In mania the elevated spirit seen in hypomania is often mixed with irritability and hostility. Jamison (2.9) has described the change: 'Humor and absorption on friends' faces are replaced by fear and concern. Everything previously (in the hypomanic state) moving with the grain is now against—you are irritable, angry, frightened, uncontrollable...'.
The psychomotor symptoms of mania are restlessness and less need for sleep. There is pressure of speech; the patient talks more and in a louder voice. There is intrusive behaviour, arguments, and attempts to dominate others. Expansiveness is manifested as increased self-esteem; for example, the patient clearly overestimates his or her own capacities or hints at unusual abilities. Jamison (2E> described how in periods of mania she did not worry about money: 'The money will come from somewhere; I am entitled; God will provide. Credit cards are disastrous, personal cheques even worse ... mania is a natural extension of the economy ... So I bought precious stones, elegant and unnecessary furniture, three watches within an hour (in the Rolex rather than Timex class)...'.
To be diagnosed as a manic episode, the disorder should last at least a week. The criteria for mania are elevated or clearly irritable mood, and at least three of the symptoms listed in Table..2. These symptoms should be severe enough to cause marked impairment in occupational functioning. Hospital admission is often needed to prevent the patient harming himself or others.
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