The disease is manic stage. Depressive-manic psychosis is a disorder requiring treatment

Manic-depressive psychosis (MDP) refers to severe mental illnesses that occur with a sequential change of two phases of the disease - manic and depressive. Between them there is a period of mental “normality” (a bright interval).

Table of contents: 1. Causes of manic-depressive psychosis 2. How manic-depressive psychosis manifests itself - Symptoms of the manic phase - Symptoms of the depressive phase 3. Cyclothymia - a mild form of manic-depressive psychosis 4. How MDP occurs 5. Manic-depressive psychosis at different periods of life

Causes of manic-depressive psychosis

The onset of the disease is most often observed at the age of 25-30 years. Relative to common mental illnesses, the rate of MDP is about 10-15%. There are from 0.7 to 0.86 cases of the disease per 1000 population. Among women, pathology occurs 2-3 times more often than in men.

Please note: The causes of manic-depressive psychosis are still under study. A clear pattern of inheritance transmission of the disease has been noted.

The period of pronounced clinical manifestations of pathology is preceded by personality traits - cyclothymic accentuations. Suspiciousness, anxiety, stress and a number of diseases (infectious, internal) can serve as a trigger for the development of symptoms and complaints of manic-depressive psychosis.

The mechanism of development of the disease is explained by the result of neuropsychic breakdowns with the formation of foci in the cerebral cortex, as well as problems in the structures of the thalamic formations of the brain. Dysregulation of norepinephrine-serotonin reactions caused by a deficiency of these substances plays a role.

Disorders of the nervous system in MDP were dealt with by V.P. Protopopov.

How does manic-depressive psychosis manifest?

Depends on the phase of the disease. The disease can manifest itself in manic and depressive forms.

Symptoms of the manic phase

The manic phase can occur in the classic version and with some peculiarities.

In the most typical cases, it is accompanied by the following symptoms:

• inappropriately joyful, exalted and improved mood;
• sharply accelerated, unproductive thinking;
• inappropriate behavior, activity, mobility, manifestations of motor agitation.

The beginning of this phase in manic-depressive psychosis looks like a normal surge of strength. Patients are active, talk a lot, and try to take on many things at once. Their mood is high, overly optimistic. Memory sharpens. Patients talk and remember a lot. They see exceptional positiveness in all events that occur, even where there is none.

Excitement gradually increases. The time allotted for sleep is reduced, patients do not feel tired.

Gradually, thinking becomes superficial; people suffering from psychosis cannot focus their attention on the main thing, they are constantly distracted, jumping from topic to topic. In their conversation, unfinished sentences and phrases are noted - “language is ahead of thoughts.” Patients have to be constantly brought back to the unsaid topic.

The patients' faces turn pink, their facial expressions are excessively animated, and active hand gestures are observed. There is laughter, increased and inadequate playfulness; those suffering from manic-depressive psychosis talk loudly, scream, and breathe noisily.

Activity is unproductive. Patients simultaneously “grab at” a large number of things, but do not bring any of them to a logical end, and are constantly distracted. Hypermobility is often combined with singing, dance movements, and jumping.

In this phase of manic-depressive psychosis, patients seek active communication, interfere in all matters, give advice and teach others, and criticize. They show a pronounced overestimation of their skills, knowledge and capabilities, which are sometimes completely absent. At the same time, self-criticism is sharply reduced.

Sexual and food instincts are enhanced. Patients constantly want to eat, sexual motives clearly appear in their behavior. Against this background, they easily and naturally make a lot of acquaintances. Women begin to use a lot of cosmetics to attract attention.

In some atypical cases, the manic phase of psychosis occurs with:

• unproductive mania– in which there are no active actions and thinking does not accelerate;
• solar mania– behavior is dominated by an over-cheerful mood;
• angry mania– anger, irritability, dissatisfaction with others come to the fore;
• manic stupor- display of fun, accelerated thinking combined with motor passivity.

Symptoms of the depressive phase

There are three main symptoms in the depressive phase:

• painfully depressed mood;
• sharply slow pace of thinking;
• motor retardation up to complete immobilization.

