Elicit Symptoms of Hypomania/Mania

Question 1

What areas should be covered when eliciting symptoms of hypomania and mania?

Answer 1

1. Core Symptoms of Hypomania/mania
2. Biological and Cognitive symptoms
3. Overoptimistic ideation and grandiosity
4. Exploring grandiose delusions and clarification
5. Risk assessment - Tendency to engage in behavior that could have serious consequences
6. Rule out co-morbidity
7. Mode of onset, duration, and progression of symptoms
8. Impact on current life

Question 2

What are the clinical features of mania?

Answer 2

1. Elevated mood/irritable mood
2. Increased energy (over activity, excitement, reduced need for sleep, pressured speech, racing thoughts, flight of ideas)
3. Increased self-esteem (overoptimistic ideation, over familiarity, grandiosity)
4. Reduced attention and increased distractibility
5. Tendency to engage in behavior with serious consequences (reckless spending, sexual disinhibition, reckless driving)
6. Marked disruption to family life, social activities, and occupation

Question 3

What questions help elicit the core features of hypomania/mania?

Answer 3

1. How are you feeling in yourself?
2. Have you sometimes felt unusually/particularly cheerful and on top of the world, without any reason?
3. If I were to ask you to rate your mood, on a scale of ‘1’ to ‘10’, how would you rate your mood now?
4. Have you felt so irritable recently that you shouted at people or started fights or arguments?
5. How is your energy level?
6. Do you find yourself extremely active but not getting tired?
7. Have you felt particularly full of energy lately or full of exciting ideas?
8. Have you felt that you were much more active or did many more things than usual?

Question 4

What questions help elicit the biological symptoms of hypomania/mania?

Answer 4

1. How are you sleeping?
2. Do you need less sleep than usual and found you did not really miss it?
3. How has your appetite been recently?
4. Have you lost/gained any weight?
5. How is the sexual side of your relationship?
6. Have you been more interested in sex recently than usual?

Question 5

What questions help elicit the cognitive symptoms of hypomania/mania?

Answer 5

1. How has your concentration been recently?
2. What is your thinking like at the moment?
3. Are you able to think clearly?
4. Do your thoughts drift off so that you do not take things in?
5. Do you find that many thoughts race through your mind and you could not slow your mind down?

Question 6

What questions help elicit overoptimistic ideation, grandiose ideas, and delusions of grandiosity?

Answer 6

1. How confident do you feel in yourself?
2. Do you feel much more self-confident than usual?
3. How do you describe your self-esteem to be?
4. How do you see yourself compared to others?
5. Are you specially chosen in any way?
6. Do you have any special powers or abilities quite out of the ordinary? Do you have any special gifts or talents? If so, what is it?
7. Is there a special mission to your life?
8. Are you a prominent person or related to someone prominent like royalty?
9. Are you very rich or famous?
10. Have you felt especially healthy?
11. Have you developed new interests lately?
12. Have you been buying interesting things recently?
13. Tell me about your plans for the future? Do you have any special plans?

Question 7

What should be done if a patient harbors grandiose delusions?

Answer 7

1. Pick up the clues from what the patient says.
2. Invite the patient to elaborate further on a positive response. Always probe for further elaboration of the beliefs and seek examples.
3. Always try to assess the degree of conviction, explanation, effects, and coping.

Question 8

What questions help assess the tendency to engage in behavior that could have serious consequences in hypomania/mania?

Answer 8

1. Has there ever been a period of time when you were not your usual self and you did things that were unusual for you like spending too much money that got you into trouble?
2. Has there ever been a period of time when you were not your usual self and that other people might have thought were excessive, foolish, or risky?

Question 9

What questions help explore the symptom history, mode of onset, duration, progress, precipitating factors, and associated problems in hypomania/mania?

Answer 9

1. How long have you been feeling this way?
2. What do you think might have caused this?
3. How is it affecting your life?
4. How do you manage to cope?
5. Do you get any help?

Question 10

What comorbidities should be ruled out during the assessment of hypomania/mania?

Answer 10

1. Depression
2. Psychotic symptoms (hallucinations)
3. Coping mechanisms (drug and alcohol misuse)