All of the above.

When I was in my 20s, unmedicated, I had more of a tendency to slowly rise to mania having been in a hypomanic state for weeks or even months. Once I hit my 30s, my hypomanic periods were brief before full blown manias set in. Nowadays, in my mid-later 40s, I'm fairly well medicated. I either have brief hypomanias that either resolve themselves without reaching full mania, or my psychiatrist is able to squash them quickly with medication adjustments.

The last time I became full blown manic with psychosis was last May 2018. That developed with anxious hypomania over two weeks then turned full blown only during its last four days before my psychiatrist put it out. I think the only reason it became full blown then was because of the stress of travel in Portugal without access to my psychiatrist. The airports were the final trigger to psychosis. I almost didn't make it on the plane home and my poor husband was crying and scared that day. He had forced me to take "as needed" Seroquel. I was willing because my mood was more excruciatingly painful than pleasant. "As needed" medications on top of my regular cocktail have helped keep me out of the hospital these last eight years. So have the many same day emergency appointments my psychiatrist has given me. I'm lucky!

I also have clear hypomanic-like mood "blips", as I call them, that can come out of nowhere at any time. Often my evening meds stop them in their tracks. Hubby makes sure I take them. He can almost always tell what's happening.

P. S. I've attached a photo of my parrot's favorite picture in our house. It's actually just a framed poster. He's somehow strangely drawn to it. We're not sure if it's because of Kafka's eyes or Prague. The translation of the French is "Prague do we let go...the little mother has claws."