Child and Adolescent Psychiatry

CHAPTER 11

Mania

Are depression and mania the opposite ends of a single mood dimension?
Just as depression can be described as ‘feeling low’, so mania can be
described as ‘feeling high’. Consequently, the simplest model of mood dis-
orders involves each individual moving up and down a single dimension of
mood that ranges from severe depression through normality (‘euthymia’)
to hypomania and on to severe mania (see Box 11.1).

Box 11.1A schematic one-dimensional model of mood

Low

Normal

High

Hypomanic

episode

Depressive

episode

Time

Manic

episode

Mood

Very High

It is a nice model that makes bipolar disorder easy to envisage, but
it cannot explain everything. To make things more complicated, there
are alsomixed episodesin which an individual meets the criteria for both
major depression and mania almost every day for at least a week. This is
challenging to plot on the graph shown in Box 11.1. It cannot simply be
that the individual switches rapidly backwards and forwards between pure
mania and pure depression because this could not explain how individuals
in a mixed episode can display manic and depressive symptoms at the same
time, for example, a simultaneous mixture of high energy and low mood.

Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.

109