Which symptoms related to communication is likely to be present in a manic patient?

A person with pressured speech may speak suddenly or erratically. Pressured speech is a common symptom of bipolar disorder.

A person with bipolar disorder may experience pressured speech during manic periods. These are periods of extreme highs.

During these times, a person may feel the need to speak rapidly, suddenly, or erratically.

In this article, we assess the links between pressured speech and bipolar disorder.

People with bipolar disorder typically experience cycles of mania and depressive moods. How quickly an individual cycles through the moods will vary from person to person. Pressured speech is a symptom of bipolar disorder that occurs during mania.

In all these cases, a person may experience:

• rapid speech without pause for others
• loud speech
• talking about subjects in a disorganized manner
• talking about inappropriate subjects
• not being able to speak fast enough to keep up with thoughts

Additional symptoms during a period of mania may include:

• inflated self-worth or delusions of grandeur
• reckless or risky behavior
• decreased need or ability to sleep
• elevated mood
• exaggerated optimism
• feeling anxious or jittery
• inability to focus
• restlessness

Learn more about the main symptoms of mania here.

Pressured speech is not a disease or disorder by itself. Rather, it is a symptom of an underlying disorder. Besides bipolar disorder, there are many potential causes of pressured speech, including schizophrenia and some forms of anxiety.

Pressured speech has no significant complications by itself. However, the underlying cause of the pressured speech may affect a person’s overall health and well-being.

A person with bipolar disorder is likely to experience periods of low self-esteem during depressive episodes. Additionally, people with bipolar disorder are more likely to attempt suicide.

Pressured speech is often the result of rapid thoughts during a manic episode. A person with bipolar disorder is not likely to experience issues with pressured speech during a depressive cycle.

The brain can usually prioritize thoughts based on their importance to a situation. A person with bipolar disorder may have difficulty separating these thoughts, meaning irrelevant thoughts may appear pressing as soon as they enter the mind.

A 2017 review found that pressured speech is more likely in adult-onset bipolar disorder than in children and adolescents.

A person may also experience pressured speech as a result of other conditions.

People with bipolar disorder may also have co-occurring conditions, including:

• Attention deficit hyperactivity disorder (ADHD): ADHD makes it difficult to focus and organize thoughts and actions. People with ADHD may experience frantic or fast-paced thinking, which can cause pressured speech.
• Anxiety: This condition may cause a person to experience pressured speech if their anxiety results in being unable to explain something quickly. They may experience rapid, uncontrollable thoughts in response to their situation.
• Schizophrenia: This can cause a breakdown of the connectors between thoughts, emotions, and behaviors, which can lead to delusion, and disorganized thoughts.
• Substance use disorders: People with bipolar disorder have a high risk of substance use disorders. This can include use of alcohol, nicotine, and recreational drugs.

Pressured speech is a common symptom of bipolar disorder and other mental health conditions. It typically occurs when a person is experiencing manic episodes.

During this time, a person may feel compelled to speak quickly, erratically, and without stopping.

Pressured speech is not a condition in itself, and treatment will typically center on resolving its underlying causes.

A manic episode — aka mania — is a period of feeling full of energy. You might talk faster than usual, notice your thoughts racing, take on lots of activities, and feel like you don’t need as much sleep.

A manic episode is a period of extremely energetic, happy, or irritable moods that last for at least a week. Manic episodes are usually a sign of bipolar I disorder.

You may feel great during a manic episode, but symptoms and behaviors can come with risks.

For instance, during an episode, you might make a risky investment, spend more money than usual, or take on too many projects without the time or ability to finish them.

Treatments for bipolar disorder — like medications, therapy, and lifestyle changes — can help people manage mood episodes like mania.

An episode of mania is defined as experiencing elevated or irritable mood with excessive energy for at least 1 week. This means you’re experiencing the symptoms for most of that week, most of the time.

Symptoms are usually severe enough to be noticeable by those around you and can sometimes require hospitalization.

While mania is often associated with bipolar disorder, it’s actually only seen in one type: bipolar I.

If you experience a milder form of mania, known as hypomania, along with depressive episodes, you may instead get a diagnosis of another type of bipolar disorder, bipolar II.

According to the DSM-5, the average age for the first episode of mania in bipolar I is 18 years old. But some people do develop symptoms in childhood or later adulthood.

Episodes of mania can be different from person to person. You might feel really great — like you’re “on top of the world” or can do anything — or you might be extremely irritable instead.

Often, people find it super difficult to concentrate or sleep during mania. This can end up having a serious impact on work or social life.

During mania, some people may do things without thought for the consequences, like spending too much money or taking risks with their physical safety.

Bipolar disorder can be treated, usually with a combination of meds and therapy. Check out 10 small steps you can take to manage bipolar disorder symptoms.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) states that an episode of mania involves at least 3 of the following behavior changes:

• elevated self-esteem, high self-confidence, or feelings of grandiosity
• less need for sleep, such as feeling rested after only 3 hours of sleep
• fast, loud, and sometimes disorganized speech, or feeling a pressure to keep talking
• racing thoughts or quickly-changing ideas
• feeling easily distracted or unable to pay attention to one thing for long
• doing many activities at once, such as work tasks, organizing social events, or seemingly purposeless movements
• engaging in activities on an impulse that can lead to harmful consequences, such as overspending money, heavy alcohol or drug use, or dangerous driving

These behaviors aren’t typical for you, so your friends and family are able to recognize the change.

