Mania and hypomania

Symptoms of mania, manic episodes, or hypomania

  • increased energy, activity, and restlessness
  • excessively high, overly good, euphoric mood
  • extreme irritability
  • racing thoughts and talking very fast, jumping from one idea to another
  • distractibility, cannot concentrate well
  • little sleep needed
  • unrealistic beliefs in one’s abilities and powers
  • poor judgement
  • spending sprees
  • a lasting period of behaviour that is different from usual
  • increased sexual drive
  • abuse of drugs, particularly cocaine, alcohol, and sleeping medications
  • provocative, intrusive, or agressive behaviour
  • denial that anything is wrong

Diagnosis of mania

For at least one week (or less if hospitalised): Mood elevated, expansive or irritable out of keeping with patients circumstances. At least three of the symptoms of mania have to be present.  The DSM-IV diagnosis of mania breaks the severity of symptoms into further subgroups:

  1. Mild: symptoms barely meet criteria for an episode of mania.
  2. Moderate: There is an extreme increase in either activity level or impaired judgment.
  3. Severe without psychotic features: The patient requires continuous supervision to prevent physical harm to self or to others.
  4. Severe with psychotic features: The patient has delusions or hallucinations which may be mood-congruent or mood-incongruent.

Diagnosis of hypomania

At least four days of sustained or persistent elevation or irritability of mood, and the presence of at least three of the symptoms of mania (DSM-IV states at least four if the only abnormality of mood is irritability).  Both ICD-10 and DSM-IV agree that there are no features of psychosis, hallucinations, or delusions associated with hypomania.