Some people w/ bipolar may have in addition to the mood disorder, psychotic symptoms such as hallucinations, delusions, paranoia - but they may be very rare and not seen again.
With regard to JS, Dr. Stein's opinion is that there is no evidence in the records that she was experiencing psychosis at the time immediately near the murders.
No evidence that she was out of touch with reality. Her journal very telling.
When she wrote about killing the kids to prevent them from embarrassment of having a suicidal mother or inheriting her bipolar disease -- this was actually rational thinking.
Dr. S said that a lot of problems and pain were falling on JS, and she decided to kill herself, and take her children with her for a number of reasons. Dr. S didn't believe it was psychotic