Cyclothymia differs from bipolar in that major depression, mania, or hypomania have never occurred. Excessive elation is a common symptom associated with manic-depressive psychoses and mania/hypomania. In hypomania or mania, some bipolar patients can suffer grandiose delusions. Hypomania may be indicative of bipolar II disorder. Some studies have suggested that hypergraphia is related to bipolar disorder, hypomania, and schizophrenia. Hypomania can be associated with narcissistic personality disorder. Besides sleepiness, this method can cause a side effect of mania or hypomania. Fibromyalgia has also been linked with bipolar disorder, particularly the hypomania component. Unipolar hypomania without accompanying depression has been noted in the medical literature. The KMRS assess 21 symptoms related to mania, hypomania, and rapid cycling. It is important to distinguish between hypomania and mania. In 1975, Jung's original distinction between mania and hypomania gained support. Sertraline has often been debated to have side effects that can trigger hypomania. Other related concepts are trance, hypnosis, hypomania and mindfulness. In contrast, hypomania usually increases functioning.