Psychotic symptoms

What are psychotic symptoms in bipolar disorder?

Psychotic symptoms are sometimes found in people with bipolar disorder, particularly in the manic phase of the illness. The severity of psychotic symptoms can significantly affect a person’s day-to-day functioning, quality of life, and cognition.

Psychotic symptoms most commonly involve hallucinations and delusions. Hallucinations are defined as a perceptual experience that occurs in the absence of any corresponding external sensory input. They are most commonly auditory, but can occur in any modality. Delusions are fixed, false beliefs that persist regardless of contradictory evidence, and are not explained by cultural beliefs. Persecutory delusions involve the belief that people are attempting to harm or even kill the individual. Delusions of reference refer to beliefs that neutral events are directed specifically towards the individual. Somatic delusions involve the belief that the individual has a serious physical disease or alteration of the body. Delusions of grandeur are characterised by an exaggerated belief that the individual has extraordinary powers, abilities, or fame.

What is the evidence for psychotic symptoms?

Moderate quality evidence suggests the prevalence of visual hallucinations in people with affective psychosis is around 15%, and the prevalence of auditory hallucinations is around 28%. These rates are lower than in schizophrenia (visual = 27%, auditory = 59%), Parkinson’s disease (15-40%), dementia with Lewy bodies (60-90%), age-related eye disease (10-60%), and death-bed visions (50%). They are higher than general population rates (7%).

Auditory hallucinations are more common than visual, olfactory, tactile or gustatory hallucinations, are most common in the early stages of bipolar disorder, and in people with bipolar disorder and a history of childhood abuse.

Moderate to low quality evidence suggests the lifetime frequency of delusions is higher than the lifetime frequency of auditory hallucinations (66-82% vs. 23-31%). Rates of delusions and auditory hallucinations are higher in people in a manic episode than in people in a depressive episode. Rates of auditory hallucinations are most common in people with mixed-manic presentations.

September 2021

Image: ©Bruce Rolff –

Last updated at: 1:25 am, 17th October 2021
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