From the Guidelines
Hypomania is characterized by a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least four consecutive days, with at least three specific symptoms, including inflated self-esteem, decreased need for sleep, and increased talkativeness, as outlined in the diagnostic criteria 1. The criteria for hypomania include:
- 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 These symptoms must represent a noticeable change from the person's usual behavior and be observable by others, as noted in the practice parameter for the assessment and treatment of children and adolescents with suicidal behavior 1. It is essential to distinguish hypomania from normal happiness, as hypomania can escalate to mania or be part of a cycling mood pattern, requiring timely intervention with mood stabilizers or antipsychotics, and early recognition is crucial to prevent severe consequences, such as suicidal behavior 1. Key features of hypomania include:
- Less severe than full mania
- Doesn't cause marked impairment in social or occupational functioning
- Doesn't require hospitalization
- Doesn't include psychotic features
- A key feature of bipolar II disorder, distinguishing it from bipolar I disorder which involves full manic episodes.
From the Research
Criteria for Hypomania
The criteria for hypomania are described in the DSM-5 as "a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy" 2. The key points to consider are:
- A distinct period of abnormally and persistently elevated, expansive, or irritable mood
- Abnormally and persistently increased activity or energy The addition of increased activity or energy as a coprimary symptom in the DSM-5 criteria decreases the prevalence of manic and hypomanic episodes, but does not affect longitudinal clinical outcomes 2.
Comparison with Other Studies
Other studies have focused on the treatment of bipolar disorder, including the use of atypical antipsychotics as mood stabilizers 3, 4, 5. However, these studies do not specifically address the criteria for hypomania.
Relevance to Bipolar Disorder
The criteria for hypomania are an important aspect of bipolar disorder diagnosis and treatment. Understanding these criteria can help clinicians accurately diagnose and treat patients with bipolar disorder, and avoid potential drug-drug interactions that can occur with polypharmacy 6. Some key points to consider when treating bipolar disorder include:
- The use of atypical antipsychotics as mood stabilizers
- The potential for drug-drug interactions with polypharmacy
- The importance of accurate diagnosis and treatment to avoid adverse drug reactions.