The Paradox of Mixed Mania

In pure hypomania, the person's going to act with an increased certainty about their own ideas or abilities and that high certitude is going to lead to stubborn arguments. They're not going to feel confident at all because they're also depressed. In mixed mania, it looks similar but feels much worse in part because these patients just have so much anxiety so their desperation to get to sleep is even more charged. And next is irritability. This often a mild paranoid sense that people have it out for me and the patient is quickly to cut off relationships or split others into good and bad.