The initial symptoms of this phase of manic-depressive psychosis are accompanied by sleep disturbances, frequent awakenings at night, and inability to sleep. Appetite gradually decreases, a state of weakness develops, constipation and pain in the chest appear. The mood is constantly depressed, the patients' faces are apathetic and sad. Growing depressive state. Everything present, past and future is presented in black and hopeless colors. Some patients with manic-depressive psychosis have ideas of self-blame, patients try to hide in inaccessible places, and experience painful experiences. The pace of thinking slows down sharply, the range of interests narrows, symptoms of “mental chewing gum” appear, patients repeat the same ideas, in which self-deprecating thoughts stand out. Those suffering from manic-depressive psychosis begin to remember all their actions and attach ideas of inferiority to them. Some consider themselves unworthy of food, sleep, respect. They feel that doctors are wasting their time and unreasonably prescribing medications for them, as if they are unworthy of treatment.

Please note: Sometimes it is necessary to transfer such patients to forced feeding.

Most patients experience muscle weakness, heaviness throughout the body, they move with great difficulty.

With a more compensated form of manic-depressive psychosis, patients independently look for the dirtiest work for themselves. Gradually, ideas of self-blame lead some patients to thoughts of suicide, which they can completely turn into reality.

Depression is most pronounced in the morning hours, before dawn. By evening, the intensity of her symptoms decreases. Patients mostly sit in inconspicuous places, lie on beds, and like to lie under the bed, as they consider themselves unworthy to be in a normal position. They are reluctant to make contact; they respond monotonously, slowly, without unnecessary words.

The faces bear the imprint of deep sorrow with a characteristic wrinkle on the forehead. The corners of the mouth are downturned, the eyes are dull and inactive.

Options for the depressive phase:

• asthenic depression– in patients with this type of manic-depressive psychosis, ideas of their own callousness in relation to loved ones dominate, they consider themselves unworthy parents, husbands, wives, etc.
• anxious depression– occurs with the manifestation of extreme degrees of anxiety and fear, leading patients to suicide. In this state, patients can fall into a stupor.

Almost all patients in the depressive phase experience Protopopov's triad - rapid heartbeat, constipation, dilated pupils.

Symptoms of disordersmanic-depressive psychosisfrom the internal organs:

• high blood pressure;
• dry skin and mucous membranes;
• lack of appetite;
• in women, disorders of the menstrual cycle.

In some cases, MDP is manifested by dominant complaints of persistent pain and discomfort in the body. Patients describe the most varied complaints from almost all organs and parts of the body.

Please note: Some patients try to resort to alcohol to alleviate complaints.

The depressive phase can last 5-6 months. Patients are unable to work during this period.

Cyclothymia is a mild form of manic-depressive psychosis

There are both a separate form of the disease and a milder version of TIR.

Cyclotomy occurs in phases:

• hypomania– the presence of an optimistic mood, an energetic state, active activity. Patients can work a lot without getting tired, have little rest and sleep, their behavior is quite orderly;
• subdepression– conditions with deterioration of mood, decline in all physical and mental functions, craving for alcohol, which disappears immediately after the end of this phase.

How does TIR proceed?

There are three forms of the disease:

• circular– periodic alternation of phases of mania and depression with a light interval (intermission);
• alternating– one phase is immediately replaced by another without a light interval;
• single-pole– identical phases of depression or mania occur in a row.

Please note: usually the phases last for 3-5 months, and light intervals can last several months or years.

In children, the onset of the disease may go unnoticed, especially if the manic phase is dominant. Young patients look hyperactive, cheerful, playful, which does not immediately make it possible to note unhealthy traits in their behavior compared to their peers.

In the case of the depressive phase, children are passive and constantly tired, complaining about their health. With these problems they get to the doctor faster.

In adolescence, the manic phase is dominated by symptoms of swagger and rudeness in relationships, and there is a disinhibition of instincts.

One of the features of manic-depressive psychosis in childhood and adolescence is the short duration of the phases (on average 10-15 days). With age, their duration increases.

Treatment measures are based on the phase of the disease. Severe clinical symptoms and the presence of complaints require treatment of manic-depressive psychosis in a hospital. Because, being depressed, patients can harm their health or commit suicide.

The difficulty of psychotherapeutic work lies in the fact that patients in the depression phase practically do not make contact. An important point in treatment during this period is the correct selection of antidepressants. The group of these drugs is diverse and the doctor prescribes them based on his own experience. Usually we're talking about about tricyclic antidepressants.

