Diagnostic aspects

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On the positive side, hyperthymic individuals are enterprising, ambitious, and driven, often achieving considerable social and vocational prominence. (105) Abuse of stimulants is not so much an attempt to ward off depression and fatigue as an effort to enhance their already high-level drive and, sometimes, to further curtail their already reduced need for sleep. Hyperthymic individuals typically marry three or more times. Others, without entering into legally sanctioned matrimony, form three or more families in different cities; these men are capable of maintaining such relationships for long periods, testifying to their financial and personal resourcefulness, as well as their generosity towards their lovers and the offspring from such unions. Unlike the antisocial psychopath who is predatory on others and neglects or abuses his women and children, these men care for their loved ones. But obviously the 'arrangement' involving women of different generations is complex, and a fertile soil for jealousy, drama, scandal, and tragedy. Nonetheless, it is not uncommon to see more than three or four women crying profusely and expressing their common grief at the funerals of these men!

Although individuals with hyperthymia optimally enjoy the advantage of their reduced need for sleep (giving more time and energy to invest in work and pleasure), some present clinically because of insomnia. Thus, in a predominantly male sample of executives presenting to a sleep centre, (105) habitual sleep need was 4 to 5 h; however, they had been intermittently bothered by 'nervous energy' and difficulty falling asleep. Now, in late middle age, alcohol was no longer an effective hypnotic. Although they vigorously denied depressive and other mental symptoms—indeed, they had extremely low scores on self-rated depression—spouses or lovers provided collateral information about brief irritable-depressive dips, especially in the morning and, in some cases, more protracted 'fatigue states' of days to weeks during which the subject would vegetate. Despite these depressive dips, these patients were distinguished from the constantly shifting moods of cyclothymic patients by the fact that the depressions arose from a baseline of trait hypomania of a more or less stable course. Our most current diagnostic guidelines for a hyperthymic temperament consist of the following traits on a habitual basis since at least early adulthood: cheerful, overoptimistic, or exuberant; extraverted and people-seeking, often to the point of being overinvolved or meddlesome; overtalkative, eloquent, and jocular; uninhibited, stimulus-seeking, and sexually-driven; vigorous, full of plans, improvident; overconfident, self-assured, and boastful attitudes that may reach grandiose proportions.

A systematic retrospective review of the case records of people with manic depression, whose course was dominated by manic episodes, was recently undertaken in Munich,(l07) yielding attributes overlapping with our proposed list: active, vivid, extraverted, verbally aggressive, self-assured, strong willed, engaged in self-employed professions, risk-taking, sensation-seeking, breaking social norms, spendthrift, and generous. The fact that at least 10 per cent of patients with major depression in an Italian study(l08) could be characterized as premorbidly hyperthymic, suggests that this temperament has relevance to both major affective poles. This is an important diagnostic consideration, because rather than being considered narcissistic depressions, these should be recognized as a soft bipolar variant. (8)

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