Manic Phase Of Bipolar Disorder: What It Is, And Its 7 Characteristics
Bipolar disorder type I is one of the most severe mood pathologies, as it usually manifests itself in the form of affective oscillations that fluctuate between the extremes of mania and depression.
Both forms of clinical expression occur in a sequence that is not necessarily alternating (several depressive episodes occurring consecutively, for example), but with timely treatment they can be mediated by periods of stability.
For its part, mania is essential to understand this mental health problem For this reason, it will occupy a central position in this article.
Manic episodes are periods in which a person experiences an abnormally high mood , which manifests itself as a kind of overflowing euphoria. Sometimes the symptom can take on a nuance of irritability, with the sufferer showing a critical attitude towards others or towards themselves, and reacting abruptly to environmental circumstances that could make them feel upset.
In strict terms, it is required that the state of mind lasts for at least a week, and that it conditions (due to its intensity) the ability to carry out daily responsibilities normally. In this sense, it can compromise work or academic life, and even require a period of hospitalization in order to avoid possible harm to oneself or others.
Mania is the most relevant symptom in bipolar disorder type I, as it is the only one required to make its diagnosis (whose prevalence rises to 0.6% of the world population). Depression, therefore, does not necessarily have to be present (although it is the most common). Mania should not be confused with hypomania, a less disabling form, which constitutes (along with the presence of depressive episodes) the axis of bipolar disorder type II (0.4% globally).
Below we will detail the symptoms that are typical of manic episodes in bipolar disorder exemplifying each of them to demonstrate their potential impact on the life of the person who suffers from them and that of their loved ones.
1. Exaggerated self-esteem or grandiosity
One of the defining characteristics of mania is the inflammation in the perception that the person projects on himself, which experiences an expansion that exceeds all limits of reason. She can refer to herself using attributes that suggest greatness or superiority, exaggerating her personal qualities to the extreme. The exaggeration of one’s own worth can also be accompanied by the devaluation of that of others
This symptom acquires its maximum expression through the feeling of omnipotence, which harbors unrealistic beliefs about one’s own abilities and which can be associated with risky behavior for life or physical integrity, as well as the wear and tear of physical or material resources.
Another circumstance that can occur in this context is erotomania, a form of delirium that is characterized by feeling like the object of another person’s love, without an objective cause being appreciated that could support such reasoning. Generally it is a figure of notable social significance, which serves to strengthen some beliefs of superiority on which the self-image is built. The symptom is more common in severe cases.
2. Decreased need for sleep
People who go through a manic phase can abruptly reduce the time they spend sleeping (limiting it to three hours a day or less), and they even remain awake for entire nights. This is due to a pressing need to engage in activities, and occasionally a belief that sleep itself is an unnecessary waste of time.
The feeling of tiredness fades, and the person dedicates all their nighttime hours to maintaining a frenetic pace of intentional activities, which are carried out erratically and excessively. Just as at a certain moment an inflexible commitment to certain types of tasks is evident, these can be unexpectedly abandoned in favor of others that arouse unusual interest, which implies an incessant use of energy.
Under this state, obvious physical and mental exhaustion occurs, but of which the person appears to be unaware. There are studies suggesting that such a reduction in the need for sleep is one of the symptoms with the greatest predictive power for the appearance of manic episodes in people with bipolar disorder who were until that moment in a phase of stability.
3. Taquilalia
Another characteristic of manic episodes is the substantial increase in speech latency , with a much higher production of words than is usual in the periods between episodes. Alterations may emerge such as derailment (speech without an apparent common thread), tangentiality (addressing issues that are irrelevant to the central topic being addressed) or distracted speech (change of topic in response to stimuli found in the environment). and attract attention).
In the most serious cases, an alteration in verbal communication known as “word salad” may occur, in which the content of the speech is devoid of any hint of intelligibility, so that the interlocutor feels unable to appreciate its meaning or intention. .
4. Acceleration of thought
The acceleration of thought (tachypsychia) is directly connected to the increase in the rate of verbal production Both realities are firmly interconnected, so that compromise in the integrity of mental contents will result in affected speech. This pressure of thought overwhelms the person’s ability to translate it into operational terms for efficient use, observing what is known as a “flight of ideas.”
