Is extreme paranoia a symptom of bipolar 1?

If a person: had psychosis associated with either mania or depression that could occur. But - No, in general, paranoia is not a diagnostic criteria.

It can be: Lithium and Lamictal are great meds for Bipolar I. Renal function, and thyroid needs to be closely monitored if you are to stay on the Lithium. Use of atypical antipsychotics comes into play if things like paranoia interfere with quality of life. Sometimes meds need to be adjusted or changed as symptoms evolve over time. Sodium levels should be checked on occasion if you have confusion on Lamictal