Inappropriately elevated mood is a condition that is the exact opposite of depression. If it haunts a person for quite a long time and is accompanied by other inadequate or illogical manifestations, then it is considered a mental disorder. This condition is classified as manic and requires special treatment. Depending on the severity of symptoms, consultation with a psychotherapist or psychiatrist may be required.
Features of the development of mania
In some cases, manic tendencies can be a personality trait, just like apathy tendencies. Increased activity, constant mental agitation, inadequately elevated mood, outbursts of anger or aggression - all these are symptoms of manic syndrome. This is the name given to a whole group of conditions that have different causes and sometimes different symptoms.
Both various life situations and incidents, as well as uncorrected pathological character traits, lead to the development of mania. A person prone to manic behavior is very often obsessed with an idea, he strives to realize it, even if it is unrealistic. Often the patient is driven by theories that have political, religious or scientific justifications. Quite often, patients show a tendency to active social and community activities.
A significant proportion of manic patients have so-called overvalued thoughts and ideas. Sometimes they can be global, sometimes these are ideas at the everyday level. From the outside, the behavior of patients talking about their ideas sometimes looks quite comical. If a highly valuable thought is global in nature, the patient, on the contrary, seems thoughtful and enthusiastic to others. Especially if he has enough education and erudition to substantiate his beliefs.
This condition is not always a pathology; it can be individual characteristics of the psyche. Treatment is necessary if overvalued thoughts and ideas get out of control and consume the patient’s entire life, in other words, interfere with the life of himself or those around him.
When do you need a doctor's help?
Manic syndrome is already a deviation from the norm, which is characterized by a number of symptoms that are more unpleasant for others than for the patient himself. This disease manifests itself as disturbances in mental activity and the emotional sphere.
Usually the behavior of a manic patient is incomprehensible to others and looks at least strange.
There are certain symptoms that indicate the need for medical attention:
- Extremely elevated mood, up to constant mental excitement and euphoria.
- Optimism that does not correspond to the situation, the patient does not notice real problems and is not inclined to experience a bad mood appropriate to the situation.
- Accelerated speech, accelerated thinking, lack of concentration on objects and phenomena that do not interest the patient. Therefore, with mania, learning is often difficult, when you have to pay attention to rather boring things.
- Increased mobility, active gestures and exaggerated facial expressions.
- Extravagance, pathological generosity. The patient can spend all his savings in a minute, without realizing responsibility for his actions.
- Insufficient control over behavior. The patient does not realize that his high mood is not appropriate everywhere.
- Hypersexuality, often with promiscuity (for example, a person who has never been prone to cheating before suddenly begins to flirt “indiscriminately”, enters into close relationships that he would never have dared to enter into before, even to the point of starting several novels in parallel or starting into a series of “short, non-binding relationships”, which later, after the episode of mania has passed, he will repent and feel shame and even disgust, sincerely not understanding “how this could happen”).
Treatment is complicated by the fact that the patient himself often does not recognize himself as sick. He considers his condition to be normal, subjectively pleasant, and does not understand why others do not like his behavior: after all, he feels better than ever before. It is difficult to send such a patient to see a doctor and persuade him to undergo therapy.
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Symptoms and signs of the disease
In addition to the signs listed above, there are several characteristic symptoms that unite almost all manic states:
- Tendency to thoughtlessly waste money.
- Tendency to make bad deals and gamble.
- Frequent violation of the law.
- Tendency to provoke fights and conflicts.
- Excessive alcohol consumption or addiction to other bad habits.
- Promiscuous sexual behavior.
- Pathological sociability - the patient often meets strange, suspicious individuals and spends time in a variety of companies.
If these signs get out of control, qualified medical attention is needed. It is important to understand that such behavior is not promiscuity, but symptoms of a disease that needs to be treated. Appealing to common sense is useless.
In some cases, the patient has a specific mania - for example, a mania of a special purpose. Then the patient is sincerely confident in his special mission and tries to implement it with all his might, despite the skepticism of others.
Types of manic states
There are several classifications based on the manifestations of mania and their content.
- Persecution mania is accompanied by paranoia. The patient is convinced that he is being persecuted; anyone can act as a persecutor - from relatives and friends to the intelligence services.
- Mania for a special purpose - the patient is sure that he needs to create a new religion, make a scientific discovery, save humanity.
- Delusions of grandeur are similar to the previous one. The main difference is that the patient does not have a goal, he simply considers himself the chosen one - the smartest, the most beautiful, the richest.
- Mania of guilt, politeness, self-destruction, nihilistic - rarer situations. Patients prone to alcohol abuse often experience mania of jealousy.
According to the emotional state, manic syndrome can be:
- Joyful mania is excitement, an unreasonably elevated mood.
- Angry – hot temper, tendency to create conflict situations.
- Paranoid – manifested by paranoia of persecution, paranoia of relationships.
- Oneiric – accompanied by hallucinations.
- Manic-depressive syndrome is characterized by alternating mania and depression.
With manic-depressive syndrome, intervals may alternate after an equal amount of time, or one type of behavior predominates. Sometimes the next phase may not occur for years.
Treatment of manic states
Diagnosed mania is a condition that requires mandatory treatment. It is customary to carry out complex therapy: pharmacological and psychotherapeutic. Pharmaceutical drugs are selected to relieve symptoms: for example, a patient with increased excitability will receive a prescription for sedatives, antipsychotics help relieve the accompanying symptoms, and mood stabilizers are used to prevent the development of the next phase.
As for psychotherapeutic treatment, usually work with a specialist goes in the direction of cognitive and cognitive-behavioral therapy, as well as psychoeducation (targeted informing the patient about the disease and training to recognize early signs (“markers”) of phase changes and quickly respond to them in order to prevent development of the next full-blown depression or mania). During psychotherapy, the cause of the disease can be found and eliminated, and the patient’s behavior and way of thinking can be adjusted. On average, treatment takes about a year, but after improvement, dynamic observation is required, since manic syndrome can recur.
Regardless of the patient's condition, it is important to begin treatment when the first symptoms appear. Psychotherapists at the CELT clinic also work with manic states. With serious experience and high qualifications, they will help you regain your mental health.
