Mania chronic

Bipolar disorder is a mood disorder characterized by one or more episodes of mania or hypomania, often with a history of one or more major depressive episodes.1 It is a chronic illness with a course characterized by relapses and improvements or remissions. Mood episodes can be manic, depressed, or mixed. They can be separated by long periods of stability or can cycle... 

The classic symptoms of depression are listed in Table 12.1, which is based on DSM-IV criteria. For a diagnosis of major depressive disorder, most of these symptoms must be present, including the first two (APA, 2000). These symptoms should be of sufficient intensity and chronic duration (at least 2 weeks) to cause clinically significant distress and impairment in social or economic functioning. However, they should not be a result of another psychiatric or somatic illness, nor of drug misuse or bereavement. For a diagnosis of mania, the symptoms are a mirror image of those for depression (Table... 

Unipolar disorder An affective disorder characterised by chronic dysphoria. The two contrasting forms of unipolar disorder are major depression and mania. 

The accounts in this book converge on a difficult truth Except in rare instances, medications do not cure affective disorders. Mental illnesses are chronic. There is typically an unpredictable ebb and flow to emotional distress. For some, difficult episodes of depression or mania are punctuated by periods of remission. Others describe good days and bad days. Yet others muddle along in a state of unre-... 

Lithium has numerous pharmacologic effects. It is able to cross through sodium channels, competing with monovalent and divalent cations in cell membranes (AHFS, 2000). Animal studies have shown that lithium at a serum level of 0.66 + — 0.08 mEq/L can increase the amphetamine-induced release of serotonin (5-hydroxytryptamine [5-HT]) and the concentrations of a serotonin metabolite (e.g., 5-hydroxyindoleacetic acid [5-HIAA]) in the perifornical hypothalamus (PFH) of rats before and after chronic lithium chloride administration (Baptista et ah, 1990), a mechanism possibly involved in lithium s antidepressant effect. The precise neurobiological mechanisms through which lithium reduces acute mania and protects against recurrence of illness remain uncertain (Lenox and Hahn,... 

Keck PE Jr, McElroy SL, Tugrul KC, et al Valproate oral loading in the treatment of acute mania. J Clin Psychiatry 54 305-308, 1993 Keck PE Jr, McElroy SL, Strakowski SM, et al Pharmacologic treatment of schizoaffective disorder. Psychopharmacology 114 529-538, 1994 Keller MB Chronic and recurrent affective disorders Incidence, course, and influencing factors, in Chronic Treatments in Neuropsychiatry. Edited by Kemah D, Recagni G. New York, Raven, 1985... 

Patients whose depression has apparently been resistant to standard antidepressant treatment often have had inadequate trials of antidepressants or have been nonadherent with drug therapy. Depression in a patient who has failed to complete an adequate trial of an antidepressant drug does not constitute treatment-resistant depression. A patient who reports a history of robust but short-lived responses to several antidepressants may be manifesting a medication-induced rapid-cycling course. Mild episodes of hypomania during the course of treatment may be overlooked, especially in a productive patient with a high level of functioning and a premorbid history of hyperthymic personality, defined as a chronic state of mild hypo-mania. In these cases, treatment with a mood stabilizer is indicated (see Chapter 5). 

U.S. Food and Drug Administration for the treatment of insomnia, almost all benzodiazepines may be used for this purpose. Benzodiazepines are most clearly valuable as hypnotics in the hospital setting, where high levels of sensory stimulation, pain, and acute stress may interfere with sleep. The safe, effective, and time-limited use of benzodiazepine hypnotics may, in fact, prevent chronic sleep difficulties (NIMH/NIH Consensus Development Conference Statement 1985). Benzodiazepines are also used to treat akathisia and catatonia and as adjuncts in the treatment of acute mania. 

It is indicated in acute and chronic schizophrenia, anxiety disorders, acute mania, hypomania and behavioural disorders in children antiemetic neuroleptanalgesia, Gilles de la Tourette s syndrome and Huntington s disease. 

It exerts sedative and tranquillizing effect and it is postulated that it blocks dopamine receptors within CNS. It is used in acute and chronic psychoses, anxiety disorders, mania and schizophrenia. 

Dwight et al. (291) reported their experience with risperidone in eight patients with schizoaffective disorder (six bipolar type two depressive type). All six bipolar type patients showed the onset of or an increase in mania shortly after starting risperidone (mean number of treatment days = 7 3 mean dose = 7 1 mg/day). In this context, O Croinin et al. (292) reported on a chronic paranoid schizophrenic patient who was admitted in an acute psychotic state unresponsive to thioridazine or CPZ. Risperidone was started (6mg/day by day 3), but by the end of the first week she was displaying hypomanic symptoms. When risperidone was discontinued and haloperidol introduced, her hypomanic symptoms resolved. 

