I have had times when my hypomania and mania switched between elated and irritable within the same week, day or even few minutes. It really depended on the triggers. If I was "free" of things that could frustrate me I could be seen dancing and singing and skipping around with glorious or other worldly deliriously happy thoughts in my head. But if I was triggered or constantly under stress, the irritability started. Irritable was kind of the very early stages with just angry thoughts racing through my head. Hell, fire fury was when it got bad.

Early stages: Hyper-energized with a nasty look on my face, and angry thoughts racing through my mind. Then if a little more, it was complain, complain, complain, complain, telling a person off, criticizing a person without any impulse control. Yelling in the diner (for most people to hear) that the waitress forgot to tell the cook to put TOMATO on my grilled cheese sandwich even though I stressed it TWO TIMES!!!!!!!!

Middle stage: Saying very nasty things to people, yelling as part of a tantrum, perhaps kicking something, throwing something against the wall, going to my car and screaming at the top of my lungs. Getting worse...If in public, strangers would make comments and yell at me to leave. Once at a pharmacy the pharmacist called out a security word on me so I had to flee. Another time a pharmacist threatened to call the police if I didn't leave, even though they didn't fill my Klonopin prescription (turned out it was too early, but I was convinced otherwise). Once after a therapy appointment my therapist called my psychiatrist and told him I scared her, and that I was "suspended" from therapy until my psychiatrist said I was "OK". Getting even worse...At work I often punched the side of my work station and my keyboard while roaring. Scared six people so much that they went to Human Resources. Was threatened to be fired. I resigned in retaliation. [Note: I ended up having to change pharmacies, and that therapist eventually made it known that she could not help me.]

Very worst stage: If in the hospital, screaming at the top of my lungs, punching the wall, beating my pocketbook into the wall at the IOP (they called 911), or slapping my face repeatedly, maybe flailing my arms and legs while screaming on the ER floor, being dragged into the isolation room and given an injection of Haldol or Ativan. Was once shadowed in the hospital (a hospital security man followed me in the psych ward) to make sure I didn't suddenly become violent.

As I recall, a few of the worst of times were motivated by the smallest things. For example, once I didn't like that I had to sleep on a cot as the third bed in a two-bed hospital room (they eventually gave me my own room). Another time was because I didn't like what the Nurse Practioner said (or her). Another time was because they wouldn't let me use my tweezers. The IOP 911 call time was because I was sick and tired of hearing people in the therapy group talking about addiction.