| ID | 125 |
|---|---|
| Name | BIPOLAR MOOD DISORDER (MANIA) |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | |
| Management | Management: Manic phase: A. Hospitalization if needed. B. General measures: 1. Maintenance of nutrition. 2. Care of personal hygiene. 3. Other measures- such as correction of sleep disturbance. C. Specific drug treatment: 1. Antipsychotic medication: i. Haloperidol 5mg to 20mg daily orally in divided doses. If oral medication is not possible, intramuscular injection of haloperidol 5mg may be given 8 hourly until manic symptoms subside. Or, ii. Chlorpromazine 300mg to 400mg daily orally in divided dosage. If oral medication is not possible, deep intramuscular injection may be given as 100mg 12 hourly until manic symptoms subside. 2. Supporting drug (anti-parkinsonism drug): Procyclidine 5-15mg daily to combat side effects of antipsychotic drugs. 3. Mood stabilizers: These drugs are used as prophylaxis to prevent both manic and depressive episodes. a. Lithium carbonate: Main use of lithium is to prevent recurrence of manic and depressive episodes. It is also used as a treatment of an acute episode of mania. Because the therapeutic & toxic doses are closer, it is essential to measure the plasma concentration of lithium therapy. Lithium therapy should not be started without consulting a psychiatrist. Before starting lithium treatment, it should be ensured that laboratory facilities are available to measure serum lithium levels. Or, b. Other mood stabilizers: i. Carbamazepine- usually 200-600mg daily in divided doses, ii. Sodium valproate- usually 200-600mg daily in divided doses, iii. Clonazepam- usually 2mg to 3mg daily in divided doses. iv. Atypical antipsychotics eg ( Olanzapine, Risperidone, Quetiapine) 4. ECT when resistant to the medicine. Depressive phase: Treatment is like that of major depressive disorder (see below). |
| Introduction | Mania as defined above is a bipolar mood (affective) disorder characterized by one or more manic episodes (elevated mood) or mixed episodes with interspersed major depressive episodes, i.e mania (or manic phase) occurs alone or in a cycle with depression. Therefore, the patients who have manic symptoms are almost prone to depression, but the reverse does not apply. The psychological features of mania are the exact opposite of those of depression. |
| History | |
| Etiology | |
| Clinical Features | Clinical features of bipolar mood disorder: Manic phase: 1. Elevated mood (feeling of euphoria or well being) 2. Pressure of speech (talkativeness- thoughts come rapidly & speech is so fast). 3. Flight of ideas- (patient may have grandiose ideas which have little substance but upon which they may act and put themselves at risk). 4. Overactivity- (confidence and self-esteem are high). 5. Irritability 6. Distractibility 7. Excessive expenditure 8. Sleep disturbance- (expressed as no need to sleep, or hours of sleep reduced extremely; typically patients wake after a few hours feeling full of energy). 9. Increased libido 10. Excessive energy- (motor activity is increased) 11. Outburst of anger 12. Delusions- delusion of persecution, the delusion of grandiosity (consistent with mood) 13. Hallucination: consistent with the mood Depressive phase: Clinical features are as like major depressive disorder (unipolar depression). Clinical difference between mania & depression: Mania Depression Mood Elevated, ranging from Depressed, varying from mild euphoria to irritability sadness to intense feelings of guilt, worthlessness & hopelessness Talk Fast, pressurized, purring, Impoverished, slow rhyming monotonous, incomplete Energy Excessive, restless, Lacking, retarded, apathetic distractible Thinking Racing thoughts. Difficulty in thinking, inability Grandiosity to concentrate, lack of decisiveness Work Hyperactivity Loss of interest, withd-rawal from activities Physical mild to moderate weight loss appetite and weight loss, constipation Sleep Insomnia or sleep disruption Insomnia or excessive sleep, early waking Behavioral Inescced sexual interest Loss of libido, impo-tance Hallucination Auditory Auditory is often abusive, hostile critical Ideation Sense of well being Suicidal ideation |
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