Mania differential diagnosis

Davis JM, Noll KM, Sharma R. Differential diagnosis and treatment of mania. In Swann AC, ed. Mania new research and treatment. Washington, DC American Psychiatric Press, 1986 1-58. Mendlewicz J, Fieve RR, Rainer JD, et al. Manic-depressive illness a comparative study of patients with and without a family history. Br J Psychiatry 1972 120 523-530. 

Activation should be at the top of the differential diagnosis list when a patient s condition deteriorates while taking antidepressants. If the physician misidentifies drug-induced activation as caused by the patient s original psychiatric disorder, the doctor is likely to continue, or even increase, the antidepressant dose, ultimately causing mania and psychosis. 

Hypomania is a less severe form of mania, and by dehnition does not cause a marked impairment in social or occupational functioning, and no delusions or haUucinations are present. " Patients with hypomania often do not seek treatment imtil they have a depressive episode, thus hypomania may not be recognized or reported. Symptoms found in hypomanic episodes are similar to those of cocaine- or antidepressant-induced mood disorders thus the differential diagnosis should rule out any substance-induced or medical conditions that present with elevated mood. Hypomanic states should be closely monitored, because 5% to 15% of patients may rapidly switch to a manic episode." ... 

Schizophrenia-related disorders, such as schizophreniform disorder, can closely mimic an acute exacerbation of mania. Attention to premorbid personal and family history may help differentiate them from mood disorders. A definitive diagnosis may not be possible, however, until the course of the illness is followed for a period of time. Clinical clues include the propensity of bipolar manics (in contrast to schizophrenics) to demonstrate pressured speech, flight of ideas, grandiosity, and overinclusive thinking. Hallucinations are less common than delusions in both mania and depression, with delusions normally taking on the qualities of expansivity, hyperreligiosity, or grandiosity. Delusions are also relatively less fixed than in schizophrenia. 

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