How big a problem is undiagnosed hypomania? By some estimates as many as 50% of people being treated for depression may have hypomania (similar to mania, but milder) episodes as well.
A recent article in Psychiatric Times encourages doctors to maintain an increased level of suspicion about the possibility of hypomania in patients who are receiving treatment for a range of mental illnesses with which bipolar disorder may be a “comorbidity” (illness occurring at the same time).
Doctors are urged to use screening tools, and to supplement them with “paper and pencil” inventories that a patient or relative can fill out. These provide clues to possible mood disorders that should be followed up on by an alert medical practitioner. Undiagnosed hypomania is common because the patient may lack insight into his or her own behavior or may deny or minimize the symptoms.
60% of patients with bipolar have at least one of these comorbidities:
- ADHD: hyper, distracted, racing thoughts, talkative, impulsive
- Borderline personality disorder: labile, impulsive, irritable
- PTSD: irritable, reckless behavior
- OCD: hyperactive around compulsions
- GAD: racing thoughts, distracted, irritable
- Addictions: impulsive, euphoric, decreased need for sleep.
Therefore, physicians should be even more suspicious of the possibility of bipolar in cases where one of these are found, not less.
Remember that “uncertainty is the rule with hypomania”. Seeking the signs and symptoms of hypomania can take years, and doctors should be reluctant to ever rule it out, since it can be so difficult to discover.
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