Manic state: what it is and how to recognize it, types, treatment

The concept of bilateral (bipolar) affective disorder combines several similar chronic mental pathologies. Their distinctive feature is cyclically alternating periods of depressive and excited states of patients. The early name of the pathology, manic-depressive syndrome, clearly reflected this symptom.

Treatment of manic states

In the treatment of pathology, the cause of the start is taken into account. Depending on it, a course of therapy is developed. It is based on the possible prescription of sedatives. This can equally be either a pharmacological agent or herbal preparations. A combination in therapy is recommended. Additionally, psychotherapeutic treatment is provided. It can be either group or individual.

Manic state symptoms

Symptoms of mania manifest themselves in an atypical attitude towards standard actions. Currently, doctors identify 142 manic episodes, which differ in the reasons that cause the disturbance. For example:

• graphomania, as an obsession with writing;
• addiction to games; gambling addiction;
• increased need for reading bibliomania;
• drug addiction, which is a craving for drugs and others.

Types of manic disorder

There are several types of manic disorders (episodes).

• Angry mania - irritability, pickiness, anger, and aggression predominate. Patients are angry towards others and themselves, they are not satisfied with the actions and behavior of others.
• Unproductive mania - elevated mood comes to the fore, but there is no desire for activity with a slight acceleration of the associative process.
• Confused mania - extreme acceleration of the associative process comes to the fore (thought processes associated with associations created by the brain; their violation is a violation of associations in the process of thinking). Association is a connection that arises in the process of thinking between elements of the psyche, as a result of which the appearance of one element, under certain conditions, evokes the image of another associated with it.
• Complex mania is a combination of various affective disorders with symptoms of other psychopathological syndromes. In the context of such manic disorders, phenomena such as staging, fantasy, which the patient himself perceives as reality, oneiroid (qualitative disturbance of consciousness), catatonic states can often manifest themselves. Various hallucinations and mental automatisms often develop. In some cases, in the context of manic syndromes, symptoms appear that at first glance are incompatible with the picture of the condition, such as senestopathy, hypochondriacal delusions, and suicidal tendencies.

Manic states can develop with manic-depressive syndrome, cyclothymia, schizophrenia, epilepsy, various types of psychoses, as well as with various organic brain lesions. In patients with manic disorders, criticism of the disease is sharply reduced; as a rule, it is completely absent; such patients are quite difficult to motivate for treatment. Most manic states are reversible. Treatment of patients with manic disorders must be carried out in a hospital setting, where they will be under 24-hour medical supervision.

Recommended articles on mania. Psychoses Schizophrenia Psychoorganic syndrome Treatment of mental illnesses Mental health Psychiatric clinic Psychiatrist

Manic depression

In this case, the patient is constantly in a sad and doomed mood. Depression can reach the point of complete refusal of any activity. Catatonia often begins, in which there is no slightest manifestation of contact with the surrounding space. The patient may suffer from a feeling of inferiority, the meaninglessness of existence. Suicide is common. The initial stage can last for years, diagnosed as melancholy.

As development progresses, the duration of periods of negative perception of what is happening increases. The patient tries to completely isolate himself from the outside world and negatively perceives everything that happens to him and those around him. There may be suspicions that the people around the patient are consciously directing events towards development according to a negative scenario.

Symptomatology

Manic syndrome, like depressive syndrome, consists of a triad of symptoms opposite to depression:

• Increased mood (hyperthymia). The affect of melancholy, abandonment, and hopelessness does not arise even when it should be expected for psychologically understandable reasons.
• Acceleration of thinking (tachypsychia) with facilitation of the associative process (reducing the delay between thoughts, reducing the severity of the criteria for the emergence of associations) up to a jump in ideas (the logic of individual judgments is not lost), the emergence of ideas of greatness (primarily one’s own) and, possibly, with denial of someone's guilt and responsibility (impunitive tendencies).
• Increased motivation and motor activity (hyperbulia). One variant of hyperbulia is the disinhibition of activity aimed at obtaining pleasure - patients in a manic state drink more alcohol (dipsomania), use drugs, eat, have many sexual relationships, etc. Another option is the use of many types of activities with an inevitable drop in productivity - neither one thing is not completed.

