Hypomania is one of the affective disorders (mood disorders), characterized by a mild degree of mania and the absence of psychotic symptoms (hallucinations, delusions).
Most patients with hypomanic conditions do not seek medical help because they consider themselves healthy, so there is no accurate data on the prevalence of the disorder.
Hypomania – affective mood disorder
Causes and risk factors
Hypomania occurs due to the following reasons:
- hormonal imbalances (menopause, postpartum syndrome, hyperfunction of the thyroid gland);
- long-term adherence to a low-calorie diet or anorexia;
- taking certain medications (opiates, teturam, yohimbine, Bromocriptine, Captopril, Baclofen, Levodopa, Cyclosporine);
- abrupt withdrawal of antidepressants;
- abuse of psychostimulant drinks (strong coffee, cola, energy drinks);
- organic brain lesions of non-infectious and infectious origin;
- hereditary predisposition;
- stress.
In some cases, hypomania turns into full-fledged mania or is replaced by depression. It is possible to achieve stable remission only in some patients.
Pathogenesis
Regardless of the cause of the development of hypomanic disorder, its manifestations include disorders of both the affective and somatopsychic spheres.
A persistent high mood is combined with an increase in overall tone, a feeling of well-being and excessive optimism. Pathologically altered affect is accompanied by a change in self-esteem towards a boastful exaggeration of one’s own merits, a conviction of one’s own infallibility and originality appears, and ideas of superiority are observed. There is no subjective critical attitude towards the disorder.
Any opposition or objection causes irritation and anger, but in most cases these signs are labile.
The pace of thinking in a person with hypomania accelerates, and speech loses expressiveness due to the fast pace. The person is unfocused, but at the same time has inexhaustible energy - such patients perform even routine work with a special emotional uplift, and also take on the implementation of many plans, without doubting their feasibility.
The patient has a special physical well-being, accompanied by a high threshold of fatigue and resistance to stress. The need for rest and sleep is reduced.
Somatopsychic signs may be dominant in the clinical picture of the disease.
Hypomania can develop within periodically repeating phases or become protracted.
During cyclothymic phases, hypomanic disorder is clearly defined in time and is characterized by a noticeable rise in mood.
The protracted course of hypomanic disorder is characterized by persistent affect. It can proceed according to the productive type, but atypical variants are also possible (presence of overvalued formations, rudimentary obsessions, depressive pain syndrome).
The relatively smooth course of hypomanic disorder can be interrupted by transient somatization disorders (vegetative crises, vital fear, asthenia, disorders of self-awareness, etc.).
Since hypomania is most often observed as part of bipolar affective disorder (BD), it is often followed by depression. Hypomania and depression can be separated by periods of even mood, but they can also alternate continuously.
In most cases, bipolar disorder has an early onset (childhood and adolescence) and a chronic course.
The course of bipolar disorder can be:
- remitting (episode – remission – episode);
- with dual phases (one episode is immediately replaced by another, opposite in polarity);
- continuous (no periods of remission between episodes).
Complete euthymic remission is observed only in some patients.
The course of the disease may become more severe over time, giving way to a more severe painful state (mania). With age, the duration of the intervals between episodes decreases.
On average, the duration of episodes ranges from 2 weeks to 2 months.
The rhythm of episodes does not depend on the individual, so patients with bipolar disorder suffer from significant instability and self-doubt. According to WHO, bipolar disorder is one of the top ten diseases that cause disability. In addition, the risk of suicide is higher in bipolar disorder than in unipolar depression.
Types of disease
Depending on the predominance of certain disorders in the clinical picture, several types of hypomania are distinguished:
- simple, or cheerful;
- angry or irritable (expansive);
- adventurous;
- Querulant - manifests itself in the form of a craving for litigiousness, a desire to constantly fight for one’s “violated” rights;
- dysphoric – characterized by the appearance of hostility towards others, irritability, intolerance.
