First stage: the patient seems elated and is slightly more active than usual, speaking quickly, his words out bursting, feeling happiness, increased abilities, experiencing fast and sharp thoughts, sharp memory and the ability to create without stopping. Patients describe it as a feeling of “high”. At this stage the ability to function in daily life is not yet disrupted and the productivity may even increase. For example, a painter, poet or a salesman will experience it as especially productive period.
Second stage: the elated mood turns unpleasant for the patients and the people surrounding him. The patient becomes impatient and bad tempered. The fast talk progresses and becomes a flow of sentences and words. One can no longer follow the words and the patient who used to be vigorous, charismatic and funny turns into incomprehensive, rude and grotesque. Plans turn grandiose and incompatible with the patient’s capabilities. While in the first stage it was difficult to determine the start of the disease, now, it is easy for the surrounding to identify a pathological state.
Third stage: in some cases the situation will deteriorate to an unorganized speech and uncontrolled and unrestrained behavior. The grandiose plans become unrealistic thoughts (delusions) of grandeur and even paranoia. The fast passage from one thought to another creates a flow of detached words, a state defined in professional terms as thoughts’ race. These people seem often as disoriented, lacking control of reality, lacking judgment and might perform destructive acts upon themselves and their surroundings. This stage is defined as a psychotic stage, i.e. the ability to perceive and evaluate reality does not exist anymore.
At this stage the hospitalization is usually unavoidable and it is the only way to avoid severe results. There endless stories about people whose life was collapsed during these few hours. for example, a businessman who invested carelessly and lost tens of thousands of dollars within less than 24 hours; the owner of a huge collection of rare books decided to give them for education purposes and had spread them on the sidewalks of his town; or a high-tech developing new technologies suddenly busy day and night in grotesque inventions not fitting his level and corresponding with government authorities asking them to recognize his inventions. One can easily loose life savings, personal and professional reputation, harming relatives and close friends or even loose his life. A psychiatric hospitalization in extreme cases is justified and even essential. The cases described here are a flow of events usually happening without medical intervention. The identification and early treatment can stop the process returning to the previous state.
Since the state of the disease is characterized by so many signs, basic criteria were created enabling to unify the way by which a manic state is being diagnosed. According to current classification by the American Psychiatric Association, the diagnosis of a manic state requires the following:
1. A defined period of at least one week in which the patient is in an irregular elated or bad tempered mood. Should this situation seem acute and requiring hospitalization, it may be diagnosed within a period shorter than a week.
2. During such period, three of the following traits have to be identified:
· Exaggerated or grandiose self esteem
· Decrease in the need for sleep
· Over speaking or the need to continue speaking
· Fast changing of subjects or the feeling of “rampaging” thoughts
· Distraction - attention is easily distracted to unimportant stimulus from the environment
· Increase in activity or restlessness
· An exaggerated dealing in pleasing activities resulting in long term damage, e.g. exaggerated shopping, high risk investments or uncontrolled sexual activity
3. The disorder is severe so that there is a risk of harming the professional, social or personal functions or that there is a risk for the patient or his surroundings thus hospitalization becomes necessary.
One should not diagnose a bipolar disorder, should these signs originate in the abuse of drugs, medicines or a physical illness.