| Hypomania | |
|---|---|
 | |
| Graphical representation of hypomania and mania | |
| Specialty | Psychiatry |
Hypomania (literally "under mania" or "less than mania") is a mood state characterized by persistent disinhibition and mood elevation (euphoria), with behavior that is noticeably different from the person's typical behavior when in a non-depressed state. It may involve irritability, but less severely than full mania. According to DSM-5 criteria, hypomania is distinct from mania in that there is no significant functional impairment; mania, by DSM-5 definition, does include significant functional impairment and may have psychotic features.
Characteristic behaviors of persons experiencing hypomania are a notable decrease in the need for sleep, an overall increase in energy, unusual behaviors and actions, and a markedly distinctive increase in talkativeness and confidence, commonly exhibited with a flight of creative ideas. Other symptoms related to this may include feelings of grandiosity, distractibility, and hypersexuality. While hypomanic behavior often generates productivity and excitement, it can become troublesome if the subject engages in risky or otherwise inadvisable behaviors, and/or the symptoms manifest themselves in trouble with everyday life events. When manic episodes are separated into stages of a progression according to symptomatic severity and associated features, hypomania constitutes the first stage of the syndrome, wherein the cardinal features (euphoria or heightened irritability, pressure of speech and activity, increased energy, decreased need for sleep, and flight of ideas) are most plainly evident.
Signs and symptoms
Individuals in a hypomanic state have a decreased need for sleep, are extremely gregarious and competitive, and have a great deal of energy. They are, otherwise, often fully functioning (unlike individuals suffering from a full manic episode).
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.
Hypomania is a feature of bipolar II disorder and cyclothymia, but can also occur in schizoaffective disorder. Hypomania is also a feature of bipolar I disorder;
it arises in sequential procession as the mood disorder fluctuates
between normal mood (euthymia) 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. Numerous people with bipolar disorder have credited hypomania with giving them an edge in their theater of work.
People who experience hyperthymia, or "chronic hypomania", encounter the same symptoms as hypomania but on a longer-term basis.
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 manic or major
depressive episodes. These periods are often interspersed with periods
of relatively normal (euthymic) functioning.
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 summer. In such cases, one speaks of a "seasonal
pattern".
If left untreated, and in those so predisposed, hypomania may transition into mania, which may be psychotic, in which case bipolar I disorder is the correct diagnosis.
Causes
Often in
those who have experienced their first episode of hypomania – generally
without psychotic features – there may 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. This commonly
surfaces in the mid to late teens. Because the teenage years are
typically an emotionally charged time of life, it is not unusual for
mood swings to be passed off as normal hormonal teen behavior and for a
diagnosis of bipolar disorder to be missed until there is evidence of an
obvious manic or hypomanic phase.
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.
Hypomania can be associated with narcissistic personality disorder.
Psychopathology
Mania
and hypomania are usually studied together as components of bipolar
disorders, and the pathophysiology is usually assumed to be the same.
Given that norepinephrine and dopaminergic
drugs are capable of triggering hypomania, theories relating to
monoamine hyperactivity have been proposed. A theory unifying
depression and mania in bipolar individuals proposes that decreased
serotonergic regulation of other monoamines can result in either
depressive or manic symptoms. Lesions on the right side frontal and
temporal lobes have further been associated with mania.
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, when the behaviors
are clearly different from how the person typically acts when not
depressed:
- pressured speech
- inflated self-esteem or grandiosity
- decreased need for sleep
- flight of ideas or the subjective experience that thoughts are racing
- easily distracted
- increase in goal-directed activity (e.g., social activity, at work, or hypersexuality), or psychomotor agitation
- 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).
Medications
Antimanic
drugs are used to control acute attacks and prevent recurring episodes
of hypomania combined with a range of psychological therapies.
The recommended length of treatment ranges from 2 years to 5 years.
Anti-Depressants may also be required for existing treatments but are
avoided in patients who have had a recent history with hypomania. Sertraline has often been debated to have side effects that can trigger hypomania.
These include:
Other anti-manic drugs that are not antipsychotics include:-
Other drugs used to treat symptoms of mania/hypomania but considered less effective include:-
Etymology
The Ancient Greek physician Hippocrates called one personality type 'hypomanic' (Greek: ὑπομαινόμενοι, hypomainómenoi).
In 19th century psychiatry, when mania had a broad meaning of insanity,
hypomania was equated by some to concepts of 'partial insanity' or monomania. 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'". Narrower operational definitions of hypomania were developed in the 1960s and 1970s.
