Manic phase of bipolar disorder: what it is, and its 7 characteristics

The type I bipolar disorder It is one of the most severe pathologies of the state of mind, as it usually manifests itself in the form of affective oscillations that oscillate between the extremes of mania and depression.

Both forms of clinical expression occur in a sequence that is not necessarily alternate (several episodes followed depressive disorders consecutively, for example), but with timely treatment they may 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 mood, which manifests itself as a kind of overwhelmed euphoria. Sometimes the symptom can acquire a tinge of irritability, showing the sufferer a critical attitude towards the others or towards himself, and reacting abruptly to environmental circumstances that could make him feel annoyed.

Strictly speaking it is required that the mood lasts for at least a week, and that conditions (by its intensity) the ability to develop responsibilities normally everyday. In this sense, it can compromise work or academic life, and even require a time of hospitalization in order to avoid possible harm to oneself or to others.

Mania is the most relevant symptom in type I bipolar disorder, as it is the only one that is required to make its diagnosis (whose prevalence rises to 0.6% of the population world). The depression, therefore, it does not have to be present in a necessary way (although it is the 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 bipolar disorder type II (0.4% at the level global).

Hereinafter we will detail the symptoms that are typical of manic episodes in bipolar disorder, exemplifying each one of them to show its potential impact on the life of the person who suffers them and that of their relatives.

1. Exaggerated self-esteem or grandiosity

One of the defining characteristics of mania is inflammation in the perception that the person projects onto itself, which undergoes an expansion that exceeds all limits of what is reasonable. She can refer to herself making use of attributes that suggest greatness or superiority, oversizing her personal qualities to the extreme. The exaggeration of one's worth can be accompanied, in addition, by the devaluation of that of others.

This symptom acquires its maximum expression through the sensation of omnipotence, which harbors unreal beliefs about one's own skills and that can be associated with risk behaviors for life or physical integrity, as well as the waste of physical resources or materials.

Another circumstance that may occur in this context is erotomania, a form of delusion characterized by feel like the object of someone else's love, without appreciating an objective cause that could support such reasoning. Generally it is a figure of notable social importance, which serves to strengthen some beliefs of superiority on which the self-image is built. The symptom is more common in severe cases.

2. Disminution of necesity of sleep

People who are going through a manic phase can abruptly reduce the time they spend sleeping (limiting it to three hours a day or less), and even keep vigil for whole nights. This is due to a pressing need to get involved in activities, and occasionally to the belief that sleep itself is an unnecessary waste of time.

The feeling of tiredness fades, and the person spends all his night hours to maintain a frenetic pace of intentional activities, which are carried out erratically and excessive. 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 an unusual interest, which implies an incessant use of the Energy.

Under this state there is an obvious physical and mental exhaustion, but of which the person seems to be unaware. There are studies suggesting that such a reduction in the need to 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.

3. Taquilalia

Another characteristic of manic episodes is the substantial increase in speech latency., with a production of words much higher than what is usual in the periods between episodes. Alterations may emerge such as derailment (speech without an apparent thread), tangentiality (addressing issues irrelevant to the central topic being addressed) or distracted speech (change of subject in response to stimuli that are in the environment and monopolize the attention).

In the most severe cases, an alteration in verbal communication known as "word salad" can break out, in which the content of the speech is devoid of any hint of intelligibility, so the interlocutor feels unable to appreciate its meaning or intention.

4. Thought acceleration

The acceleration of thought (tachypsychia) is directly connected with the increase in the rate of verbal production. Both realities are firmly interconnected, so that the compromise in the integrity of the mental contents will translate into affected speech. This pressure of thought overflows the capacity of the person 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 discourse with which it began a conversation (and that harbored a clear communicative intention) is interrupted by a cluster of secondary ideas that overlap each other in a chaotic way, and that end up dissolving in a frenetic flow of mental contents that flow into a raging ocean of words disjointed.