Manic disorders are associated with a person’s affective state and inappropriate behavior. This is not a disease, but an episode. Namely, the human condition associated with
Psychical deviations
This human condition can last for different periods of time. It can last for one day, or maybe a whole week. For a better understanding, it should be said that manic disorders have the opposite characteristics of depression. With the latter, a person cannot force himself to carry out any activity, may not get out of bed, etc. And manic disorders are characterized by activity and focus on something. The patient experiences outbursts of anger, aggression and even rage. There are also cases when a person experiences manic-depressive disorder with obsessive thoughts. For example, some people feel that someone is watching them or is inventing some kind of atrocity against them.
Therefore, the behavior of patients becomes cautious, they look for a trick everywhere. They can also find confirmation of their suspicions in random coincidences. It is impossible to explain to people like this that they are mistaken. Since they are confident that they are right and can find irrefutable, from their point of view, evidence that they are being watched or persecuted.
Obsession is a condition that borders on mental disorder
The reason for this behavior may be the person’s character or his reaction to unpleasant situations. It happens that a person is ready to implement his plans at any cost, despite the fact that there are certain circumstances that prevent their implementation. The goals can be different, for example, religion, politics, rare art, or simply activity related to social activities. A person has thoughts that dominate all others. This behavior seems funny if the target is small. But it is worth saying that major scientific discoveries or great achievements in other fields of activity were carried out by precisely this type of people.
Obsession with a goal borders on a mental disorder, but is not one. A person’s thoughts and actions are aimed at achieving a certain result. At the same time, they are clear and understandable. Focus on results occupies all a person’s thoughts, and to achieve or implement it, he will do everything possible and impossible. When a person begins to dream about something, all his thoughts are focused on what he wants. It is in such states that people are able to achieve great results.
And manic indicates that a person has mental disorders. His train of thoughts is chaotic, absurd, he himself does not know what he wants. People around him do not understand such a person; his behavior is aggressive.
Mental disorders. Symptoms
What symptoms indicate manic (mental) disorder?
- The person is in an excited state. That is, he is not just in an elevated good mood, but he is overexcited.
- Overly optimistic attitude towards any situation.
- Extreme speed of thought process.
- Hyperactivity.
- A person becomes wasteful.
- Does not control his actions, actions, words.
The main difficulty is that a person cannot admit the fact that he is sick and needs professional medical help. He himself believes that everything is fine with him and refuses to see a specialist. Convincing him to start treatment is almost impossible.
Main signs of the disorder
What actions does a person take that indicate they are experiencing manic bipolar personality disorder?
- A person begins to spend a lot of money. He can lose all his savings.
- Signs unfavorable contracts, does not think about the consequences of transactions.
- Creates provocative situations with surrounding people, which lead to conflicts and quarrels.
- People with manic disorders begin to have problems drinking alcohol.
- May violate the law.
- As a rule, people with this disease have a large number of sexual relationships.
- Suspicious people appear in your social circle.
- Often a selfish attitude towards others appears, allocates a special place for oneself in society, and
A person has the feeling that he is omnipotent. Therefore, he spends a lot of money, does not think about the future and believes that at any moment money will come to him in the amount that is needed. He is convinced of his higher purpose.
Manic disorder: symptoms and types
Manic states can be divided into several types. For example, it often occurs: A person feels like he is being watched and chased. Sometimes he knows his enemies and is convinced that they want to harm him or cause some kind of damage. Such stalkers can be relatives or friends, as well as strangers. Sometimes a person feels like they want to kill him, beat him or injure him in some way.
There is a mania of higher destiny, when a person believes that he was sent to earth with a certain mission and must perform some significant act. For example, create a new religion or save everyone from the end of the world and so on.
These conditions are accompanied by the fact that the patient thinks that he is the most beautiful or the richest, etc. There are different possible manifestations of the fact that a person suffers from a disease such as bipolar affective disorder. not always associated with greatness and omnipotence. There are also cases when a person, on the contrary, thinks that he is to blame for everything. Or, for example, he must serve everyone and so on.
There is a mania of jealousy. As a rule, it occurs in people who abuse alcohol. It is interesting that a manic disorder can include several manias, and sometimes a person is susceptible to only one idea.
There are cases when a sick person can convince relatives and close people that he is right. This happens because he explains his manias very logically and finds evidence for them. Therefore, close people can fall under the influence of the patient and mislead themselves. As a rule, a break in communication with such a person allows you to quickly escape from under his influence.
Sometimes people who know that they have mental disorders begin to hide them from others.
Manic disorder. Treatment
What treatment should be given to a person with manic disorder? The main sign that a person is unhealthy is insomnia. Moreover, this fact does not bother the patient himself. Because he is in a state of excitement. Such a person exhausts his relatives with his behavior. Therefore, it is better if the treatment is inpatient.
Moreover, the sooner medical assistance is provided, the better. Loved ones should not expect that manic disorder will go away on its own.
Hospitalization
If noticed, you need to contact a specialist. You should be aware that physical force may be required to admit a manic person to the hospital. Because he won’t want to go to the hospital on his own. But you shouldn’t worry about it, because after recovery the person realizes that he needed medical help. It is also worth knowing that increased excitability can relate not only to manic disorder, but also be a sign of other diseases. For example, this condition is observed in alcoholics and dementia. Also, the use of certain medications causes increased excitability. Schizophrenia can present with similar symptoms. In order to accurately determine what a person is sick with, it is necessary to conduct a special examination.
Talking won't help!
You should know that inappropriate behavior of loved ones requires medical attention. You should not try to solve the problem yourself through conversations and persuasion. Sometimes you can harm the patient by attempting treatment on your own.
As a rule, loved ones always hope for the best. This makes it difficult for them to believe that their loved one has a mental disorder. Therefore, they do not dare to resort to forcibly hospitalizing him until the last minute, and try through negotiations to convince him to see a specialist. But as practice shows, conversations with people who are not mentally healthy do not have a positive effect. On the contrary, they can cause irritation and aggression in the patient. And such a state will only worsen the situation. Therefore, there is no need to be afraid, but you should seek the help of professionals. Since in the end this will play a positive role in curing a person from this illness.
Conclusion
Now you know how manic disorders manifest themselves, and you also understand what needs to be done in this situation. We hope that the information was useful to you.
