Mania describes a distinct period of abnormally and persistently elevated, expansive, or irritable mood, coupled with an increase in goal-directed activity or energy. This shift represents a noticeable departure from a person’s usual functioning and is observable by others.
Manic Episode
A manic episode is characterized by a distinct period of abnormally and persistently elevated, expansive, or irritable mood, along with abnormally and persistently increased goal-directed activity or energy, lasting at least one week and present most of the day, nearly every day. The mood disturbance must be severe enough to cause marked impairment in social or occupational functioning.
During a manic episode, individuals often experience an inflated self-esteem or grandiosity, believing they possess exceptional abilities or importance. They may have a decreased need for sleep, feeling rested after only a few hours or even no sleep at all. Speech often becomes pressured, meaning they talk rapidly and loudly, making it difficult for others to interrupt.
Thoughts may race, leading to a “flight of ideas” where topics shift quickly and seemingly illogically. Distractibility is common, with attention easily drawn to unimportant or irrelevant external stimuli. There is an increase in goal-directed activity, which can manifest in various ways, such as excessive involvement in work, social activities, or creative pursuits.
Individuals might also engage excessively in pleasurable activities that have a high potential for painful consequences, such as unrestrained buying sprees, sexual indiscretions, or foolish business investments. The presence of psychotic features, like hallucinations or delusions, automatically classifies an episode as manic. A single manic episode is sufficient for a diagnosis of Bipolar I Disorder.
Hypomanic Episode
A hypomanic episode shares similarities with a manic episode but is less severe and shorter in duration. To meet diagnostic criteria, there must be a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least four consecutive days and present most of the day, nearly every day.
Unlike a manic episode, a hypomanic episode does not cause marked impairment in social or occupational functioning and does not necessitate hospitalization. Psychotic features are absent in hypomania; if they occur, the episode is by definition considered manic.
Symptoms of hypomania mirror those of mania but are less intense. These can include an inflated self-esteem, a decreased need for sleep, increased talkativeness or feeling pressured to keep talking, and racing thoughts. Individuals may also experience distractibility, an increase in goal-directed activity, and excessive involvement in pleasurable activities with potential for negative outcomes.
The distinction lies in the severity and functional impact. Hypomania represents a clear change in functioning from the individual’s usual behavior, and this change is observable by others, but it does not lead to the significant disruption seen in a full manic episode. The presence of at least one hypomanic episode along with major depressive episodes is characteristic of Bipolar II Disorder.
Mania with Mixed Features
“Mixed features” refers to the simultaneous presence of symptoms from both mania/hypomania and depression during the same mood episode. This is a specifier that can be applied to either a manic or a hypomanic episode, rather than being a standalone type of mania.
For an episode to be specified “with mixed features,” at least three symptoms of the opposite mood polarity must be present during the majority of days of the current manic or hypomanic episode. For example, an individual might experience elevated mood and increased energy while simultaneously having profound sadness, suicidal thoughts, or a diminished interest in activities.
This presentation can be distressing and complex, as the individual experiences the agitation and heightened energy of mania alongside the despair and hopelessness of depression. Recognizing mixed features can help guide more precise diagnosis and treatment approaches.
Mania Due to Other Causes
Manic-like symptoms can arise from factors other than primary bipolar disorder, necessitating a thorough medical evaluation. One category is substance/medication-induced mania. Certain substances, including illicit drugs like stimulants (e.g., cocaine, amphetamines) and hallucinogens, or prescribed medications such as corticosteroids and some antidepressants, can trigger manic symptoms.
These symptoms emerge during or soon after substance use or withdrawal, and they resolve once the substance is eliminated. Such episodes are not indicative of an underlying bipolar disorder, although they can mimic its presentation. The mood changes must be prominent and persistent to be classified as substance/medication-induced.
Another category involves manic-like symptoms due to another medical condition. Examples include thyroid disorders, particularly hyperthyroidism, and neurological conditions such as stroke, brain tumors, or traumatic brain injuries.
Cushing’s disease, a disorder of the endocrine system, is also known to cause manic or hypomanic symptoms. Healthcare professionals should rule out these medical causes through appropriate diagnostic testing before attributing manic symptoms solely to a primary psychiatric disorder.