If the state of lethargy is dominant, antidepressants with analeptic properties are selected. Anxious depression requires the use of drugs with a pronounced calming effect.

In the absence of appetite, treatment of manic-depressive psychosis is supplemented with restorative medications

During the manic phase, antipsychotics with pronounced sedative properties are prescribed.

In case of cyclothymia, it is preferable to use milder tranquilizers and antipsychotics in small dosages.

Please note: quite recently, lithium salts were prescribed in all phases of treatment for MDP; at present, this method is not used by all doctors.

After exiting the pathological phases, patients should be included in treatment as soon as possible. different types activities, this is very important for maintaining socialization.

Explanatory work is carried out with patients' relatives about the need to create a normal psychological climate at home; a patient with symptoms of manic-depressive psychosis should not feel like an unhealthy person during light periods.

It should be noted that in comparison with other mental illnesses, patients with manic-depressive psychosis retain their intelligence and performance without degradation.

Interesting! From a legal point of view, a crime committed during the aggravation phase of TIR is considered not subject to criminal liability, but during the intermission phase it is considered criminally punishable. Naturally, in any condition, those suffering from psychosis are not subject to military service. In severe cases, disability is assigned.

Lotin Alexander, medical columnist

Manic-depressive psychosis is a mental illness that manifests itself with periodically changing mood disorders. The social danger of the sick is expressed in the tendency to commit an offense in the manic phase and suicidal acts in the depressive phase.

Manic-depressive psychosis usually occurs in the form of alternating manic and depressive moods. A manic mood is expressed in an unmotivated, cheerful mood, and a depressive mood is expressed in a depressed, pessimistic mood.

Manic-depressive psychosis is classified as bipolar affective disorder. A milder form with less severe symptoms of the disease is called cyclotomy.

Symptoms of manic-depressive psychosis are more often found among women. The average prevalence of the disease is seven patients per 1,000 people. Patients with manic-depressive psychosis represent up to 15% of the total number of patients who were hospitalized in psychiatric hospitals. Researchers define manic-depressive psychosis as an endogenous psychosis. Compounded heredity can provoke manic-depressive psychosis. Up to a certain point, patients appear completely healthy, but after stress, childbirth or a difficult life event, this disease can develop. Therefore, as a preventive measure, it is important to surround such people with a gentle emotional background, to protect them from stress and any stress.

In most cases, well-adapted, able-bodied people suffer from manic-depressive psychosis.

Manic-depressive psychosis causes

The disease is of an autosomal dominant type and often passes from mother to child, so manic-depressive psychosis owes its origin to heredity.

The causes of manic-depressive psychosis lie in the failure of higher emotional centers, which are located in the subcortical region. It is believed that disturbances in the processes of inhibition, as well as excitation in the brain, provoke the clinical picture of the disease.

The role of external factors (stress, relationships with others) is considered as associated causes diseases.

Manic-depressive psychosis symptoms

The main clinical signs of the disease are manic, depressive, and mixed phases, which change without a specific sequence. A characteristic difference is considered to be light interphase intervals (intermissions), in which there are no signs of illness and a complete critical attitude towards one’s painful state is noted. The patient retains his personal characteristics, professional skills and knowledge. Often attacks of the disease are replaced by intermediate full health. This classic course of the disease is rare, in which only manic or only depressive forms occur.

The manic phase begins with a change in self-perception, the emergence of vigor, a feeling of physical strength, a surge of energy, attractiveness and health. The sick person ceases to feel the unpleasant symptoms associated with him that previously bothered him. somatic diseases. The patient's consciousness is filled with pleasant memories, as well as optimistic plans. Unpleasant events from the past are repressed. The sick person is not able to notice expected and real difficulties. He perceives the world around him in rich, bright colors, while his olfactory and gustatory sensations are heightened. An increase in mechanical memory is recorded: the sick person remembers forgotten telephone numbers, movie titles, addresses, names, remembers current events. The speech of patients is loud and expressive; thinking is distinguished by speed and liveliness, good intelligence, but conclusions and judgments are superficial, very playful.

In a manic state, patients are restless, mobile, and fussy; their facial expressions are animated, the timbre of their voice does not match the situation, and their speech is accelerated. Patients are highly active, but sleep little, do not experience fatigue and desire constant activity. They make endless plans and try to implement them urgently, but do not complete them due to constant distractions.

