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Hypomania in clinical practice

  • Daniel J. Smith and S. Nassir Ghaemi
Abstract

Recent work suggests that a broad clinical spectrum of bipolar disorder is more common than previously thought and that the disorder may affect up to 5% of the population. The correct definition and diagnosis of hypomania is central to the identification of bipolar disorder. In this review we focus on recent diagnostic and clinical advances relating to bipolar disorder, with particular reference to hypomanic states. We also highlight some of the controversies in this field and discuss ways in which clinicians might improve their detection of bipolar disorders.

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References
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Hypomania in clinical practice

  • Daniel J. Smith and S. Nassir Ghaemi
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eLetters

Not just another hypo-manic Monday!

Arun K Chopra, Senior House Officer
07 March 2006

Editor-

Smith & Ghaemi’s (2006) excellent review of the literature aroundhypomania describes many of the difficulties in the area . A problem which they mention but do not explore is the potential for over diagnosis. They refer to a paper by Goodwin (2002) where he suggests that many, if not the majority, of UK inpatients suffering from mania are diagnosed withhypomania and that this partly might be out of a sense of politeness.

But why is it polite to diagnose hypomania? Answering this question might suggest another reason why hypomania is over diagnosed and also indicate steps to prevent this.Whilst mania is a pejorative term, hypomania is less pejorative; not just because it literally reflects a lesser mania, but also because it is a word which is not used in everyday conversation.

Mania as a word in the English language is used frequently. For example many of us are familiar with the expression ‘the traffic was manic’ orthe 1985 Bangles’ hit song ‘Just another Manic Monday’. By contrast hypomania is free from such colloquial use as the title of this letter demonstrates. It may therefore appear to be a more clinical term which is moreacceptable and preferred by many patients and their carers.

In her book ‘Illness as Metaphor’, Sontag (1978) described how cancerpatients suffered from the metaphorical use of the word as well as the illness. More recent research shows that mental illness is the new "illnessas a metaphor". (Duckworth et al ,2003)

It is impossible to separate the different uses of a word from their different meanings. However it is important that when we use a word as a diagnosis, we explore what that word means to others.

References.

The Bangles. ‘Manic Monday’ in 'Different Light' (1985)Sony Music Entertainment.

Duckworth, K., Halpern, JH.,Schutt,RK., & Gillespie, C. Use of Schizophrenia as a metaphor in US Newspapers (2003) Psychiatric Services. Vol 54. No. 10 pg 1402-1405

Goodwin (2002).Hypomania:whats in name?The British Journal of Psychiatry 181: 94-95

Sontag S. Illness as Metaphor. New York. Farrar, Strauss and Giroux.(1978)
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