The type I bipolar disorder is one of the most severe diseases of the mood, as often manifest as emotional oscillations pendulan between the extremes of mania and depression.
Both forms of clinical expression occur in a sequence that is not necessarily alternating (several depressive episodes occur consecutively, for example), but with the appropriate treatment they can be mediated by periods of stability.
For its part, mania is essential to understand this mental health problem . Therefore, it will occupy a central position in this article.
What is the manic phase of bipolar disorder?
Manic episodes are periods in which the person experiences an abnormally high state of mind , which manifests itself as a kind of overwhelmed euphoria. Sometimes the symptom can acquire a shade of irritability, showing who suffers from it a critical attitude towards others or towards himself, and reacting abruptly to circumstances in the environment that could make him feel upset.
In strict terms, it is required that the mood 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 may compromise work or academic life, and even require hospitalization time in order to avoid possible harm to oneself or to others.
Mania is the most relevant symptom in type I bipolar disorder, since it is the only one required to make its diagnosis (whose prevalence rises to 0.6% of the world population). The depression therefore must not be present in a necessary (although it is most common). Mania should not be confused with hypomania, a less disabling form, and which constitutes (together with the presence of depressive episodes) the axis of type II bipolar disorder (0.4% globally).
In the following 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 inflammation in the perception that the person projects on himself, which experiences an expansion that goes beyond all the limits of what is reasonable. It can refer to itself making use of attributes that suggest greatness or superiority, oversized to the extreme its personal qualities. The exaggeration of their own worth can be accompanied, in addition, 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 behaviors 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 delusion that is characterized by feeling object of the love of another person, without appreciating an objective cause that could support such reasoning. Generally it is a figure of notable social significance, which serves to strengthen some beliefs of superiority on which 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 even maintain wakefulness for whole nights. This is due to a pressing need to get involved in activities, and occasionally the belief that the dream itself constitutes an unnecessary waste of time.
The feeling of tiredness fades, and the person spends all of their nighttime hours maintaining a hectic pace of intentional activities, which are carried out erratically and excessively. Just as at a certain moment an uncompromising commitment towards 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 there is an obvious physical and mental exhaustion, but of which the person seems not to be aware. There are suggestive studies 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 up to that moment in a phase of stability.
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 such as derailment (speech without an apparent guiding thread), tangentiality (addressing issues irrelevant to the central issue being addressed) or distracted speech (change of subject in response to stimuli found in the environment) may emerge and they grab attention).
In the most serious cases, an alteration in verbal communication known as a “word salad” may break in, in which the content of the speech is devoid of any hint of intelligibility, making the interlocutor feel unable to appreciate its meaning or intention .
4. Acceleration of thought
The acceleration of thought (tachypsychia) is directly connected with the increase in the rate of verbal production . The two realities are firmly interconnected, so that compromise in the integrity of the mental contents will translate into impaired speech. This pressure of thought overflows the person’s ability to translate it into operational terms for its 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 discourse with which a conversation began (and that 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 fast-paced flow of mental contents that lead to a raging ocean of disconnected words.
People experiencing a manic phase of bipolar disorder may have certain higher cognitive functions , particularly attentional processes, altered . Under normal circumstances, they are capable of maintaining relevant selective attention, giving greater importance to the elements of the environment that are necessary for proper operation based on contextual clues. Thus, the projection of the focus on what was dispensable or accessory for the occasion would be inhibited.
During the manic phases, an alteration in this filtering process can be seen, 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. Because of this, it is usually extremely difficult to maintain constant vigilance on any stimulus, oscillating 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 . In this way, he can dedicate most of his time to carrying out any task that arouses his interest, engaging in it in such a way that he seems not to feel any fatigue despite the time elapsed. It is possible that this circumstance comes together with the very powerful feeling of feeling creative and constructive, inhibiting other responsibilities.
Sometimes this incessant flow of activity is resistant to the attempts of others to force their arrest, due to the concern about the possible consequences of overstraining on the person’s health (who can spend whole nights engaged in their chores). In these cases, an open opposition response to deterrence attempts may arise, accompanied by some irritability and perceived grievance.
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 the ones with the greatest descriptive power in manic episodes of bipolar disorder, and may also be one of the most damaging effects on personal and social life.
It is not uncommon that, in the context of the manic phase of bipolar disorder, the person makes risky decisions whose consequences imply a profound impairment of their financial or fiduciary resources, such as disproportionate investments in companies whose prognosis for success is poor or doubtful. Irreparable losses of personal or family patrimony are produced as a consequence, 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 behaviors without the use of adequate prophylactic strategies, can generate new problems or even increase the intensity of the symptoms typical of mania (as would occur in the case of cocaine use, 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 in the course of bipolar disorder, increase the deterioration in cognitive functions that accompany this psychopathology over time. All this has highlighted the possibility that there may be structural and functional mechanisms in the central nervous system that are at the base of its particular clinical expression.
Regarding mania, empirical evidence of a reduction in the total volume of gray matter in the dorsolateral prefrontal cortex has been found ; It contributes to functions such as attention, impulse inhibition 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 (since 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 the rewards, especially in the left cerebral hemisphere, which may be hyperactive. This fact, together with the aforementioned disturbance of the frontal cortical areas, could build the foundations of impulsiveness and attentional difficulty in 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 balance the affections and facilitate an adequate quality of life. These drugs, however, require close monitoring by the doctor due to their potential toxicity in case of inappropriate consumption (which could require changes in the dose or even the search for drug alternatives).
Psychotherapy, on the other hand, also plays an important role . In this case, it can help the person to better understand the disease they are suffering 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 leads to the achievement of greater well-being.