MANIA

Dr Madhura.T.K.

Definition:

Distinct period during which there is abnormally persisting elevated, expansive or irritable mood.

Mood disorders – syndrome, with cluster of signs & symptoms

Common underlying characteristics• Elevated mood• Increase in quantity & speed of physical &

mental activity

Clinical features

MOOD:

Elevated, feels on the top of the world

Feeling of intense well being

Irritability, outbursts of unprovoked anger

:

IMPAIRMENTS IN (N) FUNCTIONING: Excess energy, tiredness & exhaustion Over activity: ^ level of motor activity actions – hurried & clumpsy Conduct & behavior: lot of attention colorful clothes, lack of social inhibition-

abrasive, over familiar & outspoken, reckless spending of money

Cont…..

Bodily sym. ^ appetite

decreased need for sleep

^sexual need

IMPACT ON PSYCHOLOGICAL FUNCTIONS:

Thinking: Acceleration of speed Flight of ideas Flowery language DD: schizophrenia,

Delusions : Grandiose Persecutory

4 subtypes by ICD-10,HypomaniaMania without psychotic symptomsMania with psychotic symptomsManic episodes, unspecified

1.Hypomania:

Lesser degree of maniaSymptoms as that of mania, but never leads to disruption of

work or social rejectionDiagnostic guide lines: ^ mood & ^ activity- several daysConsiderable interference with work/ social activity is

consistent with hypomania.DD: Hyperthyroidism Anorexia nervosa Agitated depression Severe obsessional symptoms

2.Mania without psychotic symptoms

mood, uncontrollable excitement with ^energy

overactivity pressure of speech decreased need for sleep loss of social inhibitions unsustained attention marked distractibility grandiosity

^

Cont….

Perceptual ideas: appreciation of color Preoccupation with fine details of surfaces Subjective hyperacusis Mood : irritable & suspicious

First attack: 15- 30 yrs

Diagnostic guide lines: sym – 1wk

disruption of ordinary & social activities

mood change + ^ energy

3.Mania with psychotic symptoms

Severe form of mania Inflated self esteem, grandiose ideas, delusions,

irritability, suspiciousness into delusions of persecution,

SEVERE CASES : grandiosity mood: incongruent neutral delusions/hallucinationsDD: schizophrenia

4.Maniac episodes , unspecified.

DIAGNOSTIC GUIDELINES

ICD-10^moodUndue optimismExcessive energyOver activityDecreased need for sleepInflated self esteem, grandiosityExtravagance in spendingPressure of speechEpisode- 1wk, severe enough to disrupt work 7 social

activities

DSM-IV

Distinct period of abnormality, persistently elevated mood, expansive, irritable

Mood disturbance with 3 or more sym Symptom do not meet the criteria for a mixed

episode Mood disturbance is sufficiently severe to cause

marked impairment in occupational functioning Symptom are not due to direct physiological

effects of a substance or general medical condition

TREATMENT

Maniac episodes:

antipsychotics

mood stabiliser

olanzapine

parenteral antipsychotics

DRUGS

LITHIUM:

Main stay of Rx – acute mania

prophylactic agent

600-900mg/day, initially

TR 0.5- 1mEq/l

Monitor for hypothyroidism

SODIUM VALPROATE:TR 50 – 100 mcg/ml

20mg/day in divided doses

SE: thrombocytopenia

^ transaminase levels

Pre Rx: CBC

LFT

CARBAMAZEPINE:400-600mg/day

TR: 4-12mcg/lSE: SJ syndromePre Rx : CBC LFTEnzyme inducer, lowers blood levels of

haloperidol

LAMOTRIGINE:Adv. Doesn’t require blood level monitoring

Dose 25mg/day X 2wks

Incremental doses, 25mg further

TOPIRAMATE:

Unique feature- wt loss

25-50mg/day can be given upto 200-300mg/day

REFERENCES:

J.N.Vyas-Essentials of post-graduate psychiatry Namboodri-Concise text book of Psychiatry DSM-IV, Diagnostic manual ICD-10, Diagnostic manual Niraj Ahuja- Concise text book of Psychiatry Eapen- Essentials of Psychiatry

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