Mania vs Psychosis: What’s the Difference?

Are you unsure how to tell a manic episode apart from a psychotic episode? Learn how to differentiate between the two conditions and how to effectively treat both.

There is often a misunderstanding between mania and psychosis, and how they present in various mental health disorders like bipolar disorder, schizoaffective disorder, and schizophrenia. While these terms are mistakenly used interchangeably, they represent distinct psychological states that affect mood, behavior, and perception in different ways. Here is an explanation of the differences between mania vs psychosis, how they interact in various mental health disorders, and how to properly manage each one to help create a better understanding and take the most effective road to recovery. 

What is mania?

Mania is a state of abnormally elevated or irritable mood accompanied by increased energy, impulsivity, and excessive goal-directed activity. This state typically lasts at least seven days and must significantly impair a person’s ability to function (or require hospitalization) to be considered a manic episode. Mania is most commonly seen in bipolar I disorder, a severe mood disorder, and often includes sleep disturbances, racing thoughts, and grandiose delusions. 

What is psychosis?

Psychosis is a condition marked by a loss of contact with reality, involving delusions, hallucinations, and disorganized thinking. Unlike mania, which primarily affects mood, psychosis disrupts a person’s perception of what is real. A psychotic episode can result from various mental health disorders, such as schizophrenia, bipolar disorder, schizoaffective disorder, and in some cases, severe depression. As opposed to mania, psychosis can be brief and tied to an external trigger (like trauma or drug use), or it can be chronic and persistent. 

How are mania and psychosis connected?

Though different, mania and psychosis can occur together, most commonly in people with bipolar I disorder. Sometimes psychotic symptoms can emerge during a manic episode, which is referred to as psychotic mania or bipolar psychosis. In such cases, a person’s delusions or hallucinations typically reflect their mood. For example, during a manic episode, someone might believe they are a famous figure or possess special powers (grandiose delusion). Conversely, during a depressive episode, someone might believe they are evil or responsible for a disaster, called mood-congruent psychotic features.

What are the symptoms of mania vs psychosis?

It’s important to understand the difference between symptoms of mania and psychosis in order to properly treat and manage them. Here are two of the most common symptoms of each.

1. Elevated mood 

Elevated mood is a key symptom of mania, involving an unusually high, cheerful, or euphoric emotional state that goes beyond typical happiness. People may feel overly optimistic, energetic, or excited without any clear reason. This intense mood often leads to impulsive behavior and inflated self-confidence. While it can seem positive at first, it can quickly become disruptive or even dangerous if left untreated.

2. Decreased need for sleep 

Decreased need for sleep is another common symptom of mania, where a person feels rested and energized after only a few hours of sleep, or sometimes none at all. Though, unlike insomnia, they don’t feel tired or fatigued the next day. This symptom can fuel other manic behaviors, such as increased activity, racing thoughts, or impulsive decision-making, and often signals the onset of a manic episode in disorders like bipolar disorder.

3. Delusions 

On the other hand, delusions are most commonly seen in psychosis, characterized by fixed, false beliefs that are not based in reality. These beliefs can be paranoid (thinking others are plotting against them) or grandiose (believing one has special powers or a unique mission). Delusions are often resistant to reasoning or evidence that contradicts them and can significantly impair a person’s judgment and behavior, leading to confusion or dangerous actions.

4. Erratic behavior 

Another common symptom of psychosis, erratic behavior, involves unpredictable, disorganized, or inappropriate actions that don’t align with a situation. This can include sudden mood swings, agitation, or engaging in behaviors that seem out of context or irrational, such as speaking incoherently or acting in bizarre ways. Erratic behavior often reflects the confusion and disconnection from reality that comes with a psychotic episode.

Can mental health disorders involve mania and psychosis?

Several mental health disorders involve a combination of manic symptoms and psychotic features, making diagnosis and treatment more complex. Here are three of the most common.

1. Bipolar I disorder

Bipolar I disorder is characterized by severe manic episodes, often alternating with periods of depression. During both manic and depressive phases, people may experience psychotic symptoms like delusions or hallucinations, known as bipolar psychosis. These psychotic features usually align with the person’s mood, such as grandiose delusions during manic episodes and feelings of guilt during depressive episodes. When mood symptoms are treated, the psychosis typically resolves, but without proper treatment, episodes can become more frequent and intense.

2. Schizoaffective disorder

This hybrid disorder includes both mood disorder features and persistent psychotic symptoms. To receive a diagnosis of schizoaffective disorder, a person must experience psychosis for at least two weeks without any significant mood symptoms. This differentiates it from bipolar disorder, where psychosis typically occurs during manic or depressive episodes. In contrast, schizoaffective disorder involves psychosis that can occur independently of mood changes, making it a more complex diagnosis to manage.

3. Major depressive disorder

In some cases, severe depression can trigger psychosis, leading people to experience delusions of guilt, poverty, or worthlessness. While major depressive disorder is not considered bipolar, it still involves the interaction between significant mood disturbances and a loss of touch with reality. Typically, psychotic symptoms resolve once the depressive episode is treated, often with a combination of antidepressants and antipsychotic medications.

