Hypomania
| Classification according to ICD-10 | |
|---|---|
| F30.0 | Hypomania |
| ICD-10 online (WHO version 2019) | |
The hypomania denotes an attenuated form of mania ( hypo , "below" or "beneath"). It manifests itself in phases of a slightly elevated mood and increased drive . Mostly these alternate with depressive phases. In relation to the general population, the possibility of developing such bipolar hypomania at some point in life is estimated at 1 to 3%.
Symptoms
The symptoms correspond to those of a weakened mania . Characteristic are the (slightly) elevated mood and the increased drive . In the hypomanic episode is self-esteem very or overly large, there is an increased risk , a very pronounced sociability , a tendency to undue confidentiality and the tendency to limit violations in the social field. The slight euphoria can also be replaced by irritability and - especially in adolescents - rough behavior. There can also be changes in thinking , which then becomes extremely erratic and associative .
During hypomania, the ability to perform, perceive and make associations are objectively increased to a great extent. However, states of exhaustion can in turn drastically reduce these abilities. The person concerned sleeps longer and their appetite can be significantly changed, they either eat a lot more or a lot less than someone who does not suffer from hypomania.
Clinic and course
According to DSM IV , symptoms must have recurred over a period of at least two years and have persisted for at least four days for hypomania to occur. Episodes can last a few days or several months. Symptoms and their severity vary from person to person and from time to time.
A single more or less pronounced hypomanic episode can remain, but they are mostly repeated. In the majority of cases, the hypomania is repeatedly followed by depressive episodes . With its opposite course, the disease is called " cyclothymia " or " bipolar disorder type II", but ICD-10 does not classify cyclothymia as bipolar disorder. Often times, the depressive episodes are more frequent and longer than the hypomanic. If hypomanic symptoms occur at the same time or in very rapid alternation with depressive symptoms, one speaks of a " mixed episode " or a "mixed state". In it, those affected feel excited and driven and at the same time discouraged and depressed. There can be extended symptom-free periods between episodes, which may last for months. There is a small risk of worsening to bipolar disorder type 1 with clearly manic phases.
A hypomanic person often has problems with their own social environment because of their increased urge to talk ( logorrhea ), their increased sex drive and their need for more sociability. He also often has a distorted perception of others, so that he unjustifiably ascribes behavior directed against him (e.g. aggressiveness).
Since the cyclothymically disturbed person feels fine during a hypomanic episode, he generally lacks insight into the disease. But there are certainly those affected who, since they have already gone through several phases and have thoroughly dealt with the hypomania, are able to recognize the beginning of a hypomanic phase and take appropriate countermeasures. This can be psychoeducation or attending a self-help group .
diagnosis
In the “International Statistical Classification of Diseases and Related Health Problems” - version 2013: ICD-10 - hypomania is classified as a mental disorder that can also be associated with “significant impairment of professional activity or social activity”. The main symptoms are an elevated mood that lasts for several days, combined with increased drive.
According to the Diagnostic and Statistical Manual of Mental Disorders - 1994 version: DSM-IV - hypomania is not a disorder, but a mood condition that can be part of bipolar disorder II or cyclothymia . According to DSM-IV, serious impairment, severe suffering or psychotic symptoms must not be present in a hypomanic episode .
Frequently, the hypomania is not recognized by either the person affected or the doctor, since the person affected is usually in good spirits by definition and does not feel sick. If depression also occurs, the diagnosis is therefore often incorrectly unipolar depression . It may take years before bipolar disorder is detected. Standard psychological tests are available to help identify an acute hypomanic episode. A life review and a mood calendar or mood diary can also help with the diagnosis.
The symptoms of hypomania are typical of the serotonin syndrome (see point F and note under diagnosis / symptoms according to DSM-IV ), a consequence of the accumulation of serotonin through drug therapy and interaction with antidepressants , in particular selective serotonin reuptake inhibitors (SSRIs).
Diagnosis / symptoms according to DSM-IV
The DSM-IV describes hypomania as follows:
A. A marked period of constantly elated, exuberant, or irritable mood, lasting at least four days, that is clearly different from the usual non-depressed mood.
B. During the mood disorder phase, three (or more) of the following symptoms (four when mood is just irritable) are persistent to some degree:
- excessive self-esteem or megalomania
- decreased need for sleep (e.g. a person affected feels recovered after 3 hours of sleep)
- extraordinary talkativeness or urge to speak
- Flight of ideas or subjective experience of racing thoughts
- Absent-mindedness (this means focusing on insignificant or insignificant external stimuli)
- Increase in targeted activities (either social, professional, or school, or sexual or psychomotor restlessness)
- excessive engagement in amusements that have highly painful consequences (e.g. unrestrained shopping spree, sexual indiscretions, or reckless business investments)
C. The episode is accompanied by changes in performance or behavior that are atypical for the person in symptom-free periods.
D. The mood disorder and the change in appearance are registered by others.
E. The episode is not severe enough to cause significant social or professional impairment, or to require hospitalization, and does not have any psychotic characteristics.
Q. The symptoms are not caused by the direct physiological effects of a substance (e.g., drugs, medication, or other treatment) or by any general medical condition (e.g., overactive thyroid).
Note (in DSM-IV): Episodes similar to hypomania, which are clearly caused by somatic antidepressant treatment (medication, electroconvulsive therapy (ECT), light therapy), should not be assigned to a diagnosis of "bipolar disorder type II".
Causes and Triggers
Changes in brain metabolism can be detected during hypomanic episodes . The number and effect of individual neurotransmitters such as serotonin and dopamine in the brain have changed.
The causes of hypomania are not clearly understood. The most popular theory is the vulnerability-stress model . According to this, there is a biological and / or genetic disposition (predisposition) for hypomania. Stress or a stressful way of life and life situations then lead to the outbreak of an episode.
The behavior caused by such a trigger is not what is generally considered appropriate. So takes z. B. the joy of a positive event is longer or more intense than in symptom-free times. Objections that could diminish the feeling are pushed aside.
Hypomania-like states are also occasionally reported by healthy individuals after sleep deprivation, for example after night shifts.
Antidepressants can cause manic or hypomanic mood states in individual cases.
therapy
Individual hypomanic episodes do not always require treatment, since the social or occupational impairments are, by definition, not serious.
If the hypomanic episode occurs as part of a bipolar disorder or cyclothymia or if the person concerned suffers from the consequences of hypomania, treatment with psychotherapy , psychoeducation and / or psychotropic drugs may be indicated. The aim of therapy is to reduce the frequency, duration and severity of the episodes that occur. Ideally, there will be no more episodes.
Sedatives and sleeping pills can be used to treat individual symptoms .
Phase prophylactic drugs that are taken continuously reduce the likelihood of recurrence (occurrence of new episodes) in bipolar disorder.
literature
- Michael Bauer (Ed.): White Paper Bipolar Disorders in Germany, State of Knowledge - Deficits - What needs to be done? . 2nd Edition. Norderstedt 2006, ISBN 978-3-8334-4781-5 .
- Andreas Marneros : The hypomania and the bipolar II disorder , in: The new manual of bipolar and depressive diseases , Thieme, Stuttgart [u. a.] 2004, ISBN 3-13-109092-8 , pp. 113-118.
