Clinical features of mania

Mania causes much less diagnostic difficulty than depression. (In that respect, it resembles severe or melancholic depression, where there is seldom much doubt about the diagnosis, and where the international classifications are largely in agreement.)

Manic symptoms can be considered the opposite of depressive ones. Mood may swing rapidly between cheerfulness, irritability, or aggression. Energy is increased, with overactivity, disinhibition, distractibility, reduced need for food and sleep, increased sexual interest, and financial extravagance. This behaviour may have disastrous consequences for the patient and for others, leading to debts, relationship problems, or legal difficulties.

Thought and speech are copious (pressure of speech), often with rapid, loose connections between one topic and the next (flight of ideas), rhymes, and puns. Sometimes, the connections between the thoughts can be disrupted. Thought content is usually grandiose or paranoid. Delusions and hallucinations, also with a grandiose or paranoid content, may develop.

Hypomania is a term for mild episodes without delusions or hallucinations. Manic stupor is a rare form in which activity is greatly reduced despite elated mood and grandiose thought content.

Transient periods of depression, sometimes lasting only minutes at a time, occur during many if not most manic illnesses. If the periods of depression are more prominent, the illness may be called a mixed affective state.

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