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07-SEPTEMBER-2008 03:17:44 - Mania Pharmacology or the Pharmacology Portal may be able to help recruit one. If a more appropriate or portal exists, please adjust this template accordingly. May 2007 This article is an expansion of a section entitled Mania from within the main article Bipolar disorder. For the classical mythological figures named Mania, see Mania mythology. For other uses, see Manic disambiguation. Psychology Greek letter 'psi' Portal History Areas RESEARCH Abnormal Biological Cognitive Developmental Emotion Experimental Evolutionary Mathematical Neuropsychology Personality Positive Psychophysics Social Transpersonal APPLIED Clinical Educational Forensic Health Industrial Organizational School Sport LISTS Publications Topics Therapies view talk Manic episode Classification and external resources ICD-10 F30 ICD-9 296.0 Single manic episode, 296.4 Most recent episode manic, 296.6 Most recent episode mixed Mania from Greek μανία1 and that from μαίνομαι - mainomai, to rage, to be furious is a severe medical condition characterized by extremely elevated mood, energy, unusual thought patterns and sometimes psychosis. There are several possible causes for mania, but it is most often associated with bipolar disorder, where episodes of mania may cyclically alternate with episodes of major depression. These cycles may relate to diurnal rhythms and environmental stressors. Mania varies in intensity, from mild mania known as hypomania to full-blown mania with psychotic features hallucinations and delusions. Manic patients may need to be hospitalized to protect themselves and others. Mania and hypomania have also been associated with creativity and artistic talent.2 Contents 1 Symptoms 2 Mixed states 3 Hypomania 4 Associated disorders 5 Medical treatment 6 Psychopharmacology 7 Mania and over the counter drugs 8 Personal accounts 9 See also 10 References 11 External links Symptoms Symptoms of mania include rapid speech, racing thoughts, decreased need for sleep, hypersexuality, euphoria, impulsiveness, grandiosity, and increased interest in goal-directed activities.3 Mild forms of mania, known as hypomania, cause little or no impairment, but some people who suffer from prolonged hypomania may develop full mania.4 Another symptom of mania is racing thoughts during which the sufferer is excessively distracted by unimportant stimuli.5 This negative experience creates an inability to function and an absentmindedness where the manic individual's thoughts totally preoccupy him or her, making him or her unable to keep track of time or be aware of anything besides the neurological pattern of thoughts. Manic symptoms include irritability, anger or rage, delusions, hypersensitivity, hypersexuality, hyper-religiosity, hyperactivity, impulsiveness, racing thoughts, talkativeness, pressure to keep talking or rapid speech, and grandiose ideas and plans, decreased need for sleep e.g. feels rested after 3 or 4 hours of sleep. In manic and hypomanic cases, the afflicted person may engage in out of character behavior such as questionable business transactions, wasteful expenditures of money, risky sexual activity, abnormal social interaction, 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.citation needed Although severely elevated mood sounds somewhat desirable and enjoyable, the experience of mania is often quite unpleasant and sometimes disturbing, if not frightening, for the person involved and those close to them, 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, obsessive, impulsive, 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. There are different stages or states of mania. For example, a minor state may involve increased creativity, wit, gregariousness, and ambition. However, a more serious state of mania may involve lack of good judgment, lack of ability to focus, and even psychosis. The victim of mania may feel elated; however, he/she may also feel irritable, frustrated, and may experience derealization. A mnemonic used to remember the symptoms of mania is DIGFAST:6 D = Distractibility I = Indiscretion G = Grandiosity F = Flight of ideas A = Activity increased S = Sleep decreased need for T = Talkativeness pressured speech Mixed states Main article: Mixed episode Mania can be experienced at the same time as depression, in a mixed episode. Dysphoric mania is primarily manic and agitated depression is primarily depressed. This has caused speculation amongst doctors that mania and depression are two independent axes in a bipolar spectrum, rather than opposites. There is an increased probability of suicide in the mixed state, as depressed individuals who are also manic have the energy needed to commit the act and the thoughts of depression that would lead them initially to suicide. Hypomania Main article: Hypomania Hypomania is a lowered state of mania that does little to impair function or decrease quality of life according. In hypomania there is less need for sleep, goal motivated behavior and increased metabolism. Though the elevated mood and