I think that sometimes you just don't know during it. For me, it depended on the episode and how far into my recovery I was. Occasionally the psychosis would ease a little during and I'd realize I had had some.

When I had severe mixed episodes with psychosis, I would sometimes get so frightened that I would seek help in some way. Especially when I had delusions of persecution. But seeking help doesn't always mean thinking what was "persecuting me" wasn't real.

As I got further into my recovery, I was better able to question my distorted thinking. It may have taken a little time in, and was only occasional. More so has my ability to identify hypomania and mania withOUT psychosis improved. I'd have moments when I could ask myself "Is this normal that I would be spending $X in two days?" Or, "Might those people have found me a bit over-the-top?" Actually, the latter question was often a result of people near me telling me something was not right. I would then be more able to acknowledge the problem. But again, that is more when psychosis was not yet present.