During the off-season period, people with a tendency to various mental disorders have an increased risk of experiencing a primary episode of the disease or relapse of the disease. Patients with bipolar disorder or manic-depressive psychosis should be especially attentive to their condition. The disease manifests itself by alternating opposite phases - mania and depression. If mania is increased activity, talkativeness, energy and minimal sleep, then depression is the opposite condition, characterized by complete apathy and decreased functioning.
, manic-depressive psychosis manifests itself in intense mood swings: mania and depression, which can replace each other or alternate with periods of remission; the frequency, duration and change of episodes depends on the individual characteristics of the person. Approximately one percent of the population suffers from bipolar disorder. The disease, as a rule, develops in adolescence or socially active age (15-30 years), although cases of onset of the disease at 40 years and older have sometimes been recorded. Episodes of mania or depression last approximately 3-7 months, with depressive phases being much longer than manic phases. The change of phases can be correct or incorrect, they can alternate with periods of intermission, in addition, the disorder can be expressed in only one episode: manic or depressive.
Manic phase
There is a so-called “triad of signs” of the manic phase: increased motor activity, ideational-psychic arousal and elevated mood. The manic stage of bipolar disorder in its development goes through the following stages:Depending on the severity of symptoms, the following types of mania are distinguished:
- Hypomania (mild form), is characterized by slight increased activity and energy, slight elevation of mood, a sense of mental and physical productivity, increased social activity, talkativeness, familiarity, absent-mindedness, and hypersexuality. Occasionally, instead of an elevated mood, anger and irritability appear. The stage lasts a couple of days.
- Mania without psychotic symptoms (moderate degree) is characterized by significantly elevated mood, speech pressure, severe hyperactivity, euphoric mood, insomnia, and ideas of grandeur appear. In some cases, irritation and aggression appear. The episode lasts about a week and leads to a complete disruption of social functioning and performance.
- Mania with psychotic features (severe form), characterized by uncontrollable psychomotor agitation with violence and aggression. Delusions of grandeur or persecution develop, speech becomes incomprehensible, racing thoughts are observed, and hallucinations occur.
Depressive phase
Manic-depressive syndrome has its own triad of symptoms that are directly opposite to the manic phase: slow thinking, depressed mood and motor retardation. Stages of the depressive phase - Simple depression is a classic triad of symptoms, not burdened by delusions;
- Hypochondriacal – depression, aggravated by hypochondriacal delusions, when a person believes that he is ill, possibly terminally, this is a state of some kind of “falling in love with an illness.”
- Delusional depression, or Qatar syndrome, is large-scale, grotesque delusional ideas of a hypochondriacal or nihilistic nature, against the background of an anxious and melancholy mood. A person believes that he is rotting, that he has infected all of humanity with some kind of disease, that he has no heart, etc.
- Agitated - a classic triad of signs with mild motor retardation or a complete absence of motor retardation.
- Anesthetic depression with a symptom of loss of mental sensitivity, when patients claim that they have lost the ability to love, rejoice and have become insensitive, and therefore feel acute mental pain.
Bipolar disorder (manic depressive psychosis) diagnosis
Until recently, it was believed that bipolar disorder (manic depressive syndrome) was a very rare disease and difficult to diagnose. In Israel, the internationally recognized ICD-10 classification is used to diagnose bipolar disorder, according to which an episode of affective disorder is defined as a severe mood disorder for 1 week (for mania) and 2 weeks (for depression). Bipolar disorder (manic-depressive psychosis), for the diagnosis of which screening tables, questionnaires and tests are used, which allows the doctor to establish an accurate diagnosis and prescribe treatment. Bipolar disorder (manic depressive psychosis) treatment methods
Early contact with the center and diagnosis of the disease after the first phase significantly improves the prognosis of the disease and reduces treatment time. The goal of treatment for bipolar disorder is to relieve symptoms and achieve long-term remission. Bipolar disorder (manic depressive psychosis) treatment methods depend on the phase of the disease, and are usually carried out with single medications selected by the IsraClinic doctor. The type and dosage of the drug are selected individually, treatment is carried out under the supervision of a specialist in order to prevent a change in the phase of the disease to the opposite one under the influence of the drug, without a “bright” interval. Bipolar disorder (manic-depressive psychosis) is prevented on the recommendation of a doctor using mood stabilizers in doses prescribed by a doctor.Under manic psychosis refers to a disorder of mental activity in which disturbances of affect predominate ( mood). It should be noted that manic psychosis is only a variant of affective psychoses, which can occur in different ways. So, if manic psychosis is accompanied by depressive symptoms, then it is called manic-depressive ( this term is most popularized and widespread among the masses).
Statistical data
To date, there are no accurate statistics on the prevalence of manic psychosis among the population. This is due to the fact that from 6 to 10 percent of patients with this pathology are never hospitalized, and more than 30 percent are hospitalized only once in their lives. Thus, the prevalence of this pathology is very difficult to identify. On average, according to global statistics, this disorder affects from 0.5 to 0.8 percent of people. According to a study conducted under the leadership of the World Health Organization in 14 countries, the incidence rate has recently increased significantly.Among patients with mental illness admitted to hospital, the incidence of manic psychosis varies from 3 to 5 percent. The difference in data explains the disagreement among authors in diagnostic methods, differences in understanding the boundaries of this disease, and other factors. An important characteristic of this disease is the likelihood of its development. According to doctors, this figure for each person is from 2 to 4 percent. Statistics show that this pathology occurs in women 3–4 times more often than in men. In most cases, manic psychosis develops between the ages of 25 and 44. This age should not be confused with the onset of the disease, which occurs at an earlier age. Thus, among all registered cases, the proportion of patients at this age is 46.5 percent. Pronounced attacks of the disease often appear after 40 years. Some modern scientists suggest that manic and manic-depressive psychosis is the result of human evolution. Such a manifestation of the disease as a depressive state can serve as a defense mechanism during severe stress. Biologists believe that the disease could have arisen as a result of human adaptation to the extreme climate of the northern temperate zone. Increased sleep, decreased appetite, and other symptoms of depression helped survive long winters. The affective state in the summer increased energy potential and helped to perform a large number of tasks within a short period of time.
