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Mania in Wikipedia

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This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Mania". (Source - Retrieved 2006-09-07 14:25:28 from http://en.wikipedia.org/wiki/Mania)

Introduction

Mania is a medical condition characterised by severely elevated mood. Mania is most usually associated with bipolar disorder, where episodes of mania may cyclically alternate with episodes of depression. (Note: not all mania can be classified as bipolar disorder, as mania may result from other diseases or causes. However, bipolar disorder is the "classic" manic disease.) Hypomania is a less severe variant of mania, where there is less loss of control.

Symptoms

Although "severely elevated mood" may sound pleasant to the unafflicted, the experience of mania is often quite unpleasant and sometimes disturbing if not frightening for the person involved and may lead to impulsive behavior that may later be regretted. It can also often be complicated by the sufferer's lack of judgment and insight regarding periods of exacerbation of symptoms. Manic patients are frequently grandiose, irritable, belligerent, and frequently deny anything is wrong with them. Because mania frequently encourages high energy and decreased perception of need or ability to sleep, within a few days of a manic cycle, sleep-deprived psychosis may appear, further complicating the ability to think clearly. Racing thoughts and misperceptions lead to frustration and decreased ability to communicate with others.

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

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

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

Mixed states

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

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.

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.

Mania and over the counter prescription drugs

Phenylpropanolamine or (PPA) is a sympathomimetic drug similar in structure to amphetamine whichis present in over 130 medications, primarily decongestants, cough/cold remedies, and anorectic agents.

A report on phenylpropanolamine, or P.P.A., 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 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.

See also

Additional reading

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

Reference

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

Other meanings

Some collective mania (craze) can also take place, as individuals have a tendency to lose their own personality inside a crowd (fads, herding, crowd hysteria, stock market bubble, tulip mania).

 

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