Imagine: one morning your mood soars, you experience an unprecedented rise in spirit. There is enough energy for everything: launching a new project, starting a relationship, traveling, earning money easily and spending it as well. I want to take risks, fall in love and move mountains.
And then everything ends abruptly. I don't even have enough strength to brush my teeth. Negative thoughts eat you up from the inside, unfulfilled promises weigh you down and bring you a feeling of guilt. Until one morning...
This is what life looks like with bipolar affective disorder.
From mania to depression and back
Diagnosing bipolar disorder is quite difficult. Even experienced professionals often confuse it with other disorders and personality traits. However, it is important to know the main symptoms: if you notice most of them, you need to consult a psychotherapist.
Bipolar disorder is diagnosed when there are alternating episodes of mania and depression. It is important that external events do not cause the episode: it begins, as it were, “on its own.”
Depressive episode: symptoms
A depressive episode as part of bipolar disorder looks the same as a classic one. It can be different: someone falls into despair, someone becomes so apathetic that they cannot get out of bed. The main symptoms that indicate a depressive episode are:
- Sudden loss of interest in something that was previously very exciting;
- Cognitive difficulties: it is impossible to concentrate, even simple tasks are difficult, the thought process “slows down”;
- Problems with sleep and appetite: from insomnia to sleeping the whole day, from lack of appetite to overeating;
- Suicidal thoughts;
- Apathy;
- Feelings of guilt without objective reasons.
Manic episode: symptoms
Mania looks like a person is living at the limit:
- High energy tone;
- Feeling of excitement, excitement;
- Fast pace of speech, confusion, thoughts “jumping”;
- Desire to take risks;
- Reduced need for sleep (a person gets enough sleep quickly, can get up in the middle of the night from excess energy);
- Heightened all senses.
All people with bipolar disorder have different durations of depressive and manic episodes. The most common frequency is two cycles per year. However, a person can experience 4 or more cycles - this is called "rapid cycling" ("fast cycles"). Do not confuse rapid cycling with ordinary mood swings: the cycles are still subject to a special internal scheme, are more intense and are in no way related to external events. You can lift your mood, but it’s impossible to change the cycle on your own.
Bipolar disorder has a high risk of suicide. In a manic episode, the attempt may be impulsive; in a depressive episode, it can be driven by indifference to life, loss of energy, money and social connections.
"Why me?"
Scientists cannot identify clear reasons that lead to the development of bipolar affective disorder. Most often it is a combination of genetic, psychological and social factors.
Studies have shown that the presence of depression or bipolar disorder in one of the close relatives increases the risk of developing bipolar disorder by 5-10%. This means that the disorder may be hereditary, but genetic predisposition is not a death sentence.
People with a negative cognitive style (way of perceiving and analyzing the world) and weak coping strategies are more likely to develop bipolar disorder. You could say that some people have a psychological predisposition to acquire it.
In the development of almost any mental disorder, the environment plays a huge role: what kind of family a person was raised in, what kind of people he communicates with, what he does. Chronic stress, lack of sleep and physical activity can trigger a disorder to which a person is predisposed. This is why it is so important to monitor your lifestyle - especially if you know someone in your family has suffered from a mental disorder.
Why is bipolar disorder difficult to diagnose?
Bipolar affective disorder affects up to 7% of the world's population. However, it seems to be more common. This is because people often self-diagnose it based on frequent mood swings. In fact, the disorder can manifest itself in different ways. Because of this, bipolar disorder can be easily confused with other disorders or personality traits.
Bipolar affective disorder types I and II and cyclothymia
There are two types of bipolar affective disorder. They differ in the severity of the manic episode, the duration of the episodes, the leading emotions and the presence of a genetic predisposition to the disorder.
In type I bipolar disorder, both episodes and their alternation are clearly visible. They are so intense that a person can fall into a psychotic state. It is extremely difficult to convince a person in such a state to go to a psychotherapist. Mania may seem to him like a “superpower,” giving him a sense of omnipotence, a “special mission.”
Type II bipolar disorder involves milder manic episodes. They do not meet all the criteria for mania, so they are called hypomania. In this state, a person is more active than usual - but not so much that it leads to sudden, thoughtless changes in life, loss of money or psychosis.
In the case where the cycles are not clearly expressed, but the person experiences stable noticeable mood swings, we can talk about cyclothymia. Cyclothymia is similar to bipolar disorder, but there are not enough criteria in a person's behavior and well-being to diagnose manic, hypomanic, or depressive episodes. It often develops into bipolar affective disorder, so recognizing it in the early stages is also important.
Bar and depression
Due to mild hypomanic episodes, type II bipolar disorder is often confused with depression. The client comes to therapy with exactly this request: he experiences depressive episodes “in full” - and it is with them that he wants to deal with.
An experienced therapist must ensure that the course of depression is continuous in order to make this diagnosis. Although depression may have cyclical episodes, they alternate with a normal state - without a surge of energy or strong emotions. In addition, the occurrence of depressive episodes does not follow a specific internal pattern - in other words, they do not occur at regular intervals.
BAR and addictions
Before diagnosing bipolar disorder, you need to make sure that the person is not dependent on alcohol or drugs. They can cause a similar effect: agitation during use and “depression” during withdrawal.
If addiction is combined with bipolar disorder, it greatly aggravates its course: cycles become more frequent and intense. In psychotherapy, in this case, they first work with the addiction.
BAD and schizophrenia
As we wrote, with type I bipolar disorder, a person can fall into psychotic states: see hallucinations, hear voices, begin to believe in strange, unreal things. Previously according to the ICD ( International classification diseases) BAD was called “Manic-depressive psychosis.”