Affective psychoses have been known since the time of Hippocrates. Then the manifestations of the disorder were classified as separate diseases and defined as mania and melancholia. As an independent disease, manic psychosis was described in the 19th century by scientists Falret and Baillarger.
One of the interesting factors about this disease is the connection between mental disorders and the patient’s creative skills. The first to declare that there is no clear line between genius and insanity was the Italian psychiatrist Cesare Lombroso, who wrote a book on this topic, “Genius and Insanity.” Later, the scientist admits that at the time of writing the book he himself was in a state of ecstasy. Another serious study on this topic was the work of the Soviet geneticist Vladimir Pavlovich Efroimson. While studying manic-depressive psychosis, the scientist came to the conclusion that many famous people suffered from this disorder. Efroimson diagnosed signs of this disease in Kant, Pushkin, and Lermontov.
A proven fact in world culture is the presence of manic-depressive psychosis in the artist Vincent Van Gogh. The bright and unusual fate of this talented person attracted the attention of the famous German psychiatrist Karl Theodor Jaspers, who wrote the book “Strindberg and Van Gogh.”
Among the celebrities of our time, Jean-Claude Van Damme, actresses Carrie Fisher and Linda Hamilton suffer from manic-depressive psychosis.
Causes of manic psychosis
Causes ( etiology) manic psychosis, like many other psychoses, are unknown today. There are several compelling theories regarding the origin of this disease. Hereditary ( genetic) theory
This theory is partially supported by numerous genetic studies. The results of these studies indicate that 50 percent of patients with manic psychosis have one of their parents suffering from some kind of affective disorder. If one of the parents suffers from a unipolar form of psychosis ( that is, either depressive or manic), then the risk for a child to acquire manic psychosis is 25 percent. If there is a bipolar form of disorder in the family ( that is, a combination of both manic and depressive psychosis), then the risk percentage for the child increases twofold or more. Studies among twins indicate that psychosis develops in 20–25 percent of fraternal twins and 66–96 percent of identical twins.Proponents of this theory argue in favor of the existence of a gene that is responsible for the development of this disease. Thus, some studies have identified a gene that is localized on the short arm of chromosome 11. These studies were conducted in families with a history of manic psychosis.
Relationship between heredity and environmental factors
Some experts attach importance not only to genetic factors, but also to environmental factors. Environmental factors are, first of all, family and social. The authors of the theory note that under the influence of external unfavorable conditions, decompensation of genetic abnormalities occurs. This is confirmed by the fact that the first attack of psychosis occurs at that period of a person’s life in which some important events occur. It could be family problems ( divorce), stress at work or some kind of socio-political crisis.
It is believed that the contribution of genetic prerequisites is approximately 70 percent, and environmental - 30 percent. The percentage of environmental factors increases in pure manic psychosis without depressive episodes.
Constitutional Predisposition Theory
This theory is based on research by Kretschmer, who discovered a certain connection between the personality characteristics of patients with manic psychosis, their physique and temperament. So, he identified three characters ( or temperament) - schizothymic, ixothymic and cyclothymic. Schizotimics are characterized by unsociability, withdrawal and shyness. According to Kretschmer, these are powerful people and idealists. Ixothymic people are characterized by restraint, calmness and inflexible thinking. Cyclothymic temperament is characterized by increased emotionality, sociability and rapid adaptation to society. They are characterized by rapid mood swings - from joy to sadness, from passivity to activity. This cycloid temperament is predisposed to the development of manic psychosis with depressive episodes, that is, to manic-depressive psychosis. Today, this theory finds only partial confirmation, but is not considered as a pattern.Monoamine theory
This theory has received the most widespread and confirmation. She considers deficiency or excess of certain monoamines in nervous tissue as a cause of psychosis. Monoamines are biologically active substances that are involved in the regulation of processes such as memory, attention, emotions, and arousal. In manic psychosis, the most important monoamines are norepinephrine and serotonin. They facilitate motor and emotional activity, improve mood, and regulate vascular tone. An excess of these substances provokes symptoms of manic psychosis, a deficiency – depressive psychosis. Thus, in manic psychosis, there is an increased sensitivity of the receptors of these monoamines. In manic-depressive disorder, there is an oscillation between excess and deficiency.The principle of increasing or decreasing these substances underlies the action of drugs used for manic psychosis.
Theory of endocrine and water-electrolyte shifts
This theory examines functional disorders of the endocrine glands ( for example, sexual) as a cause of depressive symptoms of manic psychosis. The main role in this case is played by the disruption of steroid metabolism. Meanwhile, water-electrolyte metabolism takes part in the origin of manic syndrome. This is confirmed by the fact that the main medicine in the treatment of manic psychosis is lithium. Lithium weakens the conduction of nerve impulses in brain tissue, regulating the sensitivity of receptors and neurons. This is achieved by blocking the activity of other ions in the nerve cell, for example, magnesium.The theory of disrupted biorhythms
This theory is based on disorders of the sleep-wake cycle. Thus, patients with manic psychosis have a minimal need for sleep. If manic psychosis is accompanied by depressive symptoms, then sleep disturbances are observed in the form of its inversion ( change between daytime sleep and nighttime sleep), in the form of difficulty falling asleep, frequent waking up at night, or in the form of a change in sleep phases.It is noted that in healthy people, disturbances in sleep periodicity, related to work or other factors, can cause affective disorders.
Symptoms and signs of manic psychosis
Symptoms of manic psychosis depend on its form. Thus, there are two main forms of psychosis - unipolar and bipolar. In the first case, in the clinic of psychosis, the main dominant symptom is manic syndrome. In the second case, manic syndrome alternates with depressive episodes. Monopolar manic psychosis
This type of psychosis usually begins between the ages of 35 and older. The clinical picture of the disease is very often atypical and inconsistent. Its main manifestation is the phase of a manic attack or mania.Manic attack
This state is expressed in increased activity, initiative, interest in everything and in high spirits. At the same time, the patient’s thinking accelerates and becomes galloping, fast, but at the same time, due to increased distractibility, unproductive. There is an increase in basic drives - appetite and libido increase, and the need for sleep decreases. On average, patients sleep 3–4 hours a day. They become overly sociable and try to help everyone with everything. At the same time, they make casual acquaintances and enter into chaotic sexual relationships. Often patients leave home or bring strangers into the house. The behavior of manic patients is absurd and unpredictable; they often begin to abuse alcohol and psychoactive substances. They often get involved in politics - they chant slogans with fervor and a hoarse voice. Such states are characterized by an overestimation of one’s capabilities.
