Excerpt from the book “The Truth About Fear and Depression” by Heather Denkmire
Bipolar I, the most severe form of the illness, is marked by extreme manic episodes. In fact, episodes of mania in bipolar I may be so severe that they include symptoms of psychosis, or psychotic symptoms. Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing things not actually there) and delusions (false, strongly held but illogical beliefs). Which psychotic symptoms are present tend to reflect the individual’s extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the president or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, a severe mental disorder resulting in a separation between thought processes and emotion, sometimes accompanied by delusions and erratic behavior.
In some people, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant changes in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.
A person with bipolar II experiences hypomanic episodes rather than manic episodes. The difference between mania and hypomania is a matter of severity–hypomania generally does not impair daily functioning or result in hospitalization. Hypomania may feel good to the person who experiences it. Someone experiencing hypomania may perform better at school or work than he or she usually does. Without proper treatment, however, hypomania can become a severe manic episode or can turn into depression.
A cyclothymic disorder is characterized by fluctuating moods involving periods of hypomania and depression. The periods of both depressive and hypmanic symptoms are shorter, less severe, and do not occur with as much regularity as experienced by those who have bipollor II or I. However, these mood swings can impair social interactions and work relationships. Many, but not all, people with cyclothymia develop a more severe form of bipolar illness.