Lecture Notes: Understanding Mania and Bipolar Disorder

Overview

• Focus on the concept of mania, the opposite of depression.
• Mania is a state of excessive mood elevation and energy, hallmark of bipolar disorder.
• Bipolar disorder involves both manic and depressive episodes.
• Key topics: diagnosis of mania, epidemiology, prognosis, treatment, and its combinations with depression.

Diagnosing Mania

• Mood Changes: Elevated mood; feelings of greatness or euphoria that are non-reactive.
• Analogy: Like a car with no brakes - only speed is fast.
• Irritability: Some patients experience mania as irritability rather than euphoria.
• Mnemonic: DIG FAST
  • D: Distractibility
  • I: Impulsivity (risky behaviors)
  • G: Grandiosity (self-importance)
  • F: Flight of ideas (rapid thought process)
  • A: Activity (increased goal-directed activity)
  • S: Sleep (decreased need for sleep)
  • T: Talkativeness (pressured speech)
• Diagnosis requires elevated mood + 3 of 7 DIG FAST symptoms for one week.

Mania and Bipolar Disorder

• Cycle: Mania often followed by depressive episodes.
• Bipolar Disorder: Manic episodes = Bipolar Disorder diagnosis.
• Episodes in Bipolar disorder are similar to unipolar depression but treated differently.

Epidemiology and Prognosis

• Rarer than unipolar depression (~1% of population).
• Early onset, usually around age 21.
• Equal prevalence in men and women.
• High recurrence rate (>90% after one manic episode).
• Higher mortality due to increased suicide risk.

Treatment of Bipolar Disorder

• Medications: First-line treatment (mood stabilizers & antipsychotics).
• Mood Stabilizers: Lithium (lowers suicide risk), anticonvulsants (Valporic acid, Carbamazepine, Lamotrigine).
• Antipsychotics: Effective for mania and some for depression.
• Antidepressants: Not effective for bipolar depression, can worsen cycling.

Types of Bipolar Disorder

• Bipolar 1: Full manic episodes + depression.
• Bipolar 2: Hypomania + severe depression.
• Cyclothymia: Hypomania + dysthymia (milder, less severe episodes).

Mixed States and Psychotic Features

• Mixed States: Combination of depressive mood with manic energy.
• Psychotic Features: More common in bipolar disorder than unipolar depression.
• Treatment involves antipsychotics and mood stabilizers.

Conclusion

• Bipolar disorder's complexity due to various mood states.
• Further exploration recommended in specialized literature for deeper understanding.