Manic phase of bipolar disorder: what it is, and its 7 characteristics.

We analyze this symptom, why it occurs and its implications.

Bipolar disorder type I is one of the most severe mood pathologies, as it usually manifests itself in the form of affective oscillations that oscillate between the extremes of mania and depression.

Both forms of clinical expression occur in a sequence that does not necessarily alternate (several depressive episodes occur consecutively, for example), but with appropriate treatment can be mediated by periods of stability.

For its part, mania is fundamental to understanding this mental health problem.. For this reason, it will occupy a central position in this article.

What is the manic phase of bipolar disorder?

Manic episodes are periods in which the person experiences an abnormally elevated mood.This is manifested as a sort of overflowing euphoria. Sometimes the symptom can acquire a tinge of irritability, showing the sufferer a critical attitude towards others or towards himself, and reacting abruptly to environmental circumstances that could make him feel upset.

Strictly speaking, it is required that the mood lasts for at least one week, and that it conditions (due to its intensity) the ability to carry out daily responsibilities normally. In this sense it can compromise work or academic life, and even require a period of hospitalization in order to avoid possible harm to oneself or others.

Mania is the most relevant symptom in bipolar disorder type I, as it is the only one required for diagnosis (the prevalence of which is up to 0.6% of the world population). Depression, therefore, need not necessarily be present (although it is most common). Mania should not be confused with hypomania, a less disabling form, which constitutes (together with the presence of depressive episodes) the axis of bipolar disorder type II (0.4% globally).

In the following we will detail the symptoms that are typical of manic episodes in bipolar disorderWe will exemplify each of them in order to highlight their potential impact on the life of the person who suffers from them and that of his or her relatives.

1. Exaggerated self-esteem or grandiosity

One of the defining characteristics of mania is the inflammation in the perception that the person projects about himself, which undergoes an expansion that exceeds all reasonable limits. He/she may refer to him/herself using attributes that suggest greatness or superiority, overestimating his/her personal qualities to the extreme. The exaggeration of one's own worth may also be accompanied by the devaluation of the worth of others..

This symptom acquires its maximum expression through the sensation of omnipotence, which harbors unrealistic beliefs about one's own abilities and can be associated with behaviors of risk to life or physical integrity, as well as the wasting of physical or material resources.

Another circumstance that may occur in this context is erotomania, a form of delirium characterized by feeling oneself to be the object of another person's love, without any objective cause that could support such reasoning. Generally, it is a figure of notable social transcendence, which serves to reinforce some beliefs of superiority on which the self-image is built. The symptom is more common in severe cases.

2. Decreased need for sleep

People in a manic phase may abruptly reduce the time they spend sleeping (limiting it to three hours a day or less), and even stay awake for entire nights. (limiting it to three hours a day or less), and even maintain wakefulness for entire nights. This is due to a pressing need to engage in activities, and occasionally to the belief that sleep itself is an unnecessary waste of time.

The feeling of tiredness fades, and the person devotes all of his or her nighttime hours to maintaining a hectic pace of purposeful activities, which are carried out erratically and excessively. Just as at a certain moment an inflexible commitment to certain types of tasks is evident, these may be unexpectedly abandoned in favor of others that arouse unusual interest, which implies an incessant use of energy.

Under this state there is an obvious physical and mental exhaustion, but of which the person seems to be unaware. There are studies suggesting that such a reduction in the need for sleep is one of the symptoms with the greatest predictive power for the onset of manic episodes in people with bipolar disorder who were previously in a stable phase.

3. Tachylalia

Another characteristic of manic episodes is the substantial increase in speech latency, with a much higher production of words.with a production of words much higher than usual in the periods between episodes. Disturbances may emerge such as disarticulation (speech without an apparent common thread), tangentiality (addressing issues irrelevant to the central theme being addressed) or distracted speech (change of subject in response to stimuli that are in the environment and monopolize attention).

In the most severe cases, an alteration of verbal communication known as "word salad" may occur, in which the content of the speech is devoid of any hint of intelligibility, so that the interlocutor feels unable to appreciate its meaning or intention.

4. Acceleration of thought

Acceleration of thought (tachypsychia) is directly connected to the increase in the rate of verbal production.. The two realities are firmly interconnected, so that compromise in the integrity of mental content will result in impaired speech. This pressure of thought overwhelms the person's ability to translate it into operational terms for efficient use, resulting in what is known as a "leakage of ideas".

This flight of ideas involves an evident disorganization in the hierarchy of thought priorities, so that the discourse with which a conversation was initiated (and which harbored a clear communicative intention) is interrupted by an accumulation of secondary ideas that overlap each other in a chaotic manner, and which end up being diluted in a fast-paced flow of mental contents that flow into a raging ocean of unconnected words.