It is typical for manic-depressive psychosis not to notice real difficulties. A pronounced manic state is characterized by disinhibition of drives, which manifests itself in sexual arousal, as well as extravagance. Due to severe distractibility and scattered attention, as well as fussiness, thinking loses focus, and judgments turn into superficial ones, but patients are able to show subtle observation.

The manic phase includes the manic triad: painfully elevated mood, accelerated thoughts, and motor agitation. Manic affect acts as a leading sign of a manic state. The patient experiences an elevated mood, feels happiness, feels good and is happy with everything. Pronounced for him is the aggravation of sensations, as well as perception, weakening of logical and strengthening of mechanical memory. The patient is characterized by ease of conclusions and judgments, superficiality of thinking, overestimation of one’s own personality, elevating one’s ideas to ideas of greatness, weakening of higher feelings, disinhibition of drives, as well as their instability and ease when switching attention. To a greater extent, those who are ill suffer from criticism of their own abilities or their successes in all areas. The desire of patients to be active leads to a decrease in productivity. Those who are ill eagerly take on new things, expanding their range of interests and acquaintances. Patients experience a weakening of higher feelings - distance, duty, tact, subordination. Patients become untied, dressing in bright clothes and using flashy cosmetics. They can often be found in entertainment establishments and are characterized by promiscuous intimate relationships.

The hypomanic state retains some awareness of the unusualness of everything that is happening and leaves the patient with the ability to correct behavior. In the climax period, the sick cannot cope with everyday and professional responsibilities and cannot correct their behavior. Often, sick people are hospitalized at the moment of transition from the initial stage to the culminating stage. Patients experience increased mood when reading poetry, laughing, dancing and singing. The ideational excitement itself is assessed by the sick as an abundance of thoughts. Their thinking is accelerated, one thought interrupts another. Thinking often reflects surrounding events, much less often memories from the past. Ideas of revaluation are manifested in organizational, literary, acting, linguistic, and other abilities. Patients read poetry with desire, offer help in treating other patients, and give instructions to health workers. At the peak of the climax stage (at the moment of manic frenzy), the sick do not make contact, are extremely excited, and also viciously aggressive. At the same time, their speech is confused, semantic parts fall out of it, which makes it similar to schizophrenic fragmentation. Moments of reverse development are accompanied by motor calming and the emergence of criticism. The intervals of calm currents gradually increase and states of excitement decrease. Exit from phases in patients can be observed for a long time, and hypomanic short-term episodes are noted. After a decrease in excitement, as well as equalization of mood, all the patient’s judgments take on a realistic character.

The depressive phase of patients is characterized by unmotivated sadness, which is combined with motor retardation and slowness of thinking. Low mobility in severe cases can turn into complete stupor. This phenomenon is called depressive stupor. Often, inhibition is not expressed so sharply and is partial in nature, while being combined with monotonous actions. Depressed patients often do not believe in their own strengths and are prone to ideas of self-blame. Those who are ill consider themselves worthless individuals and incapable of bringing happiness to their loved ones. Such ideas are closely related to the danger of attempting suicide, and this, in turn, requires special observation from those closest to them.

A deep depressive state is characterized by a feeling of emptiness in the head, heaviness and stiffness of thoughts. Patients speak with a significant delay and are reluctant to answer basic questions. In this case, sleep disturbances and loss of appetite are observed. Often the disease occurs at the age of fifteen, but there are cases at more late period(after forty years). The duration of attacks ranges from a couple of days to several months. Some severe attacks last up to a year. The duration of depressive phases is longer than manic phases, this is especially noted in old age.

Diagnosis of manic-depressive psychosis

Diagnosis of the disease is usually carried out in conjunction with other mental disorders (psychopathy, neurosis, depression, schizophrenia, psychosis).

To exclude the possibility of organic brain damage after injury, intoxication or infection, the patient is sent for electroencephalography, radiography, and MRI of the brain. An error in the diagnosis of manic-depressive psychosis can lead to improper treatment and aggravate the form of the disease. Most patients do not receive appropriate treatment, since individual symptoms of manic-depressive psychosis are quite easily confused with seasonal mood swings.

