Introduction
What are the early signs that you're getting ready to have a manic episode? We call these early signs the prodrome. Being able to detect early signs of a manic episode can be helpful in either preventing the episode or lessening the impact of it.
Bipolar disorder is progressive. The episodes build momentum. The prodrome is the period of milder symptoms that precede the more severe symptoms. This period can be weeks to months. With bipolar disorder you can have a prodromal period before depression as well as before the mania.
The most common prodromal symptoms for mania tend to be an elevated mood, decreased need for sleep and increased activity. These symptoms can build for several weeks before it becomes an out-of-control, manic or hypomanic episode.
In this video, I discuss ways to recognize these early signs.
Video on Bipolar Disorder and Social Rhythm Therapy
youtu.be/LBt8auYzCZ8
References
Fava G. and R. Kellner. Prodromal symptoms in affective disorders. American Journal of Psychiatry 1991 148:7, 823-830
C. McAulay et al. Early Intervention for Bipolar Disorder in Adolescents: A Psychosocial Perspective. Am J Psychiatry 175:5, May 2018
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Video
- What are the early signs that you're getting ready to have a manic.
Episode? We call these the prodrome.
That's.
What I'm going to talk about in this video.
I'm Dr.
Tracey marks a psychiatrist in this channel, is about mental health.
Education and self-improvement.
I publish videos every Wednesday, so if you don't want to miss one click subscribe and the notification bell.
This video is based on a viewer question from Kokkinomalli.
She says:.
Thank you for the video, and thanks for mentioning that hypersexuality is an early warning.
Sign.
I'd love a video about the manic, prodrome, I think that would be really useful.
Thanks Kokkinomalli for your question.
Being, able to detect early signs of a manic episode can be helpful in either preventing the episode from coming altogether or lessening the impact of it.
It's kind of like preparing for a hurricane.
Even.
If you can't stop the hurricane, you can still board up your windows.
You can stock up on bottled water.
And, just like with a hurricane, bipolar disorder is progressive.
The episodes build momentum.
The prodrome is the period of milder symptoms that precede the more severe symptoms.
This period.
Can be weeks to months.
With, bipolar disorder, you can have a prodromal period that also comes before the depression, as well as before the mania.
The.
Most common prodromal symptoms for mania tend to be an elevated, mood, decreased need for sleep and increased activity.
These symptoms can build over several weeks or even months before it becomes an out-of-control, either manic or hypomanic.
Episode.
Let's take a look at these symptoms with a little more detail.
But.
Here's a disclaimer.
This is not for the purpose of diagnosing whether or not you have bipolar disorder.
So I.
Don't want you to think gosh I didn't feel the need for sleep last Thursday night, so does that mean I have bipolar disorder? No, not based on that one fact: alone.
What I'm talking about are the symptoms in people who already know that they have bipolar disorder., So.
Think of this as advanced topics in bipolar disorder and not signs to tell if you have bipolar disorder.
Okay, elevated mood.
If.
You recently came out of a depression.
This can feel like a relief.
You, finally feel really good.
But.
One of the problems with the manic phase is that you usually don't see the early symptoms as a problem.
It will often take someone else close to you to recognize that your mood is elevated beyond what someone would expect normally from you.
But, even with this.
It still may be hard to notice this particular symptom of elevated mood., Because remember.
It's not just feeling great, it's feeling like you're invincibe, or having way more confidence or audacity than you usually do., It's, something that stands out it some way.
So it's beyond just feeling good.
What's, usually much easier to recognize, is the decreased need for sleep.
This is different from disrupted or choppy sleep that you can have with bipolar disorder when you're in between episodes, you can have a poor quality of sleep.
Examples of this would be taking longer to fall asleep or not being able to sleep straight through the night.
Sometimes in between episodes.
You can even have day night reversal such that you can't go to sleep until very late in night or the early hours of the morning.
So you're sleeping most of the day and up all night.
But.
Even with this, you still feel the need to sleep.
You're, just not doing a very good job of it.
But in the prodrome phase.
