A young woman visits you for a psychiatric evaluation. She gives a history of intermittent episodes of elevated mood, increased energy, and decreased need for sleep. She says that others have commented that she becomes disinhibited and can be very offensive. These episodes have caused her to have a number of periods off work. According to the ICD-10, how long must each episode last for it to be qualified as a manic episode?
Exam Question Jul 2014
Exam Question Jul 2014
Mania
Mania
Mania is a state of abnormally elevated mood.
The features of mania include:-
- Mood. The mood is often described as elevated or expansive (an expansive mood implies the patient shows a lack of restraint in expressing their feelings and overvalues their significance). Irritability is also common.
- Thought and speech. Speech is often rapid, and difficult to interrupt (aka pressured speech). The topic of speech tends to jump quickly with little logical connection (aka flight of ideas).
- Psychotic symptoms. Delusions and hallucinations may be present and tend to be consistent with the patients mood (mood congruent). Common delusions related to special powers or purpose.
- Behaviour. Self care and normal responsibilities are often neglected. The need for sleep reduces. Sex drive tends to increase.
Hypomania
Hypomania is generally thought of as a less severe form of mania.
In the ICD-10 hypomania is differentiated from mania by duration and symptoms. Hypomania is an elevated mood for a minimum of 4 days. Mania requires a minimum of 7 days.
Features which would suggest mania rather than hypomania include:-
- Flight of ideas
- Psychotic symptoms
- Loss of social inhibitions
The DSM-IV differentiates between mania and hypomania by stipulating that hypomania occurs without any marked social or occupational interference.
