A manic episode It is defined by a specific period during which the mood is abnormal and persistent elevated, expansive or irritable. For its diagnosis, this state of mind must last for at least a week and must be accompanied by other symptoms such as highly exaggerated self-esteem, verbose language, little need for sleep, performance of high-risk activities, absence of self-criticism, among others. . All of this can lead to a significant deterioration in the social or work performance of the affected person and hospitalization may be required to prevent harm to themselves or other people around them.
In this Psychology-Online article, we explain everything you need to know about manic episode, its definition, symptoms and criteria for diagnosis.
Criteria for the diagnosis of a manic episode
Criterion A
This period of abnormal mood should last at least 1 week (or less if hospitalization is required). The mood disturbance must be accompanied by at least three other symptoms from a list that includes increased self-esteem or grandiosity, decreased need for sleep, verbose language, flight of ideas, distractibility, increased purposeful activities, or psychomotor agitation and excessive involvement in pleasurable activities with a high potential to produce serious consequences.
Criterion B
If the mood is irritable (rather than elevated or expansive), there should be at least four of the above symptoms.
It is characteristic that there is an exaggeration of self-esteem, which ranges from self-confidence lacking self-criticism to evident grandiosity that can reach delirious proportions. (Criterion B1). Subjects can give advice on matters about which they have no special knowledge (e.g., how to run the United Nations). Despite not having any special talent or experience, the subject can set out to write a novel or compose a symphony or seek publicity for an invention without any practical use. Delusional ideas of grandeur are common (e.g., having a special relationship with God or with some figure in the political, religious, or entertainment world).
Almost invariably, there is a decreased need for sleep (Criterion B2). The subject usually wakes up several hours earlier than usual, feeling full of energy. When the sleep disorder is severe, the subject can go days without sleep without feeling tired.
Manic-type speech is typically verbose, loud, rapid, and difficult to interrupt. (Criterion B3). Subjects can talk non-stop, sometimes for hours and without regard to the desires of others to communicate. Sometimes the speech is characterized by jokes, puns and funny impertinences. The subject may appear theatrical, with dramatic mannerisms and singing. Word choice may be more dominated by sounds than by meaningful conceptual relationships (e.g., assonances). If the subject’s mood is more irritable than expansive, the speech may be marked by complaints, hostile comments, or angry tirades.
Thoughts can be very fast, sometimes even faster than they can be verbalized. (Criterion B4). Some subjects with manic episodes report that this experience is similar to watching two or three television programs at the same time. There is frequently a flight of ideas that is manifested by an almost continuous flow of accelerated language, with abrupt changes from one topic to another. For example, while discussing a potential strategy for selling computers, a salesperson may go on to discuss in great detail the history of computer chips, the industrial revolution, or applied mathematics. When the flight of ideas is severe, language can become disorganized and incoherent.
The distractibility (Criterion B5) It is evidenced by the inability to block out irrelevant external stimuli (e.g., the interviewer’s tie, background noises from conversations, or room accessories). There may be a reduced ability to differentiate thoughts relevant to the topic from those that have little to do with it, or from those that are clearly irrelevant.
Increased intentional activity often involves excessive planning or participation in multiple activities (e.g., sexual, work, political, religious). (Criterion B6). There is usually an increase in sexual impulses, fantasies and behaviors.
The subject can take on several new companies at the same time, without taking into account the possible risks or the need to finish each of them well. Almost invariably, there is an increase in sociability (e.g., reconnecting with old acquaintances or calling friends or even strangers at any time of the day or night), regardless of the nosy, domineering, and demanding nature of these interactions. Frequently, these individuals demonstrate psychomotor agitation or restlessness, pacing or engaging in multiple conversations at the same time (e.g., on the phone and in person at the same time). Some people write a torrent of letters on different topics to friends, public figures or the media.
