DEFINITION

• Mania is defined by a constellation of signs and symptoms
  • Elevated and/or irritable mood
  • Heightened energy
  • Decreased need for sleep
  • More and faster increased talking; rapid speech which is difficult to interrupt (pressured speech)
  • Rapid thinking
  • Increased sense of perceptual and intellectual acuity
  • Increased impulsivity
  • Not infrequently paranoia and delusions of grandeur or persecution are present, less frequently auditory, visual, or olfactory hallucinations.
  • Religious and sexual preoccupations and grandiose notions of self are common.
  • Thinking is rapid and flighty.
  • Patients can be indefatigable, rash, intrusive, aggressive, and at times violent.
  • Unusually inflated self confidence and sense of self importance expressed in comments or in actions (taking risks without appropriate reflection on possible bad outcomes)
• Hypomania is less severe in the degree, type, and duration of mood, cognitive, and behavioral symptoms exhibited.
  
  • According to the DSM-5, hypomania need only persist for the majority of the time over 4 days, while mania requires a full week or a hospitalization.[1]
  • Hypomania does not cause significant impairment, but the patient will be noticeably different than baseline.
  • If there is significant impairment, hospitalization, or psychotic symptoms, it is a mania.
• Volatility of affect is the rule rather than the exception in mania and hypomania.
  • Even when mood is predominantly expansive and euphoric, there is usually an irritable underpinning.
• Some clinical clues in the primary care setting may include provocative dress or excessive makeup that is unusual for the patient, or clothing that is inappropriate for the weather.
• Mixed States
  • Manic and hypomanic symptoms often coexist with depressive ones (mixed states).
  • Mixed states can be transitional states from one phase of illness to another or independent clinical states.
  • Most frequently observed are patients with predominantly depressed mood and poverty of thought who simultaneously manifest restlessness and dysphoric energy, or patients with depressed mood who also exhibit flight of ideas, distractibility, anxiety and/or agitation.