5. Distraction

People who experience a manic phase of bipolar disorder may see alterations in certain higher cognitive functions, particularly attentional processes.particularly attentional processes. Under normal circumstances they are able to maintain a relevant selective attention, giving greater relevance to the elements of the environment that are necessary for proper functioning based on contextual cues. Thus, the projection of the focus on what is dispensable or accessory for the occasion would be inhibited.

During manic phases, an alteration in this filtering process can be observed, so that the various environmental stimuli compete to monopolize the resources available to the person, making it difficult for the behavior to be expressed in adaptive terms. Because of this, it is often extremely difficult to maintain sustained vigilance over any one stimulus, with attention oscillating from one point to another without being able to find a clear reference.

6. Increased purposeful activity

In the context of a manic episode there is usually a peculiar increase in the person's general level of activity.. Thus, he can devote most of his time to perform any task that arouses his interest, involving himself in it in such a way that he does not seem to feel any fatigue despite the time elapsed. It is possible that this circumstance may concur with the very powerful feeling of being creative and constructive, inhibiting the rest of responsibilities.

Sometimes this incessant flow of activity is resistant to attempts by others to force it to stop, out of concern for the possible consequences of overexertion on the health of the person (who may spend entire nights engrossed in his or her chores). In these cases, a response of open opposition to attempts at dissuasion may arise, accompanied by a certain irritability and perception of aggravation.

7. Impulsivity

Impulsivity is the difficulty to inhibit the impulse to emit a concrete behavior in the presence of a triggering stimulus (physical or cognitive), accompanied by a certain irritability and perception of aggravation. (physical or cognitive), and often also implies the impossibility of stopping it at the moment it is in progress. This symptom is one of the most descriptive in manic episodes of bipolar disorder, and may also be one of the most detrimental to personal and social life.

It is not uncommon that, in the context of the manic phase of bipolar disorder, the person takes risky decisions whose consequences imply a profound undermining of his or her economic or fiduciary resources, such as disproportionate investments in enterprises whose prognosis of success is poor or doubtful. As a consequence, irreparable losses of personal or family assets are produced, which increase the relational tension that may have been established in the inner circle of trustworthy people.

Involvement in other types of risky activities, such as substance use or sexual behaviors without the use of adequate prophylactic strategies, can generate new problems or even increase the intensity of the symptomatology of mania (as would occur in the case of cocaine use, which acts as a dopamine agonist and increases the difficulties the person is going through).

Neurobiology of bipolar disorder

Many studies have found that acute episodes of depression and mania, which occur during the course of bipolar disorder, increase the deterioration of the cognitive functions that accompany this psychopathology over time. All this has highlighted the possibility that there may be structural and functional mechanisms in the central nervous system that are at the basis of its particular clinical expression.

Regarding mania, empirical evidence of a reduction in total gray matter volume in the dorsolateral prefrontal cortex has been found.which contributes to functions such as attention, impulse inhibition or medium- and long-term planning ability. Similar findings have also been described in the inferior frontal gyrus, which is involved in word formation processes (as it has close connections with the primary motor area).

On the other hand, alterations have been detected in the areas of the brain responsible for processing rewards, especially in the left cerebral hemisphere, which may be hyperactive. This fact, together with the aforementioned disturbance of the frontal cortical areas, could be the foundation of the impulsivity and attentional difficulty of people with bipolar disorder.

It is important for the person suffering from bipolar disorder to seek specialized help, since the use of mood stabilizers is key to balance the affects and facilitate an adequate quality of life. These drugs, however, require close monitoring by the physician due to their potential toxicity in case of inappropriate consumption (which may require changes in dosage or even the search for alternative medications).

Psychotherapy, on the other hand, also plays an important role. In this case it can help the person to learn more about the disease he/she is suffering from, to detect in advance the onset of acute episodes (both depressive, manic or hypomanic), to manage subjective stress, to optimize family dynamics and to consolidate a lifestyle that results in the conquest of greater well-being.

Bibliographical references:

• Abé, Ch., Ekman, C.J., Sellgren, C., Petrovic, P., Ingvar, M. y Landén, M. (2015). Manic episodes are related to changes in frontal cortex: a longitudinal neuroimaging study of bipolar disorder 1. Brain A Journal of Neurology, 138, 3440-3448.

• Rowland, T. y Marwaha, S. (2018). Epidemiology and Risk Factors for Bipolar Disorders. Therapeutic Advances in Psychopharmacology, 8(9), 251-269.

• Satzer, D. y Bond, D.J. (2016). Manía secundaria a lesiones cerebrales focales: implicaciones para la comprensión de la neuroanatomía funcional del trastorno bipolar. Bipolar Disorders, 2016, 205-220.