Manic episodes

Treatment of Manic—Depressive Illness. Siace the 1960s, lithium carbonate [10377-37-4] and other lithium salts have represented the standard treatment of mild-to-moderate manic-depressive disorders (175). It is effective ia about 60—80% of all acute manic episodes within one to three weeks of adrninistration. Lithium ions can reduce the frequency of manic or depressive episodes ia bipolar patients providing a mood-stabilising effect. Patients ate maintained on low, stabilising doses of lithium salts indefinitely as a prophylaxis. However, the therapeutic iadex is low, thus requiring monitoring of semm concentration. Adverse effects iaclude tremor, diarrhea, problems with eyes (adaptation to darkness), hypothyroidism, and cardiac problems (bradycardia—tachycardia syndrome). 

Although lithium is not a true antipsychotic drug, it is considered with the antipsychotics because of its use in regulating the severe fluctuations of the manic phase of bipolar disorder (a psychiatric disorder characterized by severe mood swings of extreme hyperactivity to depression). During the manic phase, the person experiences altered thought processes, which can lead to bizarre delusions. The drug diminishes the frequency and intensity of hyperactive (manic) episodes. 

Depression often follows a manic episode (bipolar I disorder), but in other cases the main disorder presents as depressive episodes which are followed by or sometimes... 

Recognize the symptoms of a manic episode and depressive episode in patients with bipolar disorder. 

The primary treatment modality for manic episodes is mood-stabilizing agents, often combined with antipsychotic drugs. 

The distinguishing feature of bipolar II disorder is depression with past hypomanic episodes that often are not recalled by the individual as being unusual. Irritability and anger episodes are also common. Collateral information is essential to obtain the entire history (i.e., there cannot have been a prior full manic episode).1,14... 

Mixed Yes Criteria for both a major depressive episode and manic episode (except for duration) occur nearly every day for at least a 1 -week period... 

Rapid cycling Yes Greater than 3 major depressive or manic episodes (manic, mixed, or hypomanic) in 12 months... 

Interpersonal, family, or group therapy with a licensed psychiatric nurse practitioner/clinical nurse specialist, psychologist, social worker, or counselor assists individuals with bipolar disorder to establish and maintain a daily routine and sleep schedule and to improve interpersonal relationships.3,20 These therapies may help treat and protect against manic episodes. 

Zhang, H. Y., Shu, L., Li, H. F. et al. (2006). Risperidone versus haloperidol in treatment of acute manic episodes of bipolar 1 disorder a randomized double-blind controlled multicenter study. Journal of Chinese Psychiatry, 39(1), 33-7. 

D. There has never been a manic episode, a mixed episode, or a hypomanic episode. 

Non-motor signs of the disorder are also treatable with symptomatic medications. The frequent mood disorder can be treated with standard antidepressants, including tricyclics (such as amitryptiline) or serotonin reuptake inhibitors (SSRIs, such as fluoxetine or sertraline). This treatment is not without risks in these patients, as it may trigger manic episodes or may even precipitate suicide. Anxiety responds to benzodiazepines, as well as to effective treatment of depression. Long-acting benzodiazepines are favored over short-acting ones because of the lesser abuse potential. Some of the behavioral abnormalities may respond to treatment with the neuroleptics as well. The use of atypical neuroleptics, such as clozapine is preferred over the typical neuroleptics as they may help to control dyskinesias with relatively few extrapyramidal side-effects (Ch. 54). 

There is evidence for the contribution of serotonin dysfunction to mania, and in the mechanism of action of mood stabilizers [19], however, specific data on the serotonergic system and mania are fewer and variable. Moreover, altered functioning of other neurotransmitters in mania such as norepinephrine, dopamine, acetylcholine, and GABA, and their interaction with serotonin, are also likely to be involved in the pathogenesis of mood disorders. Differences in these neurotransmitter systems possibly underlie differences in the pathogenesis of depressive and manic episodes. 

Friedman, E., Hoau Yan, W., Levinson, D. et al. Altered platelet protein kinase C activity in bipolar affective disorder, manic episode. Biol Psych. 33 520-525,1993. 

Manic episodes may be precipitated by stressors, sleep deprivation, antidepressants, CNS stimulants, or bright light. 

During a hypomanic episode, some patients may be more productive and creative than usual, but 5% to 15% of patients may rapidly switch to a manic episode. 

The average age of onset of a first manic episode is 21 years. More than 80% of bipolar patients have more than four episodes during their lifetime. Usually there is normal functioning between episodes. 

Deficiency of acetylcholine causes an imbalance in cholinergic-adrenergic activity and can increase the risk of manic episodes. 

Two or more major depressive episodes Manic episode major depressive or mixed episode Major depressive episode + hypomanic episode Chronic subsyndromal depressive episodes Chronic fluctuations between subsyndromal depressive and hypomanic episodes (2 years for adults and 1 year for children and adolescents) Mood states do not meet criteria for any specific bipolar disorder... 

The length and severity of a mood episode and the interval between episodes vary from patient to patient. Manic episodes are usually briefer and end more abruptly than major depressive episodes. The average length of untreated manic episodes ranges from 4 to 13 months. Episodes can occur regularly (at the same time or season of theyear) and often cluster at 12-month intervals. Women have more depressive episodes than manic episodes, whereas men have a more even distribution of episodes. 

For bipolar I disorder, 90% of individuals who experience a manic episode later have multiple recurrent major depressive, manic, hypomanic, or mixed episodes alternating with a normal mood state. 

Aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone are FDA approved for the treatment of acute manic episodes in bipolar I disorder. 

Adjunctive atypical antipsychotics can be beneficial for breakthrough manic episodes or if there is incomplete response to lithium or valproate monotherapy. 

The combination of carbamazepine with lithium, valproate, and antipsychotics is often used for manic episodes in treatment-resistant patients. 

Example 3 Is Bipolar I Disorder, Single Manic Episode (296.0x) a Taxon ... 

How would one test the taxonicity of ME (in a general or restricted sample) According to the DSM, a manic episode is defined as ... 

We hope these examples make another important idea apparent. The DSM should be evaluated from the bottom up, starting with basic syndromes such as panic attacks or manic episodes and working up toward complicated disorders. Syndromes are building blocks of the DSM diagnoses, and there are considerably fewer syndromes than there are disorders. Evaluation of syndromes seems to be a logical place to start. 

I ve been diagnosed with bipolar disorder. I just went through a depression, but now I m feeling better. The problem with bipolar is that when you are treated for depression it can set off a manic episode. I have to be really careful. I ve been hospitalized four times with manic episodes. I was told by a doctor that my bipolar disorder is an imbalance in brain chemistry caused by chemical exposures. 

The unipolar mood disorders consist solely of episodes of depression. On the other hand, the bipolar mood disorders consist of episodes of both depressed and elevated mood. The periods of elevated mood are characterized by either euphoria or irritability and are called mania or hypomania depending on the level of severity. A schematic of the mood disorders is shown in Figure 3.1. Substance-induced mood disorders and mood disorders due to general medical conditions usually manifest depressed mood however, manic episodes are occasionally seen as well. 

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