Bipolar I disorder is one of the more serious mood disorders because it usually manifests as emotional swings that oscillate between the extremes of mania and depression.
The two forms of clinical expression occur in a not necessarily alternating sequence (several depressive episodes in a row, for example), but with timely treatment they can be mediated by periods of stability.
For its part, mania is the key to understanding this mental health problem.. Therefore, it will take center stage in this article.
What is the manic phase of bipolar disorder?
Manic episodes are times when the person experiences an unusually high mood, Which manifests itself as a sort of overwhelming euphoria. Sometimes the symptom can acquire a shade of irritability, showing the patient a critical attitude towards others or towards himself, and reacting sharply to environmental circumstances that can make him angry.
Strictly speaking, the mood must last for at least a week, and that it conditions (through its intensity) the ability to normally develop daily responsibilities. In this sense, it can compromise work or academic life, and even require hospitalization in order to avoid possible damage to oneself or to others.
Mania is the most relevant symptom of bipolar I disorder because it is the only one required for diagnosis (the prevalence is 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 is (with the presence of depressive episodes) the axis of bipolar disorder type II (0.4% worldwide).
In what follows, we will detail the typical symptoms of manic episodes in bipolar disorder., By illustrating each of them to highlight their potential impact on the life of the person who suffers from it and that of his immediate entourage.
1. Self-esteem or exaggerated grandiosity
One of the defining characteristics of mania is the inflammation in a person’s self-perception, which expands beyond all reasonable bounds. She can refer to herself using attributes that suggest greatness or superiority, oversizing her personal qualities to the extreme. The exaggeration of one’s own worth may be accompanied, moreover, by the devaluation of that of others..
This symptom gains its maximum expression through the feeling of omnipotence, which harbors unrealistic beliefs about one’s own abilities and which may be associated with life-threatening behaviors or physical integrity, as well as with depletion of physical or material resources.
Another circumstance that may agree in this context is erotomania, a form of delirium that is characterized by feeling the object of another’s love, without appreciating an objective cause that could support this reasoning. He is generally a figure of remarkable social importance, who serves to consolidate certain 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 are going through a manic phase may sharply reduce the time they spend sleeping (Limit to three hours a day or less), and even keep it overnight for whole nights. This is due to an urgent need to get involved in activities, and sometimes a belief that the dream itself is an unnecessary waste of time.
The feeling of fatigue subsides and the person devotes all his night hours to maintaining a frantic pace of intentional activities, which take place in an erratic and excessive manner. Just as at some point there is evidence of an inflexible commitment to certain types of tasks, these may be unexpectedly abandoned in favor of others which arouse unusual interest, which involves relentless use of l ‘energy.
Under this state, there is obvious physical and mental exhaustion, which the person seems to ignore. 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 occurrence of manic episodes in people with bipolar disorder who have so far been in a phase of depression. stability.
Another hallmark of manic episodes is the substantial increase in speech latency., With much higher word production than usual in the periods between episodes. Alterations such as derailment (apparent wireless speech), tangentiality (addressing issues unrelated to the central issue being addressed) or distracted speech (a change of subject in response to the stimuli encountered may emerge) in the environment and attract attention ).
In the most severe cases, an alteration in verbal communication called “word salad” may occur, in which the content of the speech is devoid of any indication of intelligibility, so that the interlocutor feels unable to appreciate it. meaning or intention.
4. Acceleration of thought
The acceleration of thought (tachypsychia) is directly linked to the increase in the rate of verbal production. The two realities are firmly interconnected, so the commitment to the integrity of mental content will result in affected speech. This thought pressure overflows the person’s ability to translate into operational terms for effective use, by observing what is called “brainstorming”.
This leakage of ideas involves the obvious 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 which break down. overlap chaotically, and eventually dilute in a hectic flow of mental contents that lead to a raging ocean of unrelated words.