How is mania vs psychosis diagnosed?

Diagnosing mania and psychosis requires a thorough evaluation by a mental health professional. This often includes clinical interviews, mental status exams, input from family or friends, and sometimes medical tests to rule out other causes like substance use or neurological disorders.

A manic episode is diagnosed based on clear signs of elevated mood, increased activity, and accompanying symptoms like racing thoughts or poor decision-making. According to the American Psychiatric Association, these symptoms must last at least seven consecutive days in order to be accurately diagnosed. 

On the other hand, psychosis is diagnosed through the presence of delusions, hallucinations, or disorganized thinking, regardless of mood state. These symptoms reflect a loss of contact with reality and must be significant enough to impair functioning. A diagnosis often requires ruling out other causes, such as substance use or medical conditions, and determining whether the psychosis occurs independently or as part of another mental health disorder, such as schizophrenia, schizoaffective disorder, or bipolar disorder with psychotic features.

Because symptoms of both mania and psychosis can overlap with other mental health disorders, including anxiety disorders, dissociative disorders, and personality disorders, it’s important that diagnoses be made carefully, ideally by a psychiatrist or clinical psychologist.

How are mania and psychosis treated?

Treatment for both mania and psychosis depends on the underlying condition and severity of symptoms, but often involves a combination of medication, psychotherapy, and lifestyle interventions.

Treating mania

Here are some common approaches to treating mania.

1. Mood stabilizers 

Mood stabilizers are a common and effective treatment for mania, especially in disorders like bipolar disorder. These medications help regulate extreme shifts in mood, reducing the intensity and frequency of manic episodes. By balancing brain chemistry, mood stabilizers can prevent both manic and depressive episodes, helping people maintain long-term emotional stability.

2. Atypical antipsychotics 

In more severe cases of mania, atypical antipsychotics may be prescribed, particularly when symptoms include psychosis, severe agitation, or impulsivity. These medications help reduce mood instability by targeting dopamine and serotonin receptors in the brain. Atypical antipsychotics are often prescribed alongside mood stabilizers to manage acute manic episodes and prevent relapse. 

3. Stress management strategies

Along with medication, having effective stress management strategies is very important in treating and managing mania, as stress can be a trigger for symptoms. Techniques like regular exercise, mindfulness meditation, sleep hygiene, and structured routines can help stabilize mood and reduce emotional reactivity. Additionally, cognitive behavioral therapy (CBT) and psychoeducation can teach people how to recognize early signs of mania or a manic episode to prevent one. 

Treating psychosis

Here’s an overview of how psychosis is typically treated.

1. Hospitalization

In severe cases of psychosis, hospitalization may be necessary, especially when a person poses a risk to themselves or others, or is unable to care for themselves due to severe symptoms. Inpatient care provides a safe, structured environment where people can receive intensive treatment, including antipsychotic medication, medical monitoring, and therapeutic support. Hospitalization can help stabilize acute psychotic episodes, ensure safety, and begin the process of long-term management for disorders like schizophrenia, bipolar disorder with psychotic features, or schizoaffective disorder.

2. Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) is a common form of therapy for the treatment of psychosis, often used alongside medication. CBT helps people recognize and challenge distorted thoughts and beliefs, such as delusions or paranoia, and develop healthier thinking patterns. It also teaches coping strategies for managing distress, improving daily functioning, and reducing the emotional impact of psychotic symptoms. Furthermore, CBT is especially helpful for people who continue to experience symptoms despite medication, supporting long-term recovery. 

3. Supportive therapy and community resources

Community resources, such as group therapy, are key components in treating psychosis, especially during recovery. Supportive therapy provides emotional stability and helps people cope with distress without directly confronting delusions. Resources such as peer support, case management, and housing or job assistance promote independence and reduce the risk of continuing symptoms in recovery. 

Why is distinguishing between mania and psychosis important?

Correctly identifying whether a person is experiencing mania, psychosis, or psychotic mania is crucial for the proper treatment of a person. An inaccurate diagnosis can lead to inappropriate medication, worsening symptoms, or unnecessary hospitalization. For instance, prescribing an antidepressant to someone with undiagnosed bipolar I disorder can trigger a manic episode or escalate the risk of psychotic symptoms. Similarly, failing to recognize psychosis in a patient with mania can delay the use of necessary medications, such as those used in bipolar psychosis or schizoaffective disorder.

Beyond treatment, accurate diagnosis helps reduce stigma and misunderstanding between mania and psychosis. Labeling someone as “psychotic” or “manic” without considering the context of their mood disorder or mental illness can contribute to fear and misinformation. Understanding the difference between mania and psychosis allows for more compassionate, targeted support, creating better outcomes for those experiencing bipolar mania, psychotic features, or other mood disorders.

How Charlie Health can help

If you or a loved one is struggling with a mental health disorder, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for dealing with serious mental health conditions. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. With treatment, managing your mental health is possible. Fill out the form below or give us a call to start healing today.