Hypomania: description, symptoms and treatment

Last week was great! Boiling energy, lots of ideas and projects, and everything is doable! Which one to take on ?! Without exception, all people are sociable, kind and responsive. Life is Beautiful! An inspired soul soars, sings and rejoices! And suddenly, the recession is heavy, muddy, lingering. Hopelessness, depression. So hypomania is expressed: from total positive to total negative. The disease has its own symptoms and treatment.

Hypomania in psychology - a condition similar to mania, but proceeding in less light forms. It manifests itself in a relatively stable, high spirits, occasionally, in a situation accompanied by irritation and anger. The condition lasts several days, manifesting the severity of exhaustive satisfaction, absolute productivity, a high degree of charge and activity.

The differences from mania are the absence of psychotic symptoms and the increase, sometimes quite productive, of activity efficiency and adaptability. It can often occur as a phase of bipolar disorder.

According to the ICD-10 formal definition, the condition is characterized by an overly positive or irritable attitude, clearly atypical for a particular individual, lasting at least four days.

In this way, hypomania as an affective disorder is a latent form of mania that occurs in the absence of pronounced arousal. In this case, there is no obvious behavioral disorganization or deviation from the norms of the individual's social behavior, since the symptoms of psychosis (delusions, hallucinations, etc.) are not present.

Mood disorders were also observed by Hippocrates (5th century BC), who divided them into melancholy and mania. Later, in the works of E. Kraepelin, these conditions were attributed to manic-depressive psychosis (MDP).

Around the 60s of the XX century. a number of scientists noted a certain heterogeneity of the group of states, within which monopolar and bipolar forms were determined. Later, psychologists identified two types of TIR:

• for type 1 the alternation of episodes of depression and mania (sharply elevated mood, leading to serious impairment of the functional body) is characteristic;
• for type 2 alternating depressive states are characteristic exclusively with hypomania (without serious disorders).

Since 1990, according to ICD-10, there are 3 degrees of severity of mania - hypomania, mania in the absence of psychotic symptoms, mania with psychotic symptoms.

It is noteworthy that bipolar disorders affected Ludwig van Beethoven, Virginia Wolf, Ernest Hemingway, Isaac Newton, Judy Garland, Robert Schumann and a number of other brilliant people.

A traditionally disturbed mood is considered episodic if its duration is about a week.

In hypomanic conditions, the majority of those experiencing the disorder do not consider themselves sick, therefore they do not go to doctors. It is for this reason that there are no reliable statistics on the disorder. Unrecognized affective disorder leads to a worsening of the situation.

Beyond the causes of the disorder it is characterized by disorders of both the affective and somatopsychic spheres. Stable high spirits correspond to an overestimated general tone, a sense of well-being and excessive optimism. Self-esteem and originality are exaggerated, ideas of superiority prevail, there is no critical attitude towards oneself.

The thinking process of such a person speeds up, speech loses its clarity and expressiveness. Inexhaustible energy and a certain dispersal stimulate the emergence of an emotional upsurge in the performance of even ordinary and routine work. A person enthusiastically takes up the implementation of many plans, without thinking about the reality of their implementation.

The patient has a high fatigue threshold and resistance to significant loads. The need for rest and sleep is reduced. In this case, somatic signs may dominate. The protracted nature of the disorder is possible.

In its cyclotymic periods, hypomania proceeds quite clearly, with pronounced ups and downs of mood. In cases of a protracted variant persistence of affect.

With relatively even manifestations of the disorder, temporary somatopsychological manifestations may occur in the form of autonomic crises, vital fears, asthenia, etc. More often hypomania occurs within the framework of bipolar affective disorder (BAR), where it is usually replaced by depression, forming either a continuous continuum, or cyclicity. The bipolar form of the disorder is often characterized by early manifestations (in childhood or adolescence) and a chronic form of the course, which can be:

• remitting (episode - remission - episode);
• dual phase (one episode is immediately replaced by the opposite in direction);
• continual (there are no periods of remission between episodes).

Normal remission occurs in a small number of patients. The disease can go into a more pronounced condition - mania. The average duration of episodes is in the range from 2 weeks to 2 months.

BAR are classified as diseases that cause disability. In addition, with bipolar disorders, the risks of suicide increase significantly.

There are several varieties of hypomania:

• simple ("funny");
• irritable or angry, expansive.

Depending on the personality disorders that accompany hypomania:

• querulent (with an irresistible desire of the patient for scramble, constantly fighting for "violated" rights);
• adventurous (inclination to adventures);
• dysphoric (irritability, replaced by a feeling of longing, tension, a tendency to aggressive behavior).

According to the type of influence of hypomania on the somatopsychic sphere, atypical hypomania (euphoric hypochondria) is also distinguished, the course of which is accompanied by increased mood and unrestrained activity aimed at overcoming an imaginary ailment.

Based on the severity of symptoms, they distinguish:

• a pure (explicit) form of hypomania;
• latent hypomania (erased form).

There is also the so-called productive form of hypomania, observed during cyclothymia, characterized by infrequent malfunctions of the sleep-wake cycle and acceleration of ideator processes.

The emergence of hypomania contributes to a number of reasons.