Because of this, bipolar disorder can be confused with schizophrenia. This is dangerous because the treatment for the two diagnoses is completely different.
Bipolar disorder and narcissistic personality disorder
Sometimes people with narcissistic personality disorder enter into cycles similar to manic-depressives with bipolar disorder. The difference is that with bipolar disorder there is no objective external cause: all processes are biochemically determined. In narcissistic disorder, there will be an event cause - although the client may not be aware of it.
Bipolar disorder and borderline personality disorder
With borderline personality disorder (BPD), a person has difficulty controlling emotions; he behaves unstable, especially in relationships - he can idealize and then devalue his partner - and is very afraid of being left alone. BPD often occurs together with bipolar disorder, which makes diagnosis very difficult.
BPD can also be confused with bipolar disorder due to frequent mood swings. The difference is that with BPD, mood swings are a reaction to stress (especially in relationships). With bipolar disorder, as we have already written, the shift is cyclical and obeys only internal laws.
Even experienced therapists doubt and make mistakes. And diagnosing bipolar disorder on your own is almost impossible: you need to understand how the human psyche works, notice all the details of your own behavior and look at yourself impartially.
Diagnostics and psychotherapy
How then to avoid overdiagnosis - and, conversely, not to miss a disorder if it exists? It is best to see a therapist who has experience working with bipolar disorder.
Signs that you are in good hands:
- The therapist asks you to keep a mood diary, and during sessions you discuss the notes;
- The treatment regimen is not selected immediately, but gradually. It is impossible to test for a mental disorder - therefore, the therapist can adjust the progress of work during the process;
- The therapist undergoes supervision. This point applies only to verbal psychotherapy - psychiatrists do not undergo supervision.
Treatment for bipolar disorder is usually a combination of pharmacological treatment and verbal therapy. That is, a psychotherapist and a psychiatrist who prescribes medications work with the client. The reason for mood cyclicality is biochemical, which means that in order to correct it, you need to balance the work of neurotransmitters. This is why pharmacotherapy is necessary.
The psychotherapist works with the client's behavior and reactions. To teach the client to behave competently during episodes, the therapist uses methods. It is very important to talk with the client about the disorder and educate it - so that he can independently anticipate the next episode and understand if something has gotten out of control.
Bipolar disorder is a chronic disorder and therefore requires long-term therapy and preventive monitoring. But many manage to take control of it, successfully realize themselves and socialize. The main thing is to contact a specialist in time.
Many famous people told the world that they were diagnosed with bipolar disorder: among them singer Mariah Carey, actress Carrie Fisher and rapper Oksimiron. Talking about this is good and correct. This helps reduce the stigma of mental disorders. But we do not support self-diagnosis - it blurs the idea of a real disorder.
Kay Jamieson. Restless Mind
Depressive disorders Major depressive disorder, often called clinical depression, occurs when a person has experienced at least one depressive episode. Depression without periods of mania is often called unipolar depression because the mood remains in one emotional state or “pole.” When diagnosed, there are several subtypes or specifications for treatment: - Atypical depression is characterized by reactivity and positivity of mood (paradoxical anhedonia), significant weight gain or increased appetite (“eating to relieve anxiety”), excessive sleep or sleepiness (hypersomnia), feeling heaviness in the limbs and a significant lack of socialization, as a consequence of hypersensitivity to perceived social rejection. Difficulties in assessing this subtype have led to questions about its validity and its distribution. - Melancholic depression (acute depression) is characterized by loss of pleasure (anhedonia) from most or all activities, inability to respond to pleasurable stimuli, feelings of low mood more pronounced than feelings of regret or loss, worsening symptoms in the morning, waking up early in the morning, psychomotor lethargy, excessive weight loss (not to be confused with anorexia nervosa), or severe feelings of guilt. - Psychotic depression is a term for a long-term depressive period, particularly in a melancholic nature, when the patient experiences psychotic symptoms such as delusions, or, less commonly, hallucinations. These symptoms almost always correspond to the mood (the content coincides with depressive themes). - Congealing depression - involutional - is a rare and severe form of clinical depression, including motor dysfunction and other symptoms. In this case, the person is silent and almost in a state of stupor, and is either motionless or makes aimless or even abnormal movements. Similar catatonic symptoms also occur in schizophrenia, manic episodes, or as a consequence of neuroleptic malignant syndrome. - Postpartum depression is noted as a qualifying term in the DSM-IV-TR; it refers to the excessive, persistent and sometimes disabling depression experienced by women after the birth of a child. Postpartum depression, which has an estimated chance of 10-15%, usually appears within three working months and lasts no longer than three months. - Seasonal affective disorder is a qualifying term. Depression for some people is seasonal, with episodes of depression occurring in the fall or winter and returning to normal in the spring. The diagnosis is made if depression occurs at least twice during the cold months and not at any other time of year for two years or more. - Dysthymia is a chronic, mild mood disorder in which a person complains of almost daily low mood for at least two years. Symptoms are not as severe as those of clinical depression, although people with dysthymia are also susceptible to recurrent episodes of clinical depression (sometimes called “double depression”). - Other depressive disorders (DD-NOS) are coded 311 and include depressive disorders that cause harm but do not fit officially defined diagnoses. According to DSM-IV, DD-NOS covers “all depressive disorders that do not meet criteria for any specified disorder.” These include research into the diagnoses of Recurrent Minor Depression and Minor