• Hypomania with psychosis?

I have recently been diagnosed with Bipolar Disorder type 1 and I'm trying to understand it better. Basically, I get hypomanic episodes (I'm definitely elevated but can function in social situations) but during these episodes I get psychotic symptoms (hearing voices and persecutory paranoia). Is this technically mania?

13 Answers

  • Psychologist
  • Hartford, CT

Your case needs more diagnosis before any conclusion can be made.
Hearing voices and persecutory paranoia are the complicated factors to your question .
My question to you is
When do you hear the voices?
What type of voices if you can identify them?
Do you have any religious or spiritual beliefs that might affect your perception of Life?

  • Psychologist | School
  • Grapevine, TX

As an M.A., School Psychologist, I am going to focus on faith, family, health, and wellness at the onset. I do help private practices assist families and children with intervention ideas and consultation, yet I mostly provide schoolbased support. While the bipolar diagnosis, manic symptoms, and psychotic features could manifest in minors, unique manifestations have been observed in adults. I am trained to help you answer your questions. Please consult with a physician if the need arises. You are brave to seek answers, ask, and listen to experts to understand something that is not always simple.

As simple as I can state it, my answer is as follows

PSYCHOSIS ONLY Psychotic features, such as hearing voices auditory hallucinations and paranoia any type are always characteristic of psychosis. The psychotic features you referenced are not attributed to the mood changes associated with bipolar disorder IF from psychosis only. Examples of this would be auditory hallucinations or paranoia with shaming or voices with threats.

MANIC Sometimes they are features of mania common in patients with bipolar disorder IF believed to be associated with the mood fluctuations of bipolar disorder. The common example would include hearing voices about grandiose ideas. I gave that as an example since you stated that you experienced elevations in social settings.

The features could be both manic features and psychotic features. The clinical term for that trait is comorbidity.

Keep in mind that certain medicines can have adverse side effects. While you did not reference the dosage amount or frequency of medication intake, Ability does have risks associated with it.

SUMMARY

Auditory hallucinations hearing voices and paranoia are always psychotic. They can be manic, too. They exist together in both forms.

Please let me know if I can answer further.

  • Psychologist
  • Fredericksburg, VA

It can be! Sometimes mania can include psychotic symptoms. It is important to discuss these symptoms with your medication provider so that they can work with you to help manage these symptoms.

  • Psychiatrist
  • Springfield, NJ

Hello. Thank you for your inquiry. Yes, psychosis is a common symptom of mania. Best, Dr Rajan The Rajan Center for Family Wellness does not discuss patient information via email. Please contact the office at 7743147797 for any patient matters. The information contained in this transmission may contain privileged and confidential information, including patient information protected by federal and state privacy laws. It is intended

  • Psychologist | Clinical
  • Waldorf, MD

In accordance with the ethical guidelines of the American Psychological Association APA, I want to clarify that this response is intended solely for informational and educational purposes and does not constitute a clinical assessment, diagnosis, or therapeutic relationship. That said, based on the information youve shared, it may be helpful to understand the distinction between hypomania and mania. Hypomanic episodes typically involve elevated mood, increased activity or energy, and behavioral changes, but they do not include psychotic features such as hallucinations or persecutory delusions. Hypomania is considered a milder presentation and generally does not result in significant impairment or require hospitalization.

In contrast, the presence of psychotic symptoms, such as hearing voices or experiencing paranoia, suggests a manic episode, which is more consistent with Bipolar I Disorder. The medication you mentioned, Abilify, is commonly prescribed to help manage both mood elevation and psychotic symptoms. If these symptoms persist, I encourage you to consult with your prescribing provider to discuss whether any changes to your current treatment plan may be appropriate.

If youre seeking more personalized support or a formal evaluation, I provide culturally responsive psychological services through my practice, Make It Possible, LLC, where we specialize in psychological assessment, consultation, and therapy with a focus on mood disorders and neurodiversityaffirming care. You can learn more at www.makeitpossibledr.com or contact us directly at 757 8036399.