Manic-depressive psychosis treatment

Treatment of exacerbations of manic-depressive psychosis is carried out in a hospital setting, where sedatives (psycholeptic) as well as antidepressant (psychoanaleptic) with a stimulating effect are prescribed. Doctors prescribe antipsychotic drugs, which are based on Chlorpromazine or Levomepromazine. Their function is to relieve excitement, as well as a pronounced sedative effect.

Haloperedol or lithium salts are additional components in the treatment of manic-depressive psychosis. Lithium carbonate is used, which helps in the prevention of depressive states, as well as helping to treat manic states. These medications are taken under the supervision of doctors due to the possible development of neuroleptic syndrome, which is characterized by tremors of the limbs, impaired movement, and general muscle stiffness.

How to treat manic depressive psychosis?

Treatment of manic-depressive psychosis in its protracted form is carried out with electroconvulsive therapy in combination with fasting diets, as well as therapeutic fasting and sleep deprivation for several days.

Manic-depressive psychosis can be successfully treated with antidepressants. Prevention of psychotic episodes is carried out with the help of mood stabilizers, which act as mood stabilizers. The duration of taking these drugs significantly reduces the manifestations of signs of manic-depressive psychosis and delays the approach of the next phase of the disease as much as possible.

manic psychosis refers to a disorder of mental activity in which disturbances of affect predominate (

mood

). It should be noted that manic psychosis is only a variant of affective

psychoses

Which can occur in different ways. So, if manic psychosis is accompanied by depressive symptoms, then it is called manic-depressive (

this term is most popularized and widespread among the masses

Statistical data To date, there are no accurate statistics on the prevalence of manic psychosis among the population. This is due to the fact that from 6 to 10 percent of patients with this pathology are never hospitalized, and more than 30 percent are hospitalized only once in their lives. Thus, the prevalence of this pathology is very difficult to identify. On average, according to global statistics, this disorder affects from 0.5 to 0.8 percent of people. According to a study conducted under the leadership of the World Health Organization in 14 countries, the incidence rate has recently increased significantly.

Among patients with mental illness admitted to hospital, the incidence of manic psychosis varies from 3 to 5 percent. The difference in data explains the disagreement among authors in diagnostic methods, differences in understanding the boundaries of this disease, and other factors. An important characteristic of this disease is the likelihood of its development. According to doctors, this figure for each person is from 2 to 4 percent. Statistics show that this pathology occurs in women 3–4 times more often than in men. In most cases, manic psychosis develops between the ages of 25 and 44. This age should not be confused with the onset of the disease, which occurs more early age. Thus, among all registered cases, the proportion of patients at this age is 46.5 percent. Pronounced attacks of the disease often appear after 40 years.

Interesting facts

Some modern scientists suggest that manic and manic-depressive psychosis is the result of human evolution. Such a manifestation of the disease as a depressive state can serve as a defense mechanism in case of strong

Biologists believe that the disease could have arisen as a result of human adaptation to the extreme climate of the northern temperate zone. Increased sleep duration, decreased appetite and other symptoms

depression

helped to survive long winters. The affective state in the summer increased energy potential and helped to perform a large number of tasks within a short period of time.

Affective psychoses have been known since the time of Hippocrates. Then the manifestations of the disorder were classified as separate diseases and defined as mania and melancholia. As an independent disease, manic psychosis was described in the 19th century by scientists Falret and Baillarger.

One of the interesting factors about this disease is the connection between mental disorders and the patient’s creative skills. The first to declare that there is no clear line between genius and insanity was the Italian psychiatrist Cesare Lombroso, who wrote a book on this topic, “Genius and Insanity.” Later, the scientist admits that at the time of writing the book he himself was in a state of ecstasy. Another serious study on this topic was the work of the Soviet geneticist Vladimir Pavlovich Efroimson. While studying manic-depressive psychosis, the scientist came to the conclusion that many famous people suffered from this disorder. Efroimson diagnosed signs of this disease in Kant, Pushkin, and Lermontov.

A proven fact in world culture is the presence of manic-depressive psychosis in the artist Vincent Van Gogh. The bright and unusual fate of this talented person attracted the attention of the famous German psychiatrist Karl Theodor Jaspers, who wrote the book “Strindberg and Van Gogh.”

Among the celebrities of our time, Jean-Claude Van Damme, actresses Carrie Fisher and Linda Hamilton suffer from manic-depressive psychosis.

