If you’re living with bipolar disorder, you’ve likely experienced mood swings between mania (elevated mood) and depression (low mood). But bipolar disorder can come with other symptoms, including bipolar psychosis — periods when it’s difficult to tell what’s real and what’s not.

Experiencing bipolar psychosis can be overwhelming, both for you and your loved ones. “One thing that scares me is not having control over these episodes,” shared one member of MyDepressionTeam.

Although bipolar psychosis can be scary, learning more about it can help you identify the symptoms and treat them. Keep reading to find out more about bipolar psychosis, including what it feels like and the steps you can take to manage it.

What Is Bipolar Disorder Psychosis?

According to the National Institute of Mental Health (NIMH), the term “psychosis” refers to times when a person can’t tell the difference between what’s real and what’s not. Psychosis may include grandiosity (exaggerating your sense of self, as with narcissism) or paranoia and suspicion that’s unwarranted. Psychosis can happen during the mood swings caused by bipolar disorder.

Bipolar psychosis is typically linked to bipolar 1 disorder. Around 63 percent of people with bipolar 1 disorder have experienced bipolar psychosis.

Around 63 percent of people with bipolar 1 disorder have experienced bipolar psychosis.

Does Bipolar Psychosis Occur During Manic Episodes?

People with bipolar disorder experience manic and depressive episodes. A period of mania is when your mood or energy level is extremely heightened. This may include feeling extremely happy or irritable. Depressive episodes are when you feel extremely sad or have difficulty feeling joy or pleasure.

Both depressive and manic episodes can cause psychosis. However, it’s more common during manic periods. About 57 percent of psychosis happens during mania. It’s possible to have mania without psychosis and psychosis without mania.

Bipolar Psychosis Symptoms

The range of symptoms a person experiences during psychosis is often influenced by the person’s mood when they enter psychosis.

Symptoms of bipolar psychosis vary, but some common examples include:

• Delusions — False beliefs
• Hallucinations — Seeing or hearing things that aren’t there
• Paranoia — Feeling like everyone is “out to get you” or that you’re being watched
• Disorganized thinking or speech — Including losing your train of thought or speaking with words that don’t make sense together
• Catatonia — Inability to move normally or repetitive movements

Psychosis is linked to a high risk of self-harm, suicidal thoughts, and harm to others. For this reason, you need to act quickly if you think you or a loved one may be entering a psychotic episode.

The best way to manage psychosis is to recognize the early signs and get help. Here are some of the early signs of psychosis that you can look out for:

• Isolating oneself from others
• Having difficulty focusing or racing thoughts
• Experiencing problems at school or work
• Feeling paranoid or suspicious
• Feeling strong emotions or no emotions at all
• Paying less attention to self-care, such as not sleeping enough, showering, or brushing one’s teeth

The best way to manage psychosis is to recognize the early signs and get help.

If you think you or a loved one are experiencing psychotic symptoms, seek help right away. You can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 or chatting online.

During an episode, contact your healthcare provider and try to reduce your fear by challenging your thoughts. This means questioning whether the worries you have are based on facts or if they are just assumptions that may not be true, helping you stay calm and focused on what you can control. After the episode, follow up with your healthcare provider to prevent future episodes.

Facts About Psychosis

Here are a few facts about bipolar psychosis. It’s important to remember that psychosis is not the same for everyone with bipolar disorder, and its symptoms can vary.

Psychosis Is a Common Symptom of Bipolar Disorder

Psychosis is pretty common for people with bipolar disorder — between 50 percent and 95 percent of people with bipolar disorder experience this symptom. Psychosis is more common in people who have bipolar disorder plus other comorbidities (health conditions that happen at the same time).

Psychosis might be a sign of a more serious type of bipolar disorder that can be harder to treat. But research shows mixed results on this.

