Hypomania

Overview
Hypomania (literally, below mania) is a mood state characterized by persistent and pervasive elated or irritable mood, and thoughts and behaviors that are consistent with such a mood state. It is distinguished from mania by the absence of psychotic symptoms and by its lower degree of impact on functioning. Hypomania is a feature of two mood disorders: bipolar II disorder and cyclothymia. Though hypomanic people are often associated with bipolar disorder, it is in this state that many creative talents are in their most productive and successful mood.

Episodes
According to the DSM-IV-TR, a hypomanic episode includes, over the course of at least 4 days, three or four of the following symptoms, depending on whether the predominant mood state is elation or irritability:


 * Perhaps the most noticeable symptom is pressured speech; rapid talking
 * inflated self-esteem or grandiosity;
 * decreased need for sleep;
 * flight of ideas or the subjective experience that thoughts are racing;
 * easy distractibility and attention-deficit (superficially similar to attention deficit hyperactivity disorder);
 * increase in psychomotor agitation; and
 * steep involvement in pleasurable activities that may have a high potential for negative psycho-social or physical consequences.

In the hypomanic state, people may feel like they can't slow their mind down, and that all these speeding thoughts are amazingly perfectly crafted. Some examples are speaking or writing in rhyme or alliteration without planning it first; quick responses to people talking; or the ability to improvise easily on the spot. In more severe cases, hypomanic people may actually hear constant music in their head, or see images in their mind racing by.

A very strange but possible symptom is actually emotional flattening, also known as blunted affect. A person may seem cold, uncaring, or arrogant. They may show little emotion at all.

Possible benefits
People with hypomania are generally perceived as being energetic, euphoric, overflowing with new ideas, and sometimes highly confident and charismatic, and unlike full-blown mania, they are sufficiently capable of coherent thought and action to participate in everyday activities. One in the state of hypomania might be immune to fear and doubt and have little social inhibition. They may talk to strangers easily, offer solutions to problems, and find pleasure in small activities.

Relationship to mood disorders
Cyclothymia is a condition of continued mood fluctuations between hypomania and depressive symptoms that do not meet the criteria for a Major Depressive Episode. These are often interspersed with periods of normal moods.

When a patient presents with a history of one or more hypomanic episodes and one or more depressive episodes that meet the criteria for a Major Depressive Episode, Bipolar II Disorder is diagnosed.

If left untreated, hypomania can slip deeper and deeper into mania (and sometimes psychosis), in which case, Bipolar I Disorder is diagnosed.

Treatment
It is unknown to what degree hypomanic symptoms can occur without a depressive component. Patients may be relatively unlikely to seek psychiatric treatment for hypomania alone. However, many hypomanic patients experience:


 * lower need for sleep
 * racing thoughts
 * obsessive behavior, whether mild or severe
 * poor judgment relative to a particular situation's judgment call
 * uncontrollable, or only partially controllable, impulsivity
 * excessive sexual activity

Plus other out-of-character behaviors that the person may regret following the conclusion of the mood episode.

Hypomania can signal the beginning of a more severe manic episode, and often does result in a more severe manic episode if the hypomanic episode remains untreated. A hypomanic episode can also directly precede a depressive episode.

Virtually all clinical trials of medications for the non-depressive phases of bipolar illnesses involve treating patients for psychotic mania during the initial, or acute, phase of mania. Such trials are the basis upon which appropriate medication is recommended; high doses are justified in the case of mania, in order to remove the patient from immediate danger. This is in direct contrast to hypomania, however, which involves different considerations and almost always demands much greater case-by-case clinical judgment. Typical prescribed medications for hypomania include mood stabilizers such as Depakote and lithium carbonate as well as atypical antipsychotics such as Zyprexa and Seroquel.

Famous people with hypomanic symptoms
Radiohead front man Thom Yorke reportedly responded, "Hypomania? Yes, that's exactly what it was," when asked about his mental state after the release of the group's classic album OK Computer. Iggy Pop was diagnosed with hypomania during his stay in a mental hospital in the mid 1970's. It has also been suggested that Richey Edwards, the "fatalistic Manic Street Preacher" (Mojo magazine, 2003) and the late Syd Barrett of the band Pink Floyd have experienced hypomania. In the biographical documentary An Unreasonable Man, it is speculated that Ralph Nader is also hypomanic. Honore de Balzac, French author of the Human Comedy is attributed with having hypomania; his writing sessions continued from midnight to noon, functioning on four hours of sleep. Intermittently during these episodes, Balzac would consume massive amounts of coffee. However, it is far from apparent whether these are based on psychiatric diagnosis--bipolar symptoms are frequently misunderstood, misattributed and glamorized in popular culture.

John Gartner's unverified book The Hypomanic Edge claims notable people including Christopher Columbus, Alexander Hamilton, Andrew Carnegie, Howard Zinn and Louis B. Mayer owe their innovativeness and drive, as well as their eccentricities, to hypomanic temperaments; critics, however, assert that Gartner vastly overstates his case. Within the book, though, Gartner does point out that the constructive behaviors associated with hypomania may contribute to bipolar disorder's evolutionary survival.