Causes of manic psychosis The causes (etiology) of manic psychosis, like many other psychoses, are currently unknown. There are several compelling theories regarding the origin of this disease.
Hereditary (genetic) theory

This theory is partially supported by numerous genetic studies. The results of these studies indicate that 50 percent of patients with manic psychosis have one of their parents suffering from some kind of affective disorder. If one of the parents suffers from a unipolar form of psychosis (

that is, either depressive or manic

), then the risk for a child to acquire manic psychosis is 25 percent. If there is a bipolar form of disorder in the family (

that is, a combination of both manic and depressive psychosis

), then the risk percentage for the child increases two or more times. Studies among twins indicate that psychosis develops in 20–25 percent of fraternal twins and 66–96 percent of identical twins.

Proponents of this theory argue in favor of the existence of a gene that is responsible for the development of this disease. Thus, some studies have identified a gene that is localized on the short arm of chromosome 11. These studies were conducted in families with a history of manic psychosis.

Relationship between heredity and environmental factors Some experts attach importance not only to genetic factors, but also to environmental factors. Environmental factors are, first of all, family and social. The authors of the theory note that under the influence of external unfavorable conditions decompensation of genetic abnormalities occurs. This is confirmed by the fact that the first attack of psychosis occurs at that period of a person’s life in which some important events occur. This could be family problems (divorce), stress at work, or some kind of socio-political crisis.

It is believed that the contribution of genetic prerequisites is approximately 70 percent, and environmental - 30 percent. The percentage of environmental factors increases in pure manic psychosis without depressive episodes.

Constitutional Predisposition Theory

This theory is based on research by Kretschmer, who discovered a certain connection between the personality characteristics of patients with manic psychosis, their physique and temperament. So, he identified three characters (

or temperament

) - schizothymic, ixothymic and cyclothymic. Schizotimics are characterized by unsociability, withdrawal and shyness. According to Kretschmer, these are powerful people and idealists. Ixothymic people are characterized by restraint, calmness and inflexible thinking. Cyclothymic temperament is characterized by increased emotionality, sociability and rapid adaptation to society. They are characterized by rapid mood swings - from joy to sadness, from passivity to activity. This cycloid temperament is predisposed to the development of manic psychosis with depressive episodes, that is, to manic-depressive psychosis. Today, this theory finds only partial confirmation, but is not considered as a pattern.

Monoamine theory

This theory has received the most widespread and confirmation. It looks at the deficiency or excess of certain monoamines in nerve tissue as a cause of psychosis. Monoamines are biologically active substances that are involved in the regulation of processes such as memory, attention, emotions, and arousal. In manic psychosis, monoamines such as norepinephrine and serotonin are of greatest importance. They facilitate motor and emotional activity, improve mood, and regulate vascular tone. An excess of these substances provokes symptoms of manic psychosis, a deficiency – depressive psychosis. Thus, in manic psychosis, there is an increased sensitivity of the receptors of these monoamines. In manic-depressive disorder, there is an oscillation between excess and deficiency.

The principle of increasing or decreasing these substances underlies the action of drugs used for manic psychosis.

Theory of endocrine and water-electrolyte shifts

This theory examines functional disorders of the endocrine glands (

for example, sexual

) as a cause of depressive symptoms of manic psychosis. The main role in this case is played by the disturbance of steroid metabolism. Meanwhile, water-electrolyte metabolism takes part in the origin of manic syndrome. This is confirmed by the fact that the main medicine in the treatment of manic psychosis is lithium. Lithium weakens the conduction of nerve impulses in brain tissue, regulating the sensitivity of receptors and neurons. This is achieved by blocking the activity of other ions in nerve cell, for example, magnesium.

The theory of disrupted biorhythms

This theory is based on disorders of the sleep-wake cycle. Thus, patients with manic psychosis have a minimal need for sleep. If manic psychosis is accompanied by depressive symptoms, then

sleep disorders

in the form of its inversion (

change nap and night

), in the form of difficulty falling asleep, frequent waking up at night, or in the form of a change in sleep phases.

It is noted that in healthy people, disturbances in sleep periodicity, related to work or other factors, can cause affective disorders.

Symptoms and signs of manic psychosis

Symptoms of manic psychosis depend on its form. Thus, there are two main forms of psychosis - unipolar and bipolar. In the first case, in the clinic of psychosis, the main dominant symptom is manic syndrome. In the second case, manic syndrome alternates with depressive episodes.

