Expert: Ivan Goldberg, M.D. - 1/1/2011

Question
Hi Ivan,

I have Temporal Lobe Epilepsy, along with organic mood disorder. Which, we partially believe to be bipolar-ish - I get a bit hypomanic. Not enough to fit in to the classifications, but traits.

One of those traits is pressured speech. Which I have been aware of at times, although it seems I do it more than I am aware of. My Shrink has noted that I do it in Consults, and my husband then said he is aware that I do it.

When I have been aware of myself of doing it, I have felt very hyper active. It usually only last for about 5 minutes. I will get really excited, for no good reason, really happy, talking really fast, cant stop laughing and giggeling, and genereally bursting with .... excitment or something. The last time I can remember doing it, it confused me a little ... as I didn't know where it came from. Usually it only lasts for about 5 minutes and then it stops abruptly.

Im just trying to figure out if that is a normal mood swing that normal people get, or if that is a hypomania type of thing.

My Dr has asked me to do some research, and try and have a think about these things before I see her again next week. I have tried searching for anything that might explain this, but can't find anything. So it is anything? Or nothing? If it is anything, does it have a name? Or do you know of any articles?

Thank you very much!

Answer
Hi, Bec . . .

Happy new Year!

Although I frequently diagnose "bipolar spectrum disorder" or "soft bipolar disorder" I would never make such a diagnosis if the only evidence of hypomania were brief episodes lasting 5-minutes. Such brief episodes are seen in everyday life quite often if you start to look for them. Most of the people who have such "brief hypomanic Episodes" have no family or personal histories of a mood disorder of any type.

I think you should go a Google search on the phrase, "brief hypomanic episode."

The following abstract that suggests that a two day minimum duration of hypomania might be useful in diagnosing bipolar disorder, may also interest you:

J Affect Disord. 2006 Dec;96(3):189-96.

The duration of hypomania in bipolar-II disorder in private practice: methodology and validation.
Benazzi F, Akiskal H.

Outpatient Psychiatry Center, Ravenna, Italy. f.benazzi@fo.nettuno.it

Abstract
BACKGROUND: DSM-IV 4-day minimum hypomania duration is not evidence-based. Epidemiologic data suggest that briefer hypomanias are prevalent in the community. We sought to find out the relative prevalence of short (2-3 days) versus long (>/=4 days) hypomanias in private practice.

METHODS: 206 bipolar-II (BP-II) depressed outpatients (group B) and a group of 140 remitted BP-II (group R) were assessed with the DSM-IV Structured Clinical Interview, as modified by the authors. BP-II with short vs. longer hypomania were compared on such bipolar validators as early age at onset, depressive recurrence, atypical feature specifier, depressive mixed state and bipolar family history. In addition, to ascertain the bipolar status of depressed patients with brief hypomanias, we included a comparison group of 178 major depressive disorder (MDD) patients assessed when depressed.

RESULTS: 27-30% of hypomanias (depending on whether assessment occurred when patients were depressed or in remission) had 2-3-day duration; 72% lasted less than 4 weeks. Except for the atypical feature specifier, BP-II with short vs. BP-II with longer hypomania were not significantly different on bipolar validators. Moreover, BP-II with short, like its longer hypomanic counterpart, was significantly different from the comparison MDD group on all bipolar indicators.

LIMITATIONS: Single interviewer and retrospective evaluation of duration of hypomania.

CONCLUSIONS: As BP-II patients almost never present clinically in a hypomanic episode, the retrospective assessment of the duration of these episodes is clinically unavoidable. Most hypomanias last from 2 days to a few weeks. BP-II with shorter vs. longer hypomanias had significantly higher rates of females, comorbidity and atypical features, but were otherwise indistinguishable on crucial bipolar validators. Furthermore, such validators, including bipolar family history, robustly distinguished BP-II with short hypomanias from the MDD group. The conservative 4-day threshold would misclassify one out of three BP-II as MDD. Such misclassification has relevant implications for treatment and outcome, as well as clinical research methodology for depressive and bipolar disorders.

PMID: 16427136 [PubMed - indexed for MEDLINE]

Best regards . . .

Ivan
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