There Are Different Causes

Bipolar disorder can be the cause of psychosis, along with other conditions like schizophrenia, depression, and Alzheimer’s disease. However, people who don’t have these health conditions may also experience psychosis. This may be caused by:

• Stress or trauma
• Genetics
• Differences in how your brain works
• Alcohol or substance use
• Sleep deprivation
• Medication side effects
• Certain infections

Because there are a few different causes of psychosis, your healthcare provider will narrow down the cause by excluding other factors before diagnosing you with a mental health condition.

Psychosis Occurs in Other Mental Health Conditions

Several mental health conditions can cause psychosis, like schizophrenia. For this reason, your doctor will consider your mental health history and symptoms to diagnose you with bipolar psychosis. They may ask you questions such as:

• How often do you experience symptoms of psychosis?
• How do you feel when you experience psychosis?
• Have you experienced any recent mood changes?
• Does anyone in your family have a history of psychotic episodes?

The diagnostic process will help your doctor decide whether your psychosis is a symptom of bipolar disorder or another related disorder.

Tracking Your Symptoms Can Be Beneficial

Keeping a record of when you experience psychosis can help you manage your symptoms. Write down what you were doing, how you felt, and how you managed your symptoms during and after the episode. If you can’t remember what happened, ask someone who was with you to help you record it.

Keeping a record of when you experience psychosis can help you manage your symptoms.

Recording this information will help you:

• Identify what triggers your psychosis
• Recognize the early signs of psychosis
• Find which strategies help manage how you feel during an episode
• Help your healthcare provider understand your symptoms and find the right treatment plan for you

Treatment Includes Medication, Therapy, and Lifestyle Changes

Although you cannot prevent bipolar psychosis, there are strategies you can use to improve your symptoms and decrease the risk of future episodes. Untreated psychosis can lead to agitation and aggression, so seeking treatment is important.

Medication and Therapy

As with many mental health conditions, treatment for bipolar psychosis usually involves a comprehensive plan that includes therapy, medication, and other interventions.

Coordinated specialty care is a treatment approach for psychosis that includes:

• Case management — This provides an opportunity to work with a case manager to address practical problems, like gaining access to care.
• Family support and education programs — These can help family members understand psychosis and learn how to cope, talk with their loved one, and solve problems.
• Individual or group psychotherapy — Talk therapy help manage symptoms and prevent relapse. This could include cognitive behavioral therapy (CBT), which can help you manage your symptoms and achieve your goals.
• Medication — Antipsychotic medication is often prescribed to help manage psychosis. Your healthcare provider will tailor your medication plan to your specific symptoms and condition.
• Services to assist with employment and school — A coach can help you balance school and work tasks and find a job.

Treatment options for bipolar psychosis can include therapy, medication, case management, family support programs, and services to assist with school and work.

Make sure to work with a healthcare provider who has experience with psychosis. They will work with you to create a treatment plan that works for you.

Lifestyle Changes

Managing bipolar psychosis can be difficult, but there are several lifestyle changes that can help improve your quality of life. These include:

• Getting regular exercise
• Maintaining a healthy diet
• Avoiding alcohol and substance use (other than drugs prescribed by your doctor)
• Leaning on loved ones for support
• Sleeping enough

Your Healthcare Professionals Are Your Best Resource

Be sure to talk with your doctor or a mental health professional if you have experienced symptoms of bipolar disorder, including bipolar psychosis. If you or a loved one is actively experiencing symptoms of bipolar psychosis and is at risk for becoming violent toward themselves or others, it is important to seek help right away. Call emergency services for immediate help.

Bipolar psychosis can feel overwhelming, but learning about it is the first step toward getting help. With the right treatment and care, it’s possible to feel better and enjoy life again, including time with family, school, work, and hobbies. If you or someone you know is showing signs of psychosis, don’t wait. Reach out for help right away.

Talk With Others Who Understand

On MyDepressionTeam, the social network for people with depression and their loved ones, more than 150,000 members come together to ask questions, give advice, and share their stories with others who understand life with depression or bipolar disorder.

Have you ever experienced psychosis during an episode of mania or depression? What symptoms have you noticed? Share your experience in the comments below, or start a conversation by posting on your Activities page.