Overview
This lecture covers mania, the key features and diagnosis of bipolar disorder, its epidemiology, prognosis, treatments, distinct subtypes, and how mania and depression can present in combination.
Mania: Features and Diagnosis
- Mania is marked by persistently elevated or irritable mood and increased energy or activity.
- Unlike normal happiness, mood in mania is non-reactive and does not change with circumstances.
- Mania can present as euphoria, irritability, or alternation between both.
- Major diagnostic mnemonic for mania is DIGFAST: Distractibility, Impulsivity, Grandiosity, Flight of ideas, Activity (goal-directed), Sleep (decreased need), and Talkativeness (pressured speech).
- Diagnosis of mania requires at least one week of abnormal mood and increased activity, plus three DIGFAST symptoms (four if mood is only irritable).
- Increased goal-directed activity is required for diagnosis.
Bipolar Disorder: Overview and Course
- Bipolar disorder involves episodes of mania and depression, affecting ~1% of the population.
- Men and women are equally affected; average onset age is 21.
- Patients spend about 50% of their lives in abnormal mood states.
- Mania itself is rare—only ~1% of a bipolar patient's lifespan.
- Bipolar disorder is highly recurrent, with over 90% experiencing repeated episodes.
Prognosis and Risks
- High risk for suicide, especially during depressive or mixed episodes; 1% suicide attempt rate per year.
- Mania untreated lasts 3–6 months; can be stabilized faster with treatment.
- Functional impairment occurs during episodes but may remit between episodes.
Treatment of Bipolar Disorder
- Medications (mood stabilizers and/or antipsychotics) are essential; therapy alone is insufficient.
- Lithium is effective for both mania and depression and reduces suicide risk.
- Some anticonvulsants treat specific mood states: valproic acid/carbamazepine (mania), lamotrigine (depression).
- Antipsychotics are fast-acting for mania; a few also treat bipolar depression (quetiapine, lurasidone, olanzapine, cariprazine).
- Antidepressants are usually ineffective and may be harmful; not first-line.
Types of Bipolar Disorders and Related Conditions
- Bipolar I: At least one manic episode, often with depressive episodes.
- Bipolar II: Hypomanic (less severe mania) and major depressive episodes; hypomania does not impair function.
- Cyclothymia: Chronic, mild hypomanic and depressive symptoms (not meeting full criteria); rare.
- Mood disorders are mutually exclusive—only the most specific diagnosis is given per patient.
Mixed States and Psychosis
- Mixed states: Simultaneous manic energy and depressive mood, increasing risk for suicide and reckless behavior.
- Mixed episodes count as mania; diagnose as bipolar I.
- Bipolar disorder often includes psychotic features (hallucinations, delusions), treated with antipsychotics and mood stabilizers.
Key Terms & Definitions
- Mania — Abnormally elevated or irritable mood with increased activity.
- DIGFAST — Mnemonic for mania symptoms: Distractibility, Impulsivity, Grandiosity, Flight of ideas, Activity, Sleep (less), Talkativeness.
- Bipolar disorder — Psychiatric illness with manic and depressive episodes.
- Hypomania — A milder form of mania, not causing significant impairment.
- Mood stabilizer — Medication preventing mood swings in bipolar disorder.
- Mixed state — Co-occurrence of manic and depressive symptoms.
- Psychosis — Loss of touch with reality; can accompany mood episodes.
Action Items / Next Steps
- Review the DIGFAST mnemonic and diagnostic criteria for mania.
- Memorize differences between bipolar I, bipolar II, and cyclothymia.
- Read about mood stabilizer medications and their roles.
- Prepare for practice questions on bipolar disorder diagnosis and management.