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Psychotic features were relatively common symptoms in bipolar disorder. But few studies have examined the significance of psychotic symptoms in bipolar disorder. Some studies suggest that the presence of mood-incongruent psychotic symptoms were associated with poorer outcome compared with mood-congruent psychosis. In biological aspects, subjects with psychotic bipolar disorder showed similar profiles with schizophrenia. Poor treatment outcome can be caused by psychotic symptoms. In this article author reviewed current studies on the clinical description,biological pathophysiology and the pharmacological treatments of psychotic symptoms in bipolar disorder.