Table 1 Validity of CRDC criteria for pure or mixed mania or hypomania
From: Clinical research diagnostic criteria for bipolar illness (CRDC-BP): rationale and validity
Diagnosis | Symptoms | Course | Family history/Genetics | Treatment effects | Biological |
|---|---|---|---|---|---|
Pure mania | Psychomotor activation along with euphoric mood Low insight and judgment Marked social impairment Less need for sleep May present with irritability/disruptive aggressiveness Marked talkativeness Noticeable flight of ideas Recklessness or increase of sexual drive May present with psychotic features | Usually bipolar, Multiple recurrences alternating with depression (Goodwin and Manic–depressive 2007) | Associated with BP (Goodwin and Manic–depressive 2007) | Responsive to lithium preferentially (Bowden 1995) | Associated with HPA axis activation (Swann et al. 1992) Amygdala enlargement (Foland et al. 2008) |
Mixed mania | Psychomotor activation along with dysphoric mood Depressive symptoms usually present Low insight and judgment Marked social impairment Less need for sleep Infrequent rapid cycling Marked talkativeness Noticeable flight of ideas Recklessness Increase of sexual drive May present with psychotic features | Usually bipolar, Multiple recurrences alternating with depression (Goodwin and Manic–depressive 2007) | Associated with BP | Responsive to valproate or antipsychotics preferentially (Bowden 1995; Muralidharan et al. 2013) | Associated with HPA axis activation (Swann et al. 1992) Amygdala, enlargement (Foland et al. 2008) |
Pure hypomania | Psychomotor activation along with requirement of euphoric mood Mild if present social impairment Mild decrease of insight and judgment Sleeping decreased Mild talkativeness Mild flight of ideas Mild recklessness or Mild increase of sexual drive | Usually bipolar, alternating with depression (Goodwin and Manic–depressive 2007) Multiple recurrences (Goodwin and Manic–depressive 2007) Highly undetected (Ghaemi et al. 2000) | Associated with BP and MDD to lesser degree (Simpson et al. 1993) | Usually not treated in isolation but may respond to lower levels/doses of mood stabilizers | Little studied |
Mixed hypomania | Psychomotor activation along with requirement of dysphoric mood (McElroy et al. 1992) Mild if present social impairment Mild decrease of insight and judgment Sleeping decreased Mild talkativeness Mild flight of ideas Mild recklessness or Mild increase of sexual drive | Usually bipolar, alternating with depression (Suppes et al. 2005) Multiple recurrences (Goodwin and Manic–depressive 2007), (Suppes et al. 2005) Highly undetected (Suppes et al. 2005) | Associated with BP and MDD to lesser degree | Little studied | Unknown |