Depression, listed below: - Recurrent Minor Depression (RBD) is distinguished from Major Depressive Disorder primarily due to differences in duration. People with RBD experience depressive episodes once a month, with individual episodes lasting less than two weeks and usually less than 2-3 days. To be diagnosed with RBD, episodes must occur for at least one year and, if the patient is female, regardless of the menstrual cycle. People with clinical depression can develop RBD, as well as vice versa. - Minor depression, which does not meet all criteria for clinical depression, but in which at least two symptoms are present for two weeks. Bipolar Disorders - Bipolar affective disorder, formerly known as manic-depressive illness, is described as alternating periods of manic and depressive states (sometimes very quickly followed by each other or mixed into one state in which the patient experiences symptoms of depression and mania simultaneously). Subtypes include: - Bipolar I disorder is defined as the presence or history of one or more manic episodes with or without episodes of clinical depression. For a DSM-IV-TR diagnosis, at least one manic or mixed episode is required. Although depressive episodes are not required for a diagnosis of Bipolar I disorder, they occur quite often. - Bipolar II disorder consists of repeated alternating hypomanic and depressive episodes. - Cyclothymia is a milder form of bipolar disorder that involves occasional hypomanic and dysthymic episodes, without any more severe forms of mania or depression. The main disturbance is a change in affect or mood, level of motor activity, activity of social functioning. Other symptoms, such as changes in the pace of thinking, psychosensory disturbances, statements of self-blame or overestimation, are secondary to these changes. The clinic manifests itself in the form of episodes (manic, depressive), bipolar (biphasic) and recurrent disorders, as well as in the form of chronic mood disorders. Intermissions without psychopathological symptoms are observed between psychoses. Affective disorders are almost always reflected in the somatic sphere (physiological effects, weight, skin turgor, etc.). The spectrum of affective disorders includes seasonal weight changes (usually weight gain in winter and weight loss in summer within 10%), evening cravings for carbohydrates, in particular for sweets before bedtime, premenstrual syndromes, expressed in decreased mood and anxiety before menstruation, as well as “northern depression”, which affects migrants to northern latitudes; it is observed more often during the polar night and is caused by a lack of photons.
Manic episode is an affective disorder characterized by pathologically elevated mood levels and an increase in the volume and pace of physical and mental activity.
The patient's mood is elevated inappropriately to the circumstances and can vary from carefree gaiety to almost uncontrollable excitement. Elevation of mood is accompanied by increased energy, leading to hyperactivity, excessive volume and speed of speech production, increased vital drives (appetite, sexual attraction), decreased need for sleep. Perceptual disturbances may occur. Normal social inhibition is lost, attention is not maintained, there is marked distractibility, inflated self-esteem, and over-optimistic ideas and ideas of grandeur are easily expressed. The patient has many plans, but none of them are fully realized. Criticism is reduced or absent. The patient loses the ability to critically assess his own problems; possible inappropriate actions With negative consequences for social status and material well-being, may commit extravagant and impractical acts, spend money thoughtlessly, or be aggressive, amorous, hypersexual, or playful in inappropriate circumstances.
During some manic episodes, the patient may be described as irritable and suspicious rather than elated. Mania with psychotic symptoms is experienced by 86% of patients with bipolar disorder during their lifetime. At the same time, increased self-esteem and ideas of superiority turn into delusions of grandeur, irritability and suspicion transform into delusions of persecution. In severe cases, there may be expansive-paraphrenic experiences of greatness or delusional ideas about noble origin. As a result of racing thoughts and verbal pressure, the patient’s speech often turns out to be incomprehensible to others.
Manic episodes are much less common than depression: according to various sources, their prevalence is 0.5-1%. Separately, it should be noted that a manic episode in cases where one or more affective episodes (depressive, manic or mixed) have already occurred in the past is diagnosed as part of bipolar affective disorder and is not considered independently.
Today, quite conventionally, there are three degrees of severity of manic disorders:
- Hypomania
Hypomania- this is a mild degree of mania. There is a constant mild uplift in mood (at least for several days), increased energy and activity, a sense of well-being and physical and mental productivity. Also often noted are increased sociability, talkativeness, excessive familiarity, increased sexual activity and a decreased need for sleep. However, they do not lead to serious disruptions in work or social rejection of patients. Instead of the usual euphoric sociability, irritability, increased self-esteem and rude behavior may be observed.
Concentration and attention may be disrupted, thereby reducing the ability to both work and relax. However, this condition does not prevent the emergence of new interests and vigorous activity or a moderate tendency to spend.
Mania without psychotic symptoms- this is a moderate degree of mania. The mood is elevated inappropriately to the circumstances and can vary from carefree gaiety to almost uncontrollable excitement. Elevated mood is accompanied by increased energy, leading to hyperactivity, speech pressure and a reduced need for sleep. Normal social inhibition is lost, attention is not maintained, there is marked distractibility, increased self-esteem, and over-optimistic ideas and ideas of greatness are easily expressed.
Perceptual disturbances may occur, such as experiencing a color as particularly bright (and usually beautiful), preoccupation with small details of a surface or texture, or subjective hyperacusis. The patient may take extravagant and impractical steps, spend money thoughtlessly, or may become aggressive, amorous, or playful in inappropriate circumstances. In some manic episodes, the mood is irritable and suspicious rather than elated. The first attack most often occurs at the age of 15-30 years, but can occur at any age from childhood to 70-80 years.