You don't really feel the need to sleep.
So.
It's not as though you really want to go to sleep, but you can't slow your mind.
Down.
You may be oblivious to the fact that you even need to go to sleep or that it's even time to go to bed.
You may stay up doing things during the night because you're not even tired.
If.
This happens to you, an early intervention could be to see your doctor and make medication.
Adjustments.
These adjustments could be increasing.
Your mood, stabilizer.
It could mean taking you off an antidepressant.
If you were on one during a previous depressive, episode.
It could mean keeping you on your medications, except just adding something to help you sleep.
These adjustments could halt the progression of your mania or it could lessen the severity of the episode.
Another early sign would be increased.
Activity.
I mentioned in a previous video that hypersexuality can be an early sign of a manic.
Episode.
This would fall under this category of increased activity.
Also, increased activity could be things like having more of an interest in your work or putting in more hours.
If you're a student.
It could mean having more energy to study.
More.
I had a patient with bipolar disorder.
Who was a musician.
He recognized that an early sign for him would be that he would start creating music tracks in his mind.
This might sound this good because, after all he's a musician.
But, his talent was playing the instrument and it was not writing.
The music.
It was only when he would become manic that he come up with these musical scores.
Then.
When he was out of the episode he thought the music that he created was terrible.
So, it's not as though the mania was this wonderfully, creative time for him to pump out some music.
For him.
It was more like unproductive, musical exploration that never resulted in anything usable.
But when he started thinking at that level of music creation.
He knew then that it was time to come in and see.
Me.
Another way it can look to have increased activity is having the increased need to move.
Around.
We call this agitation.
This may look like pacing or being unable to sit still for long periods of time and feeling impatient.
This kind of prodromal.
Increased activity can build up to the irritability or angry manic symptoms that some people can get.
Now.
The first time you have an episode, you're, not gonna notice.
Any of these things coming on.
It's.
Only in retrospect that you can look back and see the buildup.
In fact, even after you've had multiple episodes, you still may have trouble seeing the symptoms as they play out.
So.
What you have to do is, after you've, recovered from your last episode and you're in between episodes.
You look back on what happened in the weeks and months, leading up to your most recent episode.
Can.
You recognized any of the symptoms that fall into these three categories that fit you? Is there, something that you tend to focus.
On? It could be having increased sexual desire.
Or.
It could be getting more involved in a club or a group that you normally don't have time for, but now, when you're manic, you start reengaging with it and really get over and super involved in it.
These are just general examples, but take a hard look at your behavior.
There's bound to be some patterns.
You may need your doctor, or your therapist or a close friend to help you really see.
This.
Then write it down and let someone close to you know what you do so that they can help you look out for these behaviors as early signs.
If.
You see this coming on again.
What do you do? You, should visit your doctor again for a follow up.
Appointment.
You may not need change any of your medication, especially if your sleep is good.
But.
It's still good to be on alert, because with bipolar disorder, sometimes things can change very rapidly within a matter of weeks.
Also, If you're, someone who doesn't have a regular sleep, schedule, change, that.
I did a video where I talked about social rhythm therapy for bipolar disorder.
People, with bipolar disorder are very sensitive to changes in routine.
It's been shown that keeping a regular routine where you do certain things around the same time, shortens the recovery time from an episode and lengthens the time in between episodes.
Another reason to have a regular sleep schedule is so that you can track when you're sleeping less.
Adults need an average of seven to nine hours of sleep.
Many people with bipolar disorder have trouble sleeping more than six hours.
But.
That's an absolute least amount of sleep that you should be getting.
Less than six hours is a set up for problems and can trigger rapid cycling of your episodes.
Rapid cycling is having more than four episodes in a year.
And I did a video on that.
As well.
Let me know.
If you have any questions.
I like hearing about your experiences.
See, you next time.
♪ I am what I am today 'cause I.
Did it my way, ♪ ♪, Nothing y'all can say ♪ ♪, In this life or the next one ♪.