5. Distractability

People who live in a manic phase of bipolar disorder can have certain higher cognitive functions altered, in particular attentional processes. Under normal circumstances, they are capable of maintaining a relevant selective attention, providing a greater relevance to elements of the environment that are necessary for proper key-based operation contextual. Thus, the projection of the focus on what was expendable 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 stimuli environmental issues would compete to monopolize the resources available to the person, making it difficult for behavior to be expressed in terms adaptive. Because of this, it is often extremely difficult to maintain sustained vigilance over a stimulus. anyone, oscillating the attention from one point to another without it being able to find a reference clear.

6. Intentional increase in activity

In the context of a manic episode there is usually a peculiar increase in the level of general activity of the person. Thus, he can spend most of his time doing any task that arouses his interest, engaging in it in such a way that he seems not to feel any fatigue despite the time that has elapsed. It is possible that this circumstance concurs with the powerful feeling of feeling creative and constructive, inhibiting the rest of responsibilities.

Sometimes this incessant flow of activity is resistant to attempts by others to force their arrest, out of concern for the possible consequences of overexertion on the health of the person (who can spend whole nights absorbed in their tasks). In these cases, a response of open opposition to the deterrence attempts may arise, accompanied by a certain irritability and perception of injury.

7. Impulsiveness

Impulsivity is the difficulty to inhibit the impulse to emit a specific behavior in the presence of a triggering stimulus (physical or cognitive), and that often also implies the impossibility of stopping it when it is underway. This symptom stands as one of those with the greatest descriptive power in manic episodes of the bipolar disorder, which may also be one of the most damaging to personal life and Social.

It is not uncommon for a person to make risky decisions in the context of the manic phase of bipolar disorder, the consequences of which involve a profound impairment of his economic or fiduciary resources, such as disproportionate investments in companies whose prognosis for success is poor or doubtful. Irreparable losses of personal or family assets occur as a consequence, which increase the relational tension that could have been established in the inner circle of people from confidence.

Involvement in other types of risky activities, such as substance use or sexual behaviors without the use of strategies adequate prophylaxis, can generate new problems or even increase the intensity of the symptoms of mania (such as would occur in the case of cocaine use, which acts as a dopamine agonist and increases the difficulties for which the person is going through).

Neurobiology of bipolar disorder

Many studies have found that acute episodes of depression and mania, which occur over the course of the disorder bipolar, increase the deterioration in cognitive functions that accompany this psychopathology with the development of weather. All this has revealed 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.

When it comes to mania, empirical evidence has been found of a reduction in the total volume of gray matter in the dorsolateral prefrontal cortex; that 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 is involved in the processes of word formation (as it has close connections with the motor area primary).

On the other hand, alterations have been detected in the areas of the brain that are responsible for processing rewards, especially in the left brain 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 impulsivity and attentional difficulty in people with bipolar disorder.

It is important that the person suffering from bipolar disorder try to seek specialized help, since the use of mood stabilizers is key to balancing affects and facilitating an adequate quality of lifetime. These drugs, however, require careful monitoring 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 alternatives medicated).

Psychotherapy, on the other hand, also plays an important role. In this case, it can help the person to better understand the disease they suffer from, to detect in advance the appearance of acute episodes (both depressive and manic or hypomanic), to manage subjective stress, to optimize family dynamics and to consolidate a lifestyle that results in the conquest of a greater wellness.

Bibliographic references:

• Abé, Ch., Ekman, C.J., Sellgren, C., Petrovic, P., Ingvar, M. and Landén, M. (2015). Manic episodes are related to changes in frontal cortex: a longitudinal neuroimaging study of bipolar disorder 1. Brain A Journal of Neurology, 138, 3440-3448.

• Rowland, T. and Marwaha, S. (2018). Epidemiology and Risk Factors for Bipolar Disorders. Therapeutic Advances in Psychopharmacology, 8 (9), 251-269.

• Satzer, D. and Bond, D.J. (2016). Mania secondary to focal brain lesions: implications for understanding the functional neuroanatomy of bipolar disorder. Bipolar Disorders, 2016, 205-220.