Mania with psychotic symptoms- this is a severe degree of mania. The clinical picture is consistent with a more severe form of mania without psychotic symptoms. Increased self-esteem and ideas of grandeur can develop into delusions, and irritability and suspicion can develop into persecutory delusions. In severe cases, pronounced delusional ideas of greatness or noble origin are noted. As a result of racing thoughts and speech pressure, the patient’s speech becomes incomprehensible. Heavy and prolonged physical activity and agitation can lead to aggression or violence. Neglect of food, drink and personal hygiene can lead to dangerous condition dehydration and neglect. Delusions and hallucinations can be classified as mood-congruent or mood-incongruent.
Manic episodes, if left untreated, last 3-6 months with a high likelihood of relapse (manic episodes recur in 45% of cases). Approximately 80-90% of patients with manic syndromes develop a depressive episode over time. With timely treatment, the prognosis is quite favorable: 15% of patients recover, 50-60% recover incompletely (numerous relapses with good adaptation in the intervals between episodes), in a third of patients there is a possibility of the disease becoming chronic with persistent social and labor maladjustment.
What Triggers/Causes of a Manic Episode:
The etiology of the disorder has not yet been fully elucidated. According to the majority of neurologists and psychiatrists, the most important role in the occurrence of the disease is played by genetic factors; this assumption is supported by the high frequency of the disorder in the families of patients, the increase in the probability of developing the disease with increasing degree of relationship, as well as the 75% level of probability of developing the disease in monozygotic twins. However, the provoking influence of changes cannot be excluded environment. Possible etiological factors include: metabolic disorders of biogenic amines (serotonin, norepinephrine, dopamine), neuroendocrine disorders, sleep disorders (reduced duration, frequent awakenings, sleep-wake rhythm disturbances), and even psychosocial factors.
Pathogenesis (what happens?) during a Manic episode:
Symptoms of a Manic Episode:
Criteria for a manic episode:
- inflated self-esteem, a sense of self-importance or grandiosity;
- decreased need for sleep;
- increased talkativeness, obsessiveness in conversation;
- racing thoughts, feeling of “flight of thought”;
- instability of attention;
- increased social, sexual activity, psychomotor excitability;
- involvement in risky transactions with securities, thoughtlessly large expenses, etc.
A manic episode may include delusions and hallucinations, including
To diagnose mania, at least three of these symptoms must be present, or four if one of the symptoms is irritability, and the episode must last for at least 2 weeks, but the diagnosis can be made for shorter periods if the symptoms are unusually severe and they come quickly.
Diagnosis of a Manic Episode:
When diagnosing a manic episode, the main thing is clinical method. The main place in it belongs to questioning (clinical interview) and objective observation of the patient’s behavior. Through questioning, a subjective history is collected and clinical facts are identified that determine the patient’s mental state.
An objective history is collected by studying medical records, as well as from conversations with the patient’s relatives.
The purpose of collecting anamnesis is to obtain data about:
- hereditary burden of mental illness;
- the patient’s personality, characteristics of his development, family and social status, exogenous harm suffered, characteristics of response to various everyday situations, mental trauma;
- characteristics of the patient's mental state.
When taking a history of a patient with a manic episode, attention should be paid to the presence of risk factors such as:
- episodes of mood disorders in the past;
- family history of affective disorders;
- history of suicide attempts;
- chronic somatic diseases;
- stressful changes in life circumstances;
- alcoholism or drug addiction.
Additional examination methods include clinical and biochemical blood tests (including glucose, ALT, AST, alkaline phosphatase; thymol test);
Treatment for a Manic Episode:
Treatment for a manic state is usually inpatient; the length of hospital stay depends on the speed of symptom reduction (on average 2-3 months). Aftercare is possible in semi-inpatient or outpatient settings.
There are three relatively independent stages in the system of treatment measures:
- relief therapy aimed at treating current state;
- follow-up or stabilizing (maintenance) therapy aimed at preventing exacerbation of a previous condition;
- preventive therapy aimed at preventing relapse (repeated condition).
At the stage of relief therapy, the drugs of choice are lithium salts (lithium carbonate, lithium oxybate), carbamazepine, valproic acid salts (sodium valproate).
In case of sleep disturbance, sleeping pills (hypnotics) are added - nitrazepam, flunitrazepam, temazepam, etc.
In cases of severe psychomotor agitation, aggressiveness, and the presence of manic-delusional symptoms, antipsychotics are prescribed (usually haloperidol, which is administered parenterally if necessary), the dose of which is gradually reduced until complete withdrawal as the therapeutic effect is achieved. To quickly reduce psychomotor agitation, zuclopenthixol is used. The use of antipsychotics is necessary due to the fact that the effect of mood stabilizers appears only after 7-10 days of treatment. For motor agitation and sleep disorders, antipsychotics with a sedative effect (chlorpromazine, levomepromazine, thioridazine, chlorprothixene, etc.) are used.
If there is no effect in the first month of treatment, a transition to intensive therapy is necessary: alternating high doses of incisive antipsychotics with sedatives, adding parenterally administered anxiolytics (phenazepam, lorazepam). In cases of resistant mania, combination therapy with lithium salts and carbamazepine, lithium salts and clonazepam, lithium salts and valproic acid salts is possible.
At the second stage, the use of lithium salts should continue for an average of 4-6 months to prevent exacerbation of the condition. Use lithium carbonate or its prolonged forms; plasma lithium concentration is maintained within 0.5-0.8 mmol/l. The issue of stopping lithium therapy is decided depending on the characteristics of the disease and the need for preventive therapy.
The minimum duration of maintenance therapy is 6 months after the onset of remission. When discontinuing therapy, it is considered advisable to slowly reduce the dose of the drug over at least 4 weeks.
