Manic Episode

In medicine, depression is a significant pathological condition, whose central clinical manifestation is the major depressive episode. However, within mood disorders, in addition to depressive episodes, other episodic alterations may also occur, such as the manic and hypomanic episodes.

A manic episode most commonly begins around the age of 20, although it can also appear during adolescence or, more rarely, after the age of 50. It often begins suddenly, sometimes in connection with stressful psychosocial events, and tends to progress rapidly over a few days. Its duration may range from several weeks to months, but is generally shorter and more acute in evolution than a major depressive episode.

The diagnosis of a manic episode requires the presence, for at least one week, of a persistently elevated, expansive, or irritable mood, along with at least three (or four if the mood is only irritable) of the following symptoms:

1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feeling rested after only a few hours of sleep).
3. Excessive talkativeness compared to usual.
4. Flight of ideas or subjective experience of racing thoughts.
5. Marked distractibility.
6. Increase in goal-directed activity or psychomotor agitation.
7. Involvement in potentially risky activities (e.g., impulsive spending, disinhibited sexual behavior, reckless investments).

These manifestations must be severe enough to cause marked impairment in social or occupational functioning, require hospitalization, or be associated with psychotic features. It is also necessary to rule out that the symptoms are due to a general medical condition or the direct effects of psychoactive substances, and that they do not meet the criteria for a mixed episode.

Clinical Specifiers

When the manic episode is the most recent manifestation of a mood disorder, it can be further characterized according to severity:

1. Mild: presence of the minimum number of required symptoms (three or four) with limited functional impairment.
2. Moderate: intensification of symptoms, clear increase in activity and impairment in judgment.
3. Severe without psychotic features: marked behavioral impairment requiring almost continuous supervision to prevent harm to self or others, without psychotic symptoms.
4. Severe with psychotic features: as above, but with the presence of delusions and/or hallucinations. These may be:
   • Mood-congruent: consistent with manic themes (grandeur, special identity, connection with higher entities).
   • Mood-incongruent: inconsistent with the manic state, such as persecutory delusions, thought insertion, or disorganized symptoms.

The manic episode is also described based on its subsequent course as:

• In full remission: no significant symptoms for at least two consecutive months.
• In partial remission: some symptoms persist or the absence of symptoms has lasted for less than two months.

Particular Forms

The manic episode may also occur:

• With catatonic features: entirely overlapping with those observed in major depressive episodes.
• With postpartum onset: within the first four weeks after childbirth, with mood fluctuations, obsessive thoughts related to the infant, and in severe cases, psychotic features.

References
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