Pure mind weaves love and destiny. Any severe distortions to it could cause a psychiatric condition called Mania or its lesser version Hypomania. This could be genetic, psychological or due to environmental risk factors. It could not be ascertained exactly what is the reason but the effect of hypomania lasts for less than a week.
Hypomania causes unnecessary burden with increased energy level and hyperactivity with a decrease in sleeping hours. It could be because of underlying bipolar II disorder, cyclothymia, or schizoaffective disorder. This could cause serious damage to the lifestyle in both professional and personal life.
The heightened level of energy resulting in doing activities very fast could be a gift. But in the hypomania episode which could last for a few days could also be accompanied by an irritable mood. The tendency to talk more and shift from topic to topic may end with loosing near and dear.
Millions of people have been affected by hypomania. The preventive measures should be taken to save the self-respect along with the proper relations in the workplace or at home. Hence to stop from being treated as a maniac and to live a quality life continues reading till the end.
HYPOMANIA:
Hypomania is a mood state characterized by heightened activity or irritability. The elevated state of activity is also called as Euphoria.
Euphoria is a pleasant experience of well being and happiness and disinhibition is a total disregard for social conventions and poor risk assessment
Differences of Mania and Hypomania:
Hypomania is considered to be a less severe version of mania. But the following are the differences between mania and hypomania.
- Mania is caused by bipolar disorder type I and Hypomania are caused by bipolar disorder type II.
- In case of Mania hospitalization is necessary but not so in the case of hypomania.
- People may observe some abnormalities with hypomania but not to that of the extreme level of mania.
- In manic syndrome cases are characterized by periods of depression but not in all cases. In hypomania, it is characterized by euphoria and disinhibition or irritability.
- In cases of mania the hyper excitement is uncontrollable but in case of hypomania, it is to a great extent controllable.
- Sociable and with creative ideas in the case of hypomania but unsociable and with delusions and hallucinations with mania.
- Confident with self-esteem in the case of hypomania but with believing in superpowers and loss of insight with mania.
- The symptoms of mania are far more severe when compared to hypomania.
SYMPTOMS OF HYPOMANIA:
Symptoms of hypomania vary with intensity and from person to person. But they manifest clear-cut symptoms common to many people. Some examples of characteristics and behaviors of an hypomania include:
Lack of sleep:
The first and important symptom for hypomania is the decreased need of sleep. The sleeping pattern gets changed with the intensity of hypomania. Even a few hours of sleep gives a lot of energy to be more active for the rest of the day.
Engaging in more activities at once:
With the increased level of energy in hypomania affected people, they will be restless and cannot sit in one place for even a few minutes. They want to spend of their extra energy and engage in more activities at once and do it all the time without any idea or resolve to finish any of them.
Talkative with fast, pressured and loud speeches:
Hypomania makes the persons become more talkative on different topics, changing them by every minute or even second. The listener will become tired of hearing their fast pressured loud speeches while the hypomania patient continues speaking relentlessly with higher energy.
Rapid thinking with a flight of ideas:
The ideas and thinking of the hypomania patients are very high. They have a tendency to think rapidly and come out with various ideas and thoughts for any situations. This could change with time and get more serious.
The thinking and the ideas will be not in a sequential manner and could differ from one to another. They will be thinking or expressing an idea on a particular subject and suddenly without any reason or cause could change subjects within seconds and even come back to the original one later.
Involving in risky behaviors:
The high energy level and the feeling of being superior to others make the persons in hypomania phase to indulge in high-risk behaviors unmindful of the outcome.
This is very dangerous because it may lead to gambling and other related activities believing very strongly on the luck. This could lead to a heavy financial loss which could be damaging to the whole family and their lives.
Eccentric activities:
Some eccentric activities like spending spree, dressing in a flamboyant way or in revealing dresses or in bright colors, easy distractions by sounds especially clang associations, increased religious activities, and others could also be noticed.
A sudden increase in sexual desire:
Hypersexuality is the most common symptom of both mania and hypomania phases. This could be seen from various deviant sexual activities:
Requiring abnormal and frequent sex from partners
Going after prostitutes for sex
Trying to have an illegal affair with persons in personal or professional life
Increased time on the internet on pornographic websites, online interactions, online dating, mobile obscure conversations and many more.
Serious symptoms of hypomania:
When the above symptoms are severe or in groups occurring at most of the times, the condition of hypomania could be going to the next level of maniac phase. This is could also lead to other bipolar disorders.
Serious symptoms to seek medical attention include:
- High level of irritability and hostility without any particular reason.
- Auditory or visual hallucinations which are describing things and sounds which are really not there.
- Not believing something which is really present or delusional behaviors
Even though hypomania is not characterized by hallucinations and delusions it could be sign and symptom of severe hypomania transforming into a manic phase which is dangerous and should seek immediate psychiatric help.
After effects of hypomania phase:
Hypomania phase may last for a few days at a time of occurrence. This does not increase than a week. If it is increased for more than a week it could be because of the maniac phase or other bipolar disorders. After a hypomania phase the person may experience the following physical and psychic behaviors:
- Do not give any clear memories on what all happened during the hypomania phase.