Expansiveness, unmotivated optimism, grandiosity, and poor judgment often lead to reckless involvement in pleasurable activities such as excessive shopping, reckless driving, unreasonable financial investments, and unusual sexual behavior, which can have serious consequences. (Criterion B7). The subject can provide himself with many unnecessary things (e.g., 20 pairs of shoes, expensive antiques) without having the money to pay for them. Unusual sexual behavior may include infidelity or indiscriminate sexual encounters with strangers.
Criterion C
The symptoms do not meet the criteria for a mixed episode, which is characterized by symptoms of both a manic episode and a major depressive episode, occurring almost every day for a period of at least 1 week.
Criterion D
The disorganization resulting from the disturbance may be severe enough to cause a significant deterioration in activity or to require hospitalization in order to protect the subject from the negative consequences of his actions, which are the result of the impoverishment of his critical judgment (p. (e.g., financial losses, illegal activities, loss of employment, aggressive behavior). By definition, the presence of psychotic symptoms during a manic episode results in a significant impairment of functioning.
The disturbance must be severe enough to cause significant social or occupational impairment or to require hospitalization, or be characterized by the presence of psychotic symptoms. The episode will not be due to the direct effects of a drug, medication, other somatic treatments for depression, or exposure to a poison.
Criterion E
The episode will not be due to the direct physiological effects of a medical illness (e.g., multiple sclerosis, brain tumor). The elevated mood of a manic episode can be described as euphoric, abnormally good, joyful, or high. While the subject’s mood may initially have an infectious quality to the outside observer, it is recognized as excessive by those who know the person well. The expansive quality of mood is characterized by incessant and indiscriminate enthusiasm in interpersonal, sexual or work interactions. For example, the subject may spontaneously initiate long conversations with strangers in public places, or a salesperson may telephone strangers’ homes first thing in the morning to begin sales. Although elevated mood is considered the prototypical symptom, the predominant mood disturbance is sometimes irritability, especially when the subject’s wishes are contradicted. Mood lability (eg, alternating between euphoria and irritability) is also frequently observed.
Symptoms similar to those found in a manic episode may occur as a result of the direct effects of an antidepressant medication, electroconvulsive therapy, light therapy, or a medication prescribed for some medical illnesses (e.g., corticosteroids). These conditions are not considered manic episodes and should not lead to a diagnosis of I. For example, if a person with major depressive disorder develops manic symptoms after antidepressant treatment, the episode is diagnosed as Substance-induced mood disorder, with manic symptomsand the diagnosis of major depressive disorder should not be changed to bipolar I disorder.
There is data suggesting that subjects who experience manic-like episodes after some somatic treatment for depression may have a bipolar diathesis. These subjects may be more likely to have future manic, mixed, or hypomanic episodes that are not related to substances or somatic treatments for depression. This may be an especially important consideration in children and adolescents.
Symptoms of the manic episode and associated disorders
It is common for subjects with a manic episode do not recognize that they are sick and who resist treatment attempts. They may travel impulsively to other cities, losing contact with family members or caregivers. They may change their clothing, makeup, or personal appearance toward a more striking or sexually suggestive style, which is unusual for them. They may also engage in activities that have a disorganized or strange quality (giving candy or money, or giving advice to any stranger they encounter). The manic episode may be accompanied by pathological gambling and antisocial behavior. Ethical considerations can be forgotten, even by people who are usually considered very responsible (e.g., a stockbroker may buy and sell securities inappropriately and without the knowledge or authorization of clients; a scientist may appropriate of the findings of others).
The subject may be hostile and physically threatening to others. Some subjects, especially those with psychotic symptoms, become physically aggressive or suicidal. The adverse consequences of a manic episode (e.g., involuntary hospitalization, legal problems, or serious financial problems) often result from impaired judgment and hyperactivity.
When they have overcome the manic episode, most subjects feel sorry for their behavior during the manic episode. Some subjects report having sharper senses of smell, hearing, or vision (e.g., colors appear brighter). When there are catatonic symptoms (e.g….