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Hypomania

Hypomania is defined as a mild degree of mania characterized by increased levels of energy, physical activity and talkativeness. It is most often associated with bipolar disorders.


Presentation

Individuals affected by hypomania, often present with pressured speech, and show signs of increased self esteem along with grandiosity. There is a decreased urge to sleep, as they have elevated mood levels, and are bloated with creative ideas and thoughts. Such types of individuals get easily distracted and suffer from attention deficit disorder. There are potential signs of psychomotor agitation, with an increased participation in pleasurable activities such as harsh driving, mindless investments, and an uncontrollable buying binge and involving in sexual indiscretions.

Pressured Speech
  • After the third dose he presented with psychomotor agitation, pressured speech, irritability, aggressive behaviour and insomnia.[ncbi.nlm.nih.gov]
  • Individuals affected by hypomania, often present with pressured speech, and show signs of increased self esteem along with grandiosity.[symptoma.com]
  • Talkative, pressured speech. A reliable third party often can best assess talkativeness, though some patients are aware of their pressured speech and recount being “tongue-tied.”[mdedge.com]
  • Criteria: Minor (3 or more present; 4 if mood is irritable instead of expansive) - same minor criteria as for Mania Diagnosis Inflated self esteem or grandiosity Decreased need for sleep Pressured speech or more talkative than usual Flight of ideas or[fpnotebook.com]
  • 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: pressured speech inflated self-esteem or grandiosity[en.wikipedia.org]
Weight Loss
  • One of these is either significant weight gain or weight loss when not dieting. Sleep disturbance is another, manifested by the inability to sleep or oversleeping nearly every day.[livestrong.com]
  • There may be weight loss, reduced appetite, altered sleep pattern with early morning wakening and loss of libido. In severe cases there may be delusions of persecution or illness or impending death.[patient.info]
  • loss, and loss of libido.[apps.who.int]
Fatigue
  • We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019[patientslikeme.com]
  • Finally, daily fatigue or loss of energy is a physical symptom of depression. The cognitive symptoms of depression may manifest as frequent daily thoughts that one is worthless or thoughts and feelings of inappropriate guilt.[livestrong.com]
  • There is an increase in energy, a decreased need for sleep (but no daytime fatigue), and impaired judgment. During euphoric hypomanic episodes, people have a heightened sense of well-being and are very productive and gregarious.[sharecare.com]
  • Some people are more vulnerable to mood fluctuations and can also experience episodes of dark depression that may include feelings of hopelessness, irritability, fatigue, concentration problems, and feelings of worthlessness.[pando.com]
  • Across this spectrum, depression is by far the main symptom, including especially sleeping too much, extreme fatigue, and lack of motivation. What makes for a mood spectrum or bipolar 2 diagnosis is the presence of something else as well.[psycheducation.org]
Pneumonia
  • A 3-year-old boy was treated for pneumonia with oral clarithromycin in monotherapy. The boy became somewhat hyperactive and irritable after the second dose.[ncbi.nlm.nih.gov]
Dyspepsia
  • Moreover, there may also be elevation of prolactin levels, along with nausea and dyspepsia. Prognosis of hypomania gravely depends on the etiology, as well as the severity of the condition.[symptoma.com]
Urticaria
  • Abstract The clinical and biochemical disturbances of a patient with seasonal hypomania and cold urticaria are described and discussed with reference to histamine metabolism in mental disorder.[ncbi.nlm.nih.gov]
Flight of Ideas
  • Speech is rapid and copious (' pressure of speech '); and may rapidly flit from one subject to another (' flight of ideas ').[web.archive.org]
  • […] of ideas) are most plainly evident.[en.wikipedia.org]
  • Mania symptoms include: Abnormally and persistently elevated, expansive, or irritable mood Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual or pressure to keep talking Flight of ideas or subjective experience that[healthyplace.com]
  • Criteria: Minor (3 or more present; 4 if mood is irritable instead of expansive) - same minor criteria as for Mania Diagnosis Inflated self esteem or grandiosity Decreased need for sleep Pressured speech or more talkative than usual Flight of ideas or[fpnotebook.com]
Grandiose Ideas
  • Learn about this topic in these articles: seasonal affective disorder In seasonal affective disorder …experience a condition known as hypomania, in which they have rapid thoughts and speech, have grandiose ideas about themselves, or become short-tempered[britannica.com]
  • During the manic phase The following may be present: Grandiose ideas. Pressure of speech. Excessive amounts of energy. Racing thoughts and flight of ideas. Overactivity. Needing little sleep, or an altered sleep pattern.[patient.info]