Preventing a Manic Episode:
Which doctors should you contact if you are having a manic episode:
Is something bothering you? Do you want to know more detailed information about a manic episode, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can make an appointment with a doctor– clinic Eurolab always at your service! The best doctors They will examine you, study external signs and help identify the disease by symptoms, advise you and provide the necessary assistance and make a diagnosis. you also can call a doctor at home. Clinic Eurolab open for you around the clock.
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You? It is necessary to take a very careful approach to your overall health. People don't pay enough attention symptoms of diseases and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called symptoms of the disease. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to do it several times a year. be examined by a doctor, in order not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the organism as a whole.
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Other diseases from the group Mental disorders and behavioral disorders:
| Agoraphobia |
| Agoraphobia (fear of empty spaces) |
| Anancastic (obsessive-compulsive) personality disorder |
| Anorexia nervosa |
| Asthenic disorder (asthenia) |
| Affective disorder |
| Affective mood disorders |
| Insomnia of inorganic nature |
| Bipolar affective disorder |
| Bipolar affective disorder |
| Alzheimer's disease |
| Delusional disorder |
| Delusional disorder |
| Bulimia nervosa |
| Vaginismus of inorganic nature |
| Voyeurism |
| Generalized anxiety disorder |
| Hyperkinetic disorders |
| Hypersomnia of inorganic nature |
| Hypomania |
| Motor and volitional disorders |
| Delirium |
| Delirium not caused by alcohol or other psychoactive substances |
| Dementia due to Alzheimer's disease |
| Dementia in Huntington's disease |
| Dementia in Creutzfeldt-Jakob disease |
| Dementia in Parkinson's disease |
| Dementia in Pick's disease |
| Dementia due to diseases caused by the human immunodeficiency virus (HIV) |
| Recurrent depressive disorder |
| Depressive episode |
| Depressive episode |
| Childhood autism |
| Disocial personality disorder |
| Dyspareunia of inorganic nature |
| Dissociative amnesia |
| Dissociative amnesia |
| Dissociative anesthesia |
| Dissociative fugue |
| Dissociative fugue |
| Dissociative disorder |
| Dissociative (conversion) disorders |
| Dissociative (conversion) disorders |
| Dissociative movement disorders |
| Dissociative motor disorders |
| Dissociative seizures |
| Dissociative seizures |
| Dissociative stupor |
| Dissociative stupor |
| Dysthymia (depressed mood) |
| Dysthymia (low mood) |
| Other organic personality disorders |
| Dependent personality disorder |
| Stuttering |
| Induced delusional disorder |
| Hypochondriacal disorder |
| Histrionic personality disorder |
| Catatonic syndrome |
| Catatonic disorder of organic nature |
| Nightmares |
| Mild depressive episode |
| Mild cognitive impairment |
| Mania without psychotic symptoms |
| Mania with psychotic symptoms |
| Impaired activity and attention |
| Psychological development disorder |
| Neurasthenia |
| Undifferentiated somatoform disorder |
| Inorganic encopresis |
| Inorganic enuresis |
| Obsessive-compulsive disorder |
| Obsessive-compulsive disorder |
| Orgasmic dysfunction |
| Organic (affective) mood disorders |
| Organic amnestic syndrome |
| Organic hallucinosis |
| Organic delusional (schizophrenia-like) disorder |
| Organic dissociative disorder |
| Organic personality disorder |
| Organic emotionally labile (asthenic) disorder |
| Acute reaction to stress |
| Acute reaction to stress |
| Acute polymorphic psychotic disorder |
| Acute polymorphic psychotic disorder with symptoms of schizophrenia |
| Acute schizophrenia-like psychotic disorder |
| Acute and transient psychotic disorders |
| No genital reaction |
| Lack or loss of sex drive |
| Panic disorder |
| Panic disorder |
| Paranoid personality disorder |
| Pathological addiction to gambling (people addiction) |
| Pathological burning (pyromania) |
| Pathological theft (kleptomania) |
| Pedophilia |
| Increased libido |
| Eating inedible things (pika) in infancy and childhood |
| Postconcussion syndrome |
| Post-traumatic disorder |
| Post-traumatic stress disorder |
| Postencephalitic syndrome |
| Premature ejaculation |
| Acquired aphasia with epilepsy (Landau-Kleffner syndrome) |
| Mental and behavioral disorders due to alcohol use |
| Mental and behavioral disorders due to the use of hallucinogens |
| Mental and behavioral disorders due to cannabinoid use |
| Mental and behavioral disorders due to cocaine use |
| Mental and behavioral disorders due to caffeine use |
| Mental and behavioral disorders due to the use of volatile solvents |
| Mental and behavioral disorders due to opioid use |
| Mental and behavioral disorders due to substance use |
| Mental and behavioral disorders due to the use of sedatives and hypnotics |
| Mental and behavioral disorders due to tobacco use |
| Mental and behavioral disorders associated with the postpartum period |
| Intellectual disorders |
| Behavioral disorders |
| Gender identity disorders in children |
| Disorders of habits and desires |
| Sexual preference disorders |
| Sleep disorders of inorganic nature |
| Disorders of emotions and affect |
| Disorder of perception and imagination |
| Personality disorder |
| Multiple personality disorder |
| Thought disorder |
| Memory and attention disorder |
| Feeding disorders in infancy and childhood |
| Puberty disorder |
Manic episode
Represents a distinct period in which elevated mood, expansiveness and/or irritability persist, lasting at least a week. During the period when mood disorders are observed, the following symptoms are persistently manifested and have a pronounced character: excessively inflated self-esteem or delusions of grandeur; decreased need for sleep (for example, feeling rested after only 3 hours of sleep); excessive talkativeness or difficulty maintaining a conversation; rapid change of thoughts or subjective feeling of rapid change of thoughts; instability of attention (attention is extremely easily attracted to completely insignificant or extraneous external stimuli); increased goal-directed activity (social, at work, at school or sexual) or psychomotor agitation; Excessive involvement in pleasurable activities that may have negative consequences (for example, wild behavior, intemperance in purchasing things, immodest sexual behavior, or reckless spending of money). There are three degrees of severity in which there are General characteristics elevated mood and an increase in the volume and pace of physical and mental activity.
