DSM-5-TR Guided Film Preview

Bipolar I Disorder with Mood-Congruent Psychotic Features

Bipolar 1 disorder with mood-congruent psychosis: what you should know

What is bipolar 1 disorder?

Bipolar 1 disorder, (formerly manic-depressive disorder), is a mental illness where a person experiences drastic shifts in their mood, energy, ability to concentrate, activity levels, and the ability to carry out normal daily tasks.

Patients will go through two distinct phases: the manic phase and the depressive phase.

During the manic phase, the affected individual is unusually energetic and has an “elevated” mood. This individual will be less likely to adhere to a plan of care.

During the depressive phase of the disease, patients experience many systems that are indicative of depression, like low energy, sadness, and a sense of hopelessness.

Although the specific symptoms and the duration of symptoms for bipolar disorder will vary from person to person, there is a distinct and often extraordinary change in their behavior that warrants medical attention and care.

Risk factors for bipolar 1 disorder

congruent mood

Bipolar disorder is more common in high-income countries than in low-income ones.

Separated, divorced, or widowed individuals are at a higher risk for bipolar 1 disorder.

Research shows that the chances of bipolar 1 disorder increase by 10-fold if there is a family history of the illness.

Those chances increase further with closer relationships. For instance, if a biological mother or father had bipolar 1 disorder then the chances of getting diagnosed with the disorder are higher.

Symptoms of bipolar 1 disorder

In bipolar 1 disorder, a person will experience mania or hypomania.


Three or more of the following symptoms need to be present for a diagnosis of mania.

  • Inflated self-esteem and grandiosity – the patient feels they are unusually important or talented
  • The patient may have a decreased need for sleep and state that they feel rested and energetic even when they have only slept for three hours.
  • They are more talkative than usual and may speak in a hurried fashion. This will make their speech sound confused.
  • Flight of ideas (“my thoughts are racing!”)
  • Easily distracted by irrelevant external stimuli.
  • During manic episodes, the patient might also be engaged in activities that have high stakes or painful consequences. For instance, they might engage in indiscriminate sexual activity, make risky business investments, or go on uncontrolled buying sprees.

Mania and hypomania share the same symptoms.

The difference is in the length of time an individual experiences the symptoms.

Three or more of the above symptoms need to be present for at least 7 days for it to be diagnosed as mania.

If the symptoms last for 4 consecutive days, it is considered hypomania.

In both mania and hypomania, the symptoms are  not related to or better explained by schizoaffective disorder or do not overlap with other mood disorders, such as schizophrenia, delusional disorder, or another medical condition.

The DSM-5-TR provides definitions for manic episode severity. All manic episodes are at the very least “mild” in nature. Mild symptoms means the minimum symptoms are met to be considered a manic episode. Moderate symptoms mean a significant increase in manic activity or the person is displaying significantly affected judgment. Severe symptoms are when a person requires constant supervision to prevent harm.


An individual with bipolar 1 disorder will also experience periods of depression.

A depressive episode in bipolar 1 disorder is characterized by:

  • A loss of interest in surroundings or normal activities
  • Increased periods of sleep
  • Trouble falling and staying asleep
  • Crying and sadness for no reason
  • Trouble concentrating or making decisions
  • An inability to experience pleasure
  • Feelings of hopelessness and worthlessness
  • Suicidal thoughts

Any combination of these symptoms needs to be around for 2 weeks or more to qualify as depression.

The DSM-5-TR provides definitions for depressive episode severity, ranging from mild to severe. Those experiencing severe depression have intense and unmanageable symptoms that severely interfere with their daily functioning.

Bipolar 1 disorder with mood-congruent psychotic features

Around 50% of patients with bipolar 1 disorder will exhibit mood-congruent psychotic features.

Individuals who have mood-congruent psychosis will have hallucinations and delusions that are consistent with their current mood.

For instance, a patient going through a manic episode might believe that they are friends with the Queen of England and have had tea with her on many occasions when they clearly have not.

On the other hand, the patient might experience deep feelings of guilt over something that was completely out of their control when they are going through the depressive phase.

Doctors and researchers are still not sure what causes these psychotic features.

You can take a look at the DSM 5 Guided Film Preview Bipolar I Disorder with Mood-Congruent Psychotic Features to get an up close look of how Bipolar 1 disorder presents itself in a patient.

If you’re interested in more DSM 5 Guided Film Previews, Symptom Media provides a free trial that you can redeem now.


American Psychiatric Association. (2022). Bipolar I and bipolar II disorders. Available at: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-BipolarIandBipolarIIDisorders.pdf

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders. Fifth edition, Text Revision (DSM-5). American Psychiatric Association.

Silva, K. (2018). Bipolar Disorder Type 1. SymptomMedia. 1-37.

Ramezani, T., Gholamzadeh, S., Torabizadeh, C., Sharif, F., & Ahmadzadeh, L. (2017). Challenges of Nurses’ Empowerment in the Management of Patient Aggression: A Qualitative Study. Iranian journal of nursing and midwifery research, 22(6), 442–448. https://doi.org/10.4103/ijnmr.IJNMR_216_16

Burton, C. Z., Ryan, K. A., Kamali, M., Marshall, D. F., Harrington, G., McInnis, M. G., & Tso, I. F. (2018). Psychosis in bipolar disorder: Does it represent a more “severe” illness?. Bipolar disorders, 20(1), 18–26. https://doi.org/10.1111/bdi.12527