Markedly increased energy or activity, decreased need for sleep, pressured speech, racing thoughts, grandiosity, or risky behavior.
Mood and psychosis
Bipolar I disorder with psychotic features
During severe mania or depression, bipolar I disorder can include delusions or hallucinations. In bipolar psychosis, the psychotic symptoms track the mood episode.
How the theme may appear
Espionage, surveillance, or mission content in this pattern
Mania may produce certainty of secret recruitment, special clearance, world-saving missions, coded broadcasts, or enemies trying to stop an important operation. Persecution can intensify when grandiose plans are challenged.
Content is not diagnosis
The words “CIA,” “spyware,” “handler,” “coded message,” “AI mission,” or “government investigation” do not identify a disorder by themselves. Clinicians examine the form of the belief, associated symptoms, functional change, evidence, and course.
Clinical clues
Patterns a clinician may explore
These are prompts for assessment, not criteria you should apply to yourself or another person.
Psychosis appears during a manic or severe depressive episode and improves as the mood episode resolves.
Sudden spending, travel, restricted-site entry, nonstop messaging, and mission-driven projects may create immediate risk.
Psychosis continuing well outside mood episodes suggests that the diagnosis needs reassessment.
Do not wait
Seek urgent help when
- No sleep for multiple nights, unsafe driving or travel, spending or giving away major assets, weapons, trespassing, severe agitation, or suicidal mixed/depressive symptoms.
- Confusion, fever, abnormal movements, or fluctuating consciousness may indicate delirium, catatonia, or a medical emergency.
Questions that distinguish causes
What a thorough assessment may ask
- Lifetime history of mania
- Sleep need versus insomnia
- Energy and goal-directed activity
- Timing of psychosis relative to mood
- Substances, medications, and medical causes
Helpful direction
Care steps commonly worth discussing
- Treat severe mania with psychosis as urgent, especially when sleep is minimal, judgment is impaired, or risky plans are active.
- Temporarily protect finances, vehicles, travel plans, weapons, online accounts, and access to restricted places.
- Restore sleep and use clinician-directed mood-stabilizing and antipsychotic treatment.
- After recovery, create an early-warning plan around reduced need for sleep, rising energy, spending, mission ideas, and irritability.
Reduce escalation
What can make the situation worse
- Treating secret-agent claims as harmless imagination when they are paired with sustained mania and impaired judgment.
- Allowing major financial, legal, travel, or employment decisions during the episode.
- Using antidepressant treatment without a clinician reviewing possible bipolar history.
Continue with the next task
Related site guides
Supporting someone
Use communication that respects distress without arguing with or confirming an unverified claim.
Open guide →Prepare for an assessment
Build a precise timeline of onset, sleep, mood, experiences, substances, medicines, physical symptoms, AI use, and safety.
Open guide →Possible causes and clinical assessment
See why one theme can arise from several different psychiatric, medical, or substance-related causes.
Open guide →Urgent help
Use crisis and emergency guidance when there is immediate danger, severe self-neglect, or inability to stay safe.
Open guide →
External starting points
Browse resource packs
Trusted resources related to Bipolar psychosis
Bipolar disorder
National Institute of Mental Health
Mania, depression, psychosis, treatment, and research.
Bipolar disorder
CAMH
Canadian clinical overview of bipolar disorder.
Bipolar disorder overview
NHS
Symptoms, diagnosis, and treatment.
Bipolar disorder: assessment and management
NICE
Evidence-based clinical guideline for bipolar disorder.