Monopolar manic psychosis

This type of psychosis usually begins between the ages of 35 and older. The clinical picture of the disease is very often atypical and inconsistent. Its main manifestation is the phase of a manic attack or mania.

Manic attack This state is expressed in increased activity, initiative, interest in everything and high spirits. At the same time, the patient’s thinking accelerates and becomes galloping, fast, but at the same time, due to increased distractibility, unproductive. There is an increase in basic drives - appetite and libido increase, and the need for sleep decreases. On average, patients sleep 3–4 hours a day. They become overly sociable and try to help everyone with everything. At the same time, they make casual acquaintances and enter into chaotic sexual relationships. Often patients leave home or bring strangers into the house. The behavior of manic patients is absurd and unpredictable; they often begin to abuse alcohol and psychoactive substances. They often get involved in politics - they chant slogans with fervor and a hoarse voice. Such states are characterized by an overestimation of one’s capabilities.

Patients do not realize the absurdity or illegality of their actions. They feel a surge of strength and energy, considering themselves absolutely adequate. This state is accompanied by various overvalued or even delusional ideas. Ideas of greatness, high birth, or ideas of special purpose are often observed. It is worth noting that despite increased arousal, patients in a state of mania treat others favorably. Only occasionally are mood swings observed, which are accompanied by irritability and explosiveness.

Such a cheerful mania develops very quickly - within 3 to 5 days. Its duration ranges from 2 to 4 months. The reverse dynamics of this condition can be gradual and last from 2 to 3 weeks.

"Mania without mania" This condition is observed in 10 percent of cases of unipolar manic psychosis. The leading symptom in this case is motor excitation without increasing the speed of ideation reactions. This means that there is no increased initiative or drive. Thinking does not accelerate, but, on the contrary, slows down, concentration of attention is maintained (which is not observed with pure mania).

Increased activity in this case is characterized by monotony and lack of a sense of joy. Patients are mobile, easily establish contacts, but their mood is dull. Feelings of a surge of strength, energy and euphoria that are characteristic of classic manias are not observed.

The duration of this condition can drag on and reach up to 1 year.

Course of monopolar manic psychosis Unlike bipolar psychosis, unipolar psychosis may experience prolonged phases of manic states. So, they can last from 4 months (average duration) to 12 months (protracted course). The frequency of occurrence of such manic states is on average one phase every three years. Also, such psychosis is characterized by a gradual onset and the same ending of manic attacks. In the first years, there is a seasonality of the disease - often manic attacks develop in the fall or spring. However, over time, this seasonality is lost.

There is a remission between two manic episodes. During remission emotional background the patient is relatively stable. Patients do not show signs of lability or agitation. A high professional and educational level is maintained for a long time.

Bipolar manic psychosis

During bipolar manic psychosis, there is an alternation of manic and depressive states. Middle age This form of psychosis lasts up to 30 years. There is a clear connection with heredity - the risk of developing bipolar disorder in children with a family history is 15 times higher than in children without it.

Onset and course of the disease In 60–70 percent of cases, the first attack occurs during a depressive episode. There is deep depression with pronounced suicidal behavior. After the end of a depressive episode, there is a long period of light - remission. It can last for several years. After remission, a repeated attack is observed, which can be either manic or depressive.

Symptoms of bipolar disorder depend on its type.

Forms of bipolar manic psychosis include:

• bipolar psychosis with a predominance of depressive states;
• bipolar psychosis with a predominance of manic states;
• a distinct bipolar form of psychosis with an equal number of depressive and manic phases.
• circulatory form.

Bipolar psychosis with predominance of depressive states The clinical picture of this psychosis includes long-term depressive episodes and short-term manic states. The debut of this form is usually observed at 20–25 years of age. The first depressive episodes are often seasonal. In half of the cases, depression is of an anxious nature, which increases the risk of suicide several times.

The mood of depressed patients decreases; patients note a “feeling of emptiness.” Also no less characteristic is the feeling of “mental pain”. A slowdown is observed both in the motor sphere and in the ideational sphere. Thinking becomes viscous, there is difficulty in assimilating new information and concentrating. Appetite can either increase or decrease. Sleep is unstable and intermittent throughout the night. Even if the patient managed to fall asleep, in the morning there is a feeling of weakness. A frequent patient complaint is shallow sleep with nightmares. In general, mood fluctuations throughout the day are typical for this condition - an improvement in well-being is observed in the second half of the day.

