Everything about Mania totally explained
Mania (from Greek μανία and that from μαίνομαι - mainomai, "to rage, to be furious") is a severe medical condition characterized by extremely elevated mood, energy, unusual thought patterns and sometimes psychosis. There are several possible causes for mania, but it's most often associated with bipolar disorder, where episodes of mania may cyclically alternate with episodes of clinical depression. These cycles may relate to diurnal rhythms and environmental stressors. Mania varies in intensity, from mild mania (known as hypomania) to full-blown mania with psychotic features (hallucinations and delusions).
Manic patients may need to be hospitalized to protect themselves and others. Mania and hypomania have also been associated with creativity and artistic talent.
Symptoms
Symptoms of mania include
rapid speech, racing thoughts, decreased need for sleep,
hypersexuality,
euphoria, impulsiveness, grandiosity, and increased interest in goal-directed activities. Mild forms of mania, known as
hypomania, cause little or no impairment, but most people who suffer from prolonged hypomania due to
bipolar disorder develop full mania.
Another symptom of mania is racing thoughts during which the sufferer is excessively distracted by unimportant stimuli. This negative experience creates an inability to function and an absentmindedness where the person with mania's thoughts totally preoccupy him or her, making him or her unable to keep track of time or be aware of anything besides the neurological pattern of thoughts.
Manic symptoms include
irritability, anger or rage,
delusions, hypersensitivity,
hypersexuality, hyper-
religiosity,
hyperactivity, impulsiveness, racing thoughts, talkativeness, pressure to keep talking or rapid speech, and grandiose ideas and plans, decreased need for sleep (for example feels rested after 3 or 4 hours of sleep). In manic and less severe hypomanic cases, the afflicted person may engage in out of character behavior such as questionable business transactions, wasteful expenditures of money, risky sexual activity, abnormal social interaction, 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.
Although "severely elevated mood" sounds somewhat desirable and enjoyable, the experience of mania is often quite unpleasant and sometimes disturbing, if not frightening, for the person involved (and those close to them), 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, obsessive, impulsive, 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.
There are different "stages" or "states" of mania. For example, a minor state may involve increased creativity, wit, gregariousness, and ambition. However, a more serious state of mania may involve lack of good judgment, lack of ability to focus, and even
psychosis. The victim of mania may feel elated; however, he/she may also feel irritable, frustrated, and may experience
derealization.
A
mnemonic used to remember the symptoms of mania is
DIGFAST:
- D = Distractibility
- I = Indiscretion
- G = Grandiosity
- F = Flight of ideas
- A = Activity increased
- S = Sleep (decreased need for)
- T = Talkativeness (pressured speech)
Mixed states
Mania can be experienced at the same time as depression, in a
mixed episode.
Dysphoric mania is primarily manic and
agitated depression is primarily depressed. This has caused speculation amongst doctors that mania and depression are two independent axes in a
bipolar spectrum, rather than opposites.
There is an increased probability of suicide in the mixed state, as depressed individuals who are also manic have the energy needed to commit the act and the thoughts of depression that would lead them initially to suicide.
Hypomania
Hypomania is a lowered state of mania that does little to impair function or decrease quality of life according. In hypomania there's less need for sleep, goal motivated behavior and increased metabolism. Though the elevated mood and energy level typical of hypomania could be seen as a benefit, mania itself generally has many undesirable consequences including suicidal tendencies.
Associated disorders
A single manic episode is sufficient to diagnose
Bipolar I Disorder. Hypomania may be indicative of
Bipolar II Disorder or
Cyclothymia. However, if prominent
psychotic symptoms are present for a duration significantly longer than the mood episode, a diagnosis of
Schizoaffective Disorder is more appropriate.
Medical treatment
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.
Antipsychotics and
mood stabilizers help stabilize mood of those with mania or depression. They work by blocking the receptor for the neurotransmitter
dopamine and allowing
serotonin to still work, but in diminished capacity.
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. More recent drug solutions include
lamotrigine.
Psychopharmacology
The biological mechanism by which mania occurs isn't yet known. One hypothesised cause of mania (among others), is that the amount of the
neurotransmitter serotonin in the
temporal lobe may be excessively high. This is likely to be only part of the puzzle.
Dopamine,
norepinephrine,
glutamate and
gamma-aminobutyric acid also appear to play important roles. The temporal lobe is involved in speech, listening, reading, word association and contains the
amygdala, the almond shaped emotional center for the brain. The left amygdala is more active in women who are manic and the
orbitofrontal cortex is less active (2005). Emotional stimulation creates the ability for life events to be stored more vividly in the memory. In
women, the amygdala becomes similar to one of a manic woman during sex combined with menstruation.
Bipolar disorder is different for
men than it's for
women. Mania affects the
hypothalamus and the pituitary-adrenal-axis by causing it to secrete hormones in different amounts, that accounts for
hypersexuality, changes in
metabolism, and misdiagnosis as hormonal imbalance. Because the
hormone problem stems from a neurological problem
hormone therapy isn't the best solution. If serotonin levels are stable, hormones secreted by the
pituitary gland will stabilize. Bipolar disorder is similar to a
thought disorder combined with
hypothyroidism and
hyperthyroidism.
In the study done by Brentwood VA Medical Center in Los Angeles, California,
antidepressants were taken during mania. One third of bipolar patients developed antidepressant induced mania from their healthy state and one fourth developed antidepressant induced rapid cycling from their healthy state. For those with type II bipolar disorder, antidepressants decrease the gaps between the
depression and mania (1995).
Mania and over the counter drugs
Phenylpropanolamine (PPA) is a sympathomimetic drug similar in structure to amphetamine which was formerly present in over 130 medications, primarily decongestants, cough/cold remedies, and anorectic agents.
A report on PPA, from the Dept. of Psychiatry, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Pharmacopsychiatry 1988 stated:
» We have reviewed 37 cases (published in North America and Europe since 1960) that received diagnoses of acute mania, paranoid schizophrenia, and organic psychosis and that were attributed to PPA product ingestion. Of the 27 North American case reports, more reactions followed the ingestion of combination products than preparations containing PPA alone; more occurred after ingestion of over-the-counter products than those obtained by prescription or on-the-street; and more of the cases followed ingestion of recommended doses rather than overdoses.
» Failure to recognize PPA as an etiological agent in the onset of symptoms usually led to a diagnosis of schizophrenia or mania, lengthy hospitalization, and treatment with substantial doses of neuroleptics or lithium.
PPA is no longer available in any medication in the United States as of the year 2000.
Personal accounts
In
Electroboy: A Memoir of Mania by
Andy Behrman, he describes his experience of mania as "the most perfect prescription glasses with which to see the world...life appears in front of you like an oversized movie screen" (2002). Behrman indicates early in his memoir that he sees himself not as a person suffering from an uncontrollable disabling illness, but as a director of the movie that's his vivid and emotionally alive life. "When I'm manic, I'm so awake and alert, that my eyelashes fluttering on the pillow sound like thunder" (2002).
Further Information
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