Mania , also known as manic syndrome , is a state of increase in arousal, influence, and abnormal energy levels, or "an increased overall activation state with improved affective expression along with lability of affect. "Although mania is often conceived as a" mirror image "for depression, a high mood can be euphoria or irritability; indeed, when mania increases, irritability may be more pronounced and produce violence, or anxiety.
Symptoms of mania include a high mood (either euphoria or irritability); aviation ideas and speech pressure; and increased energy, decreased need for sleep, and hyperactivity. They are most clearly seen in fully developed hypomanic states; in full mania, however, they experience an increasingly severe exacerbation and become increasingly obscured by other signs and symptoms, such as delusions and behavioral fragmentation.
Mania is a syndrome with many causes. Although most cases occur in the context of bipolar disorder, it is a key component of other psychiatric disorders (such as schizoaffective disorder, bipolar type) and may also occur secondary to a variety of common medical conditions, such as multiple sclerosis; certain medicines may perpetuate the state of the bead, such as prednisone; or substance abuse, such as cocaine or anabolic steroids. In the current DSM-5, hypomanic episodes are separated from more severe full episodes of mania, which, in turn, are characterized as mild, moderate, or severe, with determinants in terms of certain symptom features (eg catatonia, psychosis). Mania is divided into three stages: hypomania, or stage I; acute mania, or stage II; and delirious mania (delirium), or stage III. This "staging" episode of mania is very useful from a descriptive and differential diagnostic point of view.
Mania varies in intensity, from mild mania (hypomania) to delirious mania, characterized by symptoms such as disorientation, reddish psychosis, incoherence, and catatonia. Standard tools such as Altman Self-Rating Mania Scale and Young Mania Rating Scale can be used to measure the severity of episodes of mania. Since mania and hypomania have also long been associated with artistic creativity and talent, it is not always the case that obvious bipolar men need or need medical help; Such people often retain enough self-control to function normally or unaware that they have become "maniacs" that are hard enough to do or commit. A soulful person can often be misinterpreted as being under the influence of drugs.
Video Mania
Classification
Mixed state
In a mixed affective state, individuals, although meeting the general criteria for hypomanic (discussed below) or manic episodes, experience three or more symptoms of concurrent depression. This has led to some speculation, among physicians, that mania and depression, rather than being a true "opposite pole", is, instead, two independent axes in the bipolar-unipolar spectrum.
A mixed affective state, especially with prominent bead symptoms, puts the patient at greater risk for completing suicide. Depression itself is a risk factor but, when combined with increased energy and goal-directed activity, patients are far more likely to act violently on suicidal impulses.
Hypomania
Hypomania is a lower mania condition that does little to interfere with function or decrease quality of life. Perhaps, in fact, increase productivity and creativity. In hypomania, less sleep needs and improved motivation and metabolism behaviors. Although the increase in mood and typical energy levels of hypomania can be seen as a benefit, the mania itself generally has many undesirable consequences including suicidal tendencies, and hypomania can, if a prominent mood is more irritable than euphoria, becomes a rather unpleasant experience.
Related interruptions
A single mania episode, in the absence of secondary causes, (ie, substance use, pharmacological disorders, general medical conditions) is sufficient to diagnose bipolar disorder. Hypomania can be an indication of bipolar disorder II. Bead episodes are often complicated by delusions and/or hallucinations; If psychotic characteristics persist for longer than episode mania (two weeks or more), the diagnosis of schizoaffective disorder is more appropriate. Certain "obsessive-compulsive" disorders as well as impulse control disorders share the name "mania," ie, kleptomania, pyromania, and trichotillomania. Although the unfortunate association implied by the name, however, there is no association between mania or bipolar disorder and this disorder. B 12 deficiency can also lead to characteristic mania and psychosis.
Hyperthyroidism can produce symptoms similar to mania, such as agitation, mood elevation, increased energy, hyperactivity, sleep disorders and sometimes, especially in severe cases, psychosis.
Maps Mania
Signs and symptoms
A episode mania is defined in the American Psychiatric Association's diagnostic manual as "different periods of abnormal and persistent increase, expansiveness, or mood irritation and abnormalities and steadily increased activity or energy, lasting at least 1 week and presents almost daily, almost daily (or duration if hospitalization is required), "where moods are not caused by drugs/medications or medical illnesses (eg, hyperthyroidism), and (a) cause obvious difficulties in the workplace. or in social relations and activities, or (b) requiring hospitalization to protect the person or another person, or (c) the person suffering from psychosis.