energy level typical of hypomania could be seen as a benefit, mania itself generally has many undesirable consequences including suicidal tendencies. Associated disorders A single manic episode is sufficient to diagnose Bipolar I Disorder. Hypomania may be indicative of Bipolar II Disorder or Cyclothymia. However, if prominent psychotic symptoms are present for a duration significantly longer than the mood episode, a diagnosis of Schizoaffective Disorder is more appropriate. B12 deficiency can also cause symptoms of mania and psychosis.78 Medical 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. Antipsychotics and mood stabilizers help stabilize mood of those with mania or depression. They work by blocking the receptor for the neurotransmitter dopamine and allowing serotonin to still work, but in diminished capacity. 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. More recent drug solutions include lamotrigine. The calcium-channel blocker, verapamil is useful in the treatment of hypomania and in those cases where lithium and mood stabilizers are contraindicated or ineffective.9. Verapamil is effective for both short-term and long-term treatment. 10 Psychopharmacology The biological mechanism by which mania occurs is not yet known. One hypothesised cause of mania among others, is that the amount of the neurotransmitter serotonin in the temporal lobe may be excessively high. This is likely to be only part of the puzzle. Dopamine, norepinephrine, glutamate and gamma-aminobutyric acid also appear to play important roles. The temporal lobe is involved in speech, listening, reading, word association and contains the amygdala, the almond shaped emotional center for the brain. The left amygdala is more active in women who are manic and the orbitofrontal cortex is less active 2005. Emotional stimulation creates the ability for life events to be stored more vividly in the memory. In women, the amygdala becomes similar to one of a woman during sex combined with menstruation.citation needed Bipolar disorder is different for men than it is for women. Mania affects the hypothalamus and the pituitary-adrenal-axis by causing it to secrete hormones in different amounts, that accounts for hypersexuality, changes in metabolism, and misdiagnosis as hormonal imbalance. Because the hormone problem stems from a neurological problem hormone therapy isn't the best solution. If serotonin levels are stable, hormones secreted by the pituitary gland will stabilize. Bipolar disorder is similar to a thought disorder combined with hypothyroidism and hyperthyroidism.citation needed In the study done by Brentwood VA Medical Center in Los Angeles, California, patients with bipolar II took antidepressants to measure their effect on mania. One third of bipolar patients developed antidepressant induced mania from their healthy state and one fourth developed antidepressant induced rapid cycling from their healthy state. For those with type II bipolar disorder, antidepressants decrease the gaps between the depression and mania 1995. Mania and over the counter drugs Phenylpropanolamine PPA is a sympathomimetic drug similar in structure to amphetamine which was formerly present in over 130 medications, primarily decongestants, cough/cold remedies, and anorectic agents. A report on PPA, 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 rather 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. PPA is no longer available in any medication in the United States as of the year 2000. Personal accounts In Electroboy: A Memoir of Mania by Andy Behrman, he describes his experience of mania as the most perfect prescription glasses with which to see the world...life appears in front of you like an oversized movie screen 2002. Behrman indicates early in his memoir that he sees himself not as a person suffering from an uncontrollable disabling illness, but as a director of the movie that is his vivid and emotionally alive life. When I'm manic, I'm so awake and alert, that my eyelashes fluttering on the pillow sound like thunder 2002. See also -mania suffix abnormal psychology Bipolar disorder Clinical depression Cyclothymia Hypomania International Society for Bipolar Disorders: a non-profit organization aimed at promoting research and advocacy in the field of bipolar disorders. Monomania Pyromania Social mania Trichotillomania Young Mania Rating Scale Caveat: See Symptoms above. References ^ Mania, Henry George Liddell, Robert Scott, A Greek-English Lexicon, at Perseus ^ Jamison, Kay R. 1996, Touched with Fire: Manic-Depressive Illness and the Artistic Temperament, New York: Free Press, ISBN 0-684-83183-X ^ DSM-IV ^ AJ Giannini. Biological Foundations of Clinical Psychiatry, NY Medical Examination Publishing Company, 1986. ^ Lakshmi N. Ytham, Vivek Kusumakar, Stanley P. Kutchar. 