Manic excitement

It is used in the treatment of acute and chronic schizophrenia and manic excitement. 

EXTENSIONS AND COMMENTARY This specific compound is probably the first sulfur-containing phenethylamine to have been evaluated as a potentially active CNS stimulant or psychedelic. It was a complete, total, absolute unknown. The first trials were made at the sub-microgram level, specifically at 0.25 micrograms, at 11 30 AM on September 3,1975. Part of this extreme precaution was due to the uniqueness of a new heteroatom in a phenethylamine system. But part was due to the strange manic excitement that occurred at the time of the isolation and characterizing of the final product in the laboratory. Although it was certainly all placebo response, I was jumpy and unable to stay in the lab for more than a few minutes at a time. Maybe dust in the air Maybe some skin contact with the free... 

Antianxiety medications, especially benzodiazepines, can provide relief of anxiety regardless of the cause situational stress, hyperthyroidism, or manic excitement (see figure 16-D). Of course, it is crucial to recognize and treat the underlying disorder. The use of benzodiazepines should be avoided until other measures have been tried (such as psychotherapy, relaxation training) or if anxiety is severe. 

Although BDZs are usefiil in adjunctive treatment of manic excitement and agitation there is no evidence they treat the underlying mood disorder. 

Another risk of antidepressants in vulnerable patients (particularly those with unrecognized bipolar depression) is switching, sometimes suddenly, from depression to hypomanic or manic excitement, or mixed, dysphoric-agitated, manic-depressive states. To some extent this effect is dose-related and is somewhat more likely in adults treated with tricyclic antidepressants than with serotonin reuptake inhibitors, bupropion, and perhaps with MAO inhibitors. Risk of mania with newer sedating antidepressants, including nefazodone and mirtazapine, also may be relatively low, but some risk of inducing mania can be expected with any treatment that elevates mood, including in children with unsuspected bipolar disorder. 

Administration of therapeutic doses of a tricyclic antidepressant to depressed patients results in an elevation of the mood. About 2-3 weeks should be allowed for the antidepressant to exert its effect. For this reason, the tricyclic antidepressants cannot be prescribed on an as-needed basis. With some antidepressants, sedative or antianxiety effects may appear within a few days of treatment. The manner in which these agents relieve the signs of depression is not clear. However, manic excitement as well as euphoria and insomnia can be induced in some patients, contributing to the conclusion that antidepressant agents have clinically important mood-elevating actions. 

The greater incidence of mental disorders in north Texas as compared with the south has been correlated with the lower amount of lithium carbonate in water in the north, and this compound is known to decrease manic excitement for which it is now used therapeutically. Arthur Koestler, discussing the delusional streak in all of us and not just in hooligans, hoped for a mental stabiliser to be put in the public water supply we would then conduct our lives more docilely. Lithium, probably present in all water supplies, would presumably achieve this if adjusted to optimum levels. 

Perhaps one of the most exciting new applications stems from the discovery in 1949 that small daily doses (l-2g) of LI2C03 taken orally provide an effective treatment for manic-depressive psychoses. The mode of action is not well understood but there appear to be no undesirable side effects. The dosage maintains the level of Li in the blood at about I mmol l and its action may be related to the influence of Li on the Na/K balance and (or) the Mg/Ca balance since Li is related chemically to both pairs of elements. 

Central nervous Brain/brainstem Excitation (early) Depression (late) Headache, malaise, dizziness, confusion, manic or bizarre behavior Depression, then loss of consciousness, respiratory depression, diaphragm paralysis... 

One model of an ionic mechanism of action of Li+ in affective disorders has been proposed, in which the receptors for Li+ are ion channels and cation coenzyme receptor sites, and in which the presence of intracellular Li+ in excitable cells results in the displacement of exogenous Na+ and/or other intracellular cations [13]. It has been suggested that this could lead to a decrease in the release of neurotransmitters alternatively it may be that this intracellular Li+ is altering a preexisting, disease-related electrolyte imbalance [14]. A number of observations of such imbalances in affective disorders have been made depression is associated with elevated levels of intracellular Na+ [15] retention of Li+ is observed in manic-depressive patients prior to an episode of mania [ 16] and Na+/K+ activity is defective during both mania and depression [17]. 

Antipsychotics or neuroleptics are used for intervention in patients with severe and chronic psychosis of an organic as well as induced nature. These drags are used for controlling manic phases in manic-depressive psychosis such as relieving anxiety, fear, excitement associated with somatic diseases, controlling aggression, tics, and other unequal conditions. 

