Mania
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2008-07-10T15:37:58Z
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{{expert-subject|Pharmacology}}
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{{Refimprove|date=May 2007}}
{{dablink|This article is an expansion of a section entitled [[Bipolar disorder#Manic_episode|Mania]] from within the main article '''[[Bipolar disorder]]'''''. For the classical mythological figures named Mania, see [[Mania (mythology)]].}}
{{Otheruses2|Manic}}
{{Psychology (sidebar)}}
{{DiseaseDisorder infobox
| Name = Manic episode
| ICD10 = F30
| ICD9 = {{ICD9|296.0}} Single manic episode, {{ICD9|296.4}} Most recent episode manic, {{ICD9|296.6}} Most recent episode mixed
|}}
'''Mania''' (from [[Greek language|Greek]] ''μανία''<ref>[http://www.perseus.tufts.edu/cgi-bin/ptext?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3D%2364916 Mania, Henry George Liddell, Robert Scott, ''A Greek-English Lexicon'', at Perseus]</ref> 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 is most often associated with [[bipolar disorder]], where episodes of mania may cyclically alternate with episodes of [[clinical depression]]. These cycles may relate to [[diurnal rhythm]]s and [[environmental stressor]]s. 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 mental illness|creativity]] and artistic talent.<ref>[[Kay Redfield Jamison|Jamison, Kay R.]] (1996), ''[[Touched with Fire|Touched with Fire: Manic-Depressive Illness and the Artistic Temperament]]'', New York: [[Free Press (publisher)|Free Press]], ISBN 0-684-83183-X</ref>
==Symptoms==
Symptoms of mania include [[pressure of speech|rapid speech]], racing thoughts, decreased need for sleep, [[hypersexuality]], [[Euphoria (emotion)|euphoria]], impulsiveness, grandiosity, and increased interest in goal-directed activities.<ref>[[DSM-IV]]</ref> Mild forms of mania, known as [[hypomania]], cause little or no impairment, but some people who suffer from prolonged hypomania may develop full mania.<ref> AJ Giannini. Biological Foundations of Clinical Psychiatry, NY Medical Examination Publishing Company, 1986. </ref>
Another symptom of mania is racing thoughts during which the sufferer is excessively distracted by unimportant stimuli.<ref>Lakshmi N. Ytham, Vivek Kusumakar, Stanley P. Kutchar. (2002). ''Bipolar Disorder: A Clinician's Guide to Biological Treatments'', page 3.</ref> This negative experience creates an inability to function and an absentmindedness where the manic individual'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 [[Irritation|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 (e.g. feels rested after 3 or 4 hours of sleep). In manic and 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'':<ref>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]].</ref>
*D = Distractibility
*I = Indiscretion
*G = Grandiosity
*F = Flight of ideas
*A = Activity increased
*S = Sleep (decreased need for)
*T = Talkativeness (pressured speech)
==Mixed states==
{{main|Mixed episode}}
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==
{{main|Hypomania}}
Hypomania is a lowered state of mania that does little to impair function or decrease quality of life according. In hypomania there is 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 stabilizer]]s 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 stabilizer]]s 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 salt|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]].
The calcium-channel blocker, verapamil is useful in the treatment of hypomania and in those cases where lithium and mood stabilizers are contraindicated or ineffective.<ref> AJ Giannini, WA Price. Antimanic effects of verapamil . American Journal of Psychiatry. 141:160-1604,1984.</ref>. Verapamil is effective for both short-term and long-term treatment. <ref> AJ Giannini, RS Taraszewski, RH Loiselle. Verapamil and lithium in maintenance therapy of manic patients. Journal of Clinical Pharmacology. 27:980-985,1987. </ref>
==Psychopharmacology==
The biological mechanism by which mania occurs is not 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.{{Fact|date=October 2007}}
[[Bipolar disorder]] is different for [[men]] than it is 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]].{{Fact|date=June 2008}}
In the study done by Brentwood VA Medical Center in Los Angeles, California, [[antidepressant]]s 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 [[clinical depression|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 is 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).
