Welcome to Bipolar in Focus, I'm Jane Pauley. Maybe you think you know what depression looks like but mania has many phases.
Dr. David Kahn of Columbia University and New York Presbyterian Hospital, what are the different kinds of mania?
Well, there are four basic types of presentations that I think we can cover:
classic or euphoric mania, mixed or dysphoric mania in which people are unhappy rather than happy,
psychotic mania in which people suffer from delusions and hypomania or very mild mania.
Euphoric or classic, why do we call it classic?
Because people feel really good. They are happy, they are joking, they can be extremely entertaining, they feel on top of the world and they don't want it to stop.
Dysphoric mania is less familiar.
Yes. This other type of mania, we called dysphoric mania and it is a very important condition to recognize because people with it are sometimes referred to as having agitated depression
and if treated, as depression and not as mania they will get worse instead of better. Their mood is terribly depressed.
They'll express ideas of hopelessness and helplessness, worthlessness, they may be delusional at the same time but their energy level,
their level of inner agitation and outer agitated behavior can be extreme to the point where it's the same as mania but the mood is depressed.
What's the risk of treat to get inappropriately?
If you don't treat it with mood stabilizing medication, the way that we treat well recognized mania, but only treat it with antidepressants, you tend to make people worse
more agitated, more speed it up, more anxious and more dysphoric.
They don't get less depressed. They actually get more depressed and more anxious and agitated.
Neither euphoric or dysphoric mania is necessarily accompanied with psychosis?
That's right. Many manic patients don't have psychosis but an important percentage, 15% to 20% do experience psychotic symptoms during their manic episode.
These are in euphoric mania, classic delusions of grandeur as they're popularly known.
People who believe that they have special powers or special insights, people with manic psychosis can also have delusions of paranoia that other people are envious or jealous of them
and want to bring them down or harm them in some way and they can become very dangerous during those periods of time if they tried to act on those delusions.
We throw around towards conventionally like paranoid. Are all paranoias manias?
No. Paranoia is most commonly associated with schizophrenia but we can sometimes see it in a context of a manic episode.
The difference is that when the person is out of the manic episode, the delusions go away.
What is hypomania?
Hypomania, we define in a technical way, that it is not accompanied by severe functional impairment and that it does not result in hospitalization.
In fact, people who are hypomanic may for a period of time, be very effective and very capable, creative, energetic, not needing to sleep too much,
lots of ideas, lots of ability to communicate, but carried on for too long, people with hypomania can exercise poor judgment and really begin to unravel.
Well, thank you Dr. Kahn and thank you for watching Bipolar in Focus.