Hypomania can be cheerful, angry, querulant, dysphoric
Often in clinical practice, an atypical form of hypomania is observed - euphoric hypochondria. In this form of the disease, patients believe that they are suffering from a serious disease and spend all their energy on its diagnosis and treatment.
Based on the severity of symptoms, they are distinguished:
- pure (overt) hypomania (symptoms are quite clearly expressed);
- latent hypomania (occurs in an erased form, often disguised as other pathologies).
Hypomania happens in the following cases:
- remitting – characterized by a wave-like course, in which an episode of affective disorder is replaced by remission, and then the disease worsens again;
- continuous – there is no remission between episodes;
- with dual phases - manifested by the replacement of one episode of mood disorder by another, but with the opposite polarity.
General information
Mood disorders as early as the 5th century BC. e. were divided into melancholy and mania (these terms were used by Hippocrates in his writings).
After 1896, all mood disorders, according to the concept of E. Kraepelin, began to be classified as manic-depressive psychosis (MDP). The concept of MDP, covering both manic-depressive and depressive mood disorders, remained mainstream throughout the 20th century.
In the 60s of the XX century. The heterogeneity of MDP was noted in the studies of Angst, Perris and Vinokur, who distinguished unipolar and bipolar forms of this disorder.
In 1976, Danner identified 2 types of TIR:
- Type I, in which alternating episodes of depression and mania (severely elevated mood causing a serious impairment of functional status);
- Type II, in which depression alternates only with hypomania (elevations in mood that do not cause serious disturbances).
According to the ICD-10, adopted in 1990, there are 3 degrees of severity of mania (hypomania, mania without psychotic symptoms and mania with psychotic symptoms).
A mood disorder is considered an episode of disorder if it lasts about 1 week in the case of mania of any severity.
In hypomanic states, most patients consider themselves healthy and do not consult a doctor (they can be observed in connection with somatic diseases by general medical practitioners).
Due to the fact that MDP remains unrecognized for a long time in many patients, and in hypomanic disorder the diagnosis of “recurrent depression with short periods of elevated mood” is often made, there are no accurate data on the prevalence of hypomania.
Symptoms
Symptoms of hypomania are varied:
- irritable or euphoric mood, which is not the norm for a particular person and persists for several days;
- increased physical activity;
- too fast rate of speech, talkativeness;
- decreased concentration;
- decreased need for rest;
- reduction of sleep time;
- recurrent episodes of illogical or reckless behavior;
- familiarity;
- abnormal communication skills;
- bulimia;
- increased libido, satyriasis and nymphomania.
When hypomania occurs against the background of a hyperthyroid state, the following are added to the above symptoms:
- increase in body temperature up to 38 °C;
- symptom of the setting sun (when the eyeball moves downwards, the upper eyelid does not keep up with it, as a result of which a white stripe becomes noticeable between it and the iris);
- tremor of the limbs.
How dangerous is the disorder?
Hypomania is often perceived as a gift from above: you don’t want to sleep, you have time to work, and communicate, and live “to the fullest.” It would seem that what’s wrong with a person living happily during this period of his life? Nothing, provided that he does not harm his mental and physical health.
But usually people experiencing manic hyperactivity are unable to adequately evaluate their actions. They overestimate their own capabilities. And this inevitably leads to loss of strength, apathy and a decrease in quality of life:
- Chronic lack of sleep, in addition to reducing the ability to concentrate and impairing memory, accumulates fatigue. A period of working without sleep and without rest is replaced by constant drowsiness and “fog” in the head.
- Poor nutrition and gluttony threaten vitamin deficiency and obesity. Immunity decreases, chronic diseases worsen.
- Extravagance and a frivolous attitude to life confront a person with financial problems. And the ensuing apathy prevents you from pulling yourself together and trying to correct the situation.
- For days of increased activity, you have to “pay” for months, and sometimes years, of deep depression. The longer the “take-off” period lasted, the more painful and difficult it was to get out of apathy later.
