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Mania and Hypomania, what do they consist of?

Mania and Hypomania, what do they consist of?

One night I woke up and felt good again. I thought I could take advantage of my time, that everything was possible. I felt alive and vital, full of energy. My senses seemed to wake up, the colors were very bright, they hit me hard. Things were very clear, I realized things I had never felt. I had a feeling of joy and union with the world" Papolos and Papolos, 1992.

Content

  • 1 What do we understand by Mania?
  • 2 Signs and symptoms of Mania
  • 3 Consequences of Manic Disorder
  • 4 Differential Diagnosis of Manic Disorder
  • 5 Psychotic Mania
  • 6 Postpartum and hobbies
  • 7 Mixed episode
  • 8 Hypomanic Episode

What do we understand by Mania?

The term mania has its genesis in ancient times and has varied in meaning over the years. For the year 150 B.C. Arateo described it as follows: “Melancholic cases tend toward depression and anxiety. However, if this anxiety situation persists, then in most cases there is joy and hilarity, which usually ends in mania”.

Originally, the mania it was a non-specific term that designated madness, and melancholy was a subtype of mania that was associated with the generation of ritual behaviors; for that reason, many people relate hobbies to tics, although the latter sometimes have another etiology, such as the need to confirm that doors, windows, gas and locks in the house are closed, which can usually be due to obsessive-compulsive disorder.

Today, manias are classified into mood and mood disorders, they also occur in other conditions such as cyclothymia, they also appear in some schizoaffective disorders and the Bipolar disorder mainly. Within disruptive disorders, impulse control and behavior we find the pyromania and kleptomania.

Manic episodes are defined by a specific period during which a high mood, this is the prototypical symptom of manias, but so are the expansive or irritable moods, there may be alternation between euphoria and irritability - emotional lability.

It is also known as manias to behaviors that a person repeats to satiety repetitively. Generally, their actions seem strange and somewhat curious to others, since they can be considered as "extravagant", there is a capricious concern, such as an affection or an "unusual" desire, this helps the person to release a certain burden of anxiety, anguish, stress or irritability.

Signs and symptoms of mania

It is important to note that mania has a clinical presentation that differs considerably between one patient who suffers from it and another. Manic episodes hardly appear alone, usually alternate with depressive periods; Bipolar disorder, for example, includes mania and depression.

It's like watching three or four television shows at the same time" Anonymous patient

In manias there is a feeling of euphoria, psychic hyperactivity, ideas and thoughts flow rapidly and daily physical activity may seem somewhat frantic to others.

CLINICAL CHARACTERISTICS OF MANIA
MoodExpansive, cheerful, euphoric, elevated, irritable.
CognitionAccelerated thoughts, brain drain, increased self esteem, greatness, distraction,

Psychotic symptoms: Delusions and hallucinations.

ConductIncrease in activity, excess of commitment and expenses, increase in sociability, excess of loquacity (word pressure), intrusion, sexual indiscretions, poor judgment.
SomaticDecreased need for sleep, increased energy, decreased certain physical discomfort.

Manic episodes are classified according to their severity in: mild, moderate, severe without psychotic characteristics, severe with psychotic symptoms and depending on the type of psychotic characteristics that may be congruent or inconsistent with mood.

In its mildest form it is presented as hypomania, it does not show a significant deterioration in functioning, although it can be disruptive, as is the manifestation of a behavior that could be considered as socially unacceptable or disruptive, such as highly aggressive and hostile behavior.

A manic episode can be described as an euphoric or excessively cheerful state. The mood that can be contagious to the outside observer, but those who know him best may perceive it as excessive.

In its expansive quality of mood it is characterized by an incessant and indiscriminate enthusiasm in interpersonal relationships, whether labor, academic, there may also be an increase in sexual impulses, fantasies and behaviors.

The most serious mania produces important alterations in social, academic and labor functioning, can be accompanied by psychotic features such as delusions, hallucinations and paranoia; when a psychotic or delusional mania occurs, The diagnostic accuracy can be increased by obtaining a careful and detailed longitudinal history of the current episode and the previous ones., a meticulous family history of the patient and from other people significant to him or his environment. Otherwise it can be easily confused with other conditions, therefore, the importance of consulting with professionals who can correctly diagnose and thus provide the necessary support.

Mania episodes are often accompanied by agitation or psychomotor concerns, such as shaking the leg, changing positions frequently, "walking", or presenting unproductive agitation. There are manias related to cleanliness, health, order, physical or psychological security, sex and accumulation of objects mainly.

Consequences of Manic Disorder

Some serious consequences may be: loss of employment, substance use, legal problems, breakdown or attrition of important interpersonal relationships, aggressive behavior and accidents, among others. Often expansiveness, unmotivated optimism, greatness and diminished judgment ability leads them to participate in pleasant activities that can be risky, such as: driving at high speeds, compulsively buying things that are required or not, unusual sexual behaviors, can make unreasonable economic investments, can experience a loss of social inhibitions that the individual normally has, manias have been associated with an increased risk of death from accidents and exhaustion, due in part to the increase in intentional activity in an excessive and risky manner.

