The video below is the Hypomania section from Part 1 of TSM’s lecture series on DSM-5 and the EPPP, followed by a transcript. This lecture series aims to equip those preparing for the EPPP with everything they need to know about the impact DSM-5 will be having on the EPPP. To watch all of Part 1, click here.
Transcript of DSM-5 EPPP Lecture Video: Hypomania
As part of today’s Study Session, we’ll be covering Hypomania.
The emotions and behaviors during a Hypomanic Episode must be distinct from the individual’s usual functioning and emotional range.
Hypomanic Episodes are similar to Manic Episodes in that both diagnoses require the presence of at least three of the following symptoms during the mood disturbance: inflated self-esteem or grandiosity; decreased need for sleep; increased talkativeness or pressured speech; racing thoughts or flights of ideas; distractibility; an increase in goal-directed activity or psychomotor agitation; (e.g., shopping sprees or sexual indiscretions).
Although the symptoms are described in the same manner, and there is a change in functioning that is uncharacteristic of the individual when not symptomatic, a Hypomanic Episode leads to less impairment than a Manic Episode. Individuals with hypomania do not experience the marked impairment in social or occupational functioning, nor do they require hospitalization, and they do not display the psychotic symptoms that may be present in a Manic Episode. For a hypomanic episode to be diagnosed in a child or adolescent, the symptoms must exceed cultural and environmental expectations for that child or youth’s developmental stage.
Hypomania may be difficult to recognize, as individuals in Hypomanic Episodes may simply appear to be extremely cheerful, energetic, or exuberant and may consider their symptoms pleasurable (at least initially). Individuals may become excessively verbose and loud, but can usually be understood and interrupted.
People experiencing Hypomanic Episodes often have heightened perceptual experiences (e.g., colors are vivid; sounds, tastes, and aromas are intensely experienced – sometimes termed “hyperacusis”) and become gregarious, seeking contacts to join on expansive business or creative endeavors. Distractibility, involving quick changes in goals and activities and speech, may be evident. As symptom intensity increases, it becomes increasingly difficult for an individual to complete projects or goals.
Hypomania is characteristic of Bipolar II Disorder, and the diagnosis of this disorder requires a past or current episode of hypomania as well as a past or current episode of major depressive episode, but the individual must have never had a manic episode.
Most frequently, Bipolar II Disorder begins with a depressive episode, and 12% of the individuals that are initially given a diagnosis of Major Depressive Disorder eventually experience a hypomanic episode, leading to the recognition of Bipolar II Disorder. A correctly given diagnosis of Bipolar Disorder never reverts back to Major Depressive Disorder.
Hypomanic symptoms alone do not constitute a diagnosis of Bipolar II Disorder, however. Episodes of substance-induced or medication-induced bipolar or related disorder, or symptoms resulting from the physiology inherent in medical illnesses, do not count toward a diagnosis of bipolar II disorder. The exception is made for symptoms that persist beyond the physiological effects of the treatment or substance, and meet criteria for an episode. This may occur, for example, with hypomania symptoms triggered during antidepressant treatment, but if a full syndrome (not just one or two symptoms) persists beyond the physiological effect of that treatment, it is considered sufficient evidence for a diagnosis of a hypomanic episode.
Hypomanic symptoms that do not meet criteria for a hypomanic episode, coupled with depressive symptoms that do not meet criteria for a depressive episode, with cycles of heightened and depressed mood lasting for at least 1 year in children and adolescents or for at least 2 years in adults, are suggestive of the diagnosis of Cyclothymic Disorder.
Hypomania (Hypomanic Episode)
- A milder form of a Manic Episode
- Hypomanic Episodes involve inflated self-esteem or grandiosity, decreased need for sleep, increased talkativeness or pressured speech; racing thoughts or flights of ideas; distractibility; increase in goal-directed activity or psychomotor agitation; or excessive involvement in pleasurable activities
- In some cases, the change in functioning during a Hypomanic Episode may take the form of increased creativity, efficiency, and accomplishments
- Symptoms must be experienced for at least four consecutive days
- Symptoms must be distinct from person’s usual mood and functioning
- Leads to less impairment than in Manic Episodes
- Individuals with Hypomania do not experience the marked impairment in social or occupational functioning and the display psychotic features that may be present in the Manic Episode, nor do they need hospitalization
- What best differentiates Hypomania from full or disorganized mania is symptom severity and level of impairment
- Cyclothymic Disorder includes fluctuating hypomanic and depressive symptoms without meeting full criteria for hypomanic or major depressive episodes
- When Hypomanic symptoms occur in response to antidepressant medication. the person is diagnosed as having Substance-Induced Mood Disorder, with Hypomanic Features Hypomanic Episodes, alternating with Major Depression, yields diagnosis of Bipolar II Disorder
Hypomania is characterized by an unequivocal change in an individual’s functioning that is uncharacteristic of the person when hypomanic symptoms are not present. This change in functioning is associated with:
A. decreased productivity and efficiency.
B. increased need for sleep.
C. expansive and irritable mood.
RATIONALE: C is correct, as a Hypomanic Episode involves increases in expansive, euphoric, or irritable mood. A is incorrect, as the opposite is true; temporary increases in productive behavior, may result. B is incorrect, as there is typically decreased need for sleep; and D is incorrect, as the opposite is true: Distractibility, rather than increased concentration, is one of the symptoms of hypomania.