- Feel very unhappy and ashamed of the behavior exhibited during the hypomania phase.
- Very difficult in managing and honoring the commitments made during the phase of hypomania.
- Need more rest and sleep and feel very tired.
- May lead to depression depending on the severity of the hypomania phase.
CAUSES OF HYPOMANIA:
The exact cause of hypomania is still unclear. There may be not any clear-cut reason for the cause of hypomania. It depends on various long and short-term factors. This may differ from person to person which include:
- Abusive use of alcohol or drugs
- High level of stress
- Seasonal changes – experiencing hypomania during a particular season
- Substantial and significant changes in life like divorce, childbirth, and even shifting of houses.
- Due to violence or trauma or abuse.
- Difficult life conditions over a period of time like unemployment, homelessness, poverty, social deprivation among others.
- Family history:
The genetic factor is not yet an established clear-cut cause. But a person with family members suffering from hypomania has more chances of being affected by hypomania.
- Concurring hypomania phases:
If being experienced once of hypomania phase there are more chances it to be repeated again. This could be of some serious trouble to come.
Brain chemistry:
The chemical imbalance could be one possible reason along with the malfunction of the brain nerves.
- Medications:
Some medications could cause hypomania as a side effect. This mainly includes medications of psychiatric nature. Taking antidepressant medications especially SSRIs or specific serotonin reuptake inhibitors or medications for those with dysmorphia could cause hypomania.
Stopping of a medicine taken for a period of time also could end up with a hypomania phase due to the withdrawal phase.
A recent study has not clearly mandated whether the medications of manic depression like placebo and quetiapine could cause hypomania. But it is still advised by doctors to have an utmost care in increasing the dosage of quetiapine.
- Postpartum Psychosis:
This is characterized during childbirth. After a few weeks of childbirth postpartum psychosis occurs with many women. When this occurs most of the mania symptoms are experienced by the women and could last for 12 weeks. But for women with prior bipolar illness could cause severe issues.
- Overactivity:
Overactivity could be normal for most persons. But in some cases, overactivity could be because of the underlying hypomania effect. A recent study on overactivity found that it is on par with mood change in the diagnosis of hypomania on family history and psychometric grounds.
DSM IV-TR or the Diagnostic and Statistical Manual for Mental disorders fourth edition Text review situations are changed to clinical situations by overactivity is confirmed by this study.
DIAGNOSIS OF HYPOMANIA:
On the basis of the severity of the number of symptoms, a doctor diagnoses hypomania. This is done when the hypomania phase continues for one week and in cases of hospitalization it could be done early.
The symptoms are proof enough for some psychiatric disorder. But whether it is depression or hyperactivity should be diagnosed. Also, it is to be known whether it is bipolar I manic phase or bipolar II hypomanic phase.
To diagnose hypomania phase the doctor may ask a few following questions:
- Medications were taken including the OTC and illicit medicines.
- Medical history
- Family history
- Duration of the symptoms – This could not be clearly known as the patient in the hypomania phase may not remember it.
These questions are confirmed by the doctor to prevent the wrong diagnosis of hypomania with depression or thyroid gland problems which are similar in nature with that of hypomania. The diagnosis could also differentiate hypomania with cyclothymia.
Cyclothymia is a condition which could prolong for years of periods of alternate moods of depression and hyperactivity or hypomania.
There are many diagnoses for hypomania which includes:
Diagnosis for bipolar hypomania:
DSM-5 of the American Psychiatric Association which is the Diagnostic and statistical manual of mental disorders 5th edition specifies diagnosis of bipolar hypomania as per symptoms. Bipolar hypomania is diagnosed as present when there are three of the following symptoms with persistently elevated mood or four of them in association with sustained irritable mood.
- Feeling pressure to keep on talking or in an unusually talkative mood
- Racing thoughts with a flight of ideas
- Not feeling tired even with lack of sleep
- Psychomotor agitations like restlessness, fidgetiness and pacing all the time
- Grandiosity which is unrealistic thinking of high potentials, highly lucky, superpowers, high talents, and abilities.
- Strong feeling intensely drove to accomplish specific unrealistic goals
- Eccentric activities such as easy distraction, high risk-taking activities without any care for the result, sexual indiscretions, spending spree, gambling, high-risk financial investments, and all activities with a high potential for negative outcomes.
Differential Diagnoses:
This differential diagnosis specifies from the name itself that it differentiates hypomania and mania. When symptoms of psychosis are found it is clear-cut maniac phase. When the symptoms are severe also the hypomania phase is excluded. This also rules out the medications and substance abuse from hypomania.
TREATMENT FOR HYPOMANIA:
Treatment of hypomania depends on the severity of the phase. After proper diagnoses to exclude all other possibilities of similar symptoms the treatment should be given. The medical treatment along with OCT and others could have only a limited effect.
Only the patient with hypomania phase should come forward to overcome the hypomania phase. This includes various activities like good food habits, exercises, meditation, yoga, among others to control and prevent hypomania phase.