2002. Bipolar Disorder: A Clinician's Guide to Biological Treatments, page 3. ^ 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. ^ Sethi NK, Robilotti E, Sadan Y 2005. Neurological Manifestations Of Vitamin B-12 Deficiency. The Internet Journal of Nutrition and Wellness 2 1. ^ Masalha R, Chudakov B, Muhamad M, Rudoy I, Volkov I, Wirguin I 2001. Cobalamin-responsive psychosis as the sole manifestation of vitamin B12 deficiency. Israeli Medical Association Journal 3: 701-703. ^ AJ Giannini, WA Price. Antimanic effects of verapamil . American Journal of Psychiatry. 141:160-1604,1984. ^ AJ Giannini, RS Taraszewski, RH Loiselle. Verapamil and lithium in maintenance therapy of manic patients. Journal of Clinical Pharmacology. 27:980-985,1987. The many faces facets of BP. 2007 Jul. NAMI. Retrieved October 1, 2007. Expert Opin Pharmacother. 2001 Dec;212:1963-73. Schizoaffective Dissorder. 2007 Sept. Mayo Clinic. Retrieved October 1, 2007. Schizoaffective Dissorder. 2004 May. All Psych Online: Virtual Psychology Classroom. Retrieved October 2, 2007. Increased Amygdala Activation During Mania: A Functional Magnetic Resonance Imaging Study. 2005 June. The American Journal of Psychiatry. Retrieved October 2, 2007. Psychotic Disorders. 2004 May. All Psych Online: Virtual Psychology Classroom. Retrieved October 2, 2007. Increased concentrations and lateral asymmetry of amygdala dopamine in schizophrenia. 1983 Oct. Nature. Retrieved October 2, 2007. Antidepressant-induced mania and cycle acceleration: a controversy revisited. 1995 Aug. American Journal of Psychiatry. Retrieved October 2, 2007. Risperidone therapy in treatment refractory acute bipolar and schizoaffective mania. 1996 Jan. Psychopharmacology Bulletin. Retrieved October 2, 2007. Behrman, Andy. Electroboy: A Memoir of Mania, Preface: Flying High, 2002. External links Look up Mania in Wiktionary, the free dictionary. Depression and Bipolar Support Alliance Manic Episode Symptoms Bipolar Episode Symptoms v d e WHO ICD-10 mental and behavioral disorders F · 290-319 Neurological/symptomatic Dementia Alzheimer's disease, multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, AIDS dementia complex, Frontotemporal dementia, Elopement, Sundowning, Wandering · Delirium · Post-concussion syndrome · Organic brain syndrome Psychoactive substance alcohol drunkenness, alcohol dependence, alcoholic hallucinosis, Alcohol withdrawal, delirium tremens, Korsakoff's syndrome, alcohol abuse · opioids opioid dependency · sedative/hypnotic benzodiazepine withdrawal · cocaine cocaine dependence · general Intoxication, Drug abuse, Physical dependence, Withdrawal Psychotic disorder Schizophrenia disorganized schizophrenia · Schizophreniform disorder · Schizotypal personality disorder · Delusional disorder · Folie à deux · Schizoaffective disorder Mood affective Mania · Bipolar disorder · Clinical depression · Cyclothymia · Dysthymia Neurotic, stress-related and somatoform Anxiety disorder Agoraphobia, Panic disorder, Panic attack, Generalized anxiety disorder, Social anxiety, Social phobia · OCD · Acute stress reaction · PTSD · Adjustment disorder · Conversion disorder Ganser syndrome · Somatoform disorder Somatization disorder, Body dysmorphic disorder, Hypochondriasis, Nosophobia, Da Costa's syndrome, Psychalgia · Neurasthenia Physiological/physical behavioral Eating disorder: Anorexia nervosa · Bulimia nervosa Sleep disorder: Dyssomnia Hypersomnia, Insomnia · Parasomnia REM behavior disorder, Night terror · Nightmare Sexual dysfunction: Erectile dysfunction · Premature ejaculation · Vaginismus · Dyspareunia · Hypersexuality · Female sexual arousal disorder Postpartum depression · Postnatal psychosis Adult personality and behavior Personality disorder · Passive-aggressive behavior · Kleptomania · Trichotillomania · Voyeurism · Factitious disorder · Munchausen syndrome · Ego-dystonic sexual orientation · Fetishism Mental retardation Mental retardation Psychological development developmental disorder Specific: speech and language expressive language disorder, aphasia, expressive aphasia, receptive aphasia, Landau-Kleffner syndrome, lisp · Scholastic skills dyslexia, dysgraphia, Gerstmann syndrome · Motor function developmental dyspraxia Pervasive: Autism · Rett syndrome · Asperger syndrome Behavioral and emotional, childhood and adolescence onset ADHD · Conduct disorder · Oppositional defiant disorder · Separation anxiety disorder · Selective mutism · Reactive attachment disorder · Tic disorder · Tourette syndrome · Speech stuttering · cluttering Retrieved from http://en..org/wiki/Mania Categories: Mood disorders | Greek loanwordsHidden categories: Pharmacology articles needing expert attention | Articles needing expert attention | Pages needing expert attention | Articles needing additional references from May 2007 | All articles with statements | Articles with statements since August 2008 | Articles with statements since October 2007 | Articles with statements since June 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages БългарÑ?ки Català Česky Dansk Deutsch Eesti Ελληνικά Español Esperanto Français Italiano עברית Lietuvių Magyar Nederlands 日本語 ‪Norsk bokmÃ¥l‬ Polski Português РуÑ?Ñ?кий SlovenÄ?ina СрпÑ?ки / Srpski Suomi Svenska This page was last modified on 25 August 2008, at 16:17
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