Mania vs. Hypomania

  • Medical Author:
    Roxanne Dryden-Edwards, MD

    Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

What Is Bipolar Disorder?

Mania vs. hypomania facts

  • Mania is a set of mood symptoms that includes euphoria or irritability lasting at least a week and is required to qualify for the diagnosis of bipolar disorder.
  • Hypomania is considered to be a less severe version of mania.
  • The suicide rate for people who have had a manic episode is 60 times higher than that of the general public.
  • As with most other mental health symptoms, mania or hypomania are not directly inherited from one generation to another genetically but are thought to be due to a complex group of genetic, psychological, and environmental risk factors.
  • There is no one test that definitively determines that someone is experiencing mania or hypomania, so health care professionals diagnose these sets of symptoms by gathering comprehensive medical, family, and mental health information in addition to performing physical and mental health assessments.
  • Treatment of mania or hypomania with medications tends to relieve already existing symptoms and prevent them from returning.
  • Talk therapy (psychotherapy) is an important part of helping people with mania or hypomania achieve the highest level of functioning possible.

What is mania and what is hypomania?

  • Mania is a severe episode of elevated/euphoric or irritable mood and increased energy that usually lasts at least a week and severely interferes with the sufferer's ability to function.
  • Hypomania is a less severe version of mania, in that it is characterized by somewhat elevated or irritable mood that may more mildly interfere with a person's functioning to a less debilitating degree than mania.

What are causes and risk factors for mania and hypomania?

As with most other mental health issues, mania or hypomania are not directly passed from one generation to another genetically. Rather, each is the result of a complex group of genetic, psychological, and environmental vulnerabilities. People with these symptoms or with schizophrenia and schizoaffective disorder often have risk factors in common, including a family history of any of these disorders, loss of a parent or other trauma, as well as being born prematurely.

Quick GuideBipolar Disorder: Symptoms, Testing for Bipolar Depression

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Euphoria is a symptom of mania and is considered a sense of intense happiness.

Symptom of Mania and Hypomania

Euphoria

Euphoria can be described as a heightened, exaggerated, or extremely positive sense of happiness or well-being. It is considered to represent an abnormally extreme degree of happiness or contentment beyond that which occurs in normal emotional responses. It can be described as a sense of intense joy or happiness that is beyond what would be expected under the normal circumstances. Euphoria may be experienced by those who suffer from bipolar depression (manic depression) in the manic phase. It may occasionally be seen in other psychiatric disorders, such as schizophrenia, in which emotional responses and perceptions of reality are abnormal.

What are the signs and symptoms of mania and hypomania?

Manic symptoms must last at least a week's time, unless it is part of a mixed (more rapidly alternating) mood episode, and include

  • euphoric, elevated, expansive, or irritable mood with increased energy;
  • racing thoughts;
  • pressured speech (rapid, excessive, frenzied speaking);
  • decreased need for sleep;
  • grandiose ideas (for example, false/delusional beliefs of paranoia, superiority, or failure);
  • tangential speech (repeatedly changing conversational topics to ones that are hardly related);
  • restlessness/increased goal-directed activity; and
  • impulsivity, poor judgment, or engaging in risky activity (like spending sprees, promiscuity, or excess desire for sex).

Hypomanic symptoms must last at least four days in a row and include

  • euphoric, elevated, expansive, or irritable mood and increased energy;
  • excessive self-esteem or grandiosity;
  • less need to sleep;
  • more talkative than usual or feeling pressured to continue talking;
  • expresses ideas rapidly -- quickly changes topics or feels that thoughts are racing;
  • trouble focusing;
  • restlessness or increased participation in goal-oriented activities; and
  • excessively engaging in activities that have a high likelihood of having negative consequences (for example, promiscuity, excessive spending, poor business decisions).

While mania and hypomania have many symptoms in common, mania results in more severe problems compared to hypomania.

What tests do health care professionals use to diagnose mania and hypomania?

There is no one test that definitively assesses that someone has mania or hypomania. Therefore, health care clinicians diagnose either of these mood episodes by gathering comprehensive medical, family, and mental health information to exclude the presence of other mental conditions. The health care professional will also either perform a physical examination or request that the person's primary care doctor perform one. The medical examination will usually include lab tests to evaluate the person's general health and to explore whether or not the individual has past or present other mental health symptoms like depression, anxiety, or psychotic features (for example, delusions or hallucinations) that are associated with a medical condition or exposure to a drug of abuse or other substance.

To determine if an individual has mania, mental health professionals will explore if the sufferer has at least three of the aforementioned symptoms that last most of every day for at least a week and result in either hospitalization or other severe problems with the person's functioning at home, work, school, or in the community. To diagnose a person with hypomania, a practitioner will determine if the sufferer has the symptoms described for at least four days in a row and results in a clear change in the person's functioning. However, symptoms of hypomania cannot rise to the level of severity of causing severe impairment in the person's functioning, or else it is better explained as a manic episode.

What are medications and other treatments for mania and hypomania?

People with manic or hypomanic feelings can expect their mental health professionals to consider several medical interventions in the form of medications, psychotherapies, and lifestyle advice to address symptoms -- relieving already existing symptoms and preventing symptoms from returning. Mood stabilizers and antipsychotic medications are thought to be particularly effective in treating mania or hypomania, in that these groups of medications can be useful in treating active (acute) symptoms of manic or mixed episodes, as well as preventing the return of such symptoms. Despite its stigmatized history, electroconvulsive therapy (ECT) can be a viable treatment for people whose mania is severe and has inadequately responded to psychotherapies and a number of drug trials.

What is the prognosis of mania and hypomania?

The prognosis for mania or hypomania is such that individuals tend to have episodes of some sort of mood problem up to 60% of the time. However, the episodes can often be well managed by the combination of psychotherapy and medication treatment. There are a number of potential complications of these mood problems, particularly if left untreated.

Complications of mania or hypomania can include substance use disorders, thinking (cognitive) problems, and generally more medical problems. The risk of committing suicide is 60 times higher for people who have had mania or hypomania compared to the general population.

Is it possible to prevent mania and hypomania?

While far more seems to be known about the prevention of symptoms of mania or hypomania once symptoms have occurred at least once, there is emerging research that when family focused therapy is provided to children who have more subtle symptoms prior to having a manic episode and who have relatives who have suffered from a similar mood episode, they may be less likely to develop full-blown bipolar disorder as adults.

REFERENCES:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Treatment Revision. Washington, D.C.: American Psychiatric Publishing, Inc., 2013.

Laursen, T.M., T. Munk-Olsen, M. Nordentoft, and B. Mortensen. "A comparison of selected risk factors for unipolar depressive disorder, schizoaffective disorder and schizophrenia from a Danish population-based cohort." The Journal of Clinical Psychiatry 68.11 Nov. 2007: 1673-1681.

Quick GuideBipolar Disorder: Symptoms, Testing for Bipolar Depression

Bipolar Disorder: Symptoms, Testing for Bipolar Depression

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Reviewed on 6/13/2017
References
REFERENCES:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Treatment Revision. Washington, D.C.: American Psychiatric Publishing, Inc., 2013.

Laursen, T.M., T. Munk-Olsen, M. Nordentoft, and B. Mortensen. "A comparison of selected risk factors for unipolar depressive disorder, schizoaffective disorder and schizophrenia from a Danish population-based cohort." The Journal of Clinical Psychiatry 68.11 Nov. 2007: 1673-1681.

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