Mania and Bipolar Disorder

Overview of Mania

• Mania: Characterized by excessive elevations in mood and energy.
• Opposite of depression, which involves mood dips.
• Hallmark of Bipolar Disorder (manic highs and depressive lows).

Diagnosing Mania

• Manic mood: Elevated mood; feelings of greatness, being on top of the world.
• Problem: Mood is non-reactive; patient can't experience emotions other than happiness.
• Example: Inability to react appropriately to serious events.
• Mania can manifest as euphoria or irritability.

DIG FAST Mnemonic

• D - Distractibility: Difficulty staying focused; easily distracted.
• I - Impulsivity: Acts without considering consequences; engages in risky behaviors.
• G - Grandiosity: Inflated self-esteem; feelings of being a special figure.
• F - Flight of Ideas: Rapid thoughts, difficult to follow.
• A - Activity: Increased goal-directed activity and energy.
• S - Sleep: Reduced need for sleep.
• T - Talkativeness: Rapid, pressured speech.

Diagnostic Criteria

• Elevated mood + at least 3 of the 7 DIG FAST symptoms.
• 4 of 7 if experiencing irritability as mania.
• Symptoms present for 1 week or more.

Bipolar Disorder

• Prevalence: Affects ~1% of the population.
• Onset: Early adulthood, average age 21.
• Episodes: Patients spend around 50% of life in mood episodes.
• Risk: High recurrence rate (>90% after one manic episode).

Treatment

• Medications (mood stabilizers) are essential.
  • Lithium: effective for both manic and depressive episodes.
  • Anticonvulsants: Valproic acid and carbamazepine for mania; lamotrigine for depression.
  • Antipsychotics: Fast treatment for mania.
• Antidepressants are generally not recommended.

Types of Bipolar Disorder

• Bipolar I: Episodes of mania and depression.
• Bipolar II: Hypomanic episodes and severe depression.
• Cyclothymia: Less severe, includes hypomanic and dysthymic episodes.

Mixed State

• Combination of depressive mood with increased goal-directed activity.
• High risk for reckless behavior and suicide.
• Treat with mood stabilizers and/or antipsychotics.

Key Takeaways

• Mood Disorders: Distinct types with different implications for treatment.
• Mixed State and Psychosis: Common in bipolar disorder, requires careful treatment.

Further Reading

• Explore "Memorable Psychiatry" for more in-depth understanding and practice questions.