Bipolar Disorder

S. Nassir Ghaemi, MD

What is mania?
Mania is defined as a mood change with seven symptoms. You only need three or four of the symptoms to meet the definition. The symptoms are:

Mood change (either extremely irritable or euphoric). In the classic mania, people are euphoric, but just as many are irritable.
Distractibility. You can't concentrate very well; you initiate projects, but get distracted so that you can't finish them.
Decreased need for sleep. You sleep less or the same, but have more energy than usual.
Grandiosity. You are more self-confident than usual, out of proportion to your circumstances. It doesn't have to be extreme or delusional.
Racing thoughts. Your thoughts are running through your head rapidly; they are not necessarily illogical or abnormal thoughts, just fast ones.
Increased goal-directed activities. You are doing more activities than normal. Maybe instead of working 40 hours a week, you work 50 to 60 hours a week. Instead of going out with friends one night a week, you go out five to six nights a week. The classic scenario is someone waking up at two or three in the morning and cleaning the house. You have a lot of energy.
Pressured speech or increased talkativeness. You speak very rapidly or speak a lot. For example, you are up late making long distance phone calls for hours on end.
Risk-taking behavior. You are engaging in impulsive activities. You go on spending sprees, or spend impulsively. It is common for people to spend a lot of money or go bankrupt. Other common behaviors are sexual indiscretions, such as affairs or unsafe sex; reckless driving at high speeds; and impulsive traveling. Also you may get into arguments or particularly men may get into fights.
Significant social or occupational dysfunction. Some of the risk taking behaviors or manic symptoms lead to trouble for you with your spouse, your coworkers, or your boss. The divorce rate for bipolar disorder is quite high. You lose relationships and have serious conflicts with family members. You don't have to be psychotic; you don't need to have the classic impulsive behaviors; you just need to have serious problems with relationships.

What is the difference between mania and hypomania (type II)?
Hypomania is a milder mania, but the depression is just as severe. The difference is mainly around how well someone functions. If you don't have risk-taking behaviors or significant social or occupational dysfunction, but have the other symptoms, then you have hypomania. Many people with hypomania are functioning quite well when they are not depressed.

Also for mania to be diagnosed, it needs to occur for a minimum of one week and for hypomania, it is only four days.

In both cases of bipolar disorder, people have severe depressions that are usually recurrent. In type I, they have at least one episode of mania for a week, and in type II, they have at least one hypomanic episode. However, a person with mania can also have hypomania symptoms; their diagnosis is still type I. Type II bipolar disorder means a person has experienced at least one hypomanic episode but has never experienced even one manic episode (major depression also has to occur in type II bipolar disorder).

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