1. Hypomania– a mild degree of mania, when changes in mood and behavior are too long-lasting and severe to include this condition in cyclothymia, but are not accompanied by delusions or hallucinations. There is a constant slight uplift in mood (at least for several days), increased energy and activity, a sense of well-being, physical and mental productivity. Also often noted are increased sociability, talkativeness, excessive familiarity, increased sexual activity and a decreased need for sleep. However, they do not lead to serious disruptions in work or social rejection of patients. Instead of the usual euphoric sociability, irritability, increased self-esteem and rude behavior may be observed. Concentration and attention may be disrupted, thereby reducing the ability to both work and relax. However, this condition does not prevent the emergence of new interests and vigorous activity or a moderate tendency to spend.
2. Mania without psychotic symptoms. The mood is elevated inappropriately to the circumstances and can vary from carefree gaiety to almost uncontrollable excitement. Elevated mood is accompanied by increased energy, leading to hyperactivity, speech pressure and a reduced need for sleep. Normal social inhibition is lost, attention is not maintained, there is marked distractibility, increased self-esteem, and over-optimistic ideas and ideas of greatness are easily expressed. Perceptual disturbances may occur, such as experiencing a color as particularly bright (and usually beautiful), preoccupation with small details of a surface or texture, or subjective hyperacusis. The patient may take extravagant and impractical steps, spend money thoughtlessly, or may become aggressive, amorous, or playful in inappropriate circumstances. In some manic episodes, the mood is irritable and suspicious rather than elated. The first attack most often occurs between the ages of 15 and 30, but can occur at any age, from childhood to 70–80 years. The episode must last for at least 1 week and be of such severity that it results in fairly complete disruption of normal work and social activities. The change in mood is accompanied by increased energy with the presence of speech pressure, a decreased need for sleep, ideas of grandeur and excessive optimism.
3. Mania with psychotic symptoms. Increased self-esteem and ideas of grandeur can develop into delusions, and irritability and suspicion can develop into delusions of persecution. In severe cases, pronounced delusional ideas of greatness or noble origin are noted. As a result of racing thoughts and speech pressure, the patient’s speech becomes incomprehensible. Heavy and prolonged physical activity and agitation can lead to aggression or violence. Neglect of food, drink and personal hygiene can lead to a dangerous state of dehydration and neglect. Delusions and hallucinations can be classified as mood congruent or mood incongruent. “Incongruent” includes affectively neutral delusional and hallucinatory disorders, for example: delusions of relation without guilt or blame, or voices that talk to the sufferer about events that have no emotional significance.
Therapeutic measures.
To relieve the state of mania, the drugs of first choice are mood stabilizers and antiepileptic drugs with normotimic action: lithium salt orally in doses from 900 to 1500 mg/day under the control of lithium content in plasma; the dose is selected so that the lithium content in the blood plasma ranges from 0.7 to 1.2 mmol/l, with blood taken on an empty stomach 10–12 hours after the last dose of lithium polyuronate; at the beginning of treatment, the lithium content in plasma is determined every 5–7 days; if lithium intoxication is suspected, the analysis is repeated immediately; before starting treatment, a laboratory examination is necessary to determine kidney function - a general urine test, urea nitrogen, creatinine, and in persons over 55 years of age with heart disease - also an ECG; carbamazepine in doses from 600 to 1200 mg/day orally; especially indicated in cases with rapid phase changes, with a significant predominance of mania and mixed states, with the ineffectiveness of lithium salts and valproates; increases the activity of liver enzymes and thereby accelerates the metabolism of other drugs; the content of carbamazepine in the blood plasma should be in the range of 4–10 mcg/ml, blood should be taken in the morning before the first dose of the drug; the first determination is carried out 2 weeks from the start of treatment, subsequently - according to indications; valproic acid preparations (valproates) - in doses from 500 to 2000 mg/day; especially indicated when lithium salts are ineffective, when a manic state predominates and rapid cycling; can sometimes cause dysfunction of the liver and pancreas, as well as leukemia and thrombocytopenia, and increase bleeding time; the content of valproic acid salt in blood plasma should be in the range from 50 to 100 mcg/ml; the first determination is carried out 2 weeks from the start of treatment, subsequently - according to indications; topi-ramate in doses of 200–300 mg/day.