Very often, patients express ideas of self-blame, blaming themselves for the troubles of relatives and even strangers. Ideas of self-blame are often intertwined with statements about sinfulness. Patients blame themselves and their fate, being overly dramatic.

Hypochondriacal disorders are often observed in the structure of a depressive episode. At the same time, the patient shows very pronounced concern about his health. He constantly looks for diseases in himself, interpreting various symptoms like fatal diseases. Passivity is observed in behavior, and claims towards others are observed in dialogue.

Hysterical reactions and melancholia may also be observed. The duration of such a depressive state is about 3 months, but can reach 6. The number of depressive states is greater than manic ones. They are also superior in strength and severity to a manic attack. Sometimes depressive episodes can repeat one after another. Between them, short-term and erased manias are observed.

Bipolar psychosis with predominance of manic states In the structure of this psychosis, vivid and intense manic episodes are observed. The development of a manic state can be very slow and sometimes drags on (up to 3–4 months). Recovery from this state can take from 3 to 5 weeks. Depressive episodes are less intense and have a shorter duration. Manic attacks in the clinic of this psychosis develop twice as often as depressive ones.

The debut of psychosis occurs at the age of 20 and begins with a manic attack. The peculiarity of this form is that very often depression develops after mania. That is, there is a kind of twinning of phases, without clear gaps between them. Such dual phases are observed at the onset of the disease. Two or more phases followed by remission are called a cycle. Thus, the disease consists of cycles and remissions. The cycles themselves consist of several phases. The duration of the phases, as a rule, does not change, but the duration of the entire cycle increases. Therefore, 3 and 4 phases can appear in one cycle.

The subsequent course of psychosis is characterized by the occurrence of dual phases (

manic-depressive

), and single (

purely depressive

). The duration of the manic phase is 4 – 5 months; depressed – 2 months.

As the disease progresses, the frequency of the phases becomes more stable and amounts to one phase every year and a half. Between cycles there is a remission, which lasts on average 2 – 3 years. However, in some cases it can be more persistent and long-lasting, reaching a duration of 10–15 years. During the period of remission, the patient retains some lability in mood, changes in personal characteristics, and a decrease in social and labor adaptation.

Distinct bipolar psychosis This form is characterized by a regular and distinct change of depressive and manic phases. The onset of the disease occurs between the ages of 30 and 35 years. Depressive and manic states last longer than other forms of psychosis. At the onset of the disease, the duration of the phases is approximately 2 months. However, the phases are gradually increased to 5 months or more. There is a regularity of their appearance - one to two phases per year. The duration of remission is from two to three years.

At the onset of the disease, seasonality is also observed, that is, the beginning of the phases coincides with the autumn-spring period. But gradually this seasonality is lost.

Most often, the disease begins with a depressive phase.

The stages of the depressive phase are:

• initial stage– there is a slight decrease in mood, weakening of mental tone;
• stage of increasing depression– characterized by the appearance of an alarming component;
• stage of severe depression– all symptoms of depression reach a maximum, suicidal thoughts appear;
• reduction of depressive symptoms– depressive symptoms begin to disappear.

Course of the manic phase The manic phase is characterized by the presence of increased mood, motor agitation and accelerated ideational processes.

The stages of the manic phase are:

• hypomania– characterized by a feeling of spiritual uplift and moderate motor excitement. Appetite moderately increases and sleep duration decreases.
• severe mania– ideas of grandeur and pronounced excitement appear - patients constantly joke, laugh and build new perspectives; Sleep duration is reduced to 3 hours per day.
• manic frenzy– excitement is chaotic, speech becomes incoherent and consists of fragments of phrases.
• motor sedation– the elevated mood remains, but motor excitement goes away.
• reduction of mania– mood returns to normal or even decreases slightly.

Circular form of manic psychosis This type of psychosis is also called the continua type. This means that between the phases of mania and depression there are practically no remissions. This is the most malignant form psychosis.
Diagnosis of manic psychosis

Diagnosis of manic psychosis must be carried out in two directions - firstly, to prove the presence of affective disorders, that is, the psychosis itself, and secondly, to determine the