Hypomania can be the first stage of a spiralling upswing of mood (Box..2). The main symptom of hypomania is usually intense well being but irritability is also seen. Normal happiness is transient, lasting from minutes to hours. To be diagnosed as hypomania, the elevation of mood must last for at least 4 days. The change of mood is often quite different from any seen when the patient is well.

The cardinal triad of mania comprises emotions, psychomotor symptoms, and expansiveness or increased self-esteem. A slight psychomotor restlessness and some pressured speech are often seen; for example, the person makes more frequent telephone calls. These symptoms are not severe enough to cause marked impairment in social or occupational functioning.

Jamison(29) has described this phase as follows: '...When you're high it's tremendous. The ideas and feelings are fast and frequent ...Shyness goes, the right words and gestures are suddenly there, the power to captivate others a felt certainty...Sensuality is pervasive and the desire to seduce and be seduced irresistible'. The shyness or introversion seen in mild depression or dysthymia contrast with the lack of shyness and extraversion seen in the hypomanic patient.

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