What does the research say about psychosis rates in people with bipolar disorder?
Psychosis—losing touch with reality through delusions or hallucinations—can occur in bipolar disorder, especially during manic or depressive episodes. Research shows that psychotic symptoms are quite common in bipolar disorder, though the rates vary depending on how psychosis is defined. A large meta-analysis provides the most comprehensive look at this question.
What the research says
A 2025 meta-analysis of 285 studies examined psychosis prevalence in people with bipolar disorder 7. It found that about 8% of bipolar patients also met criteria for schizophrenia, but a much broader definition—mood-incongruent psychosis (psychotic symptoms that don't match the person's mood, like delusions of control during mania)—was present in 47% of patients 7. Psychotic symptoms overall were common, especially in bipolar I disorder and during manic episodes; delusions were more frequent than hallucinations or thought disorders 7. The study highlights significant overlap between bipolar disorder and schizophrenia in terms of psychotic features 7. Other sources in this set focus on schizophrenia or bipolar disorder separately, but do not directly address psychosis rates in bipolar disorder 1234568.
What to ask your doctor
- What is my risk of experiencing psychotic symptoms with my bipolar diagnosis?
- How can I tell if my symptoms are mood-congruent or mood-incongruent psychosis?
- What treatments are available if I have psychotic features in bipolar disorder?
- Should I be monitored for schizophrenia if I have psychotic symptoms?
This question is drawn from common patient questions about this topic and answered using cited medical research. We do not provide individualized advice.