To be classified as an episode of mania, while mood disturbed and an increase in activity or energy directed at the goal there are at least three (or four if only irritability present) of the following must have consistently existed:
- Increase in self-esteem or greatness.
- Decreased sleeping needs (eg, feeling rested after 3 hours of sleep).
- More talk than usual or pressure to keep talking.
- Flight of ideas or subjective experiences thought by the mind.
- An increase in targeted activity, or psychomotor acceleration.
- Distractibility (too easily drawn to nonessential or irrelevant external stimuli).
- Excessive involvement in activity with potentially high painful consequences. (eg, over-spending, impossible commercial schemes, hypersexuality).
Although the activity that a person follows in a manic state is not always always negative, those with potentially negative results are much more likely.
If the person is depressed simultaneously, they are said to have mixed episodes.
The World Health Organization classification system defines episodes of mania as a state where moods are higher than the situations of the person who guarantees and may vary from high levels of relaxed zeal to unbridled excitement, accompanied by hyperactivity, the urge to speak, reducing sleep needs, difficulty maintaining attention and often increasing distractibility. Often, self-esteem and self-esteem are exaggerated, and great ideas of luxury are expressed. Misbehavior and risky, stupid or inappropriate behavior can result from the loss of normal social control.
Some people also have physical symptoms, such as sweating, pacing, and weight loss. In a full mania, often a mania will feel as if his goal (s) outdo all others, that no consequences or negative consequences will be minimal, and that they need not refrain in pursuing what they seek. Hypomania is different, because it can cause little or no malfunction. The hypomanic relationships with the outside world, and their interaction standards, remain intact, despite the increased mood intensity. But those with persistent, unresolved hypomania risk developing full mania, and can indeed cross the "line" without realizing they have done it.
One signature symptom of mania (and to a lesser extent, hypomania) is what many describe as racing thought. This is usually an example where the mania is excessively distracted by objectively unimportant stimuli. This experience creates a daze where individual manic thoughts really occupy him, leaving him unable to trace time, or realize anything but the flow of thought. Racing thoughts also interfere with the ability to fall asleep.
Manic state is always relative to the normal state of the intensity of the individual suffering; thus, an already irritable patient may find themselves losing their emotions even more quickly and academically gifted people may, during the hypomanic stage, adopt the seemingly "genius" characteristics and ability to perform and articulate at a rate far beyond what is will be able to during euthymia. A very simple indicator of the state of mania is if a clinically depressed patient until now suddenly becomes very energetic, cheerful, aggressive, or "too happy." Other elements of mania, often unclear, include delusions (generally in the form of splendor or persecution, according to whether the dominant atmosphere is euphoric or irritable), hypersensitivity, hyper-hyperacity, hypersexuality, hyper-religiosity, hyperactivity and impulsivity, , (usually accompanied by speech pressure) grand schemes and ideas, and decreased sleep needs (eg, feeling rested after only 3 or 4 hours of sleep); in the latter case, the eyes of such patients may appear and feel abnormally "wide" or "open," rarely flicker, and this often contributes to the wrong doctors' wrong belief that these patients are under the influence of stimulants. , when the patient, in fact, is not on the substance altering the mind or actually on depressant drugs, in a heretical attempt to ward off unwanted bead symptoms. Individuals may also engage in off-character behavior during episodes, such as questionable business transactions, wasteful spending (eg sprees expenses), risky sexual activity, recreational abuse, excessive gambling, reckless behavior (as "driving speed" or activity brave, "social interactions that are not normal (as a manifestation through, for example, on familiarity and conversation with strangers), or very vocal arguments.This behavior can increase stress in personal relationships, cause workplace problems and increase the risk of contention with enforcers There is a high risk of impulsively taking part in activities that are potentially harmful to yourself and others.
Although a "very high mood" sounds somewhat desirable and pleasurable, the experience of mania in the end is often quite unpleasant and sometimes disturbing, if not frightening, to the person involved and to those close to it, and that can lead to impulsive behaviors maybe later regretted. This can also often be complicated by the lack of judgment and insight of the sufferer regarding the characteristic status exacerbation period. Bead patients are often grandiose, obsessive, impulsive, irritable, belligerent, and often deny that something is wrong with them. Because mania often encourages high energy and reduces perceptions of need or ability to sleep, within a few days of the manic cycle, sleep-deprived psychosis can arise, further complicating the ability to think clearly. Racing and misperception cause frustration and decreased ability to communicate with others.