FAQs
Irritability and aggressiveness, sleep disturbances, depression and mania symptoms/signs, hyperactivity, anxiety, and mood swings are clusters representing common symptoms and signs of the distal prodrome of bipolar disorder (BD).
What are the symptoms of mania prodrome? ›
Irritability and aggressiveness, sleep disturbances, depression and mania symptoms/signs, hyperactivity, anxiety, and mood swings are clusters representing common symptoms and signs of the distal prodrome of bipolar disorder (BD).
What are the three stages of mania? ›
Thus, when the term “manic episode” is used it may refer to any one of the three stages of mania: hypomania, acute mania, or delirious mania. Manic episodes are often preceded by a prodrome, lasting from a few days to a few months, of mild and often transitory and indistinct manic symptoms.
What are three symptoms of a manic episode? ›
Mania
- feeling very happy, elated or overjoyed.
- talking very quickly.
- feeling full of energy.
- feeling self-important.
- feeling full of great new ideas and having important plans.
- being easily distracted.
- being easily irritated or agitated.
- being delusional, having hallucinations and disturbed or illogical thinking.
The 'idiosyncratic' prodromal symptoms included increased religiosity, taking decisions easily, reddening of eyes, being abusive, listening to loud music, recalling past events, and ideas of reference. Common prodromal symptoms closely approximated the symptoms of the disorder itself.
How long does prodromal mania last? ›
The average prodromal duration of about 3 wk in the present study was also similar to 2-4 wk period reported previously among patients with mania7,11,12.
What are 3 behavioral changes someone experiences during a manic episode? ›
Symptoms of a manic episode
Feeling extremely happy or excited — even euphoric. Not sleeping or only getting a few hours of sleep but still feeling rested. Having inflated self-esteem, thinking you're invincible. Being more talkative than usual.
What are the 4 stages of mania? ›
Stages of Bipolar Disorder
- Acute Mania. Acute mania is marked by energetic or irritable moods and accelerated activity. ...
- Mixed Mood State. Mixed mood state includes symptoms of both manic and depressed mood. ...
- Acute Major Depressive Episodes. ...
- Continuation or Maintenance Phase.
Diagnosis
- An increased interest in goal-oriented activities.
- An increased pursuit of risky or dangerous activities6
- Being easily distracted6
- Flight of ideas.
- High self-esteem.
- Increased rate of speech.
- Reduced need for sleep6
- Psychom*otor agitation (such as pacing or hand-wringing)
What causes hypomania and mania?
- High levels of stress.
- Changes in sleep patterns or lack of sleep.
- Using recreational drugs or alcohol.
- Seasonal changes – for example, some people are more likely to experience hypomania and mania in spring.
- A significant change in your life, such as moving house or going through a divorce.
dilated pupils. “sparkling” eyes, or eyes that appear more liquid than usual. eyes that change color or become black. widened or narrowed gaze, depending on the type of mania (Some say dysphoric mania, or a mood episode with mixed features of mania and depression, leads to a narrowed or squinting gaze.)
How does a manic episode start? ›
The 10 Most Common Triggers for Bipolar Mood Episodes. Arguments with your spouse, chilly weather, grief — a number of scenarios may provoke bipolar mania or depression. Certain medications, seasonal changes, and alcohol could trigger bipolar mood episodes, experts say.
What does the prodrome stage look like? ›
Various mood changes such as anxiety, depression, mood swings, sleep disturbances, irritability, anger, and suicidal ideas are reported as part of prodromal symptoms. Patient may also present with spectrum of conditions including obsessive-compulsive phenomenon and dissociative disorders.
Do prodrome symptoms come and go? ›
Prodromal schizophrenia may last anywhere from a week to a few years. Symptoms may come and go, but they often become progressively worse over time.
What are the stages of manic episode? ›
There are three stages of mania: hypomania, acute mania and delirious mania. Classifications of mania are mixed states, hypomania and associated disorders. Mania can occur in cycles over several weeks or months with no predictable triggers.
What is a full blown manic episode? ›
In full-blown mania, often the manic person will feel as though their goal(s) are of paramount importance, that there are no consequences, or that negative consequences would be minimal, and that they need not exercise restraint in the pursuit of what they are after.
