Mood disorder or hypomanic psychosis

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The hypomanic state is a mild form of manic disorder, characterized by an increase in mood, physical and mental performance, and hyperactivity that was previously unusual for a person. There are no psychotic symptoms (delusions and hallucinations).

• General information
• Etiology and pathogenesis
• Clinical types of hypomania
• Diagnostics
• Why is hypomania dangerous?
• Treatment
• Psychotherapy

General information

In a state of hypomania, a person is “ready to move mountains”; it seems that he is full of strength and energy. He gushes with ideas, makes plans, and develops vigorous activity. He feels great. Those around you are not overjoyed, especially your bosses at work. A person can perform large volumes of work, he has a surge of creative forces. Artists in this state produce masterpieces.

What's wrong with that? Such a “rise” lasts for several days, and is replaced by a loss of strength, nervous and physical exhaustion: a person tries to do something, to implement his many ideas, but is unable...

Everything begins to irritate him, the lack of understanding of those around him infuriates him even more, he becomes aggressive. A series of failures often leads to depression, and there may be suicide attempts.

Description

Episodes of hypomania usually begin suddenly, and symptoms quickly worsen over one or two days. An episode of hypomania can last anywhere from four days to several months, although some clinicians are beginning to argue that hypomanic episodes can last as little as two days. However, because such studies rely on self-reports from patients (who are typically unaware of their symptoms at first), there is no widespread agreement on this change in diagnostic criteria.

Etiology and pathogenesis

The etiology and pathogenesis of the disease have not been sufficiently studied. Factors that provoke the development of the condition are the following:

• Great overload at work, life in constant time pressure force some people to “support themselves” with psychostimulants, stimulants and energy drinks, and even antidepressants;
• pathological and physiological hormonal imbalance - hyperthyroidism, postpartum period, menopause;
• drug intoxication;
• therapeutic fasting or anorexia;
• organic diseases and brain injuries in the acute stage.

Where does the disease called hypomania come from?

There are many reasons that can provoke the development of the disease. Psychiatrists include the following as the main prerequisites for the development of hypomania:

• Organic changes in the brain. For example, traumatic brain injuries, strokes and others.
• Chronic stress, which is accompanied by constant nervous tension.
• Taking narcotic drugs and psychoactive substances with stimulant effects.
• Drinking large amounts of psychostimulant drinks. These include energy drinks, coffee, alcohol, and strong brewed tea (chifir).
• Independent and abrupt refusal of antidepressants prescribed by a doctor after taking them for a long time.
• Endocrine disorders such as menopause, postpartum depression and hyperthyroidism.

It is not always possible to determine the specific cause of the pathology. Psychiatric clinic specialists note that some patients have a hereditary predisposition to hypomania. It manifests itself in familial cases of the disease.

Clinical types of hypomania

There are pure and latent forms of hypomania.

Pure – classic hypomanic symptoms leading to aggression are clearly expressed:

• a person develops “violent activity”, devotes himself entirely to work, but cannot complete what he started, which is why he is constantly nervous and irritated;
• familiarity in communication, intrusiveness, verbosity, the desire to joke or give unnecessary advice. Having encountered misunderstanding and resistance, the patient becomes even more excited;
• inability to concentrate on something, the patient feels that everything is bothering him - bright light, loud speech, music, due to which he begins to sort things out with others;
• superficiality of judgment, frivolous actions, inability to adequately perceive constructive criticism addressed to oneself;
• reassessment of one's strengths and capabilities.

Hidden - the symptoms are the same as with pure, but there is no aggression. A person is constantly in high spirits, full of optimism, takes on everything at once, but does not get irritated and does not conflict with others.

Depending on the characteristics of the personality type, hypomania occurs:

• querulant - the patient actively “defends the rights” of himself and others, constantly writes complaints, goes to authorities, proves, accuses;
• dysphoric – angry irritable mood, hyperactivity gives way to aggression;
• adventuristic – a tendency to take risks;
• euphoric hypochondria - a person is constantly being examined, looking for “imaginary” diseases, having received negative results, does not believe, gets irritated, and starts looking again.