Increased Libido
  • Individual mHLC-32 items of increased libido, quarrels, and caffeine intake were endorsed more in BP vs. UP patients.[ncbi.nlm.nih.gov]
  • Obviously when hypo I do display classic indicators like decreased sleep, increased energy, increased libido, increased productivity and so on.[purplepersuasion.wordpress.com]
  • libido to the point where it affects other areas of life (for example, dressing more provocatively than usual, or inappropriate talk of or joking about sex) increased goal-directed behavior to the point where the individual appears driven According to[encyclopedia.com]
Hypomanic Mood
  • This hypomanic mood is clearly different from the person’s usual mood and level of functioning.[psychcentral.com]
Manic Behavior
  • Use a Shopping List One of the most common manic behaviors is uncontrollable spending or shopping.[everydayhealth.com]
Sexual Dysfunction
  • ., sexual dysfunct. - 2 (3) 3 (2) 2 (1) 1.45 (0.23-9.27) 2.93 (0.40-21.45) 2.70 (0.58-12.67) 6.24 (1.02-38.02)* F60-69 Personality dis. - - 4 (3) 2 (1) - 1 - 1 - 1 - 1 In- or outpatient care due to physical diseases K00-K93 Diseases of the digestive system[bmcpsychiatry.biomedcentral.com]
Irritability
  • […] elevated depression and hopelessness but not with irritable/risk-taking hypomania.[ncbi.nlm.nih.gov]
  • It may involve irritation, but less severely than full mania.[en.wikipedia.org]
Agitation
  • Agitated delirium or mood lability have been described in Sydenham's, but this case is the first report of criteria-based secondary mania with probable Sydenham's chorea, as well as the longest reported remission between symptomatic Sydenham's episodes[ncbi.nlm.nih.gov]
  • During these periods, you may take your agitation out on others and try to externalize your feelings of discomfort by picking fights, starting arguments, or being angry.[bridgestorecovery.com]
  • Retrieved May 08th, 2019, from hypomania noun An abnormal psychological state that is similar to but milder than mania, characterized by an elevated or agitated mood and commonly occurring in people with bipolar disorder.[yourdictionary.com]
  • Benzodiazepines, such as lorazepam, may be needed to aid sleep or reduce agitation. Mood stabilisers can also be used (usually under specialist guidance).[web.archive.org]
Excitement
  • Transcranial direct current stimulation is a noninvasive brain stimulation technique in which a weak current is applied through the scalp to produce changes in neuronal excitability in the underlying cerebral tissue.[ncbi.nlm.nih.gov]
  • Hypomania and mania are terms used to describe periods of overactive and excited behaviour that have a serious impact on your day-to-day life.[web.archive.org]
  • Hypomania and Mania Mania is when people experience periods of overactive and excited behaviour with an extreme sense of energy and optimism. Mania can change how people feel emotionally and physically.[seemescotland.org]
  • […] my copy of mosby's medical, nursing, & allied health dictionary , 6th edition, page 855, defines hypomania as "a mild degree of mania characterized by optimism; excitability; energetic, productive behavior; marked hyperactivity and talkativeness; heightened[allnurses.com]
  • If a person becomes manic, they may notice that they are: Very happy and excited Irritated with other people who don't share their optimistic outlook Feeling more important than usual Full of new and exciting ideas Moving quickly from one idea to another[awp.nhs.uk]
Hyperactivity
  • Handbook for Attention Deficit Hyperactivity Disorder in Adults. Tarporley: Springer Healthcare Ltd.; 2013. 8. Ross RG. Psychotic and manic-like symptoms during stimulant treatment of attention deficit hyperactivity disorder.[ijpm.info]
  • It may be observed before a full-blown manic episode. hypomaniac, n., hypomanic, adj. hypomania A sustained, but mild or moderate, degree of abnormal elation and hyperactivity.[medical-dictionary.thefreedictionary.com]
  • The boy became somewhat hyperactive and irritable after the second dose. After the third dose he presented with psychomotor agitation, pressured speech, irritability, aggressive behaviour and insomnia.[ncbi.nlm.nih.gov]
  • Given that norepinephrine and dopaminergic drugs are capable of triggering hypomania, theories relating to monoamine hyperactivity have been proposed.[en.wikipedia.org]
  • Hyperactive, psychomotor agitation. Determine of patients have an increase in repetitive activities or if they start many tasks but complete few. Talkative, pressured speech.[mdedge.com]
Akathisia
  • These include headache, weight gain, sedation, dizziness, akathisia and extrapyrimidal symptoms. Moreover, there may also be elevation of prolactin levels, along with nausea and dyspepsia.[symptoma.com]
  • […] alcohol misuse as a cause of mania-like symptoms; consider a diagnosis of bipolar disorder only after 7 days of abstinence previously undiagnosed learning difficulties organic causes such as excited confusional states in children with epilepsy, and akathisia[web.archive.org]