Manic mental states

Difficult to treat due to increased negative perception of everything around. Characterized by the occurrence of delusional states. At the initial stages there is a high level of expansiveness. The patient is characterized by an increased level of irritability. A typical symptom is persistent, goal-directed activity. At the same time, there are moments of heightened euphoria. The mood may become overly joyful, to an abnormal level. Pathology often becomes a factor in the development of psychiatric diagnoses. Therapy requires diagnostics. Often a long period may be diagnosed as schizophrenia or other disorders.

Patients are often overly optimistic about everything that happens in life. Judgments become superficial, and the level of attention decreases. During periods of increased alertness, the patient may not be able to feel tired.

What is bipolar disorder

People suffering from bipolar disorder tend to periodically or regularly fall into an uncontrollable depressed or emotional state. People are unable to regulate such mood swings on their own. They do not give in to volitional efforts. In addition, patients are not always able to critically assess their situation. A bad mood is often attributed to life circumstances, and during periods of euphoria, many lose control over their behavior.

The depression stage of bipolar disorder has classic symptoms:

• low mood;
• apathy;
• asthenia;
• lack of motivation in study and work;
• inability to feel pleasure;
• tendency to long-term worries, a sense of one’s own insignificance.

In severe cases, thoughts appear about the complete hopelessness of existence and the desire to commit suicide. A person in the depressive stage of the disorder may seem depressed about something or simply appear melancholic. The duration of depression of consciousness varies from several days to several months.

The manic period develops immediately after depression or against the background of emotional stability. It is characterized by a euphoric, excited state. In some patients, aggression and extreme anxiety predominate in behavior. Almost everyone loses the ability to adequately assess reality. To those around them, patients at this stage appear eccentric, intoxicated, unreasonably happy, irresponsible, or embittered. Often the behavior of patients is devoid of any logic and resembles madness. Psychosis can last for several hours, days or weeks. During this period, auditory and visual hallucinations and delusional ideas may appear.

The stage of hypomania has similar symptoms to mania, but is less pronounced. In this type of disorder, the ability to control behavior is partially preserved. Patients easily take on several tasks at the same time, are extremely energetic, react violently to what is happening around them, and amaze with activity and efficiency. It can be difficult to determine the inadequacy of such behavior from the outside, since the actions of patients are often outwardly logical and effective.

Diagnostics

According to the international classification of diseases ICD-10, to make a diagnosis, three of the following criteria must be present, persisting for at least 4 days in a row:

• impaired concentration, rapid distractibility;
• increased sociability;
• restless disorderly activity;
• lack of need for sleep;
• increased libido.

The presence and severity of manic symptoms, in addition to an objective examination, is determined using special scales and tests.

The Altman scale was developed at the University of Illinois and consists of 5 items that meet the diagnostic criteria of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders in the United States) - mood, self-esteem, need for sleep, speech and activity.

The Young Rating Scale is one of the main tools for determining the severity of manic symptoms. Consists of 11 items that the patient fills out after completing the clinical interview. The interpretation is based on information about the condition over the last 48 hours, the results of the conversation and answers to the questions on the scale.

Rorschach test (“Rorschach Blots”) - helps to determine the mental characteristics of a person. The patient is asked to interpret 10 ink spots (blots), located symmetrically about the vertical axis. The subject's free associations are used to judge his emotional state, belonging to one or another personality type, and tendency toward mania.

Therapy methods

Treatment of manic syndromes includes medication and psychotherapy.

Psychotic mania is grounds for hospitalization. Relief of psychopathology is carried out with psychotropic drugs - tranquilizers, sedatives, neuroleptics, mood stabilizers. Lithium salts have a specific effect on the disease. In some cases, homeopathy preparations are used.

Psychotherapy is carried out in parallel with medication treatment.

Three directions are applied:

1. Cognitive-behavioral – the patient understands the essence of his disease, what led to it; learns how to avoid relapse (more about the method).
2. Interpersonal – helps to understand relationships with others, learn to constructively solve problems and find a way out of conflict situations.
3. Family – work with both the patient and his family members. Focused on improving family relationships, informing family members about the disease, teaching the correct behavior with a manic patient.

