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Mania vs Hypomania


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"Substantial impairment of major life activities," as interpreted by my doctor, seems to mean that if there's no hospital, no arrest-worthy behavior (except maybe shoplifting or recreational drug use), and no obvious psychosis (minor delusions don't count), it's hypo.

That said, he does believe in a sliding scale, as shown by the fact that, on a bad day, I'm "BP 1.5."

Perhaps if I had wasted tens of thousands, not just thousands, of dollars last fall, I would have been upgraded. On the other hand, compared to the folks in the state mental hospital where he did a residency, I am always pretty tame.

SG

unmanic

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Heya Unregistered,

Well, the new thinking is just that.

Pure unipolar at one end of the spectrum, hospital-worthy mania at the other end, and some psychs are tentatively tacking on psychotic disorders just off that end. Which I think is a bit specious, b/c psychosis can overlap with mood. But anyways.

Usually this spectrum has a break in the line between BPII and BPI.

Originally BPI (severe mania with or without having ever had a depression) was/is characterized by things like incarceration and hospitalization and psychosis.

But.

Really it's about severe impact on social/occupational/something else (I don't have my mini-DSM here) functioning.

Which is being redefined (duh) to include things like beating up your spouse. Things that might not necessarily end you up in some kind of big grey building, but that tear your life apart. And maybe mixed eps belong in mania or hypomania. This is more up-in-the-air now too.

Plus length of eps, like 7 days for mania and 4 for hypomania, which is a silly criteria IMHO. B/c who knows *when* an ep starts and ends??? The other silly criteria is that for hypomania you have to have had at least one depressive ep. Why? What if your cycles are between hypomania and okay?

I'm a doctor, not a psychiatrist, but the spectrum thing seems sensible to me.

Wah, I could have asked McIntyre that when he spoke yesterday about BP spectrum, but my damn social phobia.

--ncc--

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Here's what I can offer from my daughter and her doctor seems to think it's on target (that she doesn't swing, to the extent of the definition, to mania but, rather hypomania (and I praise God for that blessing):

She is happier than normal - almost giddy at times - almost child-like at times but not in thinking in her degree of excitment - concentration is affected - energy level is higher - sleep is difficult - she is "free-er" with her speech (and she is one to say it like it is anyways)......but no outrageous acts that stand out as being excentric such as drinking, overspending, excessive desire for sex, quitting jobs for no reasonetc. - things that she can't control.

She does have hallucinations regardless (even in what seems to be a normal state although we now think she may have achieved what is a perennial level of low hypomania through her medication and PDoc said that is not a problem as long as it does not deterimentally effect her daily life...it doesn't...she just stays happy most of the day).

It's the issue of how the mania affects the way you live that counts - can you still make intelligent decisions and control your impulses.

I hope this helps...and I'd love to know if anyone else who has bipolar and hallucinations has them "regardless" of what state they are in. Stress is definitely a precursor for my dd (i.e. her job) and it could be that she'll have a dual diagnosis but just wondering!

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...some psychs are tentatively tacking on psychotic disorders just off that end. Which I think is a bit specious, b/c psychosis can overlap with mood. But anyways.

Really it's about severe impact on social/occupational/something else (I don't have my mini-DSM here) functioning.

The other silly criteria is that for hypomania you have to have had at least one depressive ep. Why? What if your cycles are between hypomania and okay?

--ncc--

bp I can and sometimes does have psychotic features, hence the overlap... without concurrent mood episode, then you can't say it happened because of the manic mood (only mania can have psychosis) and it becomes a separate problem, probably schizophrenia.

i question the ending up in prison dx since that's what sane criminals do too. prison is not necessarily a symptom. --but i do agree with you about the severe and persistent (off meds) destructive impact on one's life.

the "at least one depress. ep." is for bp II--not hypomania. the criteria for hypomania is..hypomania. while it is recognized that there are pure hypomanics out there, they are not in the dsm because they haven't done those destructive things that would qualify them as manic. there's no reason to say there's anything wrong with them. if anything, more power to them. our culture prizes that energetic temperament. stable hyperthymics are our fourth cousin or so.

7

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(I'm BP1 w/psychosis)

To me, the difference between a hypo and manic episode is whether or not you are going to totally fuck up your life for months, if not years to come due to the effects of your episode.

My recent hypomania (kept down from full mania by all my drugs no doubt) caused lots of missed work, wild partying, lots of irresponsible sex, and a pregnancy resulting (for many reasons) in abortion. That is severe enough.

This hypo episode was very, very close to a full mania, but my pdoc changed some meds and we got it down.

My last full mania caused me to leave my husband, move to another state, get an apartment on someone else's credit (with their permission) with no job of my own, and then act like the office slut and do no work once I did get a job. I got fired, partied out of control every night and day (no drugs, just drinking), and got myself pregnant. I had an abortion. That was 4 years ago.

My advice is to stay far away from both of these states. The difference does not matter when you consider that for BP1 and BP2 patients, the suicide rates are the same. Roughly 10-15% end their own lives, while about 50% seriously attempt it.

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My recent hypomania (kept down from full mania by all my drugs no doubt) caused lots of missed work, wild partying, lots of irresponsible sex, and a pregnancy resulting (for many reasons) in abortion. That is severe enough.

This hypo episode was very, very close to a full mania, but my pdoc changed some meds and we got it down.

My last full mania caused me to leave my husband, move to another state, get an apartment on someone else's credit (with their permission) with no job of my own, and then act like the office slut and do no work once I did get a job. I got fired, partied out of control every night and day (no drugs, just drinking), and got myself pregnant. I had an abortion. That was 4 years ago.

IMHO the first one sounds like mania not hypomania and the second one like pre-psychotic mania.

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