This flight of ideas supposes the evident disorganization in the hierarchy of priorities of thought, so that the speech with which a conversation began (and which harbored a clear communicative intention) is interrupted by a cluster of secondary ideas that overlap between yes in a chaotic way, and that end up being diluted in a frenetic flow of mental contents that flow into a raging ocean of unconnected words.
5. Distractibility
People experiencing a manic phase of bipolar disorder may see certain higher cognitive functions altered , particularly attentional processes. Under normal circumstances, they are capable of maintaining relevant selective attention, giving greater relevance to the elements of the environment that are necessary for adequate functioning based on contextual cues. Thus, the projection of the focus on what was dispensable or accessory for the occasion would be inhibited.
During manic phases, an alteration can be seen in this filtering process, so that the various environmental stimuli would compete to monopolize the resources available to the person, making it difficult for the behavior to be expressed in adaptive terms. For this reason, it is usually extremely difficult to maintain sustained vigilance over any stimulus, swinging attention from one point to another without it being able to find a clear reference.
6. Increased intentional activity
In the context of a manic episode There is usually a peculiar increase in the person’s general activity level Thus, he can dedicate most of his time to carrying out any task that arouses her interest, getting involved in it in such a way that he does not seem to feel any fatigue despite the time that has passed. It is possible that this circumstance coexists with the very powerful sensation of feeling creative and constructive, inhibiting the rest of responsibilities.
Sometimes this incessant flow of activity is resistant to the attempts of others to force it to stop, out of concern about the possible consequences of overexertion on the health of the person (who can spend entire nights engrossed in their chores). In these cases, a response of open opposition to dissuasion attempts may arise, accompanied by a certain irritability and perception of grievance.
7. Impulsiveness
Impulsivity is the difficulty in inhibiting the impulse to emit a specific behavior in the presence of a triggering stimulus (physical or cognitive), and which often also implies the impossibility of stopping it when it is underway. This symptom stands as one of those that has the greatest descriptive power in the manic episodes of bipolar disorder, and may also be one of those that generates the greatest damage to personal and social life.
It is not uncommon for, in the context of the manic phase of bipolar disorder, the person to make risky decisions whose consequences imply a profound impairment of their economic or fiduciary resources, such as disproportionate investments in companies whose prognosis for success is poor or doubtful. As a consequence, irreparable losses of personal or family assets occur, which increase the relational tension that could have been established in the intimate circle of trusted people.
Involvement in other types of risk activities, such as substance use or sexual behavior without the use of appropriate prophylactic strategies, can generate new problems or even increase the intensity of the symptoms of mania (as would occur in the case of mania). cocaine consumption, which acts as a dopamine agonist and increases the difficulties the person is going through).
Neurobiology of bipolar disorder
Many studies have found that acute episodes of depression and mania, which occur during the course of bipolar disorder, increase the deterioration of the cognitive functions that accompany this psychopathology over time. All of this has revealed the possibility that there may be structural and functional mechanisms in the central nervous system that underlie its particular clinical expression.
Regarding mania, Empirical evidence has been found of a reduction in the total volume of gray matter in the dorsolateral prefrontal cortex ; which contributes to functions such as attention, inhibition of impulses or the ability to plan in the medium and long term. Similar findings have also been described in the inferior frontal gyrus, which participates in word formation processes (as it has close connections with the primary motor area).
On the other hand, alterations have been detected in the areas of the brain that are responsible for processing rewards, especially in the left cerebral hemisphere, which can be found in a situation of hyperactivity. This fact, together with the aforementioned disturbance of the frontal cortical areas, could build the foundations of the impulsivity and attentional difficulty of people with bipolar disorder.
It is important that the person suffering from bipolar disorder tries to seek specialized help, since the use of mood stabilizers is key to balancing emotions and facilitating an adequate quality of life. These drugs, however, require careful control by the physician due to their potential toxicity in case of inappropriate consumption (which could require changes in the dose or even the search for alternative medications).
Psychotherapy, on the other hand, also plays an important role. In this case, it can help the person to better understand the illness they suffer from, to detect in advance the appearance of acute episodes (both depressive, manic and hypomanic), to manage subjective stress, to optimize family dynamics and to strengthen a lifestyle that results in the achievement of greater well-being.
