Abnormal Psychology

Mood Disorders and Suicide 219

During a manic episode, the person may also be highly distractible and unable

to screen out irrelevant details in the environment or in conversations, as evidenced

by the parenthetical comment about the blue check handker-

chief in Case 6.4. Another symptom of a manic episode is

excessive planning of, and participation in, multiple activities.

A college student with this symptom might participate in eight

time-intensive extracurricular activities, including a theatri-

cal production, a musical performance, a community service

group, and a leadership position in a campus political group.

The expansiveness, unwarranted optimism, grandiosity,

and poor judgment of a manic episode can lead to the reck-

less pursuit of pleasurable activities, such as spending sprees

or unusual sexual behavior (infi delity or indiscriminate sex-

ual encounters with strangers). These activities often lead to

adverse consequences: credit card debt from the spending

sprees or sexually transmitted diseases, including HIV, from

unprotected sexual encounters.

People who have had a manic episode report afterward that

they felt as if their senses were sharper during the episode—that

their ability to smell or hear was better. Unfortunately, during a manic episode, indi-

viduals often don’t recognize that they’re ill; this was the case with Jamison, who, for

many years, resisted getting treatment.

Typically, a manic episode begins suddenly, with symptoms escalating rapidly

over a few days; symptoms can last from a few weeks to several months. Compared

to an MDE, a manic episode is briefer and ends more abruptly.

Mixed Episode

Another building block for diagnosing bipolar disorders is a mixed episode—an

episode of mood disturbance characterized by symptoms of both manic and major

depressive episodes. Prominent symptoms usually include:

agitation,•

• insomnia,


• appetite dysregulation,


• psychotic features, and


• suicidal thinking.

CASE 6.4 • FROM THE INSIDE: Flight of Ideas

Here is an example of a fl ight of ideas, which a man wrote in his diary during a manic

episode:

I have to choose my words very carefully. For what I am doing is, I believe, something which has

not very often been attempted (BEELZEBUB ON BED in form of blue fl y). It is to think at precisely

the same point in the space-time continuum by both methods of thought (Coughing, running

at the nose, bottom of feet wet) (blue check handkerchief)—inductive and deductive (so hot,

have to remove coat and purple pullover query CAESER’S) artistic and rational (itching), nega-

tive and positive—in the terminology expounded [previously]...

(Custace, 1952, pp. 138–139)

During a manic episode, individuals may gamble

excessively or act antisocially, behaviors they

would never otherwise do. Similarly, people who

are otherwise very ethical may behave unethically

during a manic episode.

Jack Sullivan/Alamy

Flight of ideas

Thoughts that race faster than they can

be said.

et al., 2009). Another symptom of mania is a fl ight of ideas, thoughts that race

faster than they can be said. When speaking while in this state of mind, the per-

son may fl it from topic to topic, as illustrated in Case 6.4; fl ight of ideas has com-

monly been described as something like watching two or three television programs

simultaneously.