==See also==
*[[-mania]] (suffix)
* [[abnormal psychology]]
*[[Bipolar disorder]]
*[[Clinical depression]]
*[[Cyclothymia]]
*[[Hypomania]]
* [[International Society for Bipolar Disorders]]: a non-profit organization aimed at promoting research and advocacy in the field of bipolar disorders.
*[[Monomania]]
*[[Pyromania]]
*[[Social mania]]
*[[Trichotillomania]]
*[[Young Mania Rating Scale]]
Caveat: See "Symptoms" above.
==References==
{{reflist|1}}
* [http://www.nami.org/Content/ContentGroups/bp_and_Schizophrenia_Digest/The_Many_Faces_and_Facets_of_BP.htm The many faces & facets of BP]. 2007 Jul. ''NAMI''. Retrieved [[October 1]], [[2007]].
* ''Expert Opin Pharmacother''. 2001 Dec;2(12):1963–73.
* [http://www.mayoclinic.com/health/schizoaffective-disorder/DS00866 Schizoaffective Dissorder]. 2007 Sept. Mayo Clinic. Retrieved [[October 1]], [[2007]].
* [http://allpsych.com/disorders/psychotic/schizoaffective.html Schizoaffective Dissorder]. 2004 May. All Psych Online: Virtual Psychology Classroom. Retrieved [[October 2]], [[2007]].
* [http://ajp.psychiatryonline.org/cgi/content/full/162/6/1211 Increased Amygdala Activation During Mania: A Functional Magnetic Resonance Imaging Study]. 2005 June. ''The American Journal of Psychiatry''. Retrieved [[October 2]], [[2007]].
* [http://allpsych.com/disorders/psychotic/index.html Psychotic Disorders]. 2004 May. All Psych Online: Virtual Psychology Classroom. Retrieved [[October 2]], [[2007]].
* [http://www.nature.com/nature/journal/v305/n5934/abs/305527a0.html Increased concentrations and lateral asymmetry of amygdala dopamine in schizophrenia]. 1983 Oct. Nature. Retrieved [[October 2]], [[2007]].
* [http://ajp.psychiatryonline.org/cgi/citemap?id=ajp;152/8/1130 Antidepressant-induced mania and cycle acceleration: a controversy revisited]. 1995 Aug. ''American Journal of Psychiatry''. Retrieved [[October 2]], [[2007]].
* [http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=8927675&dopt=Citation Risperidone therapy in treatment refractory acute bipolar and schizoaffective mania]. 1996 Jan. ''Psychopharmacology Bulletin.'' Retrieved [[October 2]], [[2007]].
*Behrman, Andy. ''[[Electroboy|Electroboy: A Memoir of Mania]]'', "Preface: Flying High", 2002.
== External links ==
{{Wiktionary}}
*[http://www.dbsalliance.org Depression and Bipolar Support Alliance ]
*[http://counsellingresource.com/distress/mood-disorders/manic-symptoms.html Manic Episode Symptoms]
*[http://www.bipolar4all.co.uk/phpbb2 Bipolar Episode Symptoms]
{{Mental and behavioural disorders}}
[[Category:Mood disorders]]
[[Category:Greek loanwords]]
[[bg:Мания]]
[[ca:Mania]]
[[cs:Manický syndrom]]
[[da:Mani (sindstilstand)]]
[[de:Manie]]
[[et:Maania]]
[[el:Μανία]]
[[es:Manía]]
[[eo:Manio]]
[[fr:Manie]]
[[it:Mania (disturbi psichici)]]
[[he:מאניה]]
[[hu:Mánia]]
[[nl:Manie]]
[[ja:躁病]]
[[no:Mani]]
[[pl:Mania]]
[[pt:Mania]]
[[ru:Маниакальный синдром]]
[[sk:Mánia (psychiatria)]]
[[sr:Манија]]
[[fi:Mania]]
[[sv:Mani (beteende)]]