Working with overactive people

Abstract

The symptoms portrayed here — pressure of speech, flight of ideas, overactivity — are indicative of someone experiencing hypomania bordering on mania, the latter being a rarer and more serious situation, sometimes culminating in a delirious episode. Hypomania is an affective disorder with an insidious onset. It begins with mild elation or euphoria, a general feeling of wellbeing, and progresses to general overactivity and grandiosity. It can occur in isolation but is more commonly associated with severe mood swings indicative of manic-depressive psychoses. A complete picture of someone experiencing a hypomanic state would include:

• A feeling of wellbeing, denies that he may be ill;

• Easily provoked, may be impulsively aggressive;

• Mood can quickly change from laughing to crying (lability);

• Pressure of speech and flight of ideas, comprising a continuous and rapid change of topics, often includes rhyming and punning, as in Alice’s case;

• Grandiose delusions may be present; if so, a history of gross overspending is usually common;

• Neglect of or inappropriate self-care. Dress and personal hygiene may be generally neglected, or dress may be overexpressive and not in the client’s usual style. Aspects of clothing or additions may have special meaning;

‘I’ll see you on the dark side of the moon light becomes you it goes with your. Bugs Bunny is on I’ll have to watch it, botch it can’t do it well. Imagine all the people living life that way. What do you think of it eh?’

‘I’ve written to the Queen, I’ve written to the Prime Minister, they haven’t answered yet, I bet they won’t so I’ll phone. What do you think?’

Alice paces around the room pointing out the phone, gesticulating and absently picking up and putting down items while talking. The cup of tea which she’d managed to make for herself when offering one to the community mental health nurse (CMHN) remains untouched in spite of frequent prompts to have a drink.

‘My husband moans at me, says I’m high. Silly devil, I’m not Everest double glazing, although we could do with some, get it chirpy, chirpy cheap, cheap. What do you think?’