Thus, an inadequate perception of reality that accompanies hypomania leads to loss of control over the situation, conflicts at work and poor relationships with loved ones.
There are many known cases of hypomania in creative people. Some writers and composers could live with inspiration for several months in a row, creating masterpieces of art and literature. But after a period of creative growth, they experienced a period of burnout. Wanting to “reanimate” lost inspiration, some of them tried to stimulate themselves with alcohol and drugs, but temporary insights were replaced by even greater “failures.”
Hypomania syndrome is dangerous due to its consequences and a person’s desire to regain their former energy by any means.
Features of hypomania in children
The main manifestations of hypomanic state in children and adolescents:
- impulsiveness;
- grimacing;
- tendency to gross pranks;
- speech disinhibition;
- stubbornness and disobedience;
- motor disinhibition, fussiness in movements;
- a sharp increase in the severity of manifestations of instincts (for example, a craving for masturbation or gluttony);
- difficulty falling asleep.
Children with hypomania are characterized by stubbornness and disobedience.
Diagnostics
The diagnosis is made if the patient has an abnormal mood (irritable or euphoric) for more than four days, combined with increased physical and mental activity, disinhibition, decreased need for sleep, and increased appetite.
To determine the cause of hypomania, consultations are held with an endocrinologist, neurologist, and narcologist.
In clinical practice, an atypical form of hypomania is observed - euphoric hypochondria. Patients believe that they suffer from a serious disease and spend all their energy on its diagnosis and treatment.
Symptoms
Hypomania is usually accompanied by a large number of symptoms. One of the main signs that is common to almost all patients is excessive aggression. It occurs in a number of cases:
- An individual who works with great fanaticism on a project is convinced that everyone around him is trying to interfere with his activities.
- The need for a lot of communication with other people.
- A strong desire to do everything better than everyone else, as a result of which the individual refuses to sleep.
- The personality does not accept adequate criticism and reacts aggressively to every remark.
Such symptoms of hypomania are inherent in the pure form. Hidden hypomania manifests itself in almost the same way. The difference is that hidden hypomanes are less conflicting. They do not see the real picture of what is happening, they accept criticism normally and strive to regularly communicate with new people. To help someone, they may take on the most difficult tasks and not expect any benefit from it.
Hypomaniacs are also characterized by other signs:
- greed for food;
- excessive sexual arousal;
- strong desire to drink alcohol;
- shopping addiction (obsessive desire to shop).
Such a person constantly feels a surge of energy that has nowhere to go. Pure hypomania can affect the patient’s life in a negative way.
Treatment
Treatment of hypomania is aimed primarily at eliminating the causes that caused it. In case of overdose of caffeine and other psychoactive substances, detoxification therapy is prescribed. If hypomania develops as a result of dysfunction of the thyroid gland, therapy with thyreostatic drugs is indicated, and in some cases, surgical treatment.
If hypomania is caused by hyperfunction of the thyroid gland, the use of thyreostatics is indicated
To relieve the symptoms of hypomania, patients are prescribed mood stabilizers (mode stabilizers) and benzodiazepine-type sleeping pills. If standard therapy does not lead to improvement, atypical antipsychotics may be additionally prescribed.
Negative consequences
Hypomania is a phenomenon in which high mood turns into unhealthy carelessness. The thirst for performing a large number of actions reduces the duration of sleep, leading to insomnia.
Communication turns into intrusiveness and annoying people. Healthy confidence comes from self-confidence. Irritability gives way to aggression.
This syndrome poisons people's lives. Families and relationships with people are destroyed, and one’s position in society is lost. Health indicators are deteriorating.
- The development of VSD, psychosis or other mental illnesses is possible.
- Deterioration and memory loss.
- Decreased immunity, vitamin deficiency, disruption of the gastrointestinal tract.
Untreated hypomania can lead to psychosis
