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What changes someone's experience from hypomania to mania?  Are there clear markers?

I'm asking because I have the following symptoms:

  • elevated mood
  • psychomotor agitation
  • talking a lot/excessively and quickly
  • thoughts moving quickly and jumping from topic to topic
  • finding random things funny that objectively aren't
  • messed up sleep schedule
  • hypersexuality

It's clearly some form of mood episode.  I'm currently functioning through it okay.  I've been increasing my contact with people I know to make sure that they can see me in case I go downhill.  I almost hospitalized myself Tuesday, but I spent the night with a friend itself and de-escalated myself. 

I also have auditory hallucinations (that are now significantly better) and I had a 30-minute stint of paranoia.

 

I know no one hear can diagnose.  I listed my symptoms in case it's easy to use them for an example/putting an answer together.  I'm just curious where you draw the line.  To some degree it doesn't matter, but I like to be able to understand things.

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Everything sounded like bp2 until you mentioned hallucinations, if I had credentials I’d say it sounds like bp1. But who am I? Just another person who has bp1. 

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Thanks!  I realized my question wasn’t great.  I know definitively that I have bp type 1 from previous mixed and manic episodes.  What I don’t know is what I should be watching for in order to turn the current hypomania into full-blown mania.  Is that a bit clearer?

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For me the difference has to do with functioning. With hypomania I can still do my job; with mania I can't. Or if I'm engaging in risky behaviors, like driving recklessly, and am thus putting my safety and the safety of others at risk. 

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2 hours ago, dancesintherain said:

Thanks!  I realized my question wasn’t great.  I know definitively that I have bp type 1 from previous mixed and manic episodes.  What I don’t know is what I should be watching for in order to turn the current hypomania into full-blown mania.  Is that a bit clearer?

I would guess the hallucinations starting, and doing things that are detrimental to your safety, pocketbook, relationships?

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Thank you all.  I guess it makes sense that it’s more a question of degree.  It’s hard to gauge impact on functioning with me currently unemployed, but I feel like it would cause some problems...largely because I don’t trust myself to open my mouth and speak at a reasonable rate and organized.

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Posted (edited)

this might be a bit old  (DSM 4), but might be helpful

Key points

1. All symptoms in mania can exist with hypomania with the exception of psychotic symptoms

2. Insight is still present with hypomania

3. hypomania does not present an impairment in social or occupational function.

_____________________________________________

https://www.ncbi.nlm.nih.gov/books/NBK55388/

Patients in the acute manic phase exhibit expansive, grandiose affect, which may be predominantly euphoric or irritable. Although dysphoric mood is more frequently associated with depressive episodes, factor analytic studies of symptoms in patients with pure mania suggest dysphoric mood (such as depression, guilt and anxiety) can be prominent in some manic patients (Cassidy et al., 1998; Cassidy & Carroll, 2001).

The clinical presentation of mania is marked by several features, which can lead to significant impairment to functioning (see also the vignette below). These may include inflated self-esteem and disinhibition, for example, over-familiar or fractious and outspoken behaviour. To the observer, an individual with mania may appear inappropriately dressed, unkempt or dishevelled. The person may have an urge to talk incessantly and their speech may be pressured, faster or louder than usual and difficult for others to interrupt. In severe forms of mania, flight of ideas can render speech incoherent and impossible to understand. The patient may find that racing thoughts or ideas can be difficult to piece together into a coherent whole. Patients often describe increased productivity and creativity during the early stages of mania which may feel satisfying and rewarding. However, as the episode worsens severe distractibility, restlessness, and difficulty concentrating can render the completion of tasks impossible. Patients often experience a decreased need for sleep and begin sleeping less without feeling tired. After prolonged periods with little or no sleep the individual can become physically exhausted with no desire to rest. The person may find it hard to stay still or remain seated and other forms of psychomotor restlessness may be apparent, such as excessive use of gestures or fidgeting. Appetite may also increase, although food intake does not always increase to compensate. There might be an increase in impulsive risk-taking behaviour with a high potential for negative consequences. Libido may rise, with increased interest in sexual activity, which may culminate in risky sexual practices. In severe cases individuals may develop psychotic symptoms such as grandiose delusions and mood-congruent hallucinations – for example, the voice of God sending messages of special purpose. Alternatively, persecutory delusions may develop, but are usually consistent with a general grandiose theme such as the belief that others are actively trying to thwart the person’s plans or remove their power. Insight is lost in mania – the individual is unaware that their behaviour is abnormal and does not consider him or herself to be in need of treatment. Clinical interventions may be seen as attempts to undermine the person’s esteem and power and could provoke or worsen irritability even in patients who are predominantly euphoric.

