Educationals

CLINICAL FEATURES
MANIC OR HYPOMANIC EPISODE

The clinical features of manic and hypomanic episode are by and large the same but differ in severity. Unlike manic episodes, in hypomanic episodes the disturbances are not severe enough to cause impairment in social and occupational functioning and generally do not necessitate hospitalization.

Euphoria and Elation

Patients feel very happy. They exhibit good humour which is infectious in nature. They may express their happiness by singing popular hit numbers and dancing. A 70 year old patient was singing 'Tu chiz badi hai mast mast...' a hit Hindi film song, during his manic episode. During the episode he may be generally jovial and cheerful but when he is stopped from doing certain activity or is provoked he may become irritable, angry, abusive and violent. Another clinical manifestation of this euphoria is the over familiarity which many of the patients have during the manic episode. Sometimes the mood during the manic episode may be more irritable than euphoric (disphoric mania) due to which they make themselves a source of nuisance and annoyance.

Inflated self-esteem and grandiosity

He may appear to have an air of confidence. He may feel that he is very rich and famous. He may also think that he is blessed with some supernatural powers and can communicate with God. Many of the patients try to talk in English and put on expensive, fancy colorful clothes, ornaments and goggles, as these are supposed to be the symbols of higher status. Similarly they claim to have close contacts with famous people like the Prime Minister, Chief Minister or some famous film stars.

Increased energy and activity

Increased energy and activity may be creative and productive in hypomanic state. Many famous personalities had some of the most creative and productive years of their life during their hypomanic episodes. Theodore Roosevelt, during these episodes, worked very hard, for days together, talking, telephoning and writing thousands of letters! Similarly Robert Schumann gave the world his best musical pieces and Ernest Hemingway wrote extensive lectures during such periods.

The same increased energy and activity during manic episode no longer remains goal directed and so becomes non-productive. George-III of England, popularly called as the 'mad monarch' bolted his food and rode his horse to death during his manic episode. Some of the patients may make big business plans and borrow or invest a big amount during their manic episode and end up with heavy losses. Many patients get involved in excessive religious activities. Visiting temples, planning a pilgrimage, giving sermons and preaching about God and religion become their daily chores.

Pressure of speech and flight of ideas

A patient in a manic episode can be easily identified due to his peculiar way of talking. He starts talking spontaneously, even before any questions are asked to him. Once he starts, he keeps on talking and it is very difficult to interrupt him. He has lots of thoughts in his mind about which he wants to talk and he jumps from one topic to another. When asked about his morning breakfast a patient in his manic phase said "I had only bread; No butter; It is so expensive; Only politicians can afford it: They are responsible for the poverty; I will contest the next election and bring the reforms...." He may use rhyming words and poetic manners. One of the patients used to say "I am fine; I have no time; Let the sun shine; But I'll have my wine at nine".

Changes in Sleep, Appetite and Sexual Activities

Patients during their manic episodes have decreased need for sleep. These patients may sleep only for an hour or two. In spite of doing lots of activities throughout the day, they don't seem to get tired, fatigued or require rest.

They may develop a voracious appetite. The warning signal for one of the patients was an increase in her appetite which would herald the onset of the manic episode. The relatives would bring her to hospital as soon as she started demanding lots of fruits. She would eat a dozen bananas, few apples and other available fruits, at a time.

Increased sexual activities are frequently noticed in these patients. It may manifest in the form of eve teasing, promiscuous behavior, demanding more frequent sexual relations at odd times and places from the spouse, visiting commercial sex workers or putting up marriage proposals to any familiar or unfamiliar individuals.