Although psychotic symptoms often occur in the manic phase of bipolar disorder, psychotic mania has been and continues to be frequently misdiagnosed as schizophrenia or other psychotic illnesses. In addition, the role of antipsychotic agents in the acute and maintenance treatment of psychotic mania remains unclear. In this paper, we present an overview of studies of psychosis in mania. We also review studies of conventional and newer antipsychotic agents in the acute and maintenance treatment of psychotic mania to help clarify the role of these agents in treating this illness.