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Manic episode
ICD-10 F30
ICD-9 296.0 Single manic episode, 296.4 Most recent episode manic, 296.6 Most recent episode mixed
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Mania is a medical condition characterised by severely elevated mood. Mania is most usually associated with bipolar disorder, where episodes of mania may cyclically alternate with episodes of depression. (Note: not all mania can be classified as bipolar disorder, as mania may result from other diseases or causes. However, bipolar disorder is the "classic" manic disease.) Hypomania is a less severe variant of mania, where there is less loss of control.

SymptomsEdit

Although "severely elevated mood" sounds pleasant, the experience of mania is usually unpleasant and sometimes frightening for the person involved and may lead to impulsive behavior that may later be regretted. It can also often be complicated by the sufferer's lack of judgment and insight regarding periods of exacerbation of symptoms. Manic patients are frequently grandiose, irritable, belligerent, and frequently deny anything is wrong with them. Because mania frequently encourages high energy and decreased perception of need or ability to sleep, within a few days of a manic cycle, sleep-deprived psychosis may appear, further complicating the ability to think clearly. Racing thoughts and misperceptions lead to frustration and decreased ability to communicate with others.

In addition to decreased need for sleep, other manic symptoms include irritability, hypersexuality, hyper-religiosity, hyperactivity, talkativeness, flight-of-ideas, and grandiose ideas and plans. In manic and less severe, hypomanic cases, the afflicted person may engage in out of character behaviour such as questionable business transactions, wasteful expenditures of money, risky liaisons or highly vocal arguments uncharacteristic of previous behaviors. These behaviors increase stress in personal relationships, problems at work and increases the risk of altercations with law enforcement as well as being at high risk of impulsively taking part in activities potentially harmful to self and others.

A mnemonic used to remember the symptoms of mania is DIGFAST[1]:

  • D = Distractibility
  • I = Indiscretion (excessive pleasure activities)
  • G = Grandiosity
  • F = Flight of ideas
  • A = Activity increased
  • S = Sleep deficit
  • T = Talkativeness (pressure speech)

Mixed statesEdit

Mania can be experienced at the same time as depression, in a mixed state. Dysphoric mania is primarily manic and a depressive mixed state is primarily depressed. This has caused speculation amongst doctors that mania and depression are two independent axes in a bipolar spectrum, rather than opposites.

TreatmentEdit

Before beginning treatment for mania, careful differential diagnosis must be performed to rule out non-psychiatric causes.

Acute mania in bipolar disorder is typically treated with mood stabilizers and/or antipsychotic medication. Note that these treatments need to be prescribed and monitored carefully to avoid harmful side-effects such as neuroleptic malignant syndrome with the antipsychotic medications. It may be necessary to temporarily admit the patient involuntarily until the patient is stabilized.

When the symptoms of mania have gone, long-term treatment then focuses on prophylactic treatment to try to stabilize the patient's mood, typically through a combination of pharmacotherapy and psychotherapy.

Lithium is the classic mood stabilizer to prevent further manic and depressive episodes. Anticonvulsants such as valproic acid and carbamazepine are also used for prophylaxis.

External links Edit

See alsoEdit

Additional readingEdit

College-level texts on abnormal psychology will contain a section on mania.

Reference Edit

  1. ^  Carlat DJ, The Psychiatric Review of Symptoms: A Screening Tool for Family Physicians, American Academy of Family Physicians, URL: http://www.aafp.org/afp/981101ap/carlat.html, Accessed on: August 13, 2005.
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