, family, or support groups can offer comfort and understanding, reducing feelings of isolation.

​​Psychotic symptoms, though common in bipolar disorder, vary in how they impact the condition's progression and outcomes. With support and management strategies that work for you, you can regain balance and continue to lead a fulfilling life. 

Helping someone experiencing psychosis

Supporting someone in the midst of psychosis requires sensitivity and patience. You’ll want to:

  • Maintain a calm and non-confrontational stance.
  • Offer reassurance and support.
  • Acknowledge their feelings, even if you don’t share their perceptions.

You could risk making things worse if you try to convince them that their beliefs are false, dismiss or belittle their experiences, argue with them, or encourage dangerous or impulsive behaviors, potentially leading to increased distress, isolation, or even harm to themself or others.

People experiencing a psychotic episode have a higher risk of suicide. If someone demonstrates severe symptoms — such as expressing suicidal thoughts, showing intense paranoia or agitation, or acting abusively or violently — contact local emergency services immediately.

Stability through support

The complexities of bipolar disorder and psychosis may present challenges, but you don’t have to face them alone. With the right knowledge, support, and strategies in place, you can find stabilization and greater control over your life. 


Support groups, education, and therapy are just as essential for those who care for individuals with bipolar psychosis as they are for the affected person themself.

From online therapy to medication management, Cerebral can deliver a tailored approach to address these mental health needs. Discover how we’re different from other online mental health providers.

Images by vecstock and tirachardzon Freepik.

The information in this blog is provided as a general educational resource only, and is not to be used or relied on for any diagnostic or treatment purpose. This information should not be used as a substitute for professional diagnosis and treatment and does not create any patient-physician relationship between you and Cerebral. Please consult your health care provider before making any health care decisions or to get guidance about a specific medical condition.

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Remember: Seek immediate help if you're ever thinking about acting on suicidal thoughts, in a crisis, or experiencing extreme emotional distress.  Call or text 988 for the National Suicide Prevention Hotline. Call 911 if you’re having a mental health emergency. Text HOME to 741-741 if you're emotionally distressed and need immediate support. Regular monitoring and support for mental health alongside strategies to reduce these risks and maintain safety should be aspects of one’s treatment plan in their later years. It’s also vital for adults in their 50s and above to have routine health screenings and maintain a comprehensive care treatment plan that addresses both mental and physical health. Should treatments for bipolar change as you get older? The short answer: Most likely. As you age, both your body and your brain can undergo significant changes that can alter your symptoms and the way you respond to bipolar treatment options. 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All of these strategies can enhance quality of life and support overall well-being.  Getting personalized mental health care While aging with bipolar disorder can present new challenges, understanding these changes can lead to better management strategies and a higher quality of life. It's important to consult licensed professionals who can tailor treatment plans with age-associated adjustments. After all, the aging process affects all of us differently. Some may feel and function just like they did in their younger years, while others may have developed health conditions that impact their mobility, ability to drive, or ability to perform daily tasks. Because retirement and aging can bring about many life transitions, you may want to consider online therapy and virtual medication management. Some of the benefits of choosing an online mental health service like Cerebral over traditional in-person visits include: Convenient access to care from the comfort of your home: This is especially helpful if you live in an area with few mental health resources, live in more than one home throughout the year, or have limited mobility.  Frequent monitoring and easier communication with licensed providers: This can be crucial in managing medication adjustments and addressing any emerging issues promptly. An integrated approach that includes both psychiatric medication management and psychotherapy: This holistic approach addresses both the biochemical and psychological aspects of the disorder in a coordinated manner under one simple, affordable monthly payment. Plus, Cerebral offers more flexible scheduling options than traditional in-person visits. This flexibility is particularly beneficial for individuals with bipolar disorder, whose symptoms can fluctuate unpredictably, requiring more frequent support or prompt interventions. Explore more: How Does Cerebral Work? Images by freepik, freepik, and freepik on Freepik. *The information in this blog is provided as a general educational resource only, and is not to be used or relied on for any diagnostic or treatment purpose. This information should not be used as a substitute for professional diagnosis and treatment and does not create any patient-physician relationship between you and Cerebral. Please consult your health care provider before making any health care decisions or to get guidance about a specific medical condition.
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