hypomania_vs_mania_flashcards (1)
What is the duration required to diagnose mania?
At least 7 days
What is the duration required to diagnose hypomania?
Less than 7 days, typically 3-4 days
Does mania cause severe functional impairment?
Yes, it causes severe functional impairment in social and work settings
Does hypomania cause severe functional impairment?
No, it typically does not impair functional capacity in social or work settings
Does mania often require hospitalization?
Yes, due to risk of harm to self or others
Does hypomania often require hospitalization?
No, it is unlikely to require hospitalization
Are psychotic symptoms present in mania?
Yes, mania may present with psychotic symptoms
Are psychotic symptoms present in hypomania?
No, hypomania does not exhibit psychotic symptoms
What are the common mood symptoms in both hypomania and mania?
Predominately elevated and irritable
What are the common speech and thought symptoms in both hypomania and mania?
Pressured speech and flight of ideas
What are the common behavioral symptoms in both hypomania and mania?
Insomnia, loss of inhibitions (sexual promiscuity, overspending, risk-taking), increased appetite
What helps differentiate mania from hypomania?
The length of symptoms, severity, and presence of psychotic symptoms
summarise Hypomania vs. mania
Hypomania vs. mania
Mania Hypomania
Lasts for at least 7 days - Causes severe functional impairment in social and work setting
May require hospitalization due to risk of harm to self or others
May present with psychotic symptoms
A lesser version of mania
Lasts for < 7 days, typically 3-4 days. Can be high functioning and does not impair functional capacity in social or work setting
Unlikely to require hospitalization
Does not exhibit any psychotic symptoms
Therefore, the length of symptoms, severity and presence of psychotic symptoms (e.g. delusions of grandeur, auditory hallucinations) helps differentiates mania from hypomania.
The following symptoms are common to both hypomania and mania
Mood
predominately elevated
irritable
Speech and thought
pressured
flight of ideas: characterised by rapid speech with frequent changes in topic based on associations, distractions or word play
poor attention
Behaviour
insomnia
loss of inhibitions: sexual promiscuity, overspending, risk-taking
increased appetite
A 38-year-old man presents to your clinic complaining of insomnia and restlessness that has been going on for the past four days. He appears elevated in mood and speaks at an increased rate, but denies hearing any voices or having any special powers. Despite his symptoms, he has continued working as a news reporter and he has no forensic history. You last saw him in your clinic five days ago for a routine asthma appointment, when he presented as calm and euthymic.
What is the most likely diagnosis?
First episode of psychosis
Generalised anxiety disorder
Hypomanic episode
Manic episode
Schizotypal personality disorder
Hypomanic episode
Hypomania is characterised by elevated mood, pressured speech and flight of ideas but without psychotic symptoms
The most likely diagnosis is a hypomanic episode. The patient’s symptoms of elevated mood, increased speech rate, insomnia, and restlessness lasting for four days are consistent with a hypomanic episode. He does not have any psychotic symptoms such as auditory hallucinations or delusions of grandeur which would suggest mania. Furthermore, his ability to continue working suggests that his functional capacity in social or work settings is not impaired, which again points towards hypomania rather than mania. Therefore, a hypomanic episode is the correct option in this case.
First episode psychosis is incorrect as the man in this scenario denies voice-hearing and there is no mention of other psychotic features, such as delusions, passivity or thought blocking. A hypomanic episode is the more likely diagnosis given the elevated mood, pressured speech and acute onset.
Generalised anxiety disorder is more likely to present with symptoms of excessive worry and anxiety, rather than acute restlessness, rapid speech and elevated mood.
Diagnosis of a manic episode requires symptoms of mania lasting for at least seven days, unlike the four days in this scenario. Symptoms will usually disrupt a person’s social and occupational functioning as well, whilst the man in this case has continued to attend his work. Unlike during a hypomanic episode, a person presenting with mania may also present with psychotic symptoms, such as delusions (usually grandiose) or hallucinations (usually voice-hearing).
Schizotypal personality disorder is usually diagnosed in people who present as isolative and suspicious. They have unusual thoughts, speech and behaviours, which usually hinder their ability to form and maintain relationships. This is a chronic pattern of symptoms and behaviours rather than a fluctuating mental state, as is suggested by the acute change over the past four days in this scenario.
Which one of the following symptoms may indicate mania rather than hypomania?
Predominately elevated mood
Delusions of grandeur
Increased appetite
Flight of ideas
Irritability
The correct answer is Delusions of grandeur. Delusions of grandeur, or grandiose delusions, are a key feature that differentiates mania from hypomania according to the DSM-5 criteria. These are false beliefs in one’s own superiority, power, knowledge, identity or special relationship to a deity or a famous person. In the context of mania, they can be expansive and often fantastical. This symptom indicates a break from reality which is not seen in hypomania.
Discussing the other options:
Predominately elevated mood is common in both mania and hypomania. The difference lies in the degree and duration of this elevation. A manic episode requires a distinct period of abnormally and persistently elevated mood for at least one week (or less if hospitalisation is required), whereas in hypomania it must last at least four consecutive days.
Increased appetite, while it can be present in both conditions as part of increased goal-directed activity or energy, it does not differentiate between mania and hypomania. However, significant weight gain or an increase in appetite may suggest other conditions such as atypical depression or bipolar disorder with atypical features.
Flight of ideas is characterised by rapid shifts in thought from one idea to another based on associative thinking. While this symptom can be seen in both mania and hypomania, the severity tends to be more pronounced during manic episodes but alone it does not distinguish between these two states.
Lastly, Irritability can occur in both mania and hypomania particularly when others fail to go along with the individual’s expansive mood or plans. However, irritability alone does not indicate whether an individual has crossed over from hypomanic state into full-blown manic episode.