By definition, the symptoms of mania are severe enough to get in the way of your life and functioning. They might, for example, cause:

• problems at work
• job loss
• financial losses
• difficulties in your relationships

The symptoms can be severe enough to require hospital care to stay safe.

To diagnose a manic episode, your doctor will rule out other causes of these symptoms, including drug or medication use and other medical conditions.

Let’s talk symptoms in detail:

Increased self-esteem

This symptom is like a boost in uncritical self-confidence. It might look like taking on new projects without any particular experience, such as beginning to write a novel without a writing background, or seeking publicity for an invention without thinking through all the details.

Grandiose thinking is also common, such as believing you have a special relationship with a famous political or religious figure.

Less need for sleep

An episode of mania usually involves a decreased need for sleep.

You might wake up several hours earlier than usual, but still feel full of energy. When this is severe, people can sometimes go days without sleep and still not feel tired.

Rapid speech

Mania can often involve rapid, loud speech that’s difficult to interpret. You may feel like talking nonstop, even if others are unwilling to communicate.

Jokes, puns, dramatic mannerisms, and singing are common.

You or those around you may also notice that you’re using a mode of speech called clanging. This is where you link words together based on their sounds rather than meaning. Compulsive rhyming and alliteration are common.

If your mood is more irritable than elevated, your speech may be marked by complaints, hostile comments, anger, or rants.

Racing thoughts

Your thoughts might race at a much faster pace than they can be articulated during a manic episode. Some people say it’s like they’re watching 2 or 3 TV shows at the same time.

You can also have flight of ideas — a nearly continuous flow of fast speech with abrupt changes from one topic to another. When this symptom is severe, your speech may appear disorganized or difficult to follow.

Feeling easily distracted

You may easily lose attention and end up focusing on irrelevant objects. For example, during a conversation you might find your attention is drawn to background noises or objects in the room rather than the conversation you’re having.

It can also be more difficult to differentiate between the thoughts that are linked to the conversation and thoughts that are only slightly relevant (or not very relevant at all). This can lead you to lose track and derail the chat.

Doing lots of activities

It’s common to overextend yourself during mania — organizing and taking part in many activities even if you’re not always able to finish them. You might find yourself working on projects at all hours of the day and night with little sleep or rest.

You may also feel extra social, renewing old acquaintances, or calling friends (or even strangers), sometimes at odd hours of the day or night. The other person might see these interactions as intrusive or demanding.

Hypersexuality — an increased drive toward sexual activities — can occur during a manic episode.

Finally, you might seem restless or agitated, moving around more than usual or holding multiple conversations at the same time, such as over the phone and in person.

High-risk behaviors

The expansive feelings, elevated self-esteem, and grandiosity you experience can sometimes lead you to engage in activities that have harmful consequences.

Typically, you won’t realize the harm these actions can cause at the time.

Some examples include:

• unsafe driving
• heavy alcohol or drug use
• excessive spending or risky business investments
• sexual activity that’s unusual for you

Managing bipolar disorder and mania can be tricky, but with trial and error, you can find the best ways to cope.

The signs of a manic episode are different for everyone. Taking time to know your triggers can help you feel empowered and more in control when they arise.

Mood tracking is a great way to do this.

Apps or writing journals work well for some people. The Depression and Bipolar Support Alliance (DBSA) provides a free wellness tracker that you can print out and stick on your wall or keep in a folder.

You might also find it useful to ask a loved one (or two) to let you know when they notice any signs, because you may not always be aware it’s happening.

The International Bipolar Foundation gives the following tips for preventing an episode of mania:

• Reach out when you notice signs of an impending mood episode. Talk with your treatment team and reach out to family or friends. Tackling it early can prevent the episode from worsening.
• Avoid using alcohol and other substances. These can interact with medications and affect mood.
• Be patient — both with yourself and finding the right treatments. Finding the right medication and coping tools can take some time. Be gentle with yourself.
• Take it one step at a time. Small steps might involve setting up a sleep routine, talking with a friend for support, or reaching out to a mental health pro.
• Find support. Join a support group where you can talk with others about your experiences.
• Try stress management techniques. Relieving stress can boost overall well-being. Some go-to options are exercise, meditation, yoga, or gardening.
• Accept help. It can take some practice accepting help from others, but getting the right support from loved ones and professionals is essential to avoid depression and isolation.
• Set up an emergency action plan. This safety plan can be used in a crisis situation. Create a list of resources and coping strategies to use when you need it.
• Get quality Zzzs. Getting enough sleep, maintaining good sleep habits, and creating a quiet, dark sleep environment can all benefit your mental health.

It’s important to continue with your treatment plan — no matter how good you might feel during a manic episode. While you might feel like you no longer need meds, when the episode is over, stopping meds can have unpleasant side effects.

After a manic episode is over, make a point to look after yourself and get back into a regular routine for sleeping, eating, and exercising.

For more support with managing bipolar disorder, check out the DBSA and International Bipolar Foundation.