Learning Objective
By the end of this module, the student should be able to identify the diagnostic criteria, clinical features, and key mnemonic for manic episodes in bipolar disorder, and apply this knowledge to clinical scenarios.
Definition
A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood accompanied by increased activity or energy.
Duration: ≥ 1 week (or any duration if hospitalization is required).
Functional impact: Must cause marked impairment in social or occupational functioning.
Diagnostic Criteria (DSM-5)
A manic episode requires:
- Elevated, expansive, or irritable mood plus increased goal-directed activity or energy.
- ≥ 3 of the following (≥ 1 week, or any duration if hospitalization is required):
| Feature | Description | Mnemonic |
|---|---|---|
| Distractibility | Difficulty focusing, easily sidetracked | D |
| Impulsivity/Indiscretion | Hedonistic behavior, risk-taking | I |
| Grandiosity | Inflated self-esteem, unrealistic beliefs about abilities | G |
| Flight of Ideas | Racing thoughts, rapid topic shifts | F |
| Activity/Agitation ↑ | Increased goal-directed activity, psychomotor agitation | A |
| Sleep ↓ | Decreased need for sleep without fatigue | S |
| Talkativeness | Pressured speech, talking more than usual | T |
Mnemonic: DIG FAST – helpful for rapid recall during exams.
Key Points
- Manic episodes are part of bipolar I disorder.
- Hospitalization is often required for severe mania.
- Can present with psychotic features if severe.
- Differentiate from hypomanic episodes: hypomania is less severe, lasts ≥ 4 days, and does not cause marked functional impairment.
Clinical Table – Manic vs Hypomanic Episodes
| Feature | Manic Episode | Hypomanic Episode |
|---|---|---|
| Duration | ≥ 1 week (any if hospitalized) | ≥ 4 days |
| Functional impairment | Marked | Not marked |
| Psychotic features | May occur | Absent |
| Hospitalization | May be required | Usually not |