The treatment to hypomania include:
Medical treatment of hypomania:
Mood stabilizers are the most common and effective way to treat hypomania. The following medicinal stabilizers can be prescribed by the doctor:
- A valproic acid such as semisodium (Depakote), Carbamazepine (Tegretol), Lamotrigine (Lamictal) which is an anticonvulsant drug
- Lithium (Camcolit, Liskonum, Pirates) a mood stabilizer with antidepressant effects
- Benzodiazepines which are anti-anxiety drugs
- Until the stabilizers take effect to reduce the hypomania symptoms the doctor will also prescribe antipsychotics neuroleptics which are major tranquilizers. Some important antipsychotics include:
- Olanzapine or Zyprexa
- Quetiapine or Seroquel
- Risperidone or Risperdal
The doctor may try several different sets of medications before discovering the right combination to treat the hypomania symptoms effectively. Even if there are some side effects the medical treatment should be continued. Regarding the side effects, the doctor should be consulted and also before stopping of the medication.
In the case of no remedy with medications, the doctor may advise ECT or electroconvulsive therapy.
ECT:
Electroconvulsive therapy is widely used nowadays under the influence of anesthesia. This was not safer before without it and had negative complications like fractured bones, memory loss, and other serious side effects.
A small seizure of the brain is caused by passing small quantities of electric current through the brain. This seizure changes the brain chemical history and could treat hypomania among other mental disorders.
It is done only with the proper information to the hypomania patient and his close relatives. This is done under the influence of anesthesia after proper approval.
ECT is advised only if the following situations occur:
- Ineffective medical treatment of hypomania phase
- Hypomania over a long period of time
- In cases of Catatonia when there is lack of physical movements, or fast, strange and rapid movements, lack of speech and other mental illnesses.
- Severe depression with resistance to eat
Self-help treatment of hypomania:
Treating hypomania starts with the self-help. First and important point of treatment is to make the affected person to realize the issue of hypomania. The acceptance of something abnormal is happening in situations is the prime concern.
Once this realization is dawned on the person going through the hypomania phase will enable the general physician or the psychiatrist to treat easily. Since any medical treatment should be taken seriously this help from the patient is very important.
Apart from medications, the following self-help techniques could be applied to treat hypomania:
Seeking help:
With the realization of the abnormality, the first step is to seek professional help to diagnose the condition and get medication. ]
Talkative treatment:
Since during the hypomania phase because of high energy levels the talking increases and this could be used as a treating method. Talkative method while in the stable state will help in ascertaining the correct diagnoses for the patient for treatment.
Community –based treatment:
Once diagnosed with hypomania phase and due to its severity could cause an inability to carry out the regular activities. This is when the community-based treatment could be done.
They can be referred to community-based health and mental centers. Apart from getting the medical treatment, they could be with similar kind of persons.
They could also get help from social workers for conducting and learning to cope with the day to day requirements.
CBT:
CBT or cognitive behavioral therapy for a short period of a few months could help in a better way. They change the pattern of thinking and attitude, thereby changing the behavior. It also involves the feelings and helps the patient in the following ways:
- Solving sleeping difficulties and relationship problems
- Substance abuse like alcohol or drugs
- Reduces anxiety and depression
- Solving emotional problems
MCBT:
Mindfulness cognitive behavioral therapy is an advanced version of CBT. This makes the patient be mindful of the activities and be in the present.
Psycho-education:
Education to solve issues on the owner or with the help of others.
Inter-personal therapy:
This therapy involves sorting out the issues in relations and having better communication and relationship with the community.
Family-focused therapy:
This advanced interpersonal therapy helps in identifying the mood changes and its time to increase for the better communication and healthy relationship with the near and dear.
Maintaining a mood diary:
If the mood changes are identified earlier it is better. For this maintaining, a mood diary gains importance. The diary will help in critical situations and also the family members could understand the mood and act accordingly.
Identifying triggers and warning signs:
Once you come across the early symptoms like lack of sleep, not feeling like eating you should become aware of the situation and try to avoid the further intensity of the hypomania phase.
Making a self-management plan:
When stable during a hypomania phase it is necessary to make a plan to manage the daily activities to control the effects of hypomania phase. This includes the following:
- Going to bed on time
- Eating regularly the right food
- Avoiding alcohol, drugs, and even caffeine
- Being in some quiet and calm place avoiding noisy, bright and busy environments.
- Postpone any hyperactivity like spending spree, investing in high risks, or making any life-changing decisions.
- Exercising daily along with meditation and yoga in an open environment. These outdoor activities connected to the outer world and to get an idea of the bigger picture of what is happening around us.
Hypomania could not be prevented and the triggers could happen at any time. Hence to live a stress-free life with proper and healthy diet can help in controlling and preventing hypomania.
Hypomania could ruin relationships, professional hardships and even the possibility of losing it. So care should be taken to be in treatment and with the help of family and community could lead a normal life.
https://www.ncbi.nlm.nih.gov/pubmed
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5702285
https://www.mind.org.uk/information-support/types-of-mental-health-problems/hypomania-and-mania/#.W6d3Odcza1s