Hypomania

Hypomania
Classification and external resources
Specialty Psychiatry
ICD-10 F30.0
Patient UK Hypomania

Hypomania (literally “under mania” or "less than mania") is a mood state characterized by persistent disinhibition and pervasive elevated (euphoric) with or without irritable mood but generally less severe than full mania. Characteristic behaviors are extremely energetic, talkative, and confident commonly exhibited with a flight of creative ideas.[1] While hypomanic behavior often generates productivity and excitement, it can become troublesome if the subject engages in risky or otherwise inadvisable behaviors.[2] When manic episodes are “staged” according to symptomatic severity and associated features, hypomania constitutes the first stage, or stage I, of the syndrome, wherein the cardinal features (heightened mood, pressure of speech and activity, increased energy and decreased need for sleep, and flight of ideas) are most plainly evident.

Presentation

Individuals in a hypomanic state have a decreased need for sleep, are extremely outgoing and competitive, have a great deal of energy and are otherwise often fully functioning (unlike full mania).[3]

Distinctive markers

Specifically, hypomania is distinguished from mania by the absence of psychotic symptoms and grandiosity, and by its lesser degree of impact on functioning.[4][5]

Hypomania is a feature of bipolar II disorder and cyclothymia, but can also occur in schizoaffective disorder.[5] Hypomania is also a feature of bipolar I disorder as it arises in sequential procession as the mood disorder fluctuates between normal mood and mania. Some individuals with bipolar I disorder have hypomanic as well as manic episodes. Hypomania can also occur when moods progress downwards from a manic mood state to a normal mood. Hypomania is sometimes credited with increasing creativity and productive energy.[6][7]

People who experience hyperthymia, or "chronic hypomania",[8] encounter the same symptoms as hypomania but long-term.[9]

Associated disorders

Cyclothymia, a condition of continuous mood fluctuations, is characterized by oscillating experiences of hypomania and depression that fail to meet the diagnostic criteria for either a hypomanic or major depressive episodes. These periods are often interspersed with periods of relatively normal (euthymic) functioning.[10]

When a patient presents with a history of at least one episode of both hypomania and major depression, each of which meet the diagnostic criteria, bipolar II disorder is diagnosed. In some cases, depressive episodes routinely occur during the fall or winter and hypomanic ones in the spring or early summer and, in such cases, one speaks of a “seasonal pattern.”[11]

If left untreated, and in those so predisposed, hypomania may transition into full-blown mania, which may be psychotic, in which case bipolar I disorder is the correct diagnosis.[12] (See also, Kindling model)

Causes

Studies show it can be caused by chemical imbalances in the brain. While most often associated with bipolar disorder, hypomania is also a side effect of numerous medications, often those used in psychopharmacotherapy. In cases of true drug-induced hypomania, discontinuation of the drug that caused or triggered the episode—for example antidepressants, steroids, or stimulants such as amphetamine—usually causes a fairly swift return to normal mood. An episode of hypomania may be incorrectly judged to have uncovered an underlying bipolar disorder, but drug-induced hypomania, by definition, does not point to bipolar disorder. Hypomania is less likely to be a side effect in those with pure clinical depression or unipolar depression, unless for example tricyclic antidepressants are given in very high doses.

Often in those who have experienced their first episode of hypomania – generally without psychotic features – there might be a long or recent history of depression or a mix of hypomania combined with depression known as mixed state prior to the emergence of manic symptoms, and commonly this surfaces in the mid to late teens. Due to this being an emotionally charged time, it is not unusual for mood swings to be passed off as hormonal or teenage ups and downs and for a diagnosis of Bipolar Disorder to be missed until there is evidence of an obvious manic/hypomanic phase.[13]

Hypomania may also occur as a side effect of pharmaceuticals prescribed for conditions/diseases other than psychological states or mood disorders. In those instances, as in cases of drug-induced hypomanic episodes in unipolar depressives, the hypomania can almost invariably be eliminated by lowering medication dosage, withdrawing the drug entirely, or changing to a different medication if discontinuation of treatment is not possible.[14]

Hypomania may also be triggered by the occurrence of a highly exciting event in the patient's situation, such as a substantial financial gain or recognition.

Hypomania can be associated with narcissistic personality disorder.[15]

Evolution

Some commentators believe that hypomania actually has an evolutionary advantage.[16] People with hypomania are generally perceived as being energetic, euphoric, visionary, overflowing with new ideas, and sometimes overconfident and very charismatic, yet—unlike those with full mania—are sufficiently capable of coherent thought and action to participate in everyday activities. Like mania, there seems to be a significant correlation between hypomania and creativity. A person in the state of hypomania might be immune to fear and doubt and have negligible social and sexual inhibition. People experiencing hypomania usually have a very strong sex drive. Hypomanic people are often the "life of the party". They may talk to strangers easily, offer solutions to problems, and find pleasure in small activities. Such advantages may render them unwilling to submit to treatment, especially when symptoms do not impair functioning.[17]

Diagnosis

The DSM-IV-TR defines a hypomanic episode as including, 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:

Treatment

Medications typically prescribed for hypomania include mood stabilizers such as valproic acid, and lithium carbonate as well as atypical antipsychotics such as olanzapine and quetiapine.

If a hypomanic state is the result of medication side effects or drug abuse (e.g. amphetamines), then certain sedatives including benzodiazepines can sometimes normalize an individual's mood and energy levels.

