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The Continuum of Mania and Depression

As Defined In


4. Severe Mania: much insistence by others that patient get medical attention, patient unable to function in any goal directed activity.

            Symptoms: little or no sleep, delusional, invincible, explosive, hallucinatory, catatonic.

             Functional Impairment: needs close supervision, has no judgement, puts self and others in danger, should be hospitalized.


3. High Moderate Mania: very significant difficulty with behavior and goal directed activities, canít focus, non-productive.

              Symptoms: grandiose, very disruptive, little or no sleep, reckless, increases in energy and activities.

              Functional Impairment: little or no judgement, not directable, outlandish behaviors, canít function at work.


2. Low Moderate Mania: noticeable impairment; others feedback about behavior; less productive, unfocused.  

            Symptoms: irritable/euphoric, intrusive, grandiose, increases in energy, decrease in sleep, increase in spending and phone calls.

            Functional Impairment: poor judgement, sometimes disruptive at work and home, difficulty with goal-oriented activity.


  1. Mild Mania: no impairment or mild impairment, functioning possibly enhanced.

            Symptoms: decrease in sleep, ebullient, energetic, more social, mildly pressured.

            Functional Impairment: little or no impairment can be focused and productive.



0. The Normal Range of Emotions



1. Mild Depression: no impairment to mild impairment.

            Symptoms: subjective distress, low mood, sleep and appetite O.K.

            Functional Impairment: functions well at work and at home, little or no impairment in social relationships.


2. Low Moderate Depression: noticeable impairment; some extra effort needed to function in usual social and occupational roles.

            Symptoms: decrease/increase in sleep and appetite, decreased energy and concentration, anxious, loss of normal pleasures, sucidal.

            Functional Impairment: some impairment at work and home, misses days from work, has to push self.


3. High Moderate Depression: very significant impairment; great effort needed to function in any role; barely scrapes by.

            Symptoms: retarded/agitated, very low energy, suicidal, withdrawn, poor hygiene, much difficulty reading or concentrating.

            Functional Impairment: great difficulty functioning, rarely goes to work, has to push self very hard.


4. Severe Depression: essentially incapacitated because of depression.

            Symptoms: immobilized, canít read or concentrate, mute or extremely agitated.

            Functional Impairment: Isolated, or in bed, may be hospitalized


[1] Leverich, G.S. & Post, R.M., (1998). Life charting of affective disorders. The International Journal of Neuropsychiatric Medicine, 3 (5): 21-37



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