Specialty psychiatry Patient UK Hypomania | ICD-10 F30.0 | |
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. While hypomanic behavior often generates productivity and excitement, it can become troublesome if the subject engages in risky or otherwise inadvisable behaviors. 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 (euphoria or heightened irritability, pressure of speech and activity, increased energy and decreased need for sleep, and flight of ideas) are most plainly evident.
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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 craziness, 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 from the 1960s/1970s.
Signs and symptoms
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).
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 as 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.
People who experience hyperthymia, or "chronic hypomania", encounter the same symptoms as hypomania but long-term.
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 early summer and, in such cases, one speaks of a "seasonal pattern".
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. (See also, Kindling model)
Pathophysiology
Mania and hypomania are usually studied together in bipolar and the pathophysiology is usually assumed to be the same. Given that norepinephrine and dopamineergic drugs are capable of triggering hypomania, theories relating to monoamine hyperactivity have been proposed. A theory unifying depression and mania in bipolar 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.
Causes
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.
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.
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.
Evolution
Some commentators believe that hypomania actually has an evolutionary advantage. 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.
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. Putting someone with bipolar disorder on antidepressants can be hazardous as this may actually trigger more manic or hypomanic episodes.
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.