Terminology for Overly Excited States in Mental Health
The clinical term for a person with mental health issues who becomes overly excited is "mania" (for severe presentations) or "hypomania" (for milder presentations), both of which are hallmark features of bipolar disorder. 1, 2
Defining Mania
Mania is characterized by the following core features 1, 2:
- Marked euphoria - an abnormally elevated, expansive mood state
- Grandiosity - inflated self-esteem or unrealistic beliefs about one's abilities
- Irritability - which can be severe and is considered a mood change characteristic of mania
- Racing thoughts - rapid flow of ideas that may be difficult to control
- Increased psychomotor activity - excessive goal-directed behavior and physical restlessness
- Mood lability - rapid and extreme mood shifts 2
- Reduced need for sleep - a hallmark sign where patients function on minimal sleep without fatigue 1, 2
Additional features may include paranoia, confusion, and florid psychosis 1, 2. A manic episode must last at least 7 days (unless hospitalization is required) and represents a significant departure from the person's baseline functioning. 2
Defining Hypomania
Hypomania represents a milder form of elevated mood 3:
- Requires the same symptoms as mania (elevated/euphoric and/or irritable mood, plus at least three additional symptoms such as grandiosity, decreased need for sleep, increased talking, racing thoughts, distractibility, overactivity, and excessive involvement in risky activities) 3
- Must last at least 4 days 2, 3
- Does not cause marked impairment in social or occupational functioning 3
- Does not require hospitalization and lacks psychotic features 3
- May actually increase functioning temporarily, which helps distinguish it from mania 3
Clinical Context
The distinction between mania and hypomania is based on severity and functional impairment rather than different symptom types. 3 Mania causes marked impairment and may require hospitalization, while hypomania does not, though both involve the same core symptom categories 3.
In clinical practice, irritability must be carefully distinguished from commonplace anger problems, especially given high comorbidity with disruptive behavior disorders 2. The American Academy of Child and Adolescent Psychiatry emphasizes that when evaluating a patient with irritability and agitation, clinicians should assess for euphoria or grandiosity, as the presence of either strongly suggests bipolar disorder 2.
Important Caveat
Hypomania should be treated even when associated with improved functioning, because depression often follows hypomania in what is termed the "hypomania-depression cycle." 3 Approximately 20% of youths with major depression eventually experience manic episodes by adulthood 1, 2.