The economic impact of the condition on public health is based on treatments; There is also usually a significant loss of productivity in the subjects and they often make excessive expenses or doubtful investments, they can fall into the pathological game, to name an example.

Differential Diagnosis of Manic Disorder

DSM-V diagnostic criteria to differentiate manic episodes from the hypomanic
Manic episodeHypomanic episode
A. A differentiated period of an abnormal and persistently elevated, expansive or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).A. A differentiated period during which the mood is persistently elevated, expansive or irritable for at least 4 days and that is clearly different from the usual mood.
B. During the period of mood alteration three (or more) of the following symptoms have persisted (four if the mood is only irritable) and there has been to a significant degree:

1. Exaggerated self-esteem or greatness.

2. Decreased need for sleep (eg, you feel rested after only 3 hours of sleep).

3. More talkative than usual or verborrheic.

4. Leakage of ideas or subjective experience that thought is accelerated.

5. Distrability (eg, attention is too easily diverted to banal or irrelevant external stimuli).

6. Increase in intentional activity (either socially, at work or studies, or sexually) or psychomotor agitation.

7. Excessive involvement in pleasurable activities that have a high potential for serious consequences (eg, engaging in uncontrollable purchases, sexual indiscretions or crazy economic investments).

B. During the period of mood alteration, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and there has been to a significant degree:

1. Exaggerated self-esteem or greatness.

2. Decreased need for sleep (eg, you feel rested after only 3 hours of sleep).

3. More talkative than usual or verborrheic.

4. Leakage of ideas or subjective experience that thought is accelerated.

5. Distrability (eg, attention is too easily diverted to banal or irrelevant external stimuli).

6. Increase in intentional activity (either socially, at work or studies, or sexually) or psychomotor agitation.

7. Excessive involvement in pleasurable activities that have a high potential for serious consequences (eg, engaging in uncontrollable purchases, sexual indiscretions or crazy economic investments).

C. The symptoms do not meet the criteria for the mixed episode.C. The episode is associated with an unequivocal change in activity that is not characteristic of the subject when he is asymptomatic.
D. The alteration of mood is severe enough to cause deterioration in work or habitual social activities or relationships with others, or to need hospitalization in order to prevent damage to oneself or others, or there are psychotic symptomsD. Alteration of mood and change of activity are observable by others.
E. The symptoms are not due to the direct physiological effects of a substance (eg a drug, a medication or other treatment) or a medical illness (eg, hyperthyroidism).E. The episode is not severe enough to cause significant work or social deterioration or to need hospitalization, nor are there any psychotic symptoms.
F. The symptoms are not due to the direct physiological effects of a substance (eg, a drug, a medication or other treatment) or a medical condition (eg, hyperthyroidism).
Note: Mania-like episodes that are clearly caused by somatic antidepressant treatment (e.g., a medication, electroconvulsive therapy, light therapy) should not be diagnosed as bipolar I disorder.Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant therapy (e.g., a medication, electroconvulsive therapy, light therapy) should not be diagnosed as bipolar II disorder.

As can be seen in the previous table, most of its characteristics are opposite to those of depression. It is common that during the manic episode the individual has an exaggerated self-esteem, it manifests as excessive self-confidence of the person or in skills that may or may not have, since that confidence may be devoid of realistic and objective self-criticism, being able to reach levels of grandeur that can become delusional, such as having a special relationship with God, with some emblematic figure, in the religious, academic or entertainment field of politics, many people in this guild suffer from megalomania.

In the DSM-V the inclusion of the specifier “with mixed symptoms” for depressive episodes of recurrent unipolar major depression is contemplated. Therefore, the diagnosis of unipolar depression with subsyndromic hypomanic symptoms can be made, without considering that the patient has a bipolar disorder.

The typical manic language is verborrheic, fast and difficult to interrupt, they can talk without stopping, no matter if those who listen to them have the need to express themselves too, they can make jokes, puns and impertinences that are fun, thus making it more complex for them to be interrupted. When the subject's mood is more irritable than expansive, his talks may be marked by constant complaints, hostile comments or speeches filled with anger.

When the flight of ideas is serious, the language can become disorganized and incoherent, they can change from another very easily, this also due to the susceptibility of their attention to seemingly irrelevant stimuli, there is usually a reduction in the ability to differentiate the thoughts that come to the subject, from those that have little to do or that are irrelevant to the occasion even.

The disorganization resulting from these alterations can be severe enough to cause significant deterioration in daily activities.Sometimes hospitalization is necessary to protect the patient from the consequences of their denials of their actions, which are the result of their impoverishment of the trial. It has been shown in different studies that there may be polysomnographic abnormalities and that those who suffer from these episodes have an effect on the secretion of cortisol, norepinephrine, serotonin, acetylcholine and dopamine mainly.

