283 Hypomanic Episode

DSM-IV-TR criteria

• A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non-depressed mood. It is characterized as a period of increased energy that is not sufficient or severe enough to qualify as a Manic Episode.
• B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

• inflated self-esteem or grandiosity
• decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
• more talkative than usual or pressure to keep talking
• flight of ideas or subjective experience that thoughts are racing
• distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
• increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
• excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments

• C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic
• D. The disturbance in mood and the change in functioning are observable by others.
• E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
• F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism)

• NOTE: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder.

Associated features

• It has similar features as Manic Episode. Their mood may be described as irritable or depressive in a clinical setting.
• Along with clinical features may include tearfulness, anxiety, obsessive ruminations, panic attacks, and lots of health concerns.

Child vs. adult presentation

• In younger persons, hypomanic Episodes may be associated with school truancy, antisocial behavior, school failure, or substance use. With adults, hypomanic episodes may be associated with work, family or marital issues, and other stress related situations. The symptoms are the same in presentation, but what causes the hypomanic episodes may be different with children than adults.

Gender and cultural differences in presentation

• It affects individuals in all race categories.
• Latinos and Mediterranean cultures complain about nerves and headaches.
• Chinese and Asian cultures complain about weakness, tiredness, or imbalance.
• Middle Eastern cultures complain about problems of the heart or heartbreak.

Epidemiology

• 5%-15% of individuals with hypo-mania will ultimately develop a Manic Episode.

Etiology

• Episodes usually begin suddenly, with a quick escalation of symptoms that occur within a day or so. Episodes may last for several weeks to months and are usually more brief and abrupt in onset than Major Depressive Episodes. In many cases, the Hypomanic Episode may be preceded or followed by a Major Depressive Episode.

Empirically supported treatments

• Patients with Hypo-manic episodes will usually be prescribed medication to help eliminate or dull down the symptoms. Some common medications are mood stabilizers such as valproic acid and lithium carbonate. Atypical antipsychotics may also be used such as olanzopine and quetiapine. Besides using medications, there is not much information about alternative treatment methods.

Most Recent Episode Hypomaniac- in Bipolar I Disorder in the DSM-V

• Draft criteria for Bipolar I Disorder-Retain structure, with changes limited to the definitions of mood episodes that define each.
• Diagnostic Criteria for Bipolar I Disorder, Most Recent Episode Hypomanic
• A. Currently (or most recently) in a Hypomanic Episode (see __Criteria for Hypomanic Episode__).
• B. There has previously been at least one Manic Episode (see __Criteria for Manic Episode__).
• C. The mood symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• D. The mood episodes in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
• Specifiers and/or current features have not yet been reviewed by the Workgroup for bipolar disorder. It is anticipated that specifiers and/or features that apply across the mood disorders will be consistent across major depression and bipolar disorder. The bipolar specific rapid cycling specifier is under review to consider whether to keep as is, eliminate, or modify.