1. Excessively active work of the thyroid gland, accompanied by increased production of hormones. Contribute to the disorder of postpartum syndrome and menopause.
2. Episodes of hypomania also appear as a consequence of the phase of food excitement. The causes may be anorexia or therapeutic fasting.
3. Certain medications (opiates, baclofen, phenamine, captopril, bromocriptine, bromides, cimetidine, cyclosporin, corticosteroids, yohimbine, teturams, hallucinogens) also lead to the disease.
4. In cases of abrupt cancellation of antidepressants.
5. With excessive intake of stimulants (energy drinks, cocaine, coffee, etc.).
6. Cases of organic brain damage (infectious and non-infectious in nature).
7. Bipolar affective disorder (MDP), the occurrence of which is stimulated by hereditary factors and stresses.

Symptoms of hypomania include:

• atypical for an individual increased irritable mood, persisting for several days;
• unusual talkativeness and accelerated pace of speech;
• increased level of physical activity;
• reduced levels of need for rest and sleep;
• distracted attention;
• manifestations of recklessness and inappropriate situational behavior;
• an abnormally high degree of sociability and episodes of familiarity in communication;
• increased sexual desire.

Hidden forms of hypomania manifest their appearance by disinhibition (in childhood and adolescence), bulimia, nymphomania and satyriasis. Most likely episodes of high creative productivity, accompanied by a sense of inspiration.

Signs of hypomania caused by hyperthyroidism are tremor and Gref’s symptom (“setting sun symptom”). Often hypomania is accompanied by an increase in appetite.

For child hypomania, manifestations are characteristic:

• fussiness and obvious pronounced motor disinhibition;
• impulsivity;
• disobedience and unusual stubbornness;
• make-up faces;
• multiple words;
• penchant for rude antics;
• difficulty falling asleep;
• a sharp increase in instincts and drives (gluttony, masturbation).

The main criteria for diagnosing the disorder are the presence of an excessively elevated or irritable mood for at least 4 days.

For a reliable determination of the diagnosis, tests are used, and at least 3 symptoms from the list below should be identified as necessary and sufficient:

• high level of activity or feeling anxious;
• excessive talkativeness;
• difficulty concentrating or high distractibility;
• reduced need for rest and sleep;
• increased libido;
• small revelry or reckless actions, irresponsible behavior;
• excessive sociability with manifestations of familiarity.

Due to the fact that hypomania is provoked by various reasons, differential diagnosis is carried out in psychiatry. If an episode of hypomania is provoked by the use of psychoactive drugs, then signs of intoxication accompany the increase in mood.

In children, the disorder manifests itself mainly at the psychomotor level of response, due to the fact that at this age manic states are more atypical than in adults. It is important to consider that for preschool children and primary school children the cheerfulness, activity and lability of the mood manifested under the influence of many factors of the internal and external order are normative. It is for this reason that hypomania in children is suggested for prolonged euphoria, accompanied by impulsive and gross violations of behavior.

With such causes of the disorder as hyperthyroidism or poisoning with psychoactive drugs, therapy consists in eliminating these causes (thyreostatic drugs, surgical treatment, etc. are used).

In cases of bipolar disorder, normotics (mood stabilizers) are used:

• for example, lithosan or lithobid (the dosage is strictly individual, the lowest dose is 0.6 mmol / l);
• anticonvulsants (valproate, carbamazepine, gabapentin, oxcarbazepine, topiramate, etc.).

With insomnia prescribed benzodiazipines (clonazepam, lorazepam). Because they are addictive, they are used for a short period of time. Sometimes prescribed sedatives (zolpidem). Children are often prescribed lithium preparations.

Valproate application needs under close medical supervision. This medicine can lead to hormonal changes in teenage girls and polycystic ovary syndrome in young women.

For more effective treatment of bipolar disorder, it should be accompanied by frequent replacement of drugs with the direct participation of a doctor. Stabilizing drugs can be used for years.

Support with normotimics is usually carried out in the initial period of relief, since the preventive effect of these drugs is slow. Antidepressants can increase the severity of bipolar disorder. In these cases, the use of the drug is refused. In cases where normotimics are not effective enough, atypical antipsychotics are included in the therapy.

Bipolar disorder with a phase of hypomania provides for mandatory treatment, since stable hyperactivity naturally leads to exhaustion, apathy, and deep depressive states. Hypomania is fraught with dangerous consequences.

1. Sleep deficiency leads to significant overwork.The level of attention and memory is falling.
2. Possible overeating leads to obesity and the development of avitominosis. The body's defenses are falling, chronic diseases are exacerbating.
3. Coming apathy periods complicates self-control and creates additional life problems.
4. A series of days of excessive activation is replaced by deep depressive and quite long, up to several months, periods. The neglect of hypomania leads to a breakdown. An adequate perception of reality is disrupted. A person becomes conflicted, which leads him to social isolation.

Often hypomania occurs in creative people. In a whole series of cases, famous writers, poets, composers, artists for a long time (for months) fell into periods of inspiration, creating masterpieces of art. However, periods of recovery were certainly replaced by depressions and a significant decline in strength.

Attempts to return radiant inspiration by using alcohol or drugs lead to an absolute worsening of the situation.

For ten signs of mania, see below.