People who are going through a manic phase of bipolar disorder may see certain higher cognitive functions impaired., In particular attentional processes. Under normal circumstances, these are able to maintain relevant selective attention, giving greater relevance to the elements of the environment that are necessary for proper functioning on the basis of contextual keys. Thus, the projection of the focus on what would be dispensable or incidental for the occasion would be inhibited.
During the manic phases, an alteration of this filtering process can be observed, so that the different environmental stimuli would compete to monopolize the resources available to the person, making it difficult to express the behavior in adaptive terms. Therefore, it is generally extremely difficult to maintain a sustained watch over any stimulus, oscillating the attention from one point to another without being able to find a clear reference.
6. Increased intentional activity
Against the background of a manic episode there is usually a particular increase in the general activity level of the person. Thus, he can devote most of his time to carrying out any task that arouses his interest, getting involved in it in such a way that he does not seem to feel tired despite the time that has elapsed. It is possible that this circumstance coincides with the very powerful feeling of feeling creative and constructive, inhibiting the rest of the responsibilities.
Sometimes this incessant flow of activity resists attempts by others to force their arrest, in the face of concern about the possible consequences of overwork on the health of the person (who can remain stuck for nights in their tasks). . In these cases, an open response to dissuasive attempts may arise, accompanied by some irritability and a perception of grievance.
Impulsivity is the difficulty inhibit the impulse to emit a specific behavior in the presence of a detonating stimulus (Physical or cognitive), and this often also implies the inability to stop it when it is in motion. This symptom is one of the most descriptive power in manic episodes of bipolar disorder, and can also be one of the most damaging to personal and social life.
It is not uncommon for a person to make risky decisions in the manic phase of bipolar disorder, the consequences of which result in profound damage to their financial or fiduciary resources, such as disproportionate investments in companies with poor prognosis or doubtful. As a result, irreparable losses of personal or family property occur, which increases the relational tension that may have been established in the inner circle of trusted people.
Participating in other types of risky activity, such as substance use or sexual behavior without the use of appropriate prophylactic strategies, can lead to new problems or even increase the intensity of symptoms of mania (as in the case of cocaine use, which acts as a dopamine agonist and increases the difficulties that the person goes through).
Neurobiology of bipolar disorder
Numerous studies have shown that the acute episodes of depression and mania, which occur during bipolar disorder, increase the deterioration of cognitive functions that accompany this psychopathology over time. All of this highlighted the possibility that structural and functional mechanisms exist in the central nervous system that underlie its particular clinical expression.
As for mania, empirical evidence for a reduction in the total volume of gray matter in the dorsolateral prefrontal cortex has been found; which 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 (as it has close connections with the primary motor zone).
On the other hand, alterations have been detected in the areas of the brain responsible for processing rewards, particularly in the left cerebral hemisphere, which may be in a situation of hyperactivity. This fact, together with the aforementioned disruption of the frontal cortical areas, could lay the groundwork for impulsivity and difficulty in attention in people with bipolar disorder.
It is important for the person with bipolar disorder to try to seek specialist help, as the use of mood stabilizers is essential in balancing ailments and supporting an adequate quality of life. These drugs, however, require careful monitoring by the doctor because of their potential toxicity if used inappropriately (which may require dose changes or even research into drug alternatives).
Psychotherapy, on the other hand, also plays an important role. In this case, it can help the person to know better the disease from which they are suffering, to detect in advance the appearance of acute episodes (both depressive, manic or hypomanic), to manage subjective stress, to optimize family dynamics and to strengthen a resulting lifestyle. to the conquest of greater well-being.
Abé, Ch., Ekman, CJ, Sellgren, C., Petrovic, P., Ingvar, M. and Landén, M. (2015). Manic episodes are linked to changes in the 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 disorder. Therapeutic advances in psychopharmacology, 8 (9), 251-269.
Satzer, D. and Bond, DJ (2016). Mania secondary to focal brain injury: implications for understanding the functional neuroanatomy of bipolar disorder. Bipolar Disorders, 2016, 205-220.