Workup

The Diagnostic manual of mental disorders – IV TR given by the American Psychiatric Association suggest that, those individuals with elevated mood for a period of 4 days, and any of 3 symptoms, are known to have developed hypomania. Individuals with hypomania, exhibit symptoms which are different from depression, and they have an elevated mood level. Such individuals are closely observed for the pattern of demonstrated behavior [6].

In addition, there are 3 major factors which are not present in cases of hypomania. These include absence of psychosis, symptoms are not so severe to require hospitalization, and there is no marked impairment in functioning. Individuals suffering from hypomania do not show symptoms of psychosis, which include paranoia, hallucinations and delusions.

Treatment

Hypomania should be promptly treated, in order to avoid onset of serious and debilitating consequences. In the preliminary stages, first line monotherapy is suggested [7]. This is done using olanzapine and risperidone [8]. Other than this, mood stabilizing agents are used. These are considered to be among the most common and optimally effective ways for treating hypomania. The medications employed include lithium carbonate and valproic acid [9].

When these show no effect, benzodiapines are administered, which include clonazepam. In addition, atypical antipsychotic drugs would also be required, such as quetapine and olanzapine. First generation antipsychotic drugs have been proved to be helpful for treating episodes of hypomania. In addition, second generation drugs have also proved to be beneficial, but they have certain side effects associated with them. These include headache, weight gain, sedation, dizziness, akathisia and extrapyrimidal symptoms. Moreover, there may also be elevation of prolactin levels, along with nausea and dyspepsia [10].

Prognosis

Prognosis of hypomania gravely depends on the etiology, as well as the severity of the condition. When drugs are the inducing factors, then by mere withdrawal, mood of the affected individuals stabilizes within a short period. In other cases, medications to calm the individual are enough to do stabilize the condition of patient [5].

Etiology

Hypomania is often associated with bipolar disorder. The other causes include various medications, which are primarily used in psychopharmacotherapy. When drugs are the cause, then discontinuation of that particular drug, which triggered an episode, quickly normalizes the mood. Such drugs which may trigger an attack of hypomania include amphetamine, steroids, antidepressants and stimulants. Individuals, who have suffered from episodes of depression in the past, are likely to suffer from hypomania [2].

Epidemiology

Review of literature carried out on incidence of bipolar and hypomania disorders, suggests an incidence rate of 3 – 6.5%. According to the results presented by Zurich cohort study, prevalence rate of recurrent episodes of hypomania were estimated to be about 2.8%. The same study also revealed findings that state a prevalence rate of 5.5% amongst adult population aged 35 years. In both the subtypes of hypomania, comorbidity, along with anxiety and substance abuse was found. Research has suggested that, recurrent type of hypomania is grouped under bipolar disorders [3].

Sex distribution
Age distribution

Pathophysiology

Hypomania is a distinct disorder from mania, and is mainly differentiated by the absence of grandiosity and psychotic symptoms. Moreover, hypomania episodes are a degree less severe than that of mania attacks. In many circumstances, hypomania is also a characteristic accompaniment of bipolar disorder.