Patients do not realize the absurdity or illegality of their actions. They feel a surge of strength and energy, considering themselves absolutely adequate. This state is accompanied by various overvalued or even delusional ideas. Ideas of greatness, high birth, or ideas of special purpose are often observed. It is worth noting that despite increased arousal, patients in a state of mania treat others favorably. Only occasionally are mood swings observed, which are accompanied by irritability and explosiveness.
Such a cheerful mania develops very quickly - within 3 to 5 days. Its duration ranges from 2 to 4 months. The reverse dynamics of this condition can be gradual and last from 2 to 3 weeks.
"Mania without mania"
This condition is observed in 10 percent of cases of unipolar manic psychosis. The leading symptom in this case is motor excitation without increasing the speed of ideation reactions. This means that there is no increased initiative or drive. Thinking does not speed up, but, on the contrary, slows down, concentration of attention remains ( which is not observed in pure mania).
Increased activity in this case is characterized by monotony and lack of a sense of joy. Patients are mobile, easily establish contacts, but their mood is dull. Feelings of a surge of strength, energy and euphoria that are characteristic of classic manias are not observed.
The duration of this condition can drag on and reach up to 1 year.
Course of monopolar manic psychosis
Unlike bipolar psychosis, unipolar psychosis can experience prolonged phases of manic states. So, they can last from 4 months ( average duration) up to 12 months ( protracted course). The frequency of occurrence of such manic states is on average one phase every three years. Also, such psychosis is characterized by a gradual onset and the same ending of manic attacks. In the first years, there is a seasonality of the disease - often manic attacks develop in the fall or spring. However, over time, this seasonality is lost.
There is a remission between two manic episodes. During remission, the patient’s emotional background is relatively stable. Patients do not show signs of lability or agitation. A high professional and educational level is maintained for a long time.
Bipolar manic psychosis
During bipolar manic psychosis, there is an alternation of manic and depressive states. The average age of this form of psychosis is up to 30 years. There is a clear connection with heredity - the risk of developing bipolar disorder in children with a family history is 15 times higher than in children without it.Onset and course of the disease
In 60–70 percent of cases, the first attack occurs during a depressive episode. There is deep depression with pronounced suicidal behavior. After the end of a depressive episode, there is a long period of light - remission. It can last for several years. After remission, a repeated attack is observed, which can be either manic or depressive.
Symptoms of bipolar disorder depend on its type.
Forms of bipolar manic psychosis include:
- bipolar psychosis with a predominance of depressive states;
- bipolar psychosis with a predominance of manic states;
- a distinct bipolar form of psychosis with an equal number of depressive and manic phases.
- circulatory form.
The clinical picture of this psychosis includes long-term depressive episodes and short-term manic states. The debut of this form is usually observed at 20–25 years of age. The first depressive episodes are often seasonal. In half of the cases, depression is of an anxious nature, which increases the risk of suicide several times.
The mood of depressed patients decreases; patients note a “feeling of emptiness.” Also no less characteristic is the feeling of “mental pain”. A slowdown is observed both in the motor sphere and in the ideational sphere. Thinking becomes viscous, there is difficulty in assimilating new information and concentrating. Appetite can either increase or decrease. Sleep is unstable and intermittent throughout the night. Even if the patient managed to fall asleep, in the morning there is a feeling of weakness. A frequent patient complaint is shallow sleep with nightmares. In general, mood fluctuations throughout the day are typical for this condition - an improvement in well-being is observed in the second half of the day.
Very often, patients express ideas of self-blame, blaming themselves for the troubles of relatives and even strangers. Ideas of self-blame are often intertwined with statements about sinfulness. Patients blame themselves and their fate, being overly dramatic.
Hypochondriacal disorders are often observed in the structure of a depressive episode. At the same time, the patient shows very pronounced concern about his health. He constantly looks for diseases in himself, interpreting various symptoms as fatal diseases. Passivity is observed in behavior, and claims towards others are observed in dialogue.
Hysterical reactions and melancholy may also be observed. The duration of such a depressive state is about 3 months, but can reach 6. The number of depressive states is greater than manic ones. They are also superior in strength and severity to a manic attack. Sometimes depressive episodes can repeat one after another. Between them, short-term and erased manias are observed.
Bipolar psychosis with predominance of manic states
The structure of this psychosis includes vivid and intense manic episodes. The development of a manic state is very slow and sometimes delayed ( up to 3 – 4 months). Recovery from this state can take from 3 to 5 weeks. Depressive episodes are less intense and have a shorter duration. Manic attacks in the clinic of this psychosis develop twice as often as depressive ones.
The debut of psychosis occurs at the age of 20 and begins with a manic attack. The peculiarity of this form is that very often depression develops after mania. That is, there is a kind of twinning of phases, without clear gaps between them. Such dual phases are observed at the onset of the disease. Two or more phases followed by remission are called a cycle. Thus, the disease consists of cycles and remissions. The cycles themselves consist of several phases. The duration of the phases, as a rule, does not change, but the duration of the entire cycle increases. Therefore, 3 and 4 phases can appear in one cycle.
The subsequent course of psychosis is characterized by the occurrence of dual phases ( manic-depressive), and single ( purely depressive). The duration of the manic phase is 4 – 5 months; depressed – 2 months.
As the disease progresses, the frequency of the phases becomes more stable and amounts to one phase every year and a half. Between cycles there is a remission that lasts on average 2–3 years. However, in some cases it can be more persistent and long-lasting, reaching a duration of 10–15 years. During the period of remission, the patient retains some lability in mood, changes in personal characteristics, and a decrease in social and labor adaptation.
Distinct bipolar psychosis
This form is characterized by a regular and distinct alternation of depressive and manic phases. The onset of the disease occurs between the ages of 30 and 35 years. Depressive and manic states last longer than other forms of psychosis. At the onset of the disease, the duration of the phases is approximately 2 months. However, the phases are gradually increased to 5 months or more. There is a regularity of their appearance - one to two phases per year. The duration of remission is from two to three years.
