Bipolar Disorder with Psychotic Features

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Bipolar Disorder with Psychotic Features
Statistics by the National Institute of Health estimate that 2.8 percent of US adults have bipolar disorder. Research shows that about half of people with bipolar disorder develop psychotic symptoms during their lifetimes. Thanks to growing awareness of mental health and common disorders, many people understand that bipolar disorder involves episodes of extremely high and low mood. But what does it mean to have bipolar disorder with psychotic features?

Let’s look at the psychotic symptoms that can occur alongside bipolar disorder and treatment options such as medication, psychotherapy, and inpatient treatment with URP Behavioral Health.

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What is Bipolar Disorder with Psychotic Features

What is Bipolar Disorder with Psychotic Features?

According to the fifth edition of the APA’s Diagnostic Statistical Manual, bipolar disorder with psychotic features is when hallucinations or delusions are present at any time during the episode. In bipolar I disorder, psychotic symptoms occur during a manic episode, and the presence of psychotic symptoms indicates that the episode is, in fact, manic. In contrast, psychotic symptoms in bipolar II disorder are only allowed to occur during a depressive episode. If you’re displaying psychotic symptoms, your practitioner should specify if they are moon-congruent or mood-incongruent.

Mood-congruent Psychotic Features

This is when the content of hallucinations and delusions during a manic episode is consistent with typical manic themes. These include themes like invulnerability and grandiosity, as well as ideas of paranoia or suspiciousness about others doubting your accomplishments and capabilities.

Mood-incongruent Psychotic Features

When you have mood-incongruent psychotic features, the content of your hallucinations and delusions is inconsistent with common themes of a manic episode. Or it’s possible that the content of your symptoms is a mix of both mood-congruent and mood-incongruent themes.

Symptoms of Bipolar Psychosis

Psychotic symptoms occur much more frequently during manic episodes compared to depressive episodes. Because the rate of psychotic symptoms during manic episodes is exceptionally high, episodes of mania can become indistinguishable from psychotic disorders.

When you have bipolar disorder, you can experience all types of psychotic symptoms, but grandiose, referential, and persecutory delusions, along with visual and auditory hallucinations, are common.


These are false perceptions of events or objects that involve senses like touch, taste, smell, sound, and sight. And while they appear real, they’re not. They can occur due to a chemical imbalance in the brain. Types of hallucinations that often occur during a manic episode include:

  • Auditory hallucinations occur when you hear sounds that aren’t real. These are also the most commonly experienced type of hallucination.
  • Visual hallucinations involve seeing objects, people, or shapes that aren’t real.

Other types include tactile hallucinations, which occur when you feel something touching your body or movement inside your body. There are also olfactory hallucinations (involving smell), presence hallucinations (feeling like someone is in the room with you), and proprioceptive hallucinations (feeling like your body is moving, such as floating or flying, when it’s not.


Grandiose delusions are the most common type of delusion during bipolar disorder. In this type, you have an unshakable belief that you have unique powers or talents. You may also have persecutory delusions that make you feel like people are after you because of your talents. Similarly, you may experience delusions of reference, in which you believe that unrelated events in the world are related to you.

Disorganized Speech

Psychosis during a manic episode may involve experiencing irrational thoughts. Consequently, you may talk too fast, and it becomes difficult for others to follow what you’re saying. Your speech becomes disorganized as you move from one subject to the next, unable to keep your train of thought.

Treatment Options

Treatment Options

Psychotic features have a significant influence on how bipolar disorder is diagnosed and treated. In fact, the high prevalence of hallucinations and delusions in bipolar disorder often results in a misdiagnosis of schizophrenia. Consequently, it results in inadequate treatment. Therefore, the best course of action is to include additional treatment for psychotic symptoms when necessary.

Antipsychotic Medication

Antipsychotic drugs are useful for alleviating acute mania and providing maintenance treatment. Although typical and atypical antipsychotic medication can reduce psychotic features occurring during acute mania, atypical formulations offer more advantages. Specifically, they can lead to fewer extrapyramidal symptoms and a low risk of tardive dyskinesia. It also reduces suicidality, improves cognition, and doesn’t increase levels of serum prolactin.

Most atypical antipsychotics are as effective as an additional form of treatment alongside mood stabilizers. And treatment-resistant clients, atypical antipsychotics work as a monotherapy solution. Similarly, clients with high levels of non-compliance are prescribed long-acting typical neuroleptic drugs to reduce symptoms.


Additionally, mental health practitioners recommend psychotherapy as a way to build your insight and change your behaviors. Studies show that talk therapy can strengthen the brain’s connections by focusing on how you perceive certain feelings and behave in response to them.

The most common talk therapy approach is cognitive behavioral therapy, which is a highly effective, evidence-based therapy. Specifically, talk therapy improves connections in the frontal lobes and amygdala, and research shows that these changes correlate with psychosis remission rates.

Because psychotic symptoms in bipolar disorder occur during a manic episode, the goal of talk therapy is to help you manage a manic episode and prevent hallucinations and/or delusions. This requires teaching you healthy coping strategies to reduce the intensity of manic symptoms.

Holistic Treatment

Most mental health experts recommend holistic treatment, which combines therapy, medication, and learning strategies. Therefore, you’ll benefit from the following:

  • Keeping track of your psychotic symptoms on a calendar and monitoring your environment and diet before and after an episode.
  • Incorporating wellness therapies like yoga, therapeutic massage, and acupuncture as part of your treatment process
  • Making lifestyle changes like sticking to a consistent sleep schedule, taking medication at the right time, getting daily exercise, and eating a whole-food diet

Inpatient Treatment

For clients who display severe psychotic symptoms, the best approach involves enrolling in a residential treatment program. Here, they can focus on treatment in an environment that encourages recovery and maintains the progress you make. The goal is to separate you from stressful environments that could potentially trigger a manic episode.


It’s not easy to live with bipolar disorder and psychotic symptoms, but early diagnosis and treatment can go a long way in improving your quality of life. If you’ve experienced the above-mentioned symptoms during a manic episode, consult your mental health practitioner on the best way to move forward.

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