  • Psychologist | Clinical
  • San Diego, CA

Yes, what youre describing sounds more like mania than hypomania, and its important that your psychiatrist reviews this closely to give you a clear and accurate diagnosis.
Heres why
Hypomania, by definition, includes elevated mood, increased energy, and other noticeable changes, but it does not include psychotic symptoms such as hearing voices or paranoid delusions.
Mania, on the other hand, can include those exact symptomspsychosis is a key feature that distinguishes mania from hypomania.
So if youre experiencing persecutory paranoia and auditory hallucinations during your elevated episodes, its clinically more consistent with manic episodes, not hypomanic.

Why its essential to have your psychiatrist review and assist
1. Diagnosis impacts treatment.
The distinction between hypomania and mania isnt just a technicalityit directly affects your treatment plan. Medications, dosages, and therapeutic strategies are tailored differently depending on the presence of psychosis and the severity of mood elevation.
2. Psychotic symptoms can signal increased risk.
Psychosis during mania increases the risk for hospitalization, disconnection from reality, and harmful behavior. Your psychiatrist needs to monitor this closely to ensure safety and stabilization.
3. They can explore other factors.
Sometimes, other conditions like trauma, PTSD, or substance use can overlap with bipolar symptoms. A psychiatrist can help rule out or identify cooccurring issues.
4. Your care should be personalized.
Every persons experience of bipolar disorder is unique. Having a collaborative, ongoing conversation with your psychiatrist helps them customize your treatment and provide support tools for longterm wellbeing.

Gentle reminder
Your insightbeing able to observe and question your own symptomsis incredibly valuable. Many people with bipolar disorder dont have that level of awareness. But only a psychiatrist has the full clinical picture to interpret these experiences safely and correctly.
So yeswhat you describe is more aligned with mania, and the most important next step is to talk with your psychiatrist about these episodes. They are your partner in understanding this condition and building a life that supports your stability and joy.

  • Psychologist
  • Round Rock, TX

Yes, likely if you are getting psychotic symptoms during what seems a hypomanic episode you are crossing over into mania. Please discuss all of it with your providers. Cloyd Taylor, M.Th, PhD cloydvtGmail.com cloydvtgmail.com

  • Psychiatrist | Psychiatry
  • New Port Richey, FL

Hello, I am writing on behalf of Dr. Adrinne Davis, providing administrative support. There are several factors involved in the symptoms you describe and the medication you listed, as well as other things you might take. These are not issues that can be addressed in an email, and they are very serious symptoms that you are experiencing. You need to speak with your prescribing provider about these symptoms or seek emergency resources in your area if you are feeling like you are not in control of your decisions or actions. If you are a resident of Florida, Dr. Davis can see you via telehealthvideo call and do an evaluation of your condition and recent episodes to determine what is the best treatment plan for you. Please fill out this form to book an appointment that works for your schedule. Thank you for reaching out and we hope to help you soon. Kay H. Cross Functional Care 3052049909 www.crossfunctionalcare.com.

  • Psychiatrist
  • Houston, Texas

Frequently manic symptoms comes with psychosis depends. They are two symptoms but often come hands by hands

  • Psychiatrist
  • New York, New York

Hypomania, by definition, does not include psychosis. If you are normal much of the time and have episodes of psychosis, it is like mixed mania and depression, as mania is usually grandiose delusions, with extreme happiness.

  • Psychologist
  • Fort Myers, Florida

First take a look between mania and hypomania- see this link for some insight,,
https://www.medicinenet.com/mania_vs_hypomania/article.htm#mania_vs_hypomania_facts

Second - Understand psychosis features associated with bi-polar...
https://www.verywellmind.com/bipolar-psychosis-symptoms-379872

  • Psychologist
  • AURORA, OR

You likely have Bipolar I with psychosis. Schizoaffective disorder should be ruled out. A medication cocktail that involves both an anti-depressant and a mood stabilizer is indicated.

Dr. Scott T Alvord

  • Psychiatrist
  • San Leandro, CA

Actually, hearing voices and persecutory paranoia are not symptoms that are typical of mania. Mania is a state where the person is engaged in frenetic activity, sometimes barely sleeping, usually involving grandiose plans, with little concerns for the feelings or needs of other people.

T. Stanton, MD

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