When it comes to "mania", many people may mistakenly think that it mainly refers to "abandoning clothes and running away, climbing high and singing", or "beating people and destroying things, not avoiding relatives and strangers" and other violent states that completely lose thei

Depressive disorders are generally divided into two categories by the medical community based on their clinical manifestations: one is unipolar depression, which is what we commonly call "depression" characterized by low mood, reduced motivation, and slow thinking; the other is called "bipolar depression" or "bipolar disorder," also known as bipolar affective disorder or bipolar disorder , which is actually what is commonly known as "manic depression" or "manic depression." The main clinical feature of "bipolar depression" is alternating or mixed episodes of mania or hypomania and depression.

"Mania" and "hypomania" states

When it comes to "mania", many people may mistakenly think that it mainly refers to a state of complete irrational madness such as "leaving clothes and running away, climbing high and singing", or "beating people and destroying things, not avoiding relatives and strangers", etc. In fact, such symptoms are not mainstream.

The "mania" referred to in bipolar disorder refers to a state in which patients feel uncontrollable excitement and energy, and feel overconfident. Its fanaticism goes beyond normal mood and energy changes, interfering with daily life, work and social interaction, causing various obstacles or dangers, and even breaking social taboos and norms. Of course, a manic state doesn't always mean feeling overconfident or overly euphoric. It can also manifest as extreme irritability.

Symptoms of "mania" include: uncontrollable excitement, elation or irritability, agitation, high energy levels or activity levels that are difficult to control (such as constant movement, fidgeting, or moving around), difficulty concentrating or concentrating, excessive self-esteem and ego, lack of social inhibition, racing thoughts, reduced or no sleep, risky or reckless activities, thoughts of suicide or self-harm, and psychotic symptoms such as hallucinations and delusions.

As early as 2000 years ago, the Chinese medicine work "The Yellow Emperor's Internal Classic Lingshu" "Mania 22" has a penetrating description of "mania" "Mania begins, sleeps less and is not hungry, is a virtuous person, self-defining wisdom, self-respecting, good at scolding, day and night", which shows that traditional Chinese medicine has already conducted in-depth research on this.

The so-called "hypomania" in bipolar disorder is a relatively mild form of mania. Symptoms can include: a higher, happier mood than usual, higher irritability or rude behavior, overconfidence, higher activity or energy levels than usual for no clear reason, a strong feeling of physical and mental health, being more sociable and conversational than usual, having a stronger sex drive than usual, feeling the need to sleep less than usual, and more.

The difference between hypomania and mania lies in the severity of the symptoms. Both involve changes in mood and behavior that go beyond normal, day-to-day changes.

Types and clinical characteristics of bipolar disorder

According to the internationally accepted " American Diagnostic and Statistical Manual of Mental Disorders, 5th Edition " ht Classification in ml2 (DSM-5), bipolar disorder ( bipolar disorder) mainly has the following 7 types:

type	clinical features
bipolar disorder Type 1 disorder	has had at least one manic episode; neither the manic nor the depressive episode is likely to be attributed to schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum disorders and other psychotic disorders.
bipolar disorder type Ⅱ	has had at least one hypomanic episode and one depressive episode; no history of manic episodes; neither hypomania nor depression is likely to be attributed to schizoaffective disorder, schizophrenia, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum disorders and other psychotic disorders.
cyclothymic disorder	Persistent mood instability, including numerous periods of mild depression and mild elevation.
Substance/drug-induced bipolar and related disorders	refers to the clinical manifestations of patients who meet the diagnostic criteria for manic, hypomanic or depressive episodes when taking substances, drugs or receiving certain treatments, and this reaction exceeds the physiological response of the drug or treatment.
Bipolar and related disorders caused by other physical diseases	refer to the clinical manifestations caused by certain physical diseases that meet the diagnostic criteria for manic, hypomanic or depressive episodes. Evidence such as medical history, physical examination, and auxiliary examinations confirmed that the patient's above-mentioned symptoms were due to some physical disease. Common diseases include Cushing's syndrome, multiple sclerosis, stroke, and traumatic brain injury.
Other specific bipolar and related disorders	refer to those individuals who have a history of depressive disorder and fully meet the criteria for hypomania except for 4 consecutive days of episodes, as well as those individuals who have hypomanic symptoms for 4 or more consecutive days, but have too few symptoms to meet the bipolar type I diagnostic label.
Unspecified bipolar and related disorders	This category applies to those who have typical symptoms of bipolar and related disorders and cause clinically significant suffering or impairment in social, occupational or other important functions, but do not fully meet the diagnostic criteria for any of the bipolar and related disorders.

Among the celebrities in ancient and modern times, such as US Presidents Lincoln and Roosevelt, British Prime Minister Churchill, physicist Newton, painter Van Gogh, musician Schumann, Beethoven, writers Hemingway, Dickens, movie stars Marilyn Monroe, Vivien Leigh, writers Hemingway, Dickens, Gu Cheng, Sanmao and others have all been deeply troubled by bipolar disorder. A contemporary and prolific Chinese writer once admitted that he suffered from bipolar disorder. She even believed: "People with great creative power, such as Woolf and Van Gogh, have this kind of disease."

Regardless of unipolar depression or bipolar depression (manic depression), they are regarded as "mood diseases" in Hong Kong. However, severe bipolar disorder (bipolar disorder type Ⅰ) and schizophrenia (schizophrenia) that manifest mental symptoms such as hallucinations and delusions are classified as psychotic disorders. In fact, some patients with severe bipolar disorder (bipolar disorder type Ⅰ) are often difficult to distinguish from schizophrenia (schizophrenia), so we often see psychiatric doubts in diagnosis. I once encountered a female patient who was initially diagnosed with schizophrenia and was hospitalized in a psychiatric department many times. After more than 2 years, she was diagnosed with bipolar disorder again. The patient's manic and depressive symptoms were mixed and severe, and he was often accompanied by auditory hallucinations and delusions.

For bipolar disorder that is prone to relapse, active and continuous treatment becomes the key to controlling and improving its symptoms, preventing or reducing its attacks, and improving its prognosis. Judging from the author's diagnosis and treatment experience, the use of traditional Chinese medicine, acupuncture and other traditional Chinese medicine, combined with psychological treatments such as cognitive behavioral therapy, can play an important role in improving and stabilizing the curative effect. Through long-term treatment, many patients can manage and maintain a normal life, work and social life, and even achieve extraordinary achievements and success in academics and careers.

References

. American Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), 2013

. Dr. Chunyu: There are more than 8.4 million bipolar disorder patients in China: half genius, half haze. March 30, 2022, Sina.com