What does a manic anxiety episode look like? ›
During a manic episode, a person feels completely energized to get numerous things completed. They may even be more sexually risky, or have some awkward social engagements. Experiences of mania may also feel out-of-control which could lead to anxiety. Mania and anxiety are sometimes even similar.
How do you break a manic cycle? ›
Managing a manic episode
- Maintain a stable sleep pattern. ...
- Stay on a daily routine. ...
- Set realistic goals. ...
- Do not use alcohol or illegal drugs. ...
- Get help from family and friends. ...
- Reduce stress at home and at work. ...
- Keep track of your mood every day. ...
- Continue treatment.
The period of subclinical signs and symptoms that precedes the onset of psychosis is referred to as the prodrome. The prodromal period can last from weeks to several years, and comorbid disorders are very common during this period [42].
What is the longest a manic episode can last? ›
Episodes can cycle four or more times in a year. It can happen for a time, at any point in the course of your diagnosis. Mania lasts 4 days or longer. You can learn all the facts on bipolar disorder here.
After a manic or hypomanic episode you might: Feel very unhappy or ashamed about how you behaved. Have made commitments or taken on responsibilities that now feel unmanageable. Have only a few clear memories of what happened during your episode, or none at all.
What does an angry manic episode look like? ›
People experiencing a bipolar disorder episode often have different behaviors, activity levels, and more. This includes irritability. A person who's irritable is easily upset and often bristles at others' attempts to help them. They may be easily annoyed or aggravated with someone's requests to talk.
How do manic people act? ›
Manic symptoms can include increased energy, excitement, impulsive behaviour, and agitation. Depressive symptoms can include lack of energy, feeling worthless, low self-esteem and suicidal thoughts. You can also have psychotic symptoms.
How do you calm a manic episode? ›
For example:
- Make yourself go to bed, even if you don't feel tired.
- Try to avoid alcohol and caffeine.
- Try to remember to eat regularly, even if you don't feel like it.
- Avoid stimulating activities.
- Avoid noisy, bright or busy environments and go somewhere quiet and calm.
- Do activities you find calming or soothing.
Psychosis — experiencing hallucinations and delusions (in the most severe manic episodes).
Is mania a psychotic break? ›
During a manic phase, they may believe they have special powers. This type of psychosis can lead to reckless or dangerous behavior.
What is the first stage of mania? ›
The first manic episode is the most likely to be delusional. Psychotic symptoms are more likely to be mood incongruent than is the case with mania later in life, with one study finding mood-incongruent psychosis in 77% of adolescents having their first manic episodes,46 increasing the likelihood of misdiagnosis.
Can anxiety cause mania? ›
Insomnia, a common anxiety disorder symptom, is a significant trigger for manic episodes. Many children with bipolar disorder also suffer from at least one co-occurring anxiety disorder. The age of onset for an anxiety disorder often precedes the age of onset for bipolar disorder.
What are two key symptoms of a manic episode? ›
Both a manic and a hypomanic episode include three or more of these symptoms:
- Abnormally upbeat, jumpy or wired.
- Increased activity, energy or agitation.
- Exaggerated sense of well-being and self-confidence (euphoria)
- Decreased need for sleep.
- Unusual talkativeness.
- Racing thoughts.
- Distractibility.
Mania and hypomania are symptoms that can occur with bipolar disorder. They can also occur in people who don't have bipolar disorder.
Factors such as stress, poor sleep, and even seasonal changes can play a role in triggering your bipolar symptoms. Learn how you can reduce your risk of bipolar episodes and better manage your condition.
What are psychotic eyes? ›
The various suggested characteristics of “psychopath eyes” seem to echo the general belief that people with ASPD have no emotions to show. These descriptions include: dead, flat, or reptilian-like eyes. very dark irises, or eyes that appear black.
What are bipolar facial features? ›
Considered in more detail, the male bipolar patient face has the following features: the nose is turned down, lengthened and narrow; the mouth is narrow and set posteriorly; the chin is set forward; the mandible is wide; the cheeks are displaced inwards; the eyes are narrower; the face is wider at tragion.
