26 Manic Episodes

Manic Episodes
I. DSM-IV Diagnostic Criteria
A. At least one week of abnormally and persistently elevated, expansive or
irritable mood (may be less than one week if hospitalization is required).
B. During the period of mood disturbance at least three of the following have
persisted in a significant manner (four if mood is irritable):
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep.
3. The patient has been more talkative than usual or feels pressure to
keep talking.
4. Flight of ideas (jumping from topic-to-topic) or a subjective sense of
racing thoughts.
5. Distractibility.
6. Increased goal-directed activity or psychomotor agitation.
7. Excessive involvement in pleasurable activities with a high potential for
painful consequences (ie, sexual indiscretion)
C. Does not meet criteria for a mixed episode (see page 27).
D. Symptoms must have cause marked impairment in social or occupational
functioning, or have required hospitalization to prevent harm to self or
others, or psychotic features are present.
E. The symptoms cannot be caused by a medical condition, medication or
drugs.
II. Clinical Features of Manic Episodes
A. The most common presentation is excessive euphoria, but some patients
may present with irritability alone. These patients seek out constant
enthusiastic interaction with others, frequently using poor judgment in
those interactions.
B. Increased psychomotor activity can take the form of excessive planning
and participation, which are ultimately nonproductive. Reckless behavior
with negative consequences is common (eg, shopping sprees, excessive
spending, sexual promiscuity).
C. Inability to sleep can be severe and persist for days. Lability of mood and
grandiose delusions are common.
D. Speech is pressured, loud and intrusive, and it is often difficult to interrupt
these patients. Flight of ideas can result in gross disorganization and
incoherence of speech.
E. Patients frequently lack insight into their behavior and resist treatment.
Patients may become grossly psychotic most frequently with paranoid
features. Patients may become assaultive, particularly if psychotic.
Dysphoria is common at the height of a manic episode, and the patient
may become suicidal.