Different subtypes of Mania

Pure Type 1 appears as the mildest in severity on all measures. Pure Type 1 represents relatively mild, classic manic episodes that completely lack dysphoric or paranoid or aggressive features. They have low psychosis ratings and minimal lability of mood. They have moderate psychomotor acceleration and notable hedonic activation.

Pure Type 2 appears as the most severe on the classical manic factors 2-5 but is essentially devoid of dysphoric features. Pure Type 2 episodes have the highest scores for 13 of the 15 classical manic symptoms (irritability and aggression are the only exceptions). They are markedly disturbed in their sleep, very pressured, very psychotic, paranoid, grandiose, funny, hypersexual, intrusive and lacking in insight.

Pure Type 3 episodes are characterized by high ratings of grandiosity and psychosis but without the marked psychomotor pressure, sleep disturbance, hypersexuality, humor, and irritable paranoia of Pure Type 2 episodes. Pure Type 3 episodes also are essentially devoid of dysphoric features, but there is a slight increase of mood lability relative to Pure Types 1 and 2.

Pure Type 4 episodes are quite different from Pure Types 1-3 in having very high ratings on all symptoms of the dysphoria factor and by far the highest total score on SMS Factor 1. Pure Type 4 episodes are marked by a complete absence of euphoric mood or humor and minimal ratings of grandiosity or hypersexuality. They have by far the lowest scores on SMS Factor 4, hedonic activation. They have high levels of aggression, irritability, and psychosis, including paranoia. Pure Type 4 episodes have overall low scores on the nonmixed SMS symptoms.

Pure Type 5 episodes also differ from Pure Types 1-3 by their moderately high ratings on the dysphoria factor. At the same time, they are significantly less dysphoric than Pure Type 4 episodes. They have elevated scores on depressed mood, anxiety, and lability, and slight suicidal ideation. Unlike Pure Type 4 episodes, however, they have higher levels of grandiosity, humor, sexuality, and psychomotor activation. They are overall less psychotic, paranoid, irritable, and aggressive than Pure Type 4 episodes. Pure Type 5 episodes are second only to Pure Type 2 episodes in total severity of the classical SMS manic Factors 2-5. Overall, Pure Type 5 episodes resemble Pure Type 2 episodes but with the addition of moderate levels of dysphoria.