Based on the manifestation of affective symptoms, the disorder can occur in the form of cheerful or irritable (angry) hypomania.

Within the framework of cyclothymia, a productive type is distinguished, characterized by accelerated thinking, mild sleep disturbance, and slight distractibility.

With hypomania, a disinhibition of drives is possible, less pronounced than in a manic state: gluttony, increased libido, the inability to deny oneself pleasures, even if they are harmful to health or harm others - a craving for alcohol, drugs, gambling, wasteful shopping. The need for sleep decreases sharply.

Hypomanic psychosis

Hypomanic psychosis is a type of persistent mood disorder. This pathological condition has symptoms that are characteristic of manic syndrome. The patient is constantly hyperactive, and his state of joy is inadequate. Many patients experience excessive mood elevation. He is actively engaged in some activity or work (hyperproductivity). At the same time, patients try to perform several tasks simultaneously. Based on this, it becomes quite obvious that their enthusiasm cannot be called healthy. Despite all of the above, hypomanic psychosis cannot be compared in terms of significance, for example, with schizophrenia, since there are no personality changes and there are no particular deviations in behavioral norms. Hypomanic psychosis, like all mental disorders, must be treated in specialized institutions under inpatient supervision.

Diagnostics

According to the international classification of diseases ICD - 10, the diagnosis is established on the basis of abnormally elevated mood or irritability for 4 days and the presence of three or more of the following symptoms:

• excessive talkativeness;
• hyperactivity;
• distractibility;
• intrusiveness in communication and/or familiarity;
• reducing the need for sleep;
• frivolous behavior;
• increase libido.

To confirm the diagnosis, use the hypomania questionnaire HCL-32, or its abbreviated versions HCL-16, HCL-8.

Questions and answers

I am subject to frequent and sudden mood swings, I can move from joy to irritability and even aggression. Is this a symptom of hypomania?

Only a doctor can make a correct diagnosis based on examination, interviews with the patient and his relatives, as well as visual and laboratory diagnostic methods. Contact our clinic to get tested. We have been treating hypomania in Moscow for over 10 years. During this time, good practice has been developed, thanks to which we can return a person to a full life.

Why is hypomania dangerous?

The consequences of the condition can be divided into physiological and social.

Physiological:

• chronic lack of sleep;
• loss of strength, sharp decrease in performance;
• nervous exhaustion;
• obesity due to overeating, leading to metabolic disorders and somatic diseases;
• sexually transmitted diseases caused by promiscuity due to increased libido.

Social. Reckless behavior - gambling, waste, hooliganism, petty theft - can lead to the loss of family, home, property, and sometimes imprisonment.

All of the above provokes the development of depression, in some cases ending in suicide.

Complications

A person with hypomanic disorder may not seek medical help for a long time, regarding irritability and hyperactivity as character traits. With a late start of treatment for hypomania, the patient develops additional disorders:

• General fatigue associated with overwork due to lack of sleep. This leads to a loss of the ability to concentrate on simple tasks and memory impairment. During the day there is constant drowsiness.
• Chronic overeating or undereating can lead to obesity or malnutrition. Against this background, the development of vitamin deficiencies, frequent infectious diseases and exacerbation of chronic pathologies is possible.
• Against the backdrop of frivolity and extravagance, patients often have financial problems. They are often fired from their jobs and expelled from educational institutions. Close people stop being friends with them, and those around them try to completely reduce contacts to a minimum. When apathy occurs, a person is unable to cope with these situations.
• Periods of activity are followed by depression, which can persist for several months. A depressive state increases the adverse effects of hypomania and negatively affects a person's prognosis.

Complications of a hypomanic state occur more often in children and people with a dysfunctional lifestyle.

Treatment

During the period of “great health”, people, as a rule, do not turn to specialists. If relatives notice a previously unusual increase in mood or hyperactivity, it is necessary to persuade the patient to visit a doctor. But usually the doctor is “visited” already while in the ambulance...

