Bipolar Disorder Psychotic Symptoms: Delusions

When someone is experiencing an acute manic episode, they can sometimes have:

  • delusions – fixed, false, irrational or illogical beliefs
  • hallucinations – hearing, seeing, or sensing things that are not real.

When these psychotic symptoms occur with other manic symptoms it indicates that the person has a bipolar I disorder.

Psychotic symptoms are not seen in hypomania which is the key defining mood state of bipolar II disorder.

The presence of psychotic symptoms needs to be taken seriously

Psychotic symptoms indicate a serious episode and the person may need to be admitted into hospital for close monitoring and urgent treatment.

If there is a lot of support available from family and/or a community mental health team this can sometimes be avoided. However, a person experiencing these symptoms needs a quiet, calm and controlled environment to keep them safe and this can be hard to achieve in the home environment.

The risk is that the person acts on a delusional belief (e.g. they may believe they have the ability to fly and then try to jump out of a window) which puts them or others in danger.

Delusional beliefs are by definition fixed and held absolutely, so that even repeated and persuasive attempts by others to prove that the belief is false, fail.

Delusions

Two types of delusions can occur during a manic episode: grandiose or persecutory delusions.

Grandiose delusions

The person believes that they possess special and unique gifts or powers that others do not have, or that they have access to information that is hidden to others. This type of delusion is the most characteristic of a manic episode and is said to be ‘mood congruent’.

Examples: Having a belief that they are a king or Jesus, can cure the sick, are a multi-millionaire, or have the power of telepathy.

Persecutory delusions

The person believes that people are after him or her, or something really bad is about to happen to them or to someone they know. Although it can occur in mania, this type of delusion can also be seen in other psychotic illnesses and is therefore not diagnostic of bipolar disorder in itself.

Examples: Believing people are following them as they walk down the street, or that someone is out to hurt them or someone they know.

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