Psychotic symptoms are prevalent in more than half of individuals with bipolar disorder (BD) and can affect the course, outcome, and treatment of the illness. However, despite substantial research, the full impact of psychotic symptoms on BD remains unclear. A systematic review of 339 studies, spanning from 1940 to 2021, examined the prevalence and influence of psychotic symptoms in BD. The review found that lifetime psychosis was present in more than half of the patients, with current psychosis affecting nearly half. Delusions were more common than hallucinations across all phases of BD, and psychotic symptoms were particularly frequent in manic episodes and bipolar type I compared to type II.

While psychotic symptoms were linked to increased hospitalization rates, longer durations of hospitalizations, and poorer outcomes, they were not associated with more severe illness. Interestingly, psychosis did not correlate with psychiatric comorbidity or heightened suicidal risk, and it was less likely to lead to rapid cycling or longer illness durations. Overall, while psychotic symptoms are common in BD, they do not always have a significant negative impact on the illness course and outcomes. The findings suggest that further research is needed to understand the varying effects of psychotic symptoms on BD.

Reference: Chakrabarti S, Singh N. Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review. World J Psychiatry. 2022 Sep 19;12(9):1204-1232. doi: 10.5498/wjp.v12.i9.1204. PMID: 36186500; PMCID: PMC9521535.