Mania may also, as mentioned earlier, be divided into three "stages." Stage I corresponds to hypomania and may display typical hypomanic characteristics, such as gregariousness and euphoria. In stage II and III mania, however, the patient may be highly irritable, psychotic or even delirious. These last two stages are referred to as acute and delirious (or Bell), respectively.
Cause
Various triggers have been linked to switching from euthemic or depression states to mania. One of the common triggers of mania is antidepressant therapy. Studies show that the risk of temporary switching to antidepressants is between 6-69 percent. Dopaminergic drugs such as reuptake inhibitors and dopamine agonists may also increase the risk of switches. Other drugs may include glutaminergic agents and medications that alter the HPA axis. Lifestyle triggers include irregular sleep schedule and lack of sleep, as well as very emotional or stressful stimuli.
The various genes that have been involved in bipolar genetic studies have been manipulated in preclinical animal models to produce syndromes that reflect various aspects of mania. CLOCK and DBP polymorphisms have been associated with bipolar in population studies, and behavioral changes induced by the fall system were reversed with lithium treatment. Metabotropic glutamate receptor 6 is genetically linked to bipolar, and is found to be less expressed in the cortex. The peptide-active pituitary adenylate peptide has been associated with bipolar in gene link studies, and KO in mice produces behavioral-like mania. Targets from various treatments such as GSK-3, and ERK1 have also shown mania-like behavior in preclinical models.
Mania may be associated with stroke, especially brain lesions in the right hemisphere.
Deep brain stimulation of the subthalamic nucleus in Parkinson's disease has been associated with mania, especially with electrodes placed in ventromedial STN. The proposed mechanism involves increasing excitatory input from STN to the dopaminergic nucleus.
Mania can also be caused by physical trauma or pain. When the cause is physical, it is called secondary mania.
Mechanism
The mechanisms underlying the mania are unknown, but the neurocognitive profile of mania is consistent with dysfunction in the right prefrontal cortex, a general finding in neuroimaging studies. Various paths of evidence from post-mortem studies and mechanisms suspected of anti-manic agents showed abnormalities in GSK-3, dopamine, Protein kinase C and Inositol monophosphatase.
The meta-analysis of neuroimaging studies showed an increase in thalamic activity, and bilaterally reduced the activation of the inferior frontal gyrus. Activity in the amygdala and other subcortical structures such as ventral striatum tends to increase, although the results are inconsistent and may depend on task characteristics such as valence. Reduced functional connectivity between the ventral prefrontal cortex and the amygdala along with variable findings support the generalized disregulation hypothesis of subcortical structures by the prefrontal cortex. The bias against positive stimulation is valanced, and an increase in response within the prize circuit may affect the mania. Mania tends to be associated with right hemispheric lesions, while depression tends to be associated with left hemisphere lesions.
Post-mortem examination of bipolar disorder shows an increased expression of Protein Kinase C (CCP). Although limited, some studies show that CCP manipulation in animals produces behavioral changes that reflect mania, and treatment with tamoxifen inhibitor CCP (also anti-estrogen drugs) shows antimanic effects. Traditional antimanic drugs also show the inhibitory properties of the CCP, among other effects such as GSK3 inhibition.
Bead episodes may be triggered by dopamine receptor agonists, and this is combined with a tentative report of the increased activity of VMAT2, measured through PET scan radioligand binding, indicating the role of dopamine in mania. Reduced levels of cerebrospinal fluid from the 5-HIAA serotonin metabolite have been found in bead patients as well, which can be explained by the failure of serotonergic regulation and dopaminergic hyperactivity.
Limited evidence suggests that mania is associated with behavioral reward hypersensitivity, as well as with hypersensitivity of nerve reward. This supportive electrophysiological evidence comes from studies connecting left frontal EEG activity with mania. As the left frontal EEG activity generally though to be a reflection of the activity of the behavior activation system, it is thought to support the role for reward of hypersensitivity in mania. The provisional evidence also comes from a study that reports the relationship between beadness and negative feedback during receiving monetary gifts or losses. The evidence of neuroimaging during acute mania is uncommon, but one study reported an increase in orbitofrontal cortex activity for prize money, and other studies reported an increase in striatal activity to award negligence. The latter findings are interpreted in the context of either increased baseline activity (resulting in zero findings of reward hypersensitivity), or reducing the ability to distinguish between rewards and punishments, still favoring reward hyperactivity in mania. The punishment of hyposensitivity, as reflected in a number of neuroimaging studies as a reduction in the lateral orbitofrontal response to punishment, has been proposed as a reward mechanism for hypersensitivity in mania.
