Researchers at Duke University have refined KraepelinÕs four classes of mania to include hypomania (featuring mainly euphoria), severe mania (including euphoria, grandiosity, sexual drive, irritability, volatility, psychosis, paranoia, and aggression), extreme mania (most of the displeasures, hardly any of the pleasures), and two forms of mixed mania (where depressive and manic symptoms collide)[1].
Hypomania is not necessarily a pathology, especially if not part of a cycle of mania or depression. Patients rarely, if ever, seek out a psychiatrist complaining of hypomania. Johns Hopkins psychologist John Gartner in The Hypomanic Edge contends that many of AmericaÕs greatest visionaries Ð including Christopher Columbus, Alexander Hamilton, Andrew Carnegie, Louis B Mayer, and Craig Venter (who mapped the human genome) owed their brilliance and drive (and eccentricities) to their hypomanic temperaments.
"Mania lite", however does carry a downside. Trisha Suppes of the University of Texas, Dallas points out that many hypomanic patients have symptoms of irritability (classic "road rage" cases). The DSM, at present, fails to recognize this fact of life. Hypomania can also signal the beginning of a more severe manic episode.
Unfortunately, hypomania has not been well-researched, and much more work needs to be accomplished before psychiatrists can accurately diagnose and treat this overlooked aspect of bipolar disorder. (See Hypomanic Nation.)
People with bipolar disorder are depressed far more often than they are manic. According to the Stanley Foundation Bipolar Network, bipolar patients spend three times more days in depression than they do in mania. For bipolar II patients, a study by Hagop Akiskal of the University of California, San Diego revealed this population was depressed 37 times more than they were hypomanic.
A 2003 study by Robert Hirschfeld of the University of Texas, Galveston found bipolar patients fared worse in their depressions than unipolar patients. (See Bipolar Depression.)
Numerous studies show that bipolar disorder affects a patient's ability to think and perform mental tasks, even in states of remission. Deborah Yurgelun-Todd of McLean Hospital in Belmont, Massachusetts has argued these deficits should be included as a core feature of bipolar disorder.
By the same token, research by Kay Jamison of Johns Hopkins University and others have attributed high rates of creativity and productivity to individuals with bipolar disorder. (See Brain Damage.)