What Is Bipolar with Psychotic Features?

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  • Written By: J.M. Willhite
  • Edited By: Heather Bailey
  • Last Modified Date: 20 January 2020
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Bipolar with psychotic features is a mental health diagnosis defined by alternating periods of depression and mania accentuated by episodes of psychosis. Bipolar disorder, also known as manic depression, can prove disruptive to one’s life if appropriate treatment is not sought. In situations where one is bipolar with psychotic features, he or she experiences symptoms, including hallucinations and delusions, that necessitate additional intense therapy, including possible hospitalization.

Taken alone, manic depression can be a challenging diagnosis for anyone. Alternating periods of depression and mania can disrupt one’s life and the lives of his or her family and friends. It is unknown exactly what triggers the onset of bipolar symptoms, though research suggests hormones, heredity, and environment may all play a role. According to some medical organizations, including the Mayo Clinic, manic depression symptoms may also present in the wake of neurological changes within the brain.

To better understand the role of psychosis, a brief explanation of the depressive and manic poles is necessary. Bipolar disorder is an umbrella term with several subtypes used to categorize one’s symptoms. The subtype designation is dependent on the number of manic episodes one has experienced in relation to his or her depressive episodes. The rapidity with which one cycles between the two poles is also considered when making a diagnosis.


Diagnosing bipolar with psychotic features requires that the individual meet established requirements, such as those set forth by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Following a battery of diagnostic tests, generally including a urinalysis and a blood panel, an individual will be evaluated to determine what criteria he or she meets. Confirming a diagnosis involves a comprehensive evaluation of one’s mental health history, symptoms and current psychological state. Each categorization of bipolar disorder, especially with psychotic features, has designated signs and symptoms that must be met before a diagnosis is given.

Manic episodes can present as increased energy with little need for sleep. The individual’s thoughts are rapid and, sometimes, disjointed or hard to follow. Increased energy contributes to elevated self-esteem, which can cause the person to behave in uncharacteristic ways, such as suddenly becoming promiscuous or financially irresponsible. It is during manic episodes, primarily, that psychosis occurs.

During a manic episode, one may become delusional, adopting unrealistic or false beliefs. For instance, an individual may exhibit an irrational fear of law enforcement and be convinced someone is out to get him or her. Other presentations of bipolar with psychotic features include catatonia, such as stupor, visual and auditory hallucinations, and marked skepticism, a condition known as negativism. Extreme psychotic episodes can trigger a complete break with reality.

Various drug therapies may be utilized in the treatment of bipolar disorder. Treating bipolar with psychotic features necessitates the use of an antipsychotic medication, such as risperidone, in combination with traditional drug therapy, like lithium. Drug therapy is often combined with psychotherapy, which may include cognitive behavioral and group therapies, to promote healthy coping skills and education about one’s diagnosis. Individuals who experience pronounced delusions or hallucinations that interfere with their ability to function in everyday life may require inpatient treatment at a mental health facility until their mood is stabilized.


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