As a rule, one patient uses one of the mood stabilizers; if there is no effect of one of them, it should be replaced by another - for example, lithium polyuronate with carbamazepine, carbamazepine with valproic acid, and so on. In rare resistant cases, the simultaneous use of two mood stabilizers (or anti-epileptic drugs with a mood stabilizer effect) is possible, which, however, increases the risk of central nervous system intoxication, up to the development of a state of confusion. In the presence of severe psychomotor agitation, additional non-psychotic (delusional) symptoms, or if taking a mood stabilizer (or an anti-epileptic drug with a normotimic effect) did not produce an effect, medicines in this group, one of the antipsychotics (antipsychotic drugs) should be added: haloperidol intramuscularly or orally at a dose of 10 to 40 mg/day; clozapine orally at a dose of 100 to 400–500 mg/day; risperidone orally in tablets or drops at a dose of 2 to 6 mg/day; olanzapine orally at a dose of 5 to 20 mg/day; zuclopen-thixol orally at a dose of 30–75 mg/day, or intramuscularly at a dose of 50–150 mg every 3 days for no more than three injections.
If the treatment has no effect after 3-4 weeks, you need to do the following: check whether the patient is taking the medicine orally, especially if the treatment is carried out on an outpatient basis; if there is any doubt about this, strengthen control over medication intake or switch to parenteral administration; add an antipsychotic (antipsychotic drug) to the mood stabilizer taken by the patient; atypical antipsychotics (clozapine, rice-peridone, olanzapine) have an advantage over typical ones in such cases; increase the dose of a mood stabilizer (or an antiepileptic drug with a mood stabilizer effect); if this does not give an effect, replace the mood stabilizer (for example, lithium polyuronate with carbamazepine or with valproic acid, carbamazepine with topiramate, etc.); in rare cases of therapeutic resistance, short-term co-administration of two mood stabilizers - lithium salt and carbamazepine in low doses is possible; It must be borne in mind that such a combination increases the likelihood side effects each of them; the combination of carbamazepine and valproic acid is not used; add an anxiolytic drug from the group of benzodiazepines in medium or high doses - diazepam, clonazepam or lorazepam - to the mood stabilizer you are taking (or an antiepileptic drug with a normotimic effect); if the measures described above are ineffective, conduct a course of ECT (5–7 sessions), and then continue treatment with a mood stabilizer (or an antiepileptic drug with a mood stabilizer) in combination with an antipsychotic drug. Psychotherapy: cognitive-behavioral, family counseling. Psychoeducation. Psychosocial
Manic episode is an affective disorder characterized by pathologically elevated mood levels and an increase in the volume and pace of physical and mental activity.
The patient's mood is elevated inappropriately to the circumstances and can vary from carefree gaiety to almost uncontrollable excitement. Elevated mood is accompanied by increased energy, leading to hyperactivity, excessive volume and speed of speech production, increased vital drives (appetite, sexual desire), and decreased need for sleep. Perceptual disturbances may occur. Normal social inhibition is lost, attention is not maintained, there is marked distractibility, inflated self-esteem, and over-optimistic ideas and ideas of grandeur are easily expressed. The patient has many plans, but none of them are fully realized. Criticism is reduced or absent. The patient loses the ability to critically assess his own problems; Inappropriate actions with negative consequences for social status and material well-being are possible; he can commit extravagant and impractical actions, spend money thoughtlessly or be aggressive, amorous, hypersexual, playful in inappropriate circumstances.
During some manic episodes, the patient may be described as irritable and suspicious rather than elated. Mania with psychotic symptoms is experienced by 86% of patients with bipolar disorder during their lifetime. At the same time, increased self-esteem and ideas of superiority turn into delusions of grandeur, irritability and suspicion transform into delusions of persecution. In severe cases, there may be expansive-paraphrenic experiences of greatness or delusional ideas about noble origin. As a result of racing thoughts and verbal pressure, the patient’s speech often turns out to be incomprehensible to others.
Manic episodes are much less common than depression: according to various sources, their prevalence is 0.5-1%. Separately, it should be noted that a manic episode in cases where one or more affective episodes (depressive, manic or mixed) have already occurred in the past is diagnosed as part of bipolar affective disorder and is not considered independently.
Today, quite conventionally, there are three degrees of severity of manic disorders:
- Hypomania
- Mania without psychotic symptoms
- Mania with psychotic symptoms
Hypomania- this is a mild degree of mania. There is a constant mild uplift in mood (at least for several days), increased energy and activity, a sense of well-being and physical and mental productivity. Also often noted are increased sociability, talkativeness, excessive familiarity, increased sexual activity and a decreased need for sleep. However, they do not lead to serious disruptions in work or social rejection of patients. Instead of the usual euphoric sociability, irritability, increased self-esteem and rude behavior may be observed.
Concentration and attention may be disrupted, thereby reducing the ability to both work and relax. However, this condition does not prevent the emergence of new interests and vigorous activity or a moderate tendency to spend.
Mania without psychotic symptoms- this is a moderate degree of mania. The mood is elevated inappropriately to the circumstances and can vary from carefree gaiety to almost uncontrollable excitement. Elevated mood is accompanied by increased energy, leading to hyperactivity, speech pressure and a reduced need for sleep. Normal social inhibition is lost, attention is not maintained, there is marked distractibility, increased self-esteem, and over-optimistic ideas and ideas of greatness are easily expressed.
Perceptual disturbances may occur, such as experiencing a color as particularly bright (and usually beautiful), preoccupation with small details of a surface or texture, or subjective hyperacusis. The patient may take extravagant and impractical steps, spend money thoughtlessly, or may become aggressive, amorous, or playful in inappropriate circumstances. In some manic episodes, the mood is irritable and suspicious rather than elated. The first attack most often occurs at the age of 15-30 years, but can occur at any age from childhood to 70-80 years.