At the onset of the disease, seasonality is also observed, that is, the beginning of the phases coincides with the autumn-spring period. But gradually this seasonality is lost.
Most often, the disease begins with a depressive phase.
The stages of the depressive phase are:
- initial stage– there is a slight decrease in mood, weakening of mental tone;
- stage of increasing depression– characterized by the appearance of an alarming component;
- stage of severe depression– all symptoms of depression reach a maximum, suicidal thoughts appear;
- reduction of depressive symptoms– depressive symptoms begin to disappear.
The manic phase is characterized by the presence of increased mood, motor agitation and accelerated ideational processes.
The stages of the manic phase are:
- hypomania– characterized by a feeling of spiritual uplift and moderate motor excitement. Appetite moderately increases and sleep duration decreases.
- severe mania– ideas of grandeur and pronounced excitement appear - patients constantly joke, laugh and build new perspectives; Sleep duration is reduced to 3 hours per day.
- manic frenzy– excitement is chaotic, speech becomes incoherent and consists of fragments of phrases.
- motor sedation– the elevated mood remains, but motor excitement goes away.
- reduction of mania– mood returns to normal or even decreases slightly.
This type of psychosis is also called the continua type. This means that there are practically no remissions between the phases of mania and depression. This is the most malignant form of psychosis.
Diagnosis of manic psychosis
Diagnosis of manic psychosis must be carried out in two directions - firstly, to prove the presence of affective disorders, that is, psychosis itself, and secondly, to determine the type of this psychosis ( monopolar or bipolar).The diagnosis of mania or depression is based on the diagnostic criteria of the World Classification of Diseases ( ICD) or based on the criteria of the American Psychiatric Association ( DSM).
Criteria for manic and depressive episodes according to the ICD
| Type of affective disorder | Criteria |
| Manic episode |
|
| Depressive episode |
|
After the presence of an affective disorder has been established, the doctor determines the type of manic psychosis.
Criteria for psychosis
| Type of psychosis | Criteria |
| Monopolar manic psychosis | The presence of periodic manic phases, usually with a protracted course ( 7 – 12 months). |
| Bipolar manic psychosis | There must be at least one manic or mixed episode. The intervals between phases can reach several years. |
| Circular psychosis | One phase is replaced by another. There are no bright spaces between them. |
The American Psychiatric Association classifier identifies two types of bipolar disorder - type 1 and type 2.
Diagnostic criteria for bipolar disorder according toDSM
| Type of psychosis | Criteria |
| Bipolar disorder type 1 | This psychosis is characterized by clearly defined manic phases, in which social inhibition is lost, attention is not maintained, and a rise in mood is accompanied by energy and hyperactivity. |
| Bipolar II disorder
(may develop into type 1 disorder) | Instead of classic manic phases, hypomanic phases are present. Hypomania is a mild degree of mania without psychotic symptoms ( no delusions or hallucinations, which may be present with mania). Hypomania is characterized by the following:
|
Cyclothymia
A special variant of the mood disorder is cyclothymia. This is a state of chronic unstable mood with periodic episodes of mild depression and elation. However, this elation or, conversely, depression of mood does not reach the level of classic depression and mania. Thus, typical manic psychosis does not develop.
Such instability in mood develops at a young age and becomes chronic. Periods of stable mood occur periodically. These cyclical changes in the patient’s activity are accompanied by changes in appetite and sleep.
Various diagnostic scales are used to identify certain symptoms in patients with manic psychosis.
Scales and questionnaires used in the diagnosis of manic psychosis
| Affective Disorders Questionnaire
(Mood Disorders Questionnaire) | This is a screening scale for bipolar psychosis. Includes questions regarding the states of mania and depression. |
| Young Mania Rating Scale | The scale consists of 11 items, which are assessed during interviews. Items include mood, irritability, speech, and thought content. |
| Bipolar Spectrum Diagnostic Scale
(Bipolar Spectrum Diagnostic Scale ) | The scale consists of two parts, each of which includes 19 questions and statements. The patient must answer whether this statement suits him. |
| Scale
Beka
(Beck Depression Inventory ) | Testing is carried out in the form of a self-survey. The patient answers the questions himself and rates the statements on a scale from 0 to 3. After this, the doctor adds up the total and determines the presence of a depressive episode. |
Treatment of manic psychosis
How can you help a person in this condition?
Family support plays an important role in the treatment of patients with psychosis. Depending on the form of the disease, loved ones should take measures to help prevent exacerbation of the disease. One of the key factors of care is suicide prevention and assistance in timely access to a doctor.Help for manic psychosis
When caring for a patient with manic psychosis, the environment should monitor and, if possible, limit the patient's activities and plans. Relatives should be aware of possible behavioral abnormalities during manic psychosis and do everything to reduce the negative consequences. Thus, if the patient can be expected to spend a lot of money, it is necessary to limit access to material resources. Being in a state of excitement, such a person does not have time or does not want to take medications. Therefore, it is necessary to ensure that the patient takes the medications prescribed by the doctor. Also, family members should monitor the implementation of all recommendations given by the doctor. Taking into account the patient's increased irritability, tact should be exercised and support should be provided discreetly, showing restraint and patience. You should not raise your voice or shout at the patient, as this can increase irritation and provoke aggression on the part of the patient.
If signs of excessive agitation or aggression occur, loved ones of a person with manic psychosis should be prepared to ensure prompt hospitalization.
Family support for manic depression
Patients with manic-depressive psychosis require close attention and support from those close to them. Being in a depressed state, such patients need help, since they cannot cope with the fulfillment of vital needs on their own.
Help from loved ones with manic-depressive psychosis includes the following:
- organization of daily walks;
- feeding the patient;
- involving patients in homework;
- control of taking prescribed medications;
- providing comfortable conditions;
- visiting sanatoriums and resorts ( in remission).
In severe depressive episodes, the patient may remain in a state of stupor for a long time. At such moments, you should not put pressure on the patient and encourage him to be active, as this can aggravate the situation. A person may have thoughts about his own inferiority and worthlessness. You should also not try to distract or entertain the patient, as this can cause greater depression. The task of the immediate environment is to ensure complete peace and qualified medical care. Timely hospitalization will help avoid suicide and other negative consequences of this disease. One of the first symptoms of worsening depression is the patient's lack of interest in the events and actions happening around him. If this symptom is accompanied by poor sleep and lack of appetite, you should immediately consult a doctor.