Etymology

The Ancient Greek physician Hippocrates called one personality type 'hypomanic' (Greek: ὑπομαινόμενοι, hypomainómenoi).[19][20] In 19th century psychiatry, when mania had a broad meaning of craziness, hypomania was equated by some to concepts of 'partial insanity' or monomania.[21][22][23] A more specific usage was advanced by the German neuro-psychiatrist Emanuel Ernst Mendel in 1881, who wrote, "I recommend, taking into consideration the word used by Hippocrates, to name those types of mania that show a less severe phenomenological picture, 'hypomania'".[19][24] Narrower operational definitions of hypomania were developed from the 1960s/1970s.

See also

References

  1. ↑ Mania and Hypomania
  2. ↑ Understanding Hypomania and Mania
  3. ↑ "Bipolar Disorder in Adults" (PDF). NIH Publication No. 12-3679. National Institute of Mental Health. 2012.
  4. ↑ Guy Goodwin (Aug 2002) "Hypomania: what's in a name?", The British Journal of Psychiatry, Vol. 181, No. 2, pp. 94-95; doi:10.1192/bjp.181.2.94
  5. 1 2 Bipolar Disorder: The Management of Bipolar Disorder in Adults, Children and Adolescents, in Primary and Secondary Care. Leicester; London: British Psychological Society; Royal College of Psychiatrists,. 2006. ISBN 9781854334411. Retrieved 3 December 2015. |first1= missing |last1= in Authors list (help); |first2= missing |last2= in Authors list (help); |first3= missing |last3= in Authors list (help)
  6. ↑ Doran, Christopher (2008). The hypomania handbook : the challenge of elevated mood. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 16. ISBN 9780781775205. Retrieved 3 December 2015.
  7. ↑ Kaufman, James (2014). Creativity and mental illness. Cambridge: Cambridge University Press. p. 214. ISBN 9781316003626. Retrieved 3 December 2015.
  8. ↑ Ghaemi, S Nassir (2003). Mood disorders : a practical guide. Philadelphia: Lippincott Williams & Wilkins. p. 48. ISBN 9780781727839. Retrieved 4 December 2015.
  9. ↑ Bloch, Jon (2006). The everything health guide to adult bipolar disorder : reassuring advice to help you cope. Avon, Mass.: Adams Media,. p. 12. ISBN 9781593375850. Retrieved 4 December 2015.
  10. ↑ "Cyclothymia". BehaveNet Clinical Capsules. Retrieved 2008-01-03.
  11. ↑ "Bipolar II Disorder". BehaveNet Clinical Capsules. Retrieved 2008-01-03.
  12. ↑ Post Robert M (2007). "Kindling and sensitization as models for affective episode recurrence, cyclicity, and tolerance phenomena". Neuroscience & Biobehavioral Reviews 31 (6): 858–873. doi:10.1016/j.neubiorev.2007.04.003.
  13. ↑ Drug-Induced Dysfunction in Psychiatry. Matcheri S. Keshavan and John S. Kennedy, Editors (Taylor & Francis, 1992).
  14. ↑ Bipolar Disorder: A Summary of Clinical Issues and Treatment Options. Bipolar Disorder Sub-Committee, Canadian Network for Mood and Anxiety Treatments (CANMAT). April 1997
  15. ↑ Daniel Fulford, Sheri L. Johnson, and Charles S. Carver (December 2008). "Commonalities and differences in characteristics of persons at risk for narcissism and mania". J Res Pers. 42 (6): 1427–1438. doi:10.1016/j.jrp.2008.06.002. PMC 2849176. PMID 20376289.
  16. ↑ Fieve, Ronald R. (2006). Bipolar II: Enhance Your Highs, Boost Your Creativity, and Escape the Cycles of Recurrent Depression—The Essential Guide to Recognize and Treat the Mood Swings of This Increasingly Common Disorder. Emmaus, Pa.: Rodale Books. ISBN 978-1-59486-224-3.
  17. ↑ Doran, Christopher M. (2007). The Hypomania Handbook: The Challenge of Elevated Mood. Philadelphia: Lippincott Williams & Wilkins. pp. 104–105. ISBN 978-0-7817-7520-5. Retrieved 9 December 2013.
  18. ↑ "Hypomanic Episode". BehaveNet Clinical Capsules. Retrieved 2008-01-03.
  19. 1 2 Emanuel Mendel (1881) Die Manie, p. 36: "Hypomanie", Urban & Schwarzenberg, Vienna and Leipzig (German)
  20. ↑ P. Thomas (Apr 2004) "The many forms of bipolar disorder: a modern look at an old illness", J. Affect. Disord., Vol.79, Suppl. l, pp. 3-8, doi:10.1016/j.jad.2004.01.001
  21. ↑ Baldwin et al. (1902) Dictionary of Philosophy and Psychology, p. 101: "Monomania", Macmillan: New York; London
  22. ↑ James Johnson, M.D., Ed. (1843) "Notices of Some New Works: Dr.H. Johnson on Mental Disorders", The Medical-Chirurgical Review, Vol. 39, p. 460: Hypomania
  23. ↑ Henry Johnson (1843) On the Arrangement and Nomenclature of Mental Disorders, Longmans, London, OCLC 706786581
  24. ↑ Edward Shorter (2005) A Historical Dictionary of Psychiatry, p.132, Oxford University Press, USA ISBN 978-0-19803-923-5

External links

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