From the Guidelines
Hypomania and mania are mood states characterized by abnormally elevated energy, activity, and mood, with symptoms including increased energy, decreased need for sleep, racing thoughts, rapid speech, increased goal-directed activities, inflated self-esteem, distractibility, and impulsive behaviors. These symptoms can be identified by looking for signs of mania or hypomania, such as elated, expansive, or irritable mood, inflated self-esteem, grandiosity, decreased need for sleep, more talkative than usual, pressured speech, racing thoughts, abrupt topic changes when talking, distractible, excessive participation in multiple activities, agitated or restless, hypersexual, spends foolishly, uninhibited remarks 1. The diagnostic assessment of hypomania and mania needs to incorporate both current and past history regarding symptomatic presentation, treatment response, psychosocial stressors, and family psychiatric history, and should follow the DSM-IV-TR Criteria, including the duration criteria 1. Key symptoms of mania and hypomania include:
- Increased energy
- Decreased need for sleep
- Racing thoughts
- Rapid speech
- Increased goal-directed activities
- Inflated self-esteem
- Distractibility
- Impulsive behaviors like excessive spending or risky sexual activity
- Elated, expansive, or irritable mood
- Inflated self-esteem, grandiosity
- More talkative than usual, pressured speech
- Abrupt topic changes when talking
- Excessive participation in multiple activities
- Agitated or restless
- Hypersexual, spends foolishly, uninhibited remarks It is essential to recognize these symptoms early, as untreated episodes can lead to serious consequences, including relationship problems, financial difficulties, substance abuse, and suicidal behavior 1.
From the Research
Hypomania and Mania Symptoms
- Hypomania and mania are characterized by elevated or irritable mood, and can include symptoms such as increased energy, reduced need for sleep, and impulsive behavior 2, 3, 4
- The DSM-5 incorporates a broad concept of mixed states, which can include ≥3 nonoverlapping symptoms of the opposite polarity, such as depressive symptoms during a manic or hypomanic episode 2
- Manic episodes can be primary or secondary, and can be induced by medications used to treat neurologic disorders 4
- Symptoms of mania can become more complex and treatment refractory with time, although effective treatment can improve the long-term outcome 4
Diagnostic Considerations
- The diagnosis of hypomania or mania involves the presence of a distinct period of abnormally and persistently elevated, expansive, or irritable mood 3, 4
- The diagnosis can be complicated by the presence of mixed states, which can include symptoms of both mania and depression 2, 5
- A thorough diagnostic evaluation is necessary to determine the presence and severity of hypomania or mania, and to develop an effective treatment plan 3, 6
Treatment Options
- Treatment options for hypomania and mania include pharmacotherapy, such as mood stabilizers and antipsychotics, as well as psychoeducation and behavioral therapies 2, 3, 6, 4
- The choice of treatment depends on the severity and complexity of the symptoms, as well as the presence of any comorbid conditions 3, 6
- Combination therapy with mood stabilizers and antipsychotics may be necessary in some cases, although this can increase the risk of side effects 2, 6