Mania depression with

Affective (mood) disorders are characterized by changes in mood. The most common manifestation is depression, arranging from mild to severe forms. Psychotic depression is accompanied by hallucinations and illusions. Mania is less common than depression. In bipolar affective disorder, depression alternates with mania. 

Light therapy is an alternative treatment for depression associated with seasonal (e.g., winter) exacerbations. Possible side effects include eye strain, headache, insomnia, and hypo-mania.16,17 Also, potentially vulnerable patients, such as those with photosensitivity or a history of skin cancer, should be evaluated carefully prior to therapy.16... 

As a rule, we prefer lithium when treating bipolar patients who most often manifest classic euphoric mania. We also prefer lithinm for patients whose illness consists of a preponderance of depressive episodes with less freqnent manic or hypomanic episodes. We typically initiate lithium at 300-900mg/day given in a single bedtime dose or two divided doses. The target therapentic level is 0.8-1.2mEq/L. 

Mania For the treatment of manic episodes of manic-depressive illness. Maintenance therapy prevents or diminishes the frequency and intensity of subsequent manic episodes in those manic-depressive patients with a history of mania. 

Bipolar disorder For the maintenance treatment of Bipolar I Disorder to delay the time to occurrence of mood episodes (eg, depression, mania, hypomania, mixed episodes) in patients treated for acute mood episodes with standard therapy. 

Mood Disorders. Risperidone has also been reported to benefit major depressive disorder with psychosis, bipolar mania, and schizoaffective disorder ( 83, 84, 85, 86 and 87). 

Janicak et al. (87) studied the relative efficacy and safety of risperidone versus haloperidol in the treatment of schizoaffective disorder. Sixty-two patients (29 depressed type, 33 bipolar type) entered a randomized, double-blind, 6-week trial of risperidone (up to 10 mg/day) or haloperidol (up to 20 mg/day). They found no difference between risperidone and haloperidol in the amelioration of psychotic and manic symptoms nor any significant worsening of mania with either agent. For the total PANSS, risperidone produced a mean decrease of 16 points from baseline, compared with a 14-point decrease with haloperidol. For the total CARS-M scale, risperidone and haloperidol produced mean change scores of 5 and 8 points, respectively and for the CARS-M mania factor, 3 and 7 points, respectively. 

A retrospective study of 52 delusionally depressed patients suggested that there may be various subgroups bipolar, early onset unipolar and possibly unipolar, late onset (12). As with previous reports, there was a remarkably high rate of psychotic relapse in those patients who manifested psychotic symptoms at the index admission (i.e., depression or mania with psychotic features). Moreover, psychotic features were more common in bipolar than in unipolar depression. 

The depressive phase of manic-depressive disorder often requires concurrent use of an antidepressant drug (see Chapter 30). Tricyclic antidepressant agents have been linked to precipitation of mania, with more rapid cycling of mood swings, although most patients do not show this effect. Selective serotonin reuptake inhibitors are less likely to induce mania but may have limited efficacy. Bupropion has shown some promise but—like tricyclic antidepressants—may induce mania at higher doses. As shown in recent controlled trials, the anticonvulsant lamotrigine is effective for many patients with bipolar depression. For some patients, however, one of the older monoamine oxidase inhibitors may be the antidepressant of choice. Quetiapine and the combination of olanzapine and fluoxetine has been approved for use in bipolar depression. 

Psychosis is one of those frightening and unwelcome conditions that we hope only other people get. To be out of our minds is one of the worst things that can happen to us. And it can and does happen to many of us—or at least to someone in our family—all too frequently. Which of you readers has not had at least one family member suffer psychotic delirium due to Alzheimer s disease (there have been two in my family) or senile dementia (one more in my family), or psychotic delirium due to psychotic depression, mania, or schizophrenia (fortunately none yet in our case). Sooner or later all of us will want to know how to stop psychosis, or at least reduce it to levels compatible with social functioning. 

Antidepressants modify the long-term course of bipolar disorder as well. When given with lithium or other mood stabilizers, they may reduce depressive episodes. Interestingly, however, antidepressants can flip a depressed bipolar patient into mania, into mixed mania with depression, or into chaotic rapid cycling every few days or hours, especially in the absence of mood stabilizers. Thus, many patients with bipolar disorders require clever mixing of mood stabilizers and antidepressants, or even avoidance of antidepressants, in order to attain the best outcome. 

Psychiatric uses of benzodiazepines other than treatment of anxiety states include the initial management of mania, the control of drug-induced hyperexcitability states (eg, phencyclidine intoxication), and possibly the treatment of major depressive disorders with alprazolam. Sedative-hypnotics are also used occasionally as diagnostic aids in neurology and psychiatry. 

Bipolar affective (manic- depressive) Characterized by episodes of mania. Cyclic mania alone, rare depression alone, occasional mania-depression, usual. About 10-15% of all depressions. May be misdiagnosed as endogenous if hypomanic episodes are missed. Lithium carbonate stabilizes mood. Mania may require antipsychotic drugs as well depression managed with antidepressants. 

The hypnogram of a patient with an underlying psychiatric illness may be characterized by a delay in sleep onset, the presence of residual muscular activity causing frequent awakenings, fragmented sleep, reduced REM and slow-wave sleep, and day-time drowsiness. Such disorders are generally not associated with a recent or transient event and the cause cannot usually be identified. Often such changes in the sleep architecture are associated with major psychiatric disorders such as depression, mania, psychosis or severe anxiety states. 

Koukopoulos and Koukopoulos (1999) proposed a definition of agitated depression as a major depressive episode with one of the following motor agitation, psychic agitation or intense inner tension, and racing or crowded thoughts. This condition, which has also been referred to as black mania, can worsen dramatically under the effect of antidepressants. ... 

In a subanalysis of two 18-month maintenance studies of the use of lithium, lamotrigine, or placebo in delaying relapse in subjects with type I bipolar illness, 98 subjects 55 years of age or older were identified (82). Lithium delayed the time to mania compared with placebo, but lamotrigine also delayed the time to either mania or depression compared with placebo. 

A patient taking diltiazem developed the signs and symptoms of mania (114) and another developed mania with psychotic features (115). There have also been reports that nifedipine can cause agitation, tremor, belligerence, and depression (116), and that verapamil can cause toxic delirium (117). Nightmares and visual hallucinations have been associated with nifedipine (118). Depression has been reported as a possible adverse effect of nifedipine (119). 

The authors cited several reports of depression, mania, and psychosis with various ACE inhibitors. 

The histamine-2 receptor blockers (H-2 blockers) are used to treat hyperacidity in the stomach, and the most commonly used medications are available over the counter (without prescription). The first one was cimetidine (brand name Tagamet), which is a very common cause of delirium, confusion, psychosis, and aggression in the elderly—especially at night. The other H-2 blockers, such as ranitidine (brand name Zantac) and famotidine (brand name Pepcid), can also cause these symptoms, which are quite rare with these two drugs. Cimetidine should be avoided in the elderly and those with a serious illness. The H-2 blockers can also cause depression, mania, and nightmares. Therapists will see many patients who are taking H-2 blockers, and the patients may not... 

Maintenance treatment for manic depressive patients with a history of mania... 

In bipolar affective disorder patients suffer episodes of mania, hypomania and depression, classically with periods of normal mood in between. Manic episodes involve greatly elevated mood, often interspersed with periods of irritability or undue... 

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