In psychiatric practice, promazine is used in minor cases of psychomotor excitement in schizophrenics, in paranoid and manic-depressive conditions, for neurosis, alcoholic psychosis, and others. It is sometimes used in anesthesiological practice. The most common synonyms are propazine, trilafon, sparine, permitil, and others. 

In psychiatric practice, triflupromazine is used for psychomotor excitement in patients with schizophrenia for paranoid and manic-depressive conditions, and for neurosis. The most common synonym is vesprin. 

Haloperidol is one of the most actively used modem neuroleptics. Its high antipsychotic activity is combined with a moderate sedative effect. It effectively stops various types of psychomotor excitement. It is used for schizophrenic psychoses, manic, paranoid, and delirious conditions, depression, psychomotor excitement of various origins, and for delirium and hallucinations of different origin. The most common synonyms are haldol, vezadol, linton, and others. 

Fluanisone is a neuroleptic with sedative properties and relatively poorly expressed antipsychotic action. It is used as an independent or adjuvant drug for psychomotor excitement in severe and chronic schizophrenia and for manic-depressive disorder. Synonyms of this drug are sedalande, methorin, and others. 

Klein E, Bental E, Lerer B, et al Carbamazepine and halopeiidol vs. placebo and haloperidol in excited psychoses. Arch Gen Psychiatry 41 165-170, 1984a Klein E, Hefez A, Lavie P Effects of clomipramine infusion on sleep in depressed patients. Neuropsychobiology 1 85-88, 1984b Klein E, Lavie P, Meiraz R, et al Increased motor activity and recurrent manic episodes risk factors that predict rapid relapse in remitted bipolar disorder patients after lithium discontinuation—a double blind study. Biol Psychiatry 31 279-284, 1992... 

Opium, excitation, anxiety states and pain-induced unrest respond to it also prolonged manic states... 

The most common adverse effects with clonidine are hypotension, dry mouth, drowsiness, and dermatoiogicai reactions. These are usually mild, but hypotensive effects may be significant in normotensive manic patients. Higher doses (e.g., 0.8 to 1.2 mg) have also been reported to induce a paradoxicai excitement in some patients (270). 

Bipolar affective (manic-depressive) disorder occurs in 1-3% of the adult population. It may begin in childhood, but most cases are first diagnosed in the third and fourth decades of life. The key symptoms of bipolar disorder in the manic phase are excitement, hyperactivity, impulsivity, disinhibition, aggression, diminished need for sleep, psychotic symptoms in some (but not all) patients, and cognitive impairment. Depression in bipolar patients is phenomenologically similar to that of major depression, with the key features being depressed mood, diurnal variation, sleep disturbance, anxiety, and sometimes, psychotic symptoms. Mixed manic and depressive symptoms are also seen. Patients with bipolar disorder are at high risk for suicide. 

Affective disorders comprise the group of mental conditions that includes depression, bipolar syndrome (manic-depression), and several others that are characterized by a marked disturbance in a patient s mood.41 Patients with an affective disorder typically present with an inappropriate disposition, feeling unreasonably sad and discouraged (major depressive disorder) or fluctuating between periods of depression and excessive excitation and elation (bipolar disorder). 

Bipolar disorder A psychological disorder characterized by mood swings ranging from excitable (manic) periods to periods of depression (SYN manic-depression). 

When studying manic patients, who have a form of depression with periods of abnormal excitability and excessive activity, Australian psychiatrist John Cade found that lithium had a controlling effect on the patient s mania. He used lithium as a solvent when he attempted to inject the urine of manic patients into guinea pigs and found it made the urine less toxic. It was this finding that sparked his interest in lithium. In 1948 he injected lithium into ten patients and observed that lithium controlled their mania. 

The three most common types of depression are major depression, dysthymia, and bipolar disorder. Major depression, which may occur once but usually occurs several times in a person s life, will interfere with the ability to work, eat, sleep, study, and take pleasure in formerly enjoyed activities. Dysthymia is less severe than major depression but will interfere with feeling good and functioning well. Bipolar disorder (formerly called manic-depression) can be more serious than the other forms of depression. In this illness the person s mood swings from symptoms of depression to extreme excitement with over-activity and feelings of elation. This type of depression can progress to serious mental illness if not treated. 

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