In case of serious complications - physical exhaustion, refusal to eat, deep depression, treatment takes place in a hospital, where the patient is given intravenous drip solutions of nutritious protein preparations and glucose. Restores the functioning of the cardiovascular, respiratory, and digestive systems. Activate the patient's vitality.

For symptoms of depression, antidepressants are prescribed, but it must be remembered that with an overdose, a relapse of hypomania is possible.

After recovery from the acute condition, therapy is continued at home. Treatment includes medications (mode stabilizers, sedatives, tranquilizers) and psychotherapy.

Psychotherapy

Psychotherapy is aimed at making the patient aware of the fact that a periodically occurring state of unprecedentedly elevated mood and thirst for vigorous activity is a pathology that requires treatment. The patient must understand that with proper treatment the condition can be completely relieved, but much depends on himself, the desire to get rid of hypomania and prevent the consequences.

The following types of psychotherapy are used:

• cognitive – the patient is informed about the causes, symptoms and consequences of hypomania, helped to accept his condition, and find ways out of it;
• interpersonal – the patient is taught skills of conflict-free communication with others, methods of increasing self-esteem;
• family – carried out with the patient and his household in order to create an atmosphere of mutual understanding and support in the family.

Forecast

The state of hypomania can last up to 2 months. An undetected primary episode can develop into manic psychosis.

Relapse of hypomania is already considered within the framework of bipolar affective disorder (BD). The alternation of hypomania and a severe depressive episode, according to DSM-IV, is classified as type II bipolar disorder. According to statistics, the frequency of repeated episodes of hypomania within bipolar disorder is 50% per year.

Prevention

To reduce the risk of developing a hypomanic state, you must adhere to the following recommendations:

1. Try not to overload. Under unbearable physical and mental stress, time pressure at work and in everyday life, a person begins to uncontrollably use psychostimulants, tea, coffee, energy drinks (in order to have the strength to work “through I can’t”).
2. Be able to say “no” to your boss, count on your strengths, respect yourself both at work and at home. At home, distribute responsibilities among family members, and not take everything upon yourself.
3. Learn to relax, have fun, enjoy the little things. Find time for your favorite activities.
4. Treat chronic diseases in a timely manner, undergo annual medical examinations with doctors of all profiles, and monitor your condition. If there is the slightest deviation from the norm, consult a specialist.
5. Do not go on fad diets without consulting your doctor.
6. Do not drink alcohol or drugs.
7. Try to lead a healthy lifestyle - follow a routine, eat right, get enough sleep, do gymnastics, walk in the fresh air.

Prevention of relapses consists of strictly following all medical prescriptions, taking medications in a timely manner, without changing the dose or discontinuing medications on your own. Relatives and friends of the patient should create the most comfortable, calm environment at home and at work with the opportunity to relax, become his support and support.

Author of the article: Veits Alina Emilievna, psychiatrist, candidate of psychological sciences

Prevention

There are a number of warning signs of hypomania. If patients can be taught to recognize such early warning signs, they will be more likely to use a variety of techniques that will help reduce the likelihood of acting out and the negative consequences of misbehaving that can be associated with hypomania. Addressing such warning signs can also give patients and their doctors more time to adjust medications or initiate more careful monitoring to reduce the potential harm from inappropriate behavior.

Here are some of the typical early warning signs of an impending hypomanic episode:

• sleep disturbance;
• reduction of causeless anxiety;
• high levels of optimism without proper thoughtful planning and problem solving (for example, believing that everything will be fine even though nothing has been done to make it happen);
• an increased desire to be with others coupled with relatively poor listening skills (eg, having a long conversation with someone who clearly wants to leave);
• decreased mental concentration (such as difficulty completing a task or more disorganization than usual);
• increased libido to the extent that it affects other areas of life (for example, dressing more provocatively than usual, or inappropriate conversations or jokes about sex);
• increasing goal-directed behavior to the point that the person appears to be controllable.

According to CBT, if a patient can be taught to recognize the signs of an impending hypomanic episode early enough, he or she will have the time needed to practice the various techniques already discussed to help avoid the negative consequences of potentially risky activities.

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