Bipolar disorder is a mood disorder marked by episodes of depression and episodes of elevated or irritable mood. The two relevant poles; mania and mixed states — are key features:
Mania
A manic episode is a distinct period (at least 1 week, or any duration if hospitalization is required) of abnormally elevated, expansive, or irritable mood, along with increased energy/activity.
Typical features include:
- Inflated self-esteem or grandiosity
- Decreased need for sleep (feels rested after 3 hours)
- Pressured speech, talking more than usual
- Flight of ideas or racing thoughts
- Distractibility
- Increased goal-directed activity or psychomotor agitation
- Risky or impulsive behaviors (e.g., reckless spending, sexual indiscretions, substance use)
Severe mania can lead to psychosis (delusions, hallucinations) and often requires hospitalization.
Mixed States (Mixed Features)
A mixed state (or “with mixed features”) means symptoms of both mania/hypomania and depression occur at the same time or in very rapid shifts.
Examples:
- Depressed mood + racing thoughts
- Low energy + high agitation
- Suicidal thinking + impulsive risk-taking
- Irritability and anxiety alongside manic drive
These states are especially dangerous, as the combination of impulsivity and despair can increase risk of suicidal behavior, Crisis support: Please Get Immediate help if suicidal (911 in the US, or 988 Suicide & Crisis Lifeline).
Key Points Clinically
- Bipolar I Disorder: Defined by at least one manic episode (often with depressive episodes).
- Bipolar II Disorder: Defined by hypomanic (less severe than mania, no psychosis) and depressive episodes.
- Mixed states can occur in either type.
- Medical treatments: See a Psychiatrist
- Psychotherapy (psychoeducation, CBT, family-focused therapy) and lifestyle regulation (sleep, stress, routines) are also crucial.
Shervan K Shahhian
LIBERTY PSYCHOLOGICAL ASSOCIATION 