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Bipolar disorder - Management
When should I suspect a hypomanic or manic episode?
- A manic episode is suggested by:
- Abnormally elevated mood, extreme irritability, and sometimes aggression.
- Increased energy, activity, and restlessness, and a decreased need for sleep (e.g. the person feels rested after only 3 hours of sleep).
- Pressure of speech or incomprehensible speech.
- Flight of ideas or racing thoughts.
- Distractibility, poor concentration.
- Increased sexual drive, disinhibition, and sexual indiscretions.
- Extravagant or impractical schemes (e.g. business investments, spending sprees).
- Psychotic symptoms: delusions (usually grandiose) or hallucinations (usually voices speaking directly to the person).
- A hypomanic episode is suggested by symptoms of mania that are not severe enough to cause marked impairment in social or occupational functioning, with the absence of psychotic features. Such people may present with:
- Mild elevation of mood or irritability.
- Increased energy and activity.
- Feelings of well-being, physical and mental efficiency.
- Increased sociability, talkativeness, and over-familiarity.
- If depressive symptoms are rapidly alternating with hypomanic or manic symptoms, suspect a mixed episode.
Clarification / Additional information
- Diagnosis of a hypomanic episode requires symptoms of hypomania to last for at least 4 days.
- Diagnosis of a manic episode requires symptoms of mania to last for at least 7 days.
- Manic episodes usually begin abruptly.
Basis for recommendation
Features of a manic episode, a hypomanic episode, and a mixed episode
- These are based on: diagnostic criteria in the International statistical classification of disease [WHO, 1992] and the Diagnostic and statistical manual of mental disorders [DSM-IV, 1994]; a clinical review of Mental health emergencies [Atakan and Davies, 1997]; the Scottish Intercollegiate Guidelines Network publication, Bipolar affective disorder: A national clinical guideline [SIGN, 2005]; the National Institute for Health and Clinical Excellence (NICE) guideline, Bipolar disorder: the management of bipolar disorder in adults, children and adolescents, in primary care and secondary care [National Collaborating Centre for Mental Health, 2006; NICE, 2006]; and a review, Role of the primary care physician in bipolar disorder [Tylee and Goodwin, 2006].
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