All About Hypomania a Mental disorder


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Hypomania is a mood state characterized by persistent disinhibition and/or irritability in combination with at least three other symptoms from a list that includes inflated self-esteem, reduced need for sleep, increased talkativeness, flight of ideas or racing thoughts, distractibility, increase in goal-directed activity or psychomotor agitation, and excessive involvement in pleasurable activities which have a high potential for painful consequences. Hypomania may also be associated with disturbances in circadian rhythms (see Mania) and it does not co-occur with psychotic features.

Differential Diagnosis of Hypomania

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True hypomania always occurs during the course of an affective disorder i.e., major depressive disorder or bipolar mania. Thus, the first question to ask is “Is there bipolar diathesis?” If so, hypomanic episodes require an additional diagnosis of Bipolar I Disorder (see below). Otherwise, this is Major Depressive Disorder with Hypomanic Episodes.

Pseudo Hypomania

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The differential diagnosis of hypomania also includes states that share symptomatology with bipolar disorder but that do not represent instances of true mood elevation such as: “pseudo hypomania”, substance-induced mood disorder (due to the direct effects of a medication or other drug of abuse or a general medical condition e.g., hyperthyroidism), schizophreniform disorder and brief psychotic disorder, unipolar mania, narcissistic personality disorder, and antisocial personality disorder. In addition, symptomatic behavioral patterns in borderline personality disorder and histrionic personality disorder, which can be ego-syntonic, may mimic hypomania. Again, the first step is to establish whether there is a bipolar diathesis.

If symptoms of true hypomania are present but there is no evidence of any underlying affective disorder, then one can speak of “secondary mania” or “pseudo-hypomanic syndrome”. This type of presentation usually occurs in middle or late life and it accounts for about 10% of cases. The use of stimulants (i.e., cocaine), together with antidepressants (especially tricyclics) and L-dopa may induce symptoms that resemble true hypomania but such symptoms always resolve after withdrawal of the exogenous agent. Again, one must establish whether there is an underlying bipolar diathesis before assigning a diagnosis of Bipolar Disorder NOS

Finally, it should be mentioned that true hypomanic episodes often remit with sleep deprivation so the mere fact that clinical features abate after extended wakefulness does not necessarily mean they represent hypomania rather than mania. If all other diagnostic criteria are met, however, insomnia predates mood disturbance by many days or if sleep loss is prolonged and profound enough to cause marked psychomotor retardation/agitation then bipolar disorder may still be diagnosed notwithstanding this anomaly.

The treatment of hypomania

Generally speaking, treatment for hypomania is the same as that for mania. The first line of medication treatment is mood-stabilizing medications (i.e., lithium and/or valproic acid). However, atypical antipsychotic medications are also used to treat manic symptoms. Treatment with clonidine or guanfacine may also be helpful in the short term. Symptoms of premenstrual dysphoric disorder can often be effectively treated with SSRIs. If you have any questions about your individual circumstances please consult your doctor who can best advise you on what course of action might be most beneficial for you.

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