Mania and Bipolar Disorder

Overview

Mania is the opposite of depression, characterized by elevated mood and excessive energy.
It is the hallmark of Bipolar Disorder, which involves both manic highs and depressive lows.

Mood Changes: Patients describe their emotional state as "great," "fantastic," or "on top of the world."
- Emotional non-reactivity: Incapable of experiencing emotions other than happiness.
- Analogy: Like a car with no brakes - can’t slow down when needed.
Clinical Features (D.I.G. F.A.S.T. Mnemonic):
- D: Distractibility
- I: Impulsivity (risky behaviors)
- G: Grandiosity (self-importance, exalted figures)
- F: Flight of Ideas (rapid thoughts)
- A: Activity (increase in goal-directed activity)
- S: Sleep (decreased need)
- T: Talkativeness (pressured speech)
Diagnostic Criteria:
- Elevated mood + at least 3 DIG FAST symptoms (4 if irritable).
- Symptoms must last for one week or more.

Bipolar Disorder Statistics:
- Affects ~1% of the population.
- Onset in early adulthood (average age 21).
- 90% recurrence rate after a manic episode.
- Higher mortality rate due to suicide risk.
Bipolar Disorder Types:
- Type 1: Manic episodes with depressive episodes.
- Type 2: Hypomanic episodes with severe depression.
- Cyclothymia: Hypomanic and dysthymic episodes, milder than Bipolar Disorder.

Medications: Mood stabilizers and antipsychotics are standard.
- Lithium: Effective for both mania and depression.
- Anticonvulsants: Valproic acid (for mania), Lamotrigine (for depression).
- Antipsychotics: Faster at treating mania.
Psychotherapy: Helps but is not sufficient alone.
Antidepressants: Often ineffective and can increase cycling.

Mixed States: Combination of depressive and manic symptoms.
- High-risk for reckless behavior and suicide.
- Treated as equivalent to a manic episode in diagnosis.
Psychosis: More than half of bipolar patients may experience psychotic symptoms.
- Antipsychotics used in treatment.

Bipolar disorder requires careful diagnosis and indication-specific treatments.
Further resources: "Memorable Psychiatry" offers more insights and practice questions.