Mania with psychotic symptoms- this is a severe degree of mania. The clinical picture is consistent with a more severe form of mania without psychotic symptoms. Increased self-esteem and ideas of grandeur can develop into delusions, and irritability and suspicion can develop into persecutory delusions. In severe cases, pronounced delusional ideas of greatness or noble origin are noted. As a result of racing thoughts and speech pressure, the patient’s speech becomes incomprehensible. Heavy and prolonged physical activity and agitation can lead to aggression or violence. Neglect of food, drink and personal hygiene can lead to a dangerous state of dehydration and neglect. Delusions and hallucinations can be classified as mood-congruent or mood-incongruent.
Manic episodes, if left untreated, last 3-6 months with a high likelihood of relapse (manic episodes recur in 45% of cases). Approximately 80-90% of patients with manic syndromes develop a depressive episode over time. With timely treatment, the prognosis is quite favorable: 15% of patients recover, 50-60% recover incompletely (numerous relapses with good adaptation in the intervals between episodes), in a third of patients there is a possibility of the disease becoming chronic with persistent social and labor maladjustment.
What triggers a manic episode:
The etiology of the disorder has not yet been fully elucidated. According to the majority of neurologists and psychiatrists, the most important role in the occurrence of the disease is played by genetic factors; this assumption is supported by the high frequency of the disorder in the families of patients, the increase in the probability of developing the disease with increasing degree of relationship, as well as the 75% level of probability of developing the disease in monozygotic twins. However, the provoking influence of environmental changes cannot be excluded. Possible etiological factors include: metabolic disorders of biogenic amines (serotonin, norepinephrine, dopamine), neuroendocrine disorders, sleep disorders (reduced duration, frequent awakenings, sleep-wake rhythm disturbances), and even psychosocial factors.
Pathogenesis (what happens?) during a Manic episode:
Symptoms of a Manic Episode:
Criteria for a manic episode:
- inflated self-esteem, a sense of self-importance or grandiosity;
- decreased need for sleep;
- increased talkativeness, obsessiveness in conversation;
- racing thoughts, feeling of “flight of thought”;
- instability of attention;
- increased social, sexual activity, psychomotor excitability;
- involvement in risky transactions with securities, thoughtlessly large expenses, etc.
A manic episode may include delusions and hallucinations, including
To diagnose mania, at least three of these symptoms must be present, or four if one of the symptoms is irritability, and the episode must last for at least 2 weeks, but the diagnosis can be made for shorter periods if the symptoms are unusually severe and they come quickly.
Diagnosis of a Manic Episode:
When diagnosing a manic episode, the clinical method is the main one. The main place in it belongs to questioning (clinical interview) and objective observation of the patient’s behavior. Through questioning, a subjective history is collected and clinical facts are identified that determine the patient’s mental state.
An objective history is collected by studying medical records, as well as from conversations with the patient’s relatives.
The purpose of collecting anamnesis is to obtain data about:
- hereditary burden of mental illness;
- the patient’s personality, characteristics of his development, family and social status, exogenous harm suffered, characteristics of response to various everyday situations, mental trauma;
- characteristics of the patient's mental state.
When taking a history of a patient with a manic episode, attention should be paid to the presence of risk factors such as:
- episodes of mood disorders in the past;
- family history of affective disorders;
- history of suicide attempts;
- chronic somatic diseases;
- stressful changes in life circumstances;
- alcoholism or drug addiction.
Additional examination methods include clinical and biochemical blood tests (including glucose, ALT, AST, alkaline phosphatase; thymol test);
Treatment for a Manic Episode:
Treatment for a manic state is usually inpatient; the length of hospital stay depends on the speed of symptom reduction (on average 2-3 months). Aftercare is possible in semi-inpatient or outpatient settings.
There are three relatively independent stages in the system of treatment measures:
- relief therapy aimed at treating the current condition;
- follow-up or stabilizing (maintenance) therapy aimed at preventing exacerbation of a previous condition;
- preventive therapy aimed at preventing relapse (repeated condition).
At the stage of relief therapy, the drugs of choice are lithium salts (lithium carbonate, lithium oxybate), carbamazepine, valproic acid salts (sodium valproate).
In case of sleep disturbance, sleeping pills (hypnotics) are added - nitrazepam, flunitrazepam, temazepam, etc.
In cases of severe psychomotor agitation, aggressiveness, and the presence of manic-delusional symptoms, antipsychotics are prescribed (usually haloperidol, which is administered parenterally if necessary), the dose of which is gradually reduced until complete withdrawal as the therapeutic effect is achieved. To quickly reduce psychomotor agitation, zuclopenthixol is used. The use of antipsychotics is necessary due to the fact that the effect of mood stabilizers appears only after 7-10 days of treatment. For motor agitation and sleep disorders, antipsychotics with a sedative effect (chlorpromazine, levomepromazine, thioridazine, chlorprothixene, etc.) are used.
If there is no effect in the first month of treatment, a transition to intensive therapy is necessary: alternating high doses of incisive antipsychotics with sedatives, adding parenterally administered anxiolytics (phenazepam, lorazepam). In cases of resistant mania, combination therapy with lithium salts and carbamazepine, lithium salts and clonazepam, lithium salts and valproic acid salts is possible.
At the second stage, the use of lithium salts should continue for an average of 4-6 months to prevent exacerbation of the condition. Use lithium carbonate or its prolonged forms; plasma lithium concentration is maintained within 0.5-0.8 mmol/l. The issue of stopping lithium therapy is decided depending on the characteristics of the disease and the need for preventive therapy.
The minimum duration of maintenance therapy is 6 months after the onset of remission. When discontinuing therapy, it is considered advisable to slowly reduce the dose of the drug over at least 4 weeks.
