DIG FAST

Memory hook for the seven criterion B symptoms of a manic/hypomanic episode. Criterion A (elevated/expansive/irritable mood plus increased energy/activity) is not in the letters and must be present first.

D — Distractibility

Attention too easily drawn to unimportant or irrelevant external stimuli

Attention is too easily drawn to unimportant external stimuli (commenting on wallpaper mid-conversation, starting three tasks and finishing none). A DSM-5 criterion B symptom of mania/hypomania.

Physiology. Hyper-aroused, poorly filtered brain: elevated dopamine/norepinephrine reduces attentional control, so salient-but-irrelevant cues pull the spotlight of attention.

Safety. Minimize environmental stimulation and give one simple instruction at a time to reduce escalation.

I — Indiscretion / risky behavior

Excessive involvement in pleasurable activities with high potential for painful consequences

Excessive involvement in pleasurable activities with high potential for painful consequences: spending sprees, reckless driving, gambling, foolish investments, sexual indiscretions. Uncharacteristic and can cause financial, legal, or relationship harm.

Physiology. Reduced frontal (executive) control over reward-driven behavior, so immediate reward wins over long-term consequences.

Safety. Can be immediately dangerous (reckless driving, unsafe sex, large financial loss); document and involve family, and limit access to funds/credit during acute mania.

G — Grandiosity

Inflated self-esteem or grandiosity

Inflated self-esteem or grandiosity, ranging from unrealistic sense of one's abilities to delusions of grandeur (special powers, immense wealth, divine mission) in mania with psychotic features. Strikingly out of proportion to circumstances.

Physiology. Reduced self-monitoring and exaggerated reward signaling produce overconfident self-appraisal that ignores limits and feedback.

Safety. Do not argue with grandiose beliefs; acknowledge the feeling, stay calm and firm, and set limits on unsafe behavior.

F — Flight of ideas

Racing thoughts; speech that shifts abruptly between loosely connected topics

Subjective report of racing thoughts and/or rapid speech that shifts abruptly between loosely connected topics (by rhyme, pun, or distractible associations). If connections are lost entirely, it may be loosening of associations (more characteristic of psychosis).

Physiology. Accelerated thought processes outpace the capacity to organize them, producing rapid, tangential verbal output from a hyperactive associative network.

Safety. Document rate and coherence of speech; structure the interview with closed questions.

A — Activity increase

Increased goal-directed activity or psychomotor agitation

Increase in goal-directed activity (work, school, social, sexual) or psychomotor agitation (pacing, hand-wringing). DSM-5 requires increased activity/energy (with mood) as part of criterion A, underscoring its importance.

Physiology. Heightened dopaminergic/noradrenergic drive increases energy and motor output; reduced frontal control makes the energy poorly organized.

Safety. Channel energy safely (walking, non-competitive activities) and protect from exhaustion and injury.

S — Sleep deficit (decreased need for sleep)

Feels rested after only ~3 hours of sleep

Decreased need for sleep (feeling rested after ~3 hours) is one of the most specific symptoms of mania and an early warning sign. Distinct from insomnia, where the person wants to sleep but cannot and feels tired the next day.

Physiology. Arousal systems are 'stuck on,' suppressing the normal drive and perception of needing sleep.

Safety. A key clue distinguishing mania from depression/anxiety; prioritize sleep restoration as part of treatment.

T — Talkativeness (pressure of speech)

More talkative than usual; pressure to keep talking

More talkative than usual or a pressure to keep talking — rapid, forceful, difficult-to-interrupt speech (pressured speech). Combined with flight of ideas, gives the classic pressured, tangential speech of mania.

Physiology. Accelerated thought production plus reduced inhibition produces fast, abundant verbal output that 'leaks' the racing thoughts.

Safety. Listen briefly to build rapport, then structure the interview with closed questions; do not compete verbally.

Memory aids

• D = Distractibility
• I = Indiscretion / risky behavior
• G = Grandiosity
• F = Flight of ideas
• A = Activity increase
• S = Sleep deficit (decreased need for sleep)
• T = Talkativeness (pressure of speech)

Quick review

• D = Distractibility — Attention too easily drawn to unimportant or irrelevant external stimuli
• I = Indiscretion / risky behavior — Excessive involvement in pleasurable activities with high potential for painful consequences
• G = Grandiosity — Inflated self-esteem or grandiosity
• F = Flight of ideas — Racing thoughts; speech that shifts abruptly between loosely connected topics
• A = Activity increase — Increased goal-directed activity or psychomotor agitation
• S = Sleep deficit (decreased need for sleep) — Feels rested after only ~3 hours of sleep
• T = Talkativeness (pressure of speech) — More talkative than usual; pressure to keep talking