Mania euphoria with

Lability of affect is characterized by rapid shifts from euphoria to anger or depression. Depressive symptoms (e.g., tearfulness, suicidal threats, insomnia) may last moments, hours, or, more rarely, days, occasionally intermingled with or rapidly alternating with mania (e.g., mixed episode or dysphoric mania). 

Acute mania often presents with giddiness, euphoria, anger, or irritability. There will likely be boundless energy, rapid, loud talking, disinhibition, and perhaps a preoccupation with sex or religion. 

Treatment with steroids may initially evoke euphoria. This reaction can be a consequence of the salutary effects of the steroids on the inflammatory process or a direct effect on the psyche. The expression of the unpredictable and often profound effects exerted by steroids on mental processes generally reflects the personality of the individual. Psychiatric side effects induced by glucocorticoids may include mania, depression, or mood disturbances. Restlessness and early-morning insomnia may be forerunners of severe psychotic reactions. In such situations, cessation of treatment might be considered, especially in patients with a history of personality disorders. In addition, patients may become psychically dependent on steroids as a result of their euphoric effect, and withdrawal of the treatment may precipitate an emotional crisis, with suicide or psychosis as a consequence. Patients with Cushing s syndrome may also exhibit mood changes, which are reversed by effective treatment of the hypercortisolism. 

Patients whose first episodes of mania or bipolar depression occur between ages 30 to 60 years appear to have clearer episodes of mood disorder, have mania characterized by euphoria and irritability (rather than irritability alone), and be less likely to develop substance addiction (though they may engage in substance abuse as part of their acute episodes). Although psychosis occurs frequently and can be severe, in such late-onset cases confusion with other disorders is usually not a problem. Finally, this more classical presentation is generally responsive to lithium (Carlson, 2000). 

The essential feature of mania is a distinct period of an elevated, expansive, or irritable mood accompanied by several other symptoms (4). Mania is not synonymous with euphoria or elation but is a syndrome that can occur in a wide variety of disorders and involves aberrations in mood, behavior, and thinking. Other clinical manifestations usually include the following ... 

Mixed manic states can be characterized as the simultaneous presence of both a depressive and manic episode, meeting full criteria for both mood syndromes (except for duration) nearly every day for at least one week. This may be a relatively common occurrence, as noted earlier in the data of Goodwin and Jamison (i.e., 71% present with euphoria and 72% with depression), as well as others (30a) (9). Krasuski and Janicak (31, 32) reviewed various models to explain the interaction between mania or hypomania and depression and noted that aggression and anxiety may be important components, in addition to dysphoria, in defining mixed states. 

The psychostimulant effects of the glucocorticoids are well known (80), and their dose dependency is recognized (SED-11, 817) they may amount to little more than euphoria or comprise severe mental derangement, for example mania in an adult with no previous psychiatric history (SEDA-17, 446) or catatonic stupor demanding electroconvulsive therapy (81). In their mildest form, and especially in children, the mental changes may be detectable only by specific tests of mental function (82). Mental effects can occur in patients treated with fairly low doses they can also occur after withdrawal or omission of treatment, apparently because of adrenal suppression (83,84). 

Thirdly, the organic behavioural state produced by ECT, with its euphoria and disinhibition, may be mistaken for improvement. Often it is misdiagnosed as mania even in people who have no history of manic depression. It is credible that ECT may precipitate mania in people with a vulnerability, but this has not been definitively demonstrated (Devanand et al. 1988). 

Euphoria is unusual in patients treated with the neuroleptics because of the suppressive effects on the central nervous system (see chapter 2). It is more common among patients treated with antidepressants, stimulants, and benzodiazepine tranquilizers, especially alprazolam. Drug-induced mania is an extreme of medication spellbinding. 

The initial euphoria associated with mild cases of drug-induced mania often offer relief and hope, however unrealistic, to the patients who experience it. If the euphoria does not progress to full-blown mania, it is likely to wear off, and then apathy becomes more dominant over time. This often leads patients to ask for one antidepressant after another in the hope of recapturing that brief high. ... 

Euphoria or depression can occur, and mania has been reported in a patient with schizophrenia (82). 

Mania has rarely been associated with typical neuroleptic drugs, but has been described in patients treated with new antipsychotic drugs, especially risperidone (SEDA-22, 69) (SEDA-23, 71) (86). Risperidone-induced mania occurred in a 23-year-old man and a 21-year-old woman, who developed acute mania with euphoria, psychomotor agitation, and hypersexuality, at dosages of 4-8 mg/day (87). 

Carbon tetrachloride Stevens and Forster 1953 Literature review one report of mania with 7 months hospitalization case report of social drinker who consumed carbon tetrachloride while cleaning a gun on day 18, patient had neurological signs and hallucinations on day 84, patient had confusion, personality change, memory loss, euphoria. Summary of 15 cases of poisoning often associated with alcohol intake that worsens symptoms of confusion, disorientation, and impaired mental function. 

The monoamine hypothesis of depression was proposed in 1965 to describe the biochemical basis of depression. Basically, it proposes that depression is caused by a depletion of monoamines (e.g. noradrenaline and/or serotonin) from the synapses. This reduces synaptic activity in the brain causing depression. Conversely, it suggests that mania is caused by an excess of monoamines in synapses, with excessive synaptic activity in the brain resulting in excessive euphoria. In bipolar disorder, patients have mood changes that cycle between depression and mania (Fig. 49.2). 

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