Can you see bipolar in the eyes? ›
You can't easily identify bipolar disorder by looking at someone's eyes. However, some studies show that bipolar disorder affects eye movement and visual processing. Other physical clues of bipolar disorder include feeling full of energy, being easily irritated, lack of sleep, impulsivity, etc.
Are there signs before a manic episode? ›
Common warning signs of an impending manic episode include the following: Increased energy or a sense of restlessness. Decreased need for sleep. Rapid, pressured speech (cant stop talking)
What stage is before manic? ›
Early or prodromal stage: Years before the onset of a manic or depressive episode, you might begin to notice changes in your mood, behavior, or ability to function. These symptoms might include anxiety, depression, or difficulty sleeping.
Do people remember when they're manic? ›
When a person is in a full-blown manic and psychotic episode, memory is greatly affected. In fact, it is rare for someone who is in a deep episode to remember all that happened. This is why it's called a blackout. The average person in this situation remembers maybe 50 percent, in my experience.
What does a psychotic break look like? ›
Typically, a psychotic break indicates the first onset of psychotic symptoms for a person or the sudden onset of psychotic symptoms after a period of remission. Symptoms may include delusional thoughts and beliefs, auditory and visual hallucinations, and paranoia.
Can you be aware of your own psychosis? ›
People who have psychotic episodes are often totally unaware their behaviour is in any way strange or that their delusions or hallucinations are not real. They may recognise delusional or bizarre behaviour in others, but lack the self-awareness to recognise it in themselves.
What does prodrome feel like? ›
If lesions recur, you may feel burning, itching, or tingling near where the virus first entered your body. You also may feel pain in your lower back, buttocks, thighs, or knees. These symptoms are called a prodrome.
About half the people with herpes will experience prodrome symptoms, which are physical sensations that show up before an outbreak (when the virus is active along nerve endings).
What to do during prodrome? ›
Treatment During Prodrome
If you do not have a treatment plan, talk with your doctor and make a prodrome plan of action together. It's also important to avoid any known food or environmental triggers during this phase. Be sure to stay hydrated, and do not skip meals.
What is prodromal phase of psychosis? ›
The period of subclinical signs and symptoms that precedes the onset of psychosis is referred to as the prodrome. The prodromal period can last from weeks to several years, and comorbid disorders are very common during this period [42].
What are the stages of mania? ›
There are three stages of mania: hypomania, acute mania and delirious mania.
What is a behavioral symptom of mania? ›
Manic symptoms can include increased energy, excitement, impulsive behaviour, and agitation. Depressive symptoms can include lack of energy, feeling worthless, low self-esteem and suicidal thoughts.
What is full blown mania? ›
In full-blown mania, often the manic person will feel as though their goal(s) are of paramount importance, that there are no consequences, or that negative consequences would be minimal, and that they need not exercise restraint in the pursuit of what they are after.
What is full blown psychosis? ›
Full-blown psychotic episodes are generally characterized by two events: Hallucinations are when people see, hear, or feel things that aren't real. Examples include: Voices making commentary, giving insults, or narrating thoughts. Imaginary or distorted visions.
What is an example of a prodromal stage? ›
STAGE 2: PRODROMAL PERIOD
Prodromes may be non-specific symptoms or, in a few instances, may clearly indicate a particular disease. For example fever, malaise, headache and lack of appetite frequently occur in the prodrome of many infective disorders. It also refers to the initial in vivo round of viral replication.
What is bipolar eye? ›
So-called bipolar eyes might include: dilated pupils. “sparkling” eyes, or eyes that appear more liquid than usual. eyes that change color or become black.
How do you rule out mania? ›
There is no laboratory test that can diagnose mania. Some medical illnesses can affect your mood, and so your doctor may run laboratory tests to rule out such concerns. Your doctor may then conduct a physical exam, ask you about your personal medical and family history, and then evaluate your signs and symptoms.