Hypomania can also occur in response to certain drugs, which when withdrawn or dosage lessened, have a subsequent decline in the hypomanic episode. These drugs essentially need not be meant for psychological disorders; but even drugs for treating other types of illnesses can trigger attacks of hypomania. Hypomania primarily occurs due to chemical imbalances in the brain. Neuroimaging studies have focused on the fact that, the modulating pathways in amygdale have a pivotal role to play, in regulation of emotions such as feelings, thoughts and behavior pattern of individuals [4].

Prevention

It is not always possible to prevent occurrence of hypomania. However, following a strict treatment regime can help in the prevention of recurrent attacks.

Summary

Hypomania is a type of manic disorder, which is less severe than full blown mania. A disorder of this sort is characterized by constant non-inhibition and irritable mood. Effected individuals exhibit a peculiar behavior pattern, marked by excessive talking, high energy levels, and a highly confident attitude, which is expressed by the type of creative ideas generated. Individuals with hypomania generally churn out great amount of productivity and excitement as well; but the behavior can turn risky at times, if the high energy levels are not utilized in the right direction [1].

Patient Information

  • Definition: Hypomania is characterized by elevated mood levels, wherein the affected individual does not experience depression, and the condition is less severe than mania. Such persons are extremely talkative and are flooded with creative ideas.
  • Cause: Hypomania often coexists with bipolar disorder. Certain drugs whether for treatment of mental illness or any other diseases can also trigger attacks of hypomania. In addition, steroids, antidepressants, stimulants can cause onset of hypomania.
  • Symptoms: Individuals with hypomania often suffer from pressured speech, increase level of self esteem and decreased desire to sleep. They are flooded with ideas which are often creative in nature. Individuals get easily distracted, and are known to suffer for attention deficit disorder. However, in spite of such symptoms, affected individuals do not suffer from any type of severe symptoms. 
  • Diagnosis: Diagnosis of the condition is made, based on the type of symptoms present. Affected individuals do not suffer from depression or any other psychotic symptoms. Moreover, no marked impairment in functioning is noticed; though the symptoms may interfere with daily activities.
  • Treatment: Treatment of hypomania is done through first line monotherapy. This is done using risperidone and olanzapine. Mood stabilizers are also indicated in treatment of hypomania. First and second generation of antipsychotics, are also used for treatment of manic episodes. These, however, have several unpleasant side effects.

References

Article

  • Dell'Osso L, Pini S, Cassano GB, et al. Insight into illness in patients with mania, mixed mania, bipolar depression and major depression with psychotic features. Bipolar Disord 2002; 4:315.
  • Singh MK, Ketter TA, Chang KD. Atypical antipsychotics for acute manic and mixed episodes in children and adolescents with bipolar disorder: efficacy and tolerability. Drugs. Mar 5 2010;70(4):433-42.
  • Goldberg JF, Harrow M. A 15-year prospective follow-up of bipolar affective disorders: comparisons with unipolar nonpsychotic depression. Bipolar Disord. Mar 2011;13(2):155-63
  • Garrett A, Chang K. The role of the amygdala in bipolar disorder development. Dev Psychopathol. Fall 2008;20(4):1285-96.
  • Harrow M, Goldberg JF, Grossman LS, Meltzer HY. Outcome in manic disorders. A naturalistic follow-up study. Arch Gen Psychiatry 1990; 47:665.
  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
  • Griswold KS, Pessar LF. Management of bipolar disorder. Am Fam Physician 2000; 62:1343.
  • Pavuluri MN, Passarotti AM, Fitzgerald JM, Wegbreit E, Sweeney JA. Risperidone and divalproex differentially engage the fronto-striato-temporal circuitry in pediatric mania: a pharmacological functional magnetic resonance imaging study. J Am Acad Child Adolesc Psychiatry. Feb 2012;51(2):157-170.e5.
  • Freeman, MP, Wiegand, et al. Lithium. In: The American Psychiatric Publishing Textbook of Psychopharmacology, 4th, Schatzberg, AF, Nemeroff, CB (Eds), American Psychiatric Publishing, Inc, Washington, D.C. 2009. p.697.
  • Tohen M, Bowden CL, Smulevich AB, et al. Olanzapine plus carbamazepine v. carbamazepine alone in treating manic episodes. Br J Psychiatry 2008; 192:135.

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Last updated: 2019-07-11 22:42