All the features reported in mania – except psychotic symptoms – can also occur in hypomania to a less severe extent. Generally insight is preserved, although the person may not feel in need of help. Increased productivity and decreased need for sleep can be experienced as a positive enhancement of everyday functioning. Hypomania is accompanied by a change in functioning that is not characteristic of the person when non-depressed and the change is noticed by others, but it is not associated with marked impairment in social or occupational function. According to the DSM-IV diagnostic criteria, symptoms must last at least 4 days to merit the diagnosis of a hypomanic episode. However, there is considerable debate about how long hypomanic symptoms should be present to merit a diagnosis of bipolar II disorder (see Section 4.4.2 below).

 

Edited by argh
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well I seem to be in a manic episode then.  Because I definitely have the mood-congruent hallucinations.  They're much better.  But they've been a part of this ordeal. 

Interesting.  I do have the insight (I think) still to know what's going on and to ask for help.  Heaven forbid if I lose that.

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from this thread it does sound like you still have insight. do you have an appointment anytime soon?

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I actually just got home from an appointment.  We increased the lithiumER by 150mg (from 600 to 750) and cut the Luvox in half (with the plan to cut it out completely if I'm still manic after three days).  My last lithium level (about a week ago) was 0.5, so it's still below therapeutic.  We just have to be careful with lithium because I've gone toxic before at a reasonably low dose (900 mg). 

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2 minutes ago, dancesintherain said:

I actually just got home from an appointment.  We increased the lithiumER by 150mg (from 600 to 750) and cut the Luvox in half (with the plan to cut it out completely if I'm still manic after three days).  My last lithium level (about a week ago) was 0.5, so it's still below therapeutic.  We just have to be careful with lithium because I've gone toxic before at a reasonably low dose (900 mg). 

That sounds reasonable. So are you checking with pdoc in 3 days no matter what? 

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I can call if I need help making the decision.  If the mania is clearly not gone, I've the green light to just stop it.  My next appointment is 5/7, so we have a bit more time to play with things before the job start date. 

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On 4/26/2019 at 9:34 PM, dancesintherain said:

I can call if I need help making the decision.  If the mania is clearly not gone, I've the green light to just stop it.  My next appointment is 5/7, so we have a bit more time to play with things before the job start date. 

Unless you have treatment-resistant ocd or something like that and are running out of options, it's extremely risky to put someone with bipolar I on ssri or any antidepressant really, even with lithium on board. 

Where I work, you don't see extended release lithium used very often, mostly in cases where the instant release version gives people gastrointestinal issues, but assuming the two formulations are similar or the same, unless you already have a high blood lithium level, 750mg isn't very high. I usually see people start at 3-600mg and at 900mg within a few days to a week. Have also seen as high as 2,400mg a day, but obviously everyone is different. 

But I'm wondering if the seemingly low Lithium dosage could be contributing or simply just not doing enough to tamp down the mania. 

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For me the difference is acting versus thinking and delusions.   

Otherwise all you listed is present in hypo and mania for me. 

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Posted (edited)
On 6/1/2019 at 8:55 PM, psychwardjesus said:

Unless you have treatment-resistant ocd or something like that and are running out of options, it's extremely risky to put someone with bipolar I on ssri or any antidepressant really, even with lithium on board. 

Where I work, you don't see extended release lithium used very often, mostly in cases where the instant release version gives people gastrointestinal issues, but assuming the two formulations are similar or the same, unless you already have a high blood lithium level, 750mg isn't very high. I usually see people start at 3-600mg and at 900mg within a few days to a week. Have also seen as high as 2,400mg a day, but obviously everyone is different. 

But I'm wondering if the seemingly low Lithium dosage could be contributing or simply just not doing enough to tamp down the mania. 

sorry, I somehow missed this point. We ended up stopping the luvox.  But I was put on it for OCD symptoms that weren't going away.  I had taken ADs successfully before.  We've now concluded that it contributed to hypo/mania, but it seemed like an okay risk to take given past success. 

My lithium can't go much higher.  I went toxic when I took 900mg.  I take ER predominantly because IR upsets my already precarious GI situation.

4 hours ago, dragonfly23 said:

For me the difference is acting versus thinking and delusions.   

Otherwise all you listed is present in hypo and mania for me.  

thanks dragon.  I can see that difference being present.  I never thought any of it was real...I recognized that I was having AH.

Edited by dancesintherain

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