Mania and Hypomania in Bipolar Disorder

Christopher and Kareema are two people who have never crossed paths. Both struggling to cope with inexplicable mood swings that have left them baffled and confused. Christopher is a 25 year old who just got employed at a top ranking bank in the country. His mood alternates between these two; excessive enthusiasm and sharp irritability. These could last for weeks but never less than a week during which he is unable to fully concentrate on work or socialize at functions or with friends. During these manic periods, he feels special and unstoppable. He does things he ordinarily would not do, impulsive things like spending excessively, and becomes hyper-sexual without considering the consequences of his actions.

Kareema is 38, married with 3 lovely children. She has been noticing her mood swings for years but has never fully understood them. Although less severe as compared to Christopher’s, Kareema’s mood alternates in almost the same ways as Chris’s but goes on for not less than four days. Her mood does not cause any significant decrease in her ability to socialize or do her work.

Both Christopher and Kareema suffer mood disorders however, the main difference is that Chris suffers from Bipolar I Disorder while Kareema suffers from Bipolar II Disorder.

What is a Bipolar Disorder?

A Bipolar Disorder, as defined by the Merriam Webster Dictionary, is any of several psychological disorders of mood characterized usually by alternating episodes of depression and mania. It is also called manic depression, manic-depressive illness. It is also defined by the American Academy of Family Physicians as “a psychiatric disorder in which the affected person has both depressed and happy, energetic (manic) episodes”. People with Bipolar Disorder, also known as manic a depressive disorder, have periods of excitability and hyperactivity alternating with periods of depression. There’s often a family history of the disorder. The manic (or up-swing) period can involve behaviours such as excessive spending, rapid speech, unending energy, impulsive decision-making and sometimes psychosis. The depressive (or down-swing) period includes feelings of hopelessness and worthlessness, an inability to function and suicidal thoughts. In some people the depressive phase is less pronounced than the colourful behaviours displayed in the manic phase.

Types of Bipolar Disorder:

There are 2 types of Bipolar Disorder, these are:

• Bipolar I Disorder: here, there is usually at least one manic episode, with or without depressive episodes;
• Bipolar II Disorder: here, there is usually at least one hypomanic episode (but no manic episodes) and one major depressive episode.
• Aside the Manic and Hypomanic Phases, there is the Cyclothymic Disorder, also called Cyclothymia. This is defined b numerous periods of Hypomania symptoms as well as numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

Causes of Bipolar Disorder

The causes are not clearly understood, but both environmental and genetic factors play a role. Environmental risk factors include a history of childhood abuse, and long-term stress. Environmental factors and individual psychosocial variables may interact with generic dispositions. It is probable that recent life events and interpersonal relationships contribute to the onset and recurrence of bipolar mood episodes.

About 85% of the risk is attributed to genetics. Some research suggests that people with certain genes are more likely to develop Bipolar Disorder than others.

Bipolar Disorder also tends to run in families. Children who do not have a family history of the disorder are less likely to develop the illness compared with children with a parent or sibling who has the illness. However, it is important to note that most people with a family history of Bipolar Disorder will not develop the illness.

Are there differences between Mania and Hypomania?

Mania is a set of mood symptoms that include euphoria or irritability lasting at least a week and is required to qualify for the diagnosis of Bipolar Disorder.

Hypomania, on the other hand, is a term used to describe a lesser degree of mania, which involves a persistent mild elevation of mood, alternating with irritability, increased activity and energy, inability to concentrate, flight of ideas and insomnia; however, without hallucinations or delusions.

People with hypomania or mania may experience a decreased need of sleep, impaired judgment, and speak excessively and very rapidly.

To be classed as a manic episode, while the disturbed mood and an increase in goal directed activity or energy is present at least three (or four if only irritability is present) of the following must have been consistently present:

• Inflated self-esteem or grandiosity.
• Decreased need for sleep (e.g., feels rested after 3 hours of sleep).
• More talkative than usual or pressure to keep talking.
• Flights of ideas or subjective experience that thoughts are racing.
• Increase in goal directed activity, or psychomotor acceleration.
• Distractibility (too easily drawn to unimportant or irrelevant external stimuli).
• Excessive involvement in activities with a high likelihood of painful consequences. (e.g., extravagant shopping, improbable commercial schemes,hypersexuality Though the activities one participates in while in a manic state are not always negative, those with the potential to have negative outcomes are far more likely.

If the person is concurrently depressed, they are said to be having a mixed episode.

At the more extreme, a person in a full blown manic state can experience psychosis, a break with reality, a state in which thinking is affected along with mood. They may feel unstoppable, or as if they have been “chosen” and are on a “special mission”, or have other grandiose or delusional ideas. Mood changes, psychomotor and appetite changes, and an increase in anxiety can also occur up to 3 weeks before a manic episode develops.

Although “severely elevated mood” sounds somewhat desirable and enjoyable, the experience of mania is ultimately often quite unpleasant and sometimes disturbing, if not frightening, for the person involved and for those close to them, and it may lead to impulsive behaviour that may later be regretted. It can also often be complicated by the sufferer’s lack of judgment and insight regarding periods of exacerbation of characteristic states. Manic patients are frequently grandiose, obsessive, impulsive, irritable, belligerent, and frequently deny anything is wrong with them. Because mania frequently encourages high energy and decreased perception of need or ability to sleep, within a few days of a manic cycle, sleep-deprived psychosis may appear, further complicating the ability to think clearly. Racing thoughts and misperceptions lead to frustration and decreased ability to communicate with others.

Hypomania may feel good to some persons who experience it, though most people who experience hypomania state that the stress of the experience is very painful. Bipolar people who experience hypomania, however, tend to forget the effects of their actions on those around them. Even when family and friends recognize mood swings, the individual will often deny that anything is wrong. What might be called a “hypomanic event”, if not accompanied by depressive episodes, is often not deemed problematic, unless the mood changes are uncontrollable, volatile, or mercurially. Most commonly, symptoms continue for a few weeks to a few months.

A hypomanic episode includes, over the course of at least four days, elevated mood plus three of the following symptoms OR irritable mood plus four of the following symptoms:

• pressured speech
• inflated self-esteem or grandiosity
• decreased need for sleep
• flight of ideas or the subjective experience that thoughts are racing
• easily distracted and attention-deficit; the inability to ‘follow-through’ with complete tasks, even despite a conscious effort to do so, as similar to attention deficit hyperactivity disorder
• increase inpsychomotor agitation, or occasionally in some, increased irritability
• hypersexuality
• involvement in pleasurable activities that may have a high potential for negative psycho-social or physical consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, reckless driving, physical and verbal conflicts, foolish business investments, quitting a job to pursue some grandiose goal, etc).

Treatment

Treatment commonly includes psychotherapy as well as medications such as mood stabilizers and antipsychotics. Benzodiazepines such as Iorazepam, may be used to aid sleep or reduce agitation. Mood stabilizers include Zyprexa (Olanzapine) and various anticonvulsants.

-Hajara Hussaini Ashara

Contributor, MANI