Mania is not a death sentence

The course of manic syndrome is cyclical. Attacks are replaced by remissions. The duration of remission depends on the etiology of the disease, the correctly chosen treatment tactics, the character of the patient and the efforts of his relatives. Outside of attacks, he is an ordinary person with adequate behavior, adapted to society.

If the patient follows all the doctor’s recommendations, leads a healthy lifestyle without consuming alcohol or drugs, eats right, does not overwork, is trained to manage stressful situations, and most importantly, has a desire to get rid of this illness, he is able to delay another attack for years.

Author of the article: Veits Alina Emilievna, psychiatrist, candidate of psychological sciences

How to recognize manic syndrome

What is manic behavior (condition)? How to distinguish increased performance, irrepressible energy in a manic patient from a healthy workaholic?

• a patient with mania takes on everything at once, but never finishes what he starts, his activity is superficial;
• he often writes poetry, tends to rhyme everything, the rhymes are based on adjacent associations or consonance, they have no meaning;
• he makes grandiose plans, but is unable to implement them;
• you can’t trust his promises, he immediately forgets everything;
• there is impulsiveness and inconsistency in decision making;
• when performing tasks, there is a decrease in concentration;
• overestimation of their own capabilities does not allow such people to carry out useful activities.

In the somatic sphere, manic individuals experience: increased heart rate, palpitations, periodic increases in A/D; increased libido; increased appetite up to gluttony; low need for sleep.

Notes

1. Altman EG, Hedeker D., Peterson JL, Davis JM
   The Altman Self-Rating Mania Scale. (English) // Biological psychiatry. - 1997. - Vol. 42, no. 10. - P. 948-955. — DOI:10.1016/S0006-3223(96)00548-3. - PMID 9359982. [correct]
2. Altman E., Hedeker D., Peterson JL, Davis JM
   A comparative evaluation of three self-rating scales for acute mania. (English) // Biological psychiatry. - 2001. - Vol. 50, no. 6. - P. 468-471. - PMID 11566165. [fix]
3. Tölle R.
   Psychiatry with elements of psychotherapy / Trans. with him. G. A. Obukhova. - Minsk: Higher School, 1999. - 496 p. — 4000 copies. — ISBN 985-06-0146-9.
4. Golubev V.L., Vein A.M.
   Neurological syndromes. Guide for doctors. - Moscow: Eidos Media, 2002. - P. 607. - 832 p. — 5000 copies. — ISBN 5-94501-008-1.
5. Preda A, MacLean RW, Mazure CM, Bowers MB (January 2001). "Antidepressant-associated mania and psychosis resulting in psychiatric admissions." J Clin Psychiatry 62
   (1):30–3. PMID 11235925.
6. ↑ 12
   Clinical recommendations for the treatment of manic and mixed states in bipolar disorder / Prep. S. N. Mosolov and E. G. Kostyukova, draft clinical recommendations in accordance with the decision of the XIV Congress of Psychiatrists of Russia // Difficult Patient. — March 2008.
7. I. F. Sluchevsky.
   Psychiatry. - “Medgiz”, 1957. - P. 234.
8. ↑ 1 2 Stolyarov G.V.
   Drug psychoses and psychotomimetic drugs / ed. V. M. Banshchikova. - M.: "Medicine", 1964. - P. 246.
9. Wittchen G.-U.
   Encyclopedia of mental health / Trans. with him. AND I. Sapozhnikova, E.L. Gushansky. - Moscow: Aletheia, 2006. - 552 p. — (Humanistic psychiatry). — ISBN 5-89321-124-3.
10. Gelder M., Gat D., Mayo R.
    Oxford Manual of Psychiatry: Trans. from English - Kyiv: Sfera, 1999. - T. 1. - 300 p. — 1000 copies. — ISBN 966-7267-70-9, 966-7267-73-3.
11. Clinical Guide to Mental Disorders / Ed. D. Barlow. Translation from English, ed. Professor E.G. Eidemiller. — 3rd ed. - St. Petersburg: Peter, 2008. - 912 p. — ISBN 978-5-94723-046-8.