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Background: Estrogen has been extensively studied for its neuroprotective and modulatory effects in psychosis, including regulation of dopaminergic and glutamatergic signaling. In contrast, the neuropsychiatric effects of progesterone and synthetic progestins remain comparatively understudied. This scoping review characterizes existing research examining the relationship between progesterone/progestins and psychosis or mania. Methods: A structured PubMed search identified 51 human and animal studies, which were synthesized narratively. Results: Across human observational studies and experimental animal models, lower levels of progesterone and its active metabolite allopregnanolone were associated with more severe psychotic and manic symptoms. Hormonal fluctuations, particularly rapid declines, were linked to symptom exacerbation, whereas more stable hormonal states were associated with symptom stabilization. Experimental animal studies further support a protective role of progesterone by enhancing GABA-A inhibition via allopregnanolone and modulating dopamine signaling. Findings related to synthetic progestins were mixed, with evidence of both protective and adverse neuropsychiatric effects in susceptible individuals. Conclusions: Overall, research suggests that endogenous progesterone, via allopregnanolone, may protect against psychosis or mania, whereas synthetic progestins show variable effects. Clarifying these relationships will have important clinical implications, including identifying hormonally vulnerable periods and informing treatment strategies aimed at reducing symptom exacerbation.