Hypomania

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Hypomania a mood state characterized by persistent disinhibition and euphoria, with behavior that is noticeably different from the person’s typical behavior.


Hypomania may involve irritability.


Hypomania is distinct from mania in that there is no significant functional impairment; mania, does include significant functional impairment and may have psychotic features.


Characteristics of hypomania: are a decrease in the need for sleep, increase in energy, unusual behaviors and actions, and a markedly distinctive increase in talkativeness and confidence, commonly exhibited with a flight of creative ideas. 


Other symptoms related of hypomanis include feelings of grandiosity, distractibility, and hypersexuality.


Hypomanic behavior often generates productivity and excitement.


Hypomania, , is a lowered state of mania that does little to impair function or decrease quality of life.


Hypomania  ay actually increase productivity and creativity. 


Hypomania, is associated with less need for sleep and it increases goal-motivated behavior and metabolism.


Hypomanic behavior is troublesome if the subject engages in risky or otherwise inadvisable behaviors, or  manifests in trouble with everyday life events.


The hypomanic state is associated with decreased need for sleep, extreme gregariousness and competitiveness , and a great deal of energy. 


The hypomanic individual is often fully functional, unlike individuals suffering from a full manic episode.


It is distinguishable from mania by the absence of psychotic symptoms, and by its lesser degree of impact on functioning.


Hypomania is seen with bipolar II disorder and cyclothymia, but can also occur in schizoaffective disorder.


It is also a feature of bipolar I disorder.


Hypomania arises in sequential procession as the mood disorder fluctuates between normal mood and mania. 


Some individuals with bipolar I disorder have hypomanic as well as manic episodes. 


Hypomania can also occur when moods progress downwards from a manic mood state to a normal mood. 


Hypomania can, if the prominent mood is irritable as opposed to euphoric, be a rather unpleasant experience. 


Hypomania is sometimes credited with increasing creativity and productive energy, giving people an edge on  their work.


Cyclothymia, refers to a condition of continuous mood fluctuations of hypomania and depression that fails to meet the diagnostic criteria for either manic or major depressive episodes. 


In Cyclothymia periods are often interspersed with periods of relatively normal functioning.


With a history of at least one episode of both hypomania and major depression, each of which meet the diagnostic criteria, bipolar II disorder is diagnosed. 


In some cases, depressive episodes occur during the fall or winter and hypomanic ones in the spring or summer: seasonal pattern.


If left untreated, and in the predisposed, hypomania may transition into mania, which may be psychotic, in which case bipolar I disorder is the correct diagnosis.


In patients experiencing  their first episode of hypomania, generally without psychotic features, there may be a long or recent history of depression or a mixed-state, prior to the emergence of manic symptoms. 


Hypomania commonly surfaces in the mid to late teens. 


Hypomania can be associated with narcissistic personality disorder.


Norepinephrine and dopaminergic drugs are capable of triggering hypomania.


The depression and mania in bipolar individuals suggests  that decreased serotonergic regulation of other monoamines can result in either depressive or manic symptoms. 


Lesions on the right side frontal and temporal lobes have been associated with mania.


Diagnosis of a hypomanic episode 

 includes: over the course of at least four days, elevated mood plus three of the following symptoms OR irritable mood plus four of the following symptoms: 


pressured speech


inflated self-esteem or grandiosity


decreased need for sleep


flight of ideas or the subjective 


experience that thoughts are racing


easily distracted


increase in goal-directed activity or psychomotor agitation


involvement in pleasurable activities that may have a high potential for negative psycho-social or physical consequences 


Treatment:


Antimanic drugs are used to control acute attacks and prevent recurring episodes of hypomania combined with psychological therapies: length of treatment ranges from 2 years to 5 years. 


Anti-depressants may also be required, but are best avoided in patients who have had a recent history with hypomania.


Other anti-manic drugs that are not antipsychotics include:


Carbamazepine


Clonazepam


Lorazepam


Lithium


Valproate


Other drugs that are less effective include:


Gabapentin


Lamotrigine


Levetiracetam


Oxcarbazepine


Topiramate


Ziprasidone


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