218 CHAPTER 6
captivate others a felt certainty. There are interests found in uninteresting people.
Sensuality is pervasive and the desire to seduce and be seduced irresistible. Feelings
of ease, intensity, power, well-being, fi nancial omnipotence, and euphoria pervade
one’s marrow. But, somewhere, this changes. The fast ideas are far too fast, and there
are far too many; overwhelming confusion replaces clarity. Memory goes. Humor
and absorption on friends’ faces are replaced by fear and concerns. Everything pre-
viously moving with the grain is now against—you are irritable, angry, frightened,
uncontrollable, and enmeshed totally in the blackest caves of the mind. You never
knew those caves were there. It will never end, for madness carves its own reality.
(1995, p. 67)
Table 6.7 lists the criteria for a manic episode.Table 6.7 • DSM-IV-TR Diagnostic Criteria for a Manic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting
at least 1 week (or any duration if hospitalization is necessary).B. During the period of mood disturbance, three (or more) of the following symptoms have
persisted (four if the mood is only irritable) and have been present to a signifi cant degree:
(1) infl ated self-esteem or grandiosity
(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
(3) more talkative than usual or pressure to keep talking
(4) fl ight of ideas or subjective experience that thoughts are racing
(5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
(6) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomo-
tor agitation
(7) excessive involvement in pleasurable activities that have a high potential for painful con-
sequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish
business investments)C. The symptoms do not meet criteria for a mixed episode [discussed later in the chapter].D. The mood disturbance is suffi ciently severe to cause marked impairment in occupational func-
tioning or in usual social activities or relationships with others, or to necessitate hospitalization
to prevent harm to self or others, or there are psychotic features.E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of
abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g.,
medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of bipolar I
disorder [discussed later in the chapter].
Source: Reprinted with permission from the DSM-IV-TR Casebook: A Learning Companion to the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, (Copyright 2002) American Psychiatric Association.As noted in Table 6.7, in a manic episode, a person may begin projects (one
type of goal-directed activity, see criterion B6 in Table 6.7), even though he or she
doesn’t possess the special knowledge or training required to complete the project;
for instance, the person might try to install a dishwasher, despite knowing nothing
about plumbing. Moreover, when manic, some people are uncritically grandiose—
often believing themselves to have superior abilities or a special relationship to
political or entertainment fi gures; these beliefs may reach delusional proportions,
to the point where an individual may stalk a celebrity, believing that he or she is
destined to marry that famous person.
During a manic episode, a person needs much less sleep—so much less that
he or she may be able to go for days without it, yet not feel tired. Similarly, when
manic, the affected person may speak rapidly or loudly and may be diffi cult to in-
terrupt; he or she may talk nonstop for hours on end, not letting anyone else get a
word in edgewise. Moreover, when manic, the individual rarely sits still (Cassano