Diagnosis
In ICD-10 there are several disorders with manic syndrome: organic manic disorder (F06.30), psychotic non-psychotic mania (F30.1), psychotic psychotic mania (F30.2), other mania episodes (F30.8), episodes non-specific manic (F30.9), manic type of schizoaffective disorder (F25.0), bipolar affective disorder, current manic episode without psychotic symptoms (F31.1), bipolar affective disorder, current mania episode with psychotic symptoms (F31.2).
Treatment
Before starting treatment for mania, careful diagnosis of appeal should be made to rule out secondary causes.
Acute treatment of bipolar disorder episodes mania involves the use of mood stabilizers (valproate, lithium, or carbamazepine) or atypical antipsychotics (olanzapine, quetiapine, risperidone, or aripiprazole). Although hypomanic episodes may respond to mood stabilizers only, full-blown episodes are treated with atypical antipsychotics (often simultaneously with mood stabilizers, as these tend to produce the fastest increase).
When manic behavior has gone, long-term treatment then focuses on prophylactic treatment to try to stabilize a patient's mood, usually through a combination of pharmacotherapy and psychotherapy. The chances of having a relapse are very high for those who have had two or more episodes of mania or depression. While the drugs for bipolar disorder are important for managing the symptoms of mania and depression, studies suggest relying on drugs alone is not the most effective treatment method. Drugs are most effective when used in combination with other bipolar disorder treatments, including psychotherapy, self-coping strategies, and healthy lifestyle choices.
Lithium is a classic mood stabilizer to prevent further episodes of manic and depression. A systematic review found that long-term lithium treatment substantially reduced the risk of bipolar bead recurrence by 42%. Anticonvulsants such as valproate, oxcarbazepine and carbamazepine are also used for prophylaxis. Newer drug solutions include lamotrigine, which is another anticonvulsant. Clonazepam (Clonopin) is also used. sometimes atypical antipsychotics are used in combination with previously mentioned drugs as well, including olanzapine (Zyprexa) which helps treat hallucinations or delusions, Asenapine (Saphris, Sycrest), aripiprazole (Abilify), risperidone, ziprasidone, and clozapine are often used for people which does not respond to lithium or anticonvulsants.
Verapamil, a calcium channel blocker, is useful in the treatment of hypomania and in cases where lithium and mood stabilizers are contraindicated or ineffective. Verapamil is effective for short and long term treatment.
Antidepressant monotherapy is not recommended for the treatment of depression in patients with bipolar I or II disorders, and no benefit has been demonstrated by combining antidepressants with mood stabilizers in these patients.
Society and culture
In Andy Behrman's "Electroboy: A Memoir of Mania" he describes the mania experience as "the most perfect prescription glasses that can be used to see the world... life appears in front of you like a big screen movie." Behrman points out at the beginning of his biography that he sees himself not as a man who suffers from uncontrollable uncontrollable illness, but as the director of the film is his life that lives and lives emotionally. "When I am manic, I am very awake and alert, that my eyelashes are fluttering on the pillow sound like thunder". Many people who are artistic and perform art in various forms have mania. Winston Churchill has periods of beads symptoms that may be assets and liabilities.
Etymology
The noses of the various stages of the episode mania have changed over the decades. The word comes from Ancient Greece ????? ( where ), "madness, hustle and bustle" and verbs ???????? ( maÃÆ'nomai ), "went crazy, angry, became angry".
See also
References
Further reading
- Opin Pharmacother Expert . 2001 December; 2 (12): 1963-73.
- Schizoafective Disorders. 2007 September Mayo Clinic. Retrieved October 1, 2007.
- Schizoafective Disorders. 2004 May. All Psych Online: Virtual Psychology Class. Retrieved 2nd October 2007.
- Psychotic Disorders. 2004 May. All Psych Online: Virtual Psychology Class. Retrieved 2nd October 2007.
- Sajatovic, Martha; DiBiovanni, Sue Kim; Bastani, Bijan; Hattab, Helen; Ramirez, Luis F. (1996). "Risperidone therapy in refractory acute bipolar treatment and schizoaffective mania". Bulletin Psychopharmacology . 32 (1): 55-61. PMIDÃ, 8927675.
External links
- Symptoms of Bipolar Mania
- Depression and Bipolar Alliance Support
Source of the article : Wikipedia
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