Dysphoric mania is more frequent among women, and is associated with an increased risk of suicide in both genders.

Psychotic mania

The Psychotic symptoms such as delusions and / or hallucinations are frequent during manic episodes. Delusions of mania tend to be great, expansive, religious and sexual, although sometimes they can be inconsistent with the mood. Manic hallucinations can be auditory and visual, often they are of transitory duration, ecstatic and religious content.

There is a frequent presence of florid psychosis in adolescent patients with bipolar disorder and this contributes to the diagnosis of schizophrenia in this age group. The age of early onset of a bipolar disorder is associated with the presence of more psychotic symptoms.

The peak incidence of manic episodes occurs during the summer, although it is not uncommon for manias to occur in another season, seasonal patterns are frequent: spring / summer in mania or hypomania linked to autumn / winter depression or vice versa.

Postpartum and hobbies

The incidence of mania in the postpartum of bipolar women is 20%, the risk of recurrence of mania and depression is enough to perform an intervention and treatments in a timely manner anticipating this situation (Reich and Winokur, 1970). It is necessary provide support and containment during pregnancy and the puerperium.

It may interest you: What is postpartum depression and how to overcome it

Mixed episode

It is a period of time when a complete symptomatic picture of a manic episode and a depressive episode (except its duration) are presented, intermingled or rapidly altered within a few days. The subject can experience moods that can easily change like going from sadness, to anger and then to euphoria.

They may present disorganized thoughts or behaviors. They experience more dysphoria than those with manic episodesIt can be manifested through: unpleasant or annoying emotions, such as sadness, anxiety, irritability or restlessness.

DSM diagnostic criteria for the mixed episode
A. The criteria are met for both a manic episode and a major depressive episode (except in duration) almost every day for at least a period of 1 week.
B. The alteration of the mood is severe enough to cause a significant deterioration in work, social or relationships with others, or to need hospitalization in order to prevent damage to oneself or others, or there are psychotic symptoms.
C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug, a medication or other treatment) or to medical illness (e.g., hyperthyroidism).

Note: Mixed-like episodes that are clearly caused by a somatic antidepressant treatment (eg, a medication, electroconvulsive therapy, light therapy) should not be diagnosed as bipolar I disorder.

Hypomanic Episode

Is a attenuated form of mania characterized by a state of psychic excitement, as well as an exaggerated activity, alternating with depressive episodes. It is not usually so serious as to generate psychotic characteristics, deterioration in work or social function, they generally do not require hospitalization.

It is recommended to avoid diagnosing based solely on a transverse point of view of the patient during an acute episode., because it can be confused with other disorders, "the first stages of a florid psychosis of confusing diagnosis can be of the hypomanic type". (Carlson and Goldwin, 1973).

Serious manic episodes are usually treated in a hospital setting to provide a safe environment in which indicated medication can be given. That is why It is essential that the condition is well diagnosed and that the patient can have a better treatment and prognosis. The cognitive behavioral therapy, the Therapy focused on the client, the Rational emotive therapy (TRE), relaxation and breathing techniques, as well as group and individual therapies have proven to be of great help for the treatment of symptoms.

In the DSM-V, for the diagnosis of mania or hypomania the criterion is included: "increase in energy or objective-oriented activity with respect to the usual in the subject" is also included as a diagnostic criterion in the beta version of the ICD-11. To be classified as a manic episode, it must be associated with an unequivocal change in the person's functioning, in other words: that it is not characteristic of the person when he has no symptoms.

Conclusion

The mood disorders They are the most prevalent and debilitating. In these years, much progress has been made in the epidemiology, pathophysiology and treatment of manias. However, there is still much to do, some patients are not diagnosed or are inappropriately and therefore their treatments are also inadequate. In addition to that it is difficult for a person who feels "so good" to believe that he needs treatment, especially in the euphoria phases.

Chronicity in mania can cause personal and social deterioration manifesting itself in the family, academic, and by the persistence of symptoms or by some change in its characteristics. The presence of a mania requires a series of diagnostic considerations, Psychologists and psychiatrists are the ideal professionals to frame these conditions and work together, since diagnostic considerations extend beyond primary mood disorders, in many cases they require psychotropic drugs to be treated.

Psychologists can provide patients with tools to manage their states of euphoria, anxiety, stress, frustration and anger in more convenient ways without pernicious consequences. Psychoeducation can be done to postpone some ritual behaviors and redirect them. Early detection and timely professional help can make a big difference in the person's quality of life.

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Links

Bibliographic references

Heles, Robert E .; Yudofsky, Stuart; Talbott, John et al. Treaty of Psychiatry. Spain: Ancora, S.A.

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