• Suspect bipolar disorder in people who present with mania, hypomania, depression and a history of previous episodes of possible mania or hypomania, or a mixture of both manic and depressive symptoms.
• Mania is suggested by:
• Abnormally elevated mood, extreme irritability, and sometimes aggression.
• Increased energy or activity, 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).
• Hypomania 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, or physical and mental efficiency.
• Increased sociability, talkativeness, and over-familiarity.
• Depression is suggested by feelings of persistent sadness or low mood, loss of interest or pleasure, and low energy. Diagnosis is identical to that for unipolar depression: see the section on Assessment and diagnosis in the CKS topic on Depression, and the section on Diagnosis in the CKS topic on Depression in children.
• A mixed episode is suggested by a mixture, or rapid alternation (usually within a few hours), of manic/hypomanic and depressive symptoms.

In depth