Table of contents:

1. What is bipolar affective disorder?
2. Hypomania - symptoms
3. Hypomania and productivity
4. Is it already hypomania?
5. Hypomania Checklist-32 questionnaire (HCL-32)
6. What is the difference between hypomania and mania?
7. Hypomania - should I treat it? How to treat?
8. When is hospitalisation in a psychiatric unit required?

What is bipolar affective disorder?

Bipolar affect ive disorder (bipolar affective disorder, or formerly manic-depressive illness/psychosis or cyclophrenia) is a mood disorder in which mania or hypomania, depression and a so-called mixed episode can occur in the same person. Any combination of these episodes is possible in the course of the illness. Between episodes there is a state of remission, that is, a state without symptoms or with discrete symptoms. The disease is chronic and relapsing.

Who is affected by bipolar affective disorder? Usually young people, both men and women (in equal frequency). The first incidence is usually before the age of 20. The illness is usually diagnosed between the ages of 20 and 30.

Hypomania - symptoms

• Excessive cheerfulness.
• Irritability.
• Accelerated train of thought.
• Multitalking, multi-talking.
• Distraction.
• Increased creativity.
• Increased activity or goal-directed energy.
• Decreased need for sleep.
• Increased social, sexual activity or motor arousal.
• Willingness to engage in risky, reckless, impulsive behaviour.
• Sudden self-confidence.
• High self-esteem.

The state of morbidly heightened mood lasts for a minimum of 4 days and can lead to serious disorganisation of psychosocial life. A person in a hypomaniacal state suddenly, for no discernible reason, exudes joy, indefatigable energy, sleeps for several hours a day or hardly sleeps at all. He or she works a lot, but usually does not finish the activities he or she has started, abandons them easily and becomes irritable quickly.

Undertakes risky, reckless activities (e.g. imprudent purchases, incurring debts, big trips). Becomes irritable, has difficulty concentrating and focusing. Easily makes, often risky, social, sexual contacts. Speaks quickly, is chaotic, does not allow anyone to speak.

Hypomania and productivity

On the other hand, it is a state of greater productivity, creativity and intense success. Patients in this state tend to be the most successful professionally, and the most prolific periods in the work of artists suffering from BPAD are precisely during hypomania. Vincent van Gogh one of the greatest painters of all time struggled with BPAD with periodic psychotic episodes. Similarly, prominent writers Ernest Hemingway, Zbigniew Herbert, as well as Irving Berlin, author of White Christmas, among others, and many other prominent artists.

Many times, neither the patient nor his family and friends regard hypomania as an abnormal condition. They mistakenly believe that it represents a period of transformation, of development, of realising one's potential, a period of success. They do not see any danger. In this phase, however, there is a serious risk of hypomania developing into the chaos of mania - a disorder that is very destructive and debilitating for the family, hence the need to be particularly vigilant and to contact a psychiatrist if there is any doubt.

Hypomania - symptoms, diagnosis, treatment of affective disorders, photo: panthermedia

Is it already hypomania?

How do you distinguish hypomania from a naturally elevated mood?

In many cases this is difficult to assess. As a supportive measure, the HCL - 32 (Hypomania Check List) questionnaire - a hypomania symptom questionnaire - has been developed in which the patient self-reports questions about drive, mood and activity.

Hypomania Checklist-32 questionnaire (HCL-32)

Try to recall a time when you were in a "high" state. How did you feel at the time?

In this state: YES/NO

1. I need less sleep.
2. I feel I have more energy and activity.
3. I am more confident.
4. I enjoy my work more.
5. I have more social contacts (call more, go out more).
6. I want to travel and I travel more.
7. I tend to drive faster and take more risks when I drive.
8. I spend more/too much money.
9. I take more risks in my daily life (at work and during other activities).
10. I am more physically active (sports, etc.).
11. I plan more activities or projects.
12. I have more ideas and am more creative.
13. I am less shy or inhibited.
14. I dress more colourfully and have more extravagant things/make-up.
15. I want to meet or actually meet more people.
16. I am more interested in sex and/or have an increased sex drive.
17. I flirt more and/or have an increased sex drive.
18. I talk more.
19. I think faster.
20. I joke more when speaking.
21. I get distracted more easily.
22. I get involved in many new things.
23. My thoughts jump from topic to topic.
24. I do things faster and with more ease.
25. I am more impatient and/or get frustrated more easily.
26. I can be tiresome or irritating to others.
27. I argue more often.
28. My mood is better, more optimistic.
29. I drink more coffee.
30. I smoke more cigarettes.
31. I drink more alcohol.
32. I take more medication (sedatives, anti-anxiety, stimulants).

A positive answer to 14 or more questions may indicate a significant likelihood of having bipolar spectrum disorder. The questionnaire score itself has only indicative value and does not imply a diagnosis; it needs to be verified by a psychologist or psychiatrist. And the diagnosis itself is made on the basis of a psychiatric examination.
Polish translation of the questionnaire: Rybakowski J.K., Dudek D., Pawłowski T., Łojko D., Siwek M., Kiejna A., Rybakowski F

What is the difference between hypomania and mania?

In principle, the symptoms are similar, differing only in duration and severity and in the presence of psychotic symptoms. Hypomania also does not normally require hospitalisation.

In hypomania, compared to a manic episode, there are fewer symptoms, they are less intense and last for several days (a minimum of seven days for mania and four days for hypomania) and there are no psychotic symptoms, i.e. delusions of grandeur (the patient's belief, for example, that he is Lord, the Great Creator of the New World) persecutory (the patient's belief that he is being followed, overheard or harassed, for example by the Mafia) and other symptoms. Patients are partly in control of their behaviour and partly critical of it, which is often associated with markedly fewer consequences than in a manic episode.

Hypomania - should it be treated? How to treat?

Hypomaniacal syndrome usually requires treatment, mainly normothymic, i.e. mood-stabilising drugs are used, and treatment is usually carried out in an outpatient setting. Hospitalization is not normally required. The aim of treatment is to prevent hypomania from progressing to a manic state or to a depressive state where there is a high risk of suicide.

Normothymic drugs include: lithium, some antiepileptic drugs (carbamazepine, lamotrigine, valproic acid), antipsychotics (neuroleptics: olanzapine, aripiprazole, quetiapine). Normothymic drugs are used in the acute phase of the illness (hypomania, mania, depression), but also in a state of balanced mood (euthymia), to prevent relapse.

When is hospitalisation in a psychiatric unit required?

• When there are intense symptoms over a short period of time.
• When there is a history of hypomanic episodes progressing to manic states in this particular patient.
• When the patient does not maintain a clear critical attitude towards his/her behaviour.