Hypomania Test

What is hypomania?

Hypomania is a mood state characterized by abnormally elevated, expansive, or irritable mood and increased energy or activity levels that are distinctly noticeable but are a less severe form of full-blown mania. Hypomanic episodes typically last for at least four days and are present most of the day, nearly every day. It's important to note that, unlike mania, hypomania does not involve psychosis and does not significantly impair one's work, social activities, or relationships (American Psychiatric Association, 2013).

The symptoms of hypomania can include inflated self-esteem or grandiosity, decreased need for sleep, more talkative than usual or pressure to keep talking, flight of ideas or subjective experience that thoughts are racing, easily distracted, increase in goal-directed activity, and excessive involvement in activities that have a high potential for painful consequences.

Hypomania is often seen in bipolar II disorder, which is primarily characterized by mood swings and alternates with periods of depression. It is essential to differentiate hypomania from mania or a manic episode, as the latter has a substantial impact on daily functioning and may require different treatment approaches, including hospitalization if severe.

Hypomanic symptoms

Hypomanic symptoms are key indicators of a mood state characterized by elevated mood, energy levels, and increased activity. These symptoms may also present in other mental health conditions. It is then important for a mental health professional to identify and assess individuals who may be experiencing hypomania. Common hypomanic symptoms include:

• Elevated or irritable mood: Individuals often feel an unusually good or euphoric, or they may become unusually irritable without a clear cause.
• Increased activity or energy: A noticeable increase in physical and mental activity levels. Patients may engage in multiple projects at once or show hyperactivity.
• Reduced need for sleep: Individuals often feel rested after only a few hours.
• Excessive talkativeness: The person may talk more than usual, feel pressure to keep talking, or speak faster than normal.
• Racing thoughts: This is characterized by a flood of ideas or the feeling that thoughts are moving quickly.
• Distractibility: Attention easily moves from one task to another, making completing tasks difficult.
• Increased self-esteem or grandiosity: Patients may exhibit elevated self-confidence, sometimes to the point of unrealistic beliefs about their abilities or powers.
• Reckless behaviors: There's an uptick in activities that are high risk for painful consequences, such as unrestrained spending, sexual indiscretions, or foolish business investments.

What is a hypomanic episode?

A hypomanic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least four days and present most of the day, nearly every day. During this time, the mood disturbance is clearly different from the individual’s typical non-depressed mood.

For a comprehensive understanding, this behavioral state must include at least three (or more, if the mood is only irritable) of the following symptoms to a significant degree:

• Inflated self-esteem or grandiosity
• Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
• More talkative than usual or pressure to keep talking
• Flight of ideas or the subjective experience that thoughts are racing
• Distractibility (i.e., attention easily diverted to unimportant or irrelevant external stimuli), as reported or observed
• Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
• Excessive involvement in risky behavior and activities with a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

What triggers hypomanic episodes?

Various factors can trigger hypomanic episodes, and understanding these triggers is essential for healthcare practitioners providing care to individuals with bipolar disorder. Some common triggers for hypomanic episodes include:

• Stress: High levels of stress, whether from work, relationships, or other sources, can trigger hypomanic episodes in susceptible individuals.
• Sleep disruption: Changes in sleep patterns, such as lack of sleep or irregular sleep schedules, can contribute to the onset of hypomania.
• Substance use: Alcohol or drug abuse can trigger or exacerbate hypomanic symptoms in individuals with bipolar disorder.
• Medication changes: Abrupt changes in medication or non-compliance with prescribed medications can also precipitate hypomanic episodes.
• Life events: Significant life events in a person's life, like job changes, moving to a new place, or major life transitions, can act as triggers for hypomania.

Recognizing and addressing these triggers can be a critical part of the management and treatment plan for individuals at risk of or experiencing hypomanic episodes.

How to diagnose hypomania?

Diagnosis of hypomania requires careful evaluation and familiarity with the criteria defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Here's an outlined step-by-step approach that can be useful in diagnosing hypomania:

Step 1: Detailed patient history

Interviews and gathering personal history play a pivotal role. Asking about periods of unusually high energy, decreased need for sleep, extreme talkativeness, and more will offer a clearer view of the condition. The person's history of mood changes, effects on daily functioning, and the frequency and duration of high-energy periods should be well documented.

Step 2: Observe behaviors

Observing the patient's behavior and mood can yield valuable insights into their current state. Look for symptoms such as increased self-esteem, rapid or pressured speech, and distractibility.

Step 3: Confirmation of symptoms duration

Hypomania necessitates that these symptoms persist for at least four consecutive days and occupy the vast majority of the day, almost every day. Documenting the duration of symptoms is crucial.

Step 4: Assess the impact on daily life

It's important to check if the individual's symptoms have significantly affected their daily life. Individuals experiencing hypomania usually exhibit observable differences in their functioning, but it does not result in severe impairment to their daily activities or require hospitalization; if so, it may indicate a full-blown manic episode.

Step 5: Rule out substance-induced causes

Substances such as drugs, medication, or alcohol can mimic hypomanic symptoms. It is important to rule out these factors before diagnosing hypomania.

Step 6: Validate with DSM-5 criteria

Compare the gathered information with the DSM-5 criteria for hypomania. While self-reported questionnaires and symptom checklists can assist in screening, a comprehensive clinical assessment is essential for a definitive diagnosis.

Step 7: Differential diagnosis

The presence of similar symptoms in other disorders like ADHD or borderline personality disorder can make diagnosis challenging. A thorough differential diagnosis, ensuring these other conditions aren't better explanations for symptoms, is an important final step.

Results and interpretation of the Hypomania Test

The results and interpretation of the hypomania test, adapted from Angst and colleagues' (2005) Hypomania Checklist (HCL-32), help us determine the presence of hypomania in individuals. The HCL-32 is a validated tool designed to screen for hypomania and can aid healthcare practitioners in identifying potential cases of hypomania.

This checklist includes 32 yes/no questions that probe into experiences of mood elevation and related symptoms. The test is scored by totaling the number of "Yes" responses. Each "Yes" counts as one point, while "No" responses are not scored. As per Angst and colleagues, a threshold score of 14 or more "Yes" responses suggests the presence of hypomanic symptoms that warrant further clinical assessment and are considered specific enough to distinguish possible people experiencing hypomania.

However, it is important to remember that even if a higher score indicates a greater number of hypomanic symptoms, it does not confirm a diagnosis of bipolar disorder on its own. The context, frequency, duration, and impact of these symptoms on the individual's life must be clinically evaluated.

Next steps

After using assessments like the Hypomania Checklist-32 (HCL-32) or tools such as the Bipolar 2 Checklist and identifying a higher likelihood of hypomanic episodes, the next steps involve a thorough clinical evaluation and devising an appropriate management plan. These steps, although comprehensive, can help ensure an accurate final diagnosis and more targeted care.

Rule-out investigations

Standard medical assessments, including blood tests and sometimes brain imaging, can help rule out any medical conditions that might mimic or contribute to mood symptoms.

Differential diagnosis

Revisit diagnoses of unipolar depression or anxiety disorders. Recurrent depression with high HCL-32 scores may suggest a re-evaluation for other bipolar spectrum disorders.

Treatment planning

Formulate a treatment plan that may include psychoeducation, medication management, psychotherapy, lifestyle adjustments, and regular follow-ups to monitor progress.

Collaboration

Remember, effective treatment often involves a collaborative, team-based approach – the individual, healthcare providers, and supportive individuals in their lives working together towards managing hypomania.