Suicide Prevention
When caring for a patient with any form of psychosis, those close to them should take into account possible suicide attempts. The highest incidence of suicide is observed in the bipolar form of manic psychosis.
To lull the vigilance of relatives, patients often use a variety of methods, which are quite difficult to foresee. Therefore, it is necessary to monitor the patient’s behavior and take measures when identifying signs that indicate a person has an idea of suicide. Often people prone to suicidal ideation reflect on their uselessness, the sins they have committed or great guilt. The patient's belief that he has an incurable disease ( in some cases – dangerous for the environment) disease may also indicate that the patient may attempt suicide. The sudden reassurance of the patient after a long period of depression should make loved ones worry. Relatives may think that the patient's condition has improved, when in fact he is preparing for death. Patients often put their affairs in order, write wills, and meet people they have not seen for a long time.
Measures that will help prevent suicide are:
- Risk assessment– if the patient takes real preparatory measures ( gives favorite things, gets rid of unnecessary items, is interested in possible methods of suicide), you should consult a doctor.
- Taking all conversations about suicide seriously– even if it seems unlikely to relatives that the patient could commit suicide, it is necessary to take into account even indirectly raised topics.
- Limitation of capabilities– you need to keep piercing and cutting objects, medications, and weapons away from the patient. You should also close windows, doors to the balcony, and gas supply valve.
Moral support plays an important role in preventing suicide. When people are depressed, they are not inclined to listen to any advice or recommendations. Most often, such patients need to be freed from their own pain, so family members need to be attentive listeners. A person suffering from manic-depressive psychosis needs to talk more himself and relatives should facilitate this.
Often, those close to a patient with suicidal thoughts will feel resentment, feelings of powerlessness, or anger. You should fight such thoughts and, if possible, remain calm and express understanding to the patient. You cannot condemn a person for having thoughts about suicide, as such behavior can cause withdrawal or push them to commit suicide. You should not argue with the patient, offer unjustified consolations, or ask inappropriate questions.
Questions and comments that should be avoided by relatives of patients:
- I hope you're not planning to commit suicide- this formulation contains a hidden answer “no”, which relatives want to hear, and there is a high probability that the patient will answer exactly that way. In this case, a direct question “are you thinking about suicide” is appropriate, which will allow the person to talk out.
- What do you lack, you live better than others- such a question will cause the patient even greater depression.
- Your fears are unfounded- this will humiliate a person and make him feel unnecessary and useless.
The assistance of relatives in organizing an orderly lifestyle for the patient, a balanced diet, regular medications, and proper rest will help reduce the likelihood of relapse. An exacerbation can be provoked by premature discontinuation of therapy, violation of the medication regimen, physical overexertion, climate change, and emotional shock. Signs of an impending relapse include not taking medications or visiting a doctor, poor sleep, and changes in habitual behavior.
Actions that relatives should take if the patient's condition worsens include :
- contacting your doctor for treatment correction;
- elimination of external stress and irritating factors;
- minimizing changes in the patient's daily routine;
- ensuring peace of mind.
Drug treatment
Adequate drug treatment is the key to long-term and stable remission, and also reduces mortality due to suicide.The choice of medication depends on which symptom prevails in the clinic of psychosis - depression or mania. The main drugs in the treatment of manic psychosis are mood stabilizers. This is a class of drugs that act to stabilize mood. The main representatives of this group of drugs are lithium salts, valproic acid and some atypical antipsychotics. Among the atypical antipsychotics, aripiprazole is the drug of choice today.
Antidepressants are also used in the treatment of depressive episodes in the structure of manic psychosis ( for example, bupropion).
Drugs from the class of mood stabilizers used in the treatment of manic psychosis
| Name of the medication | Mechanism of action | How to use |
| Lithium carbonate | Stabilizes mood, eliminates symptoms of psychosis, and has a moderate sedative effect. | Orally in tablet form. The dose is set strictly individually. It is necessary that the selected dose ensures a constant concentration of lithium in the blood within the range of 0.6 - 1.2 millimoles per liter. So, with a dose of the drug of 1 gram per day, a similar concentration is achieved after two weeks. It is necessary to take the drug even during remission. |
| Sodium valproate | Smoothes mood swings, prevents the development of mania and depression. It has a pronounced antimanic effect, effective for mania, hypomania and cyclothymia. | Inside, after eating. The starting dose is 300 mg per day ( divided into two doses of 150 mg). The dose is gradually increased to 900 mg ( twice 450 mg), and for severe manic states – 1200 mg. |
| Carbamazepine | Inhibits the metabolism of dopamine and norepinephrine, thereby providing an antimanic effect. Eliminates irritability, aggression and anxiety. | Orally from 150 to 600 mg per day. The dose is divided into two doses. As a rule, the drug is used in combination therapy with other medications. |
| Lamotrigine | Mainly used for maintenance therapy of manic psychosis and prevention of mania and depression. | The initial dose is 25 mg twice a day. Gradually increase to 100 - 200 mg per day. The maximum dose is 400 mg. |
Various regimens are used in the treatment of manic psychosis. The most popular is monotherapy ( one medication is used) lithium preparations or sodium valproate. Other experts prefer combination therapy, when two or more drugs are used. The most common combinations are lithium ( or sodium valproate) with an antidepressant, lithium with carbamazepine, sodium valproate with lamotrigine.
The main problem associated with the prescription of mood stabilizers is their toxicity. The most dangerous drug in this regard is lithium. Lithium concentration is difficult to maintain at the same level. A missed dose of the drug once can cause an imbalance in lithium concentration. Therefore, it is necessary to constantly monitor the level of lithium in the blood serum so that it does not exceed 1.2 millimoles. Exceeding the permissible concentration leads to toxic effects of lithium. The main side effects are associated with kidney dysfunction, heart rhythm disturbances and inhibition of hematopoiesis ( process of blood cell formation). Other mood stabilizers also need constant biochemical blood tests.
Antipsychotic drugs and antidepressants used in the treatment of manic psychosis
| Name of the medication | Mechanism of action | How to use |
| Aripiprazole | Regulates the concentration of monoamines ( serotonin and norepinephrine) in the central nervous system. The drug, having a combined effect ( both blocking and activating), prevents both the development of mania and depression. | The drug is taken orally in tablet form once a day. The dose ranges from 10 to 30 mg. |
| Olanzapine | Eliminates symptoms of psychosis - delusions, hallucinations. Dulls emotional arousal, reduces initiative, corrects behavioral disorders. | The initial dose is 5 mg per day, after which it is gradually increased to 20 mg. A dose of 20 – 30 mg is most effective. Taken once a day, regardless of meals. |
| Bupropion | It disrupts the reuptake of monoamines, thereby increasing their concentration in the synaptic cleft and in brain tissue. | The initial dose is 150 mg per day. If the chosen dose is ineffective, it is raised to 300 mg per day. |
| Sertraline | Has an antidepressant effect, eliminating anxiety and restlessness. | The initial dose is 25 mg per day. The drug is taken once a day - in the morning or evening. The dose is gradually increased to 50 – 100 mg. The maximum dose is 200 mg per day. |
Antidepressant drugs are used for depressive episodes. It must be remembered that bipolar manic psychosis is accompanied by the greatest risk of suicide, so it is necessary to treat depressive episodes well.
Prevention of manic psychosis
What should you do to avoid manic psychosis?
To date, the exact cause of the development of manic psychosis has not been established. Numerous studies indicate that heredity plays an important role in the occurrence of this disease, and most often the disease is transmitted through generations. It should be understood that the presence of manic psychosis in relatives does not determine the disorder itself, but a predisposition to the disease. Under the influence of a number of circumstances, a person experiences disorders in the parts of the brain that are responsible for controlling the emotional state.It is practically impossible to completely avoid psychosis and develop preventive measures.
Much attention is paid to early diagnosis of the disease and timely treatment. You need to know that some forms of manic psychosis are accompanied by remission at 10–15 years. In this case, regression of professional or intellectual qualities does not occur. This means that a person suffering from this pathology can realize himself both professionally and in other aspects of his life.
At the same time, it is necessary to remember the high risk of heredity in manic psychosis. Married couples where one of the family members suffers from psychosis should be instructed about the high risk of manic psychosis in unborn children.
What can trigger the onset of manic psychosis?
Various stress factors can trigger the onset of psychosis. Like most psychoses, manic psychosis is a polyetiological disease, which means that many factors are involved in its occurrence. Therefore, it is necessary to take into account a combination of both external and internal factors ( complicated anamnesis, character traits).Factors that can provoke manic psychosis are:
- character traits;
- endocrine system disorders;
- hormonal surges;
- congenital or acquired brain diseases;
- injuries, infections, various bodily diseases;
- stress.
Emotional turmoil is more of a provoking than a causative factor. There is ample evidence that problems in interpersonal relationships and recent stressful events contribute to the development of episodes and relapses of manic psychosis. According to studies, more than 30 percent of patients with this disease have experiences of negative relationships in childhood and early suicide attempts. Attacks of mania are a kind of manifestation of the body's defenses provoked by stressful situations. The excessive activity of such patients allows them to escape from difficult experiences. Often the cause of manic psychosis is hormonal changes in the body during puberty or menopause. Postpartum depression can also act as a trigger for this disorder.
Many experts note the connection between psychosis and human biorhythms. Thus, the development or exacerbation of the disease often occurs in spring or autumn. Almost all doctors note a strong connection in the development of manic psychosis with previous brain diseases, endocrine system disorders and infectious processes.
Factors that can provoke an exacerbation of manic psychosis are:
- interruption of treatment;
- disruption of daily routine ( lack of sleep, busy work schedule);
- conflicts at work, in the family.
In case of manic psychosis, adherence to a daily routine is no less important. Getting enough sleep is just as important as taking your medications. It is known that sleep disturbance in the form of a decrease in the need for it is the first symptom of an exacerbation. But, at the same time, its absence can provoke a new manic or depressive episode. This is confirmed by various studies in the field of sleep, which have revealed that in patients with psychosis the duration of various phases of sleep changes.
Manic disorder See synonym: .
Brief explanatory psychological and psychiatric dictionary. Ed. igisheva. 2008.
See what “Manic disorder” is in other dictionaries:
"F06.30" Psychotic manic disorder of organic nature- F06.300 Psychotic manic disorder due to traumatic brain injury F06.301 Psychotic manic disorder due to cerebrovascular disease F06.302 Psychotic manic disorder due to... ...
MANIC, BIPOLAR DISORDER- See bipolar disorder, manic...
Organic (affective) mood disorder- A. General criteria F06 are identified. B. The condition must meet the criteria for one of the affective disorders set out in F30 F32. The diagnosis of affective disorder can be clarified by the fifth character: F06.30 Organic manic disorder... ... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic guidelines. Research diagnostic criteria
Bipolar affective disorder- Bipolar affective disorder... Wikipedia
Bipolar disorder- Bipolar affective disorder ICD 10 F31. ICD 9 296.80 OMIM ... Wikipedia
Bipolar disorder manic- an affective disorder manifested by manic phases, but in which a depressive phase was observed at least once. Wed. Unipolar mania... Encyclopedic Dictionary of Psychology and Pedagogy
F31.6 Bipolar affective disorder, current episode mixed- The patient must have had at least one manic, hypomanic, depressive or mixed affective episode in the past. In the present episode, either mixed or rapidly alternating manic, hypomanic or ... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic guidelines. Research diagnostic criteria
Psychotic disorder- A. Psychotic symptoms develop during the use of a substance or within 2 weeks after taking it B. Psychotic symptoms persist for more than 10 days C. The duration of the disorder does not exceed 6 months Diagnosis ... ... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic guidelines. Research diagnostic criteria
BIPOLAR DISORDER, MANIC- A type of bipolar disorder in which the last severe affective disturbances were manifested in manic episodes: see mania (2) ... Explanatory dictionary of psychology
"F06.3" Organic mood disorders (affective)- Disorders characterized by changes in mood, usually accompanied by changes in the level of general activity. The only criterion for including such disorders in this section is their presumably direct cause... ... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic guidelines. Research diagnostic criteria