The chronic effects show rapid emaciation and severe psychic disturbances, insomnia, hallucinations, apathy, melancholia, and suicidal mania. The pupils are inconstant. Acne is common. It is claimed that considerable tolerance is acquired, so that the daily hypodermic consumption may reach 2.5 g or even 10 g. Morphinists are relatively tolerant to cocaine. Sudden withdrawal leads to abstinence symptoms similar to morphine. With cocaine snuffing, where smaller amounts are used in intermittent debauches, the chronic effects such as the craving and the abstinence symptoms are proportionately less marked. Such patients develop atrophic rhinitis, with characteristic ulceration of the nasal fossae — also present in people who snuff heroin. 

Although L-dopa can increase dopamine levels in the brain, its effectiveness decreases across time, such that larger and more frequent doses are required for it to be effective. In addition, after only 2-5 years of L-dopa treatment, its duration of effect is reduced. Chronic administration of L-dopa has been reported to produce psychiatric symptoms, such as paranoia, mania, anxiety, depression, hallucinations as well as increased incidence of insomnia and nightmares (92). It is not clear whether these symptoms are associated with chronic L-dopa therapy or disease course, since the two are temporally related (94). Chronic L-dopa therapy may also produce a state where patients response to administration fluctuates, such that they experience an on/off phenomena of L-dopa s effects. Additional symptoms of dyskinesias, e.g., involuntary twisting and writhing, are associated with this on/off phenomenon. Consequently, treatment with L-dopa is typically delayed until other treatments are no longer effective. 

Affective illness is a recurrent illness characterized by episodes of depression -and in some cases, mania - that recur and remit repeatedly during the course of a patient s life. A group of minor conditions characterized by chronic intermittent symptomatology such as dysthymia or cyclothymia also exists. Sleep research over the past decades has primarily focused on major affective disorders such as unipolar or bipolar disorders, and minor affective conditions have been neglected in the research literature. Accordingly, the present chapter will largely rely on publication in that field. 

Kindling may account for the lowered seizure threshold following chronic cocaine abuse. This phenomenon has been described elsewhere (e.g. in the use of carbamazepine in the treatment of mania), and occurs when small, subconvulsive doses eventually give rise to spontaneous seizures. 

The NE system mediates various autonomic, neuroendocrine, emotional and cognitive functions. One of the central roles of NE is response to stress and aversion. This role can be summarized as an activation of response to the acute stress and aversion, followed by decreased reaction to repeated or chronic aversion. Since the response to stress and aversion is a basic part in pathology of mood disorder, NE should play an important role in anxiety, depression and mania. Indeed, this role has been demonstrated in numerous animal and human studies. Majority of antidepressant drugs and mood stabilizers affect NE system as their direct or indirect target. Various medications have different effects on NE neuronal activity. The majority of antidepressants, Li and benzodiazepines suppress NE transmission. Other medications, such as AADs, activate NE neuronal firing activity and NE release. Appropriate combination of different medications, based on the consideration of their effect on NE system, might be critical to obtain good treatment outcome. The combination of SSRIs... 

In addition to acute and chronic schizophrenia, the neuroleptics are sometimes used in the management of mania, delirium, and severe agitation, whatever the cause of these symptom complexes. It must be noted that unlike parkinsonism, where a definite dysfunction in the DA system has been established, for schizophrenia and other psychiatric diseases, no unequivocal evidence has yet been presented to prove that there is a disturbance of the DA system (e.g., dopaminergic overactivity or receptor hypersensitivity). In untreated schizophrenics the production of DA metabolites is normal. Conflicting results have been obtained in studies of the DA receptors in schizophrenics (11,12,13), but in the case of patients who have not received neuroleptics, the receptor density and affinity appear to be normal (13). The "dopamine hypothesis" in these disorders derives from the beneficial effects of drugs that block DA receptors. 

They are rarely related to the body (i.e. somatic) as they can be in depression (a common feature of which is a mistaken conviction about lost, defective, or diseased body parts). The grandiosity and fearless elation of mania are shared with dream psychosis, although these features are also found in organic delirium, especially in its chronic, post-intoxication phase. 

Pozo P, Alcantara AG. Mania-like syndrome in a patient with chronic schizophrenia during olanzapine treatment. J Psychiatry Neurosci 1998 23(5) 309-10. 

Recently a hyperactivity model induced by a combination of D-amphetamine and chlordiazepoxide was studied. Lamotrig-ine, valproate, and carbamazepine, all used to treat bipolar disorder, were all found to decrease this hyperactivity (Arban et al., 2005). Interestingly, while most mania models assume an increase in dopamine, an early model used dopamine depletion with in tracerebr oven trie ular injection of 6-hydroxydopa-mine, which induces hyper-reactivity to environmental stimuli, but not hyperactivity per se (Petty and Sherman, 1981). This model was responsive to chronic lithium and to chronic electroconvulsive shock, and also to acute chloiq romazine, while imipramine w orsened the behavior. 

Champagne S, Coste E, Peyriere H, Nigond J, Mania E, Pons M, Hillaire-Buys D, Balmes P, Blayac JP, Davy JM. Chronic constrictive pericarditis induced by long-term bromocriptine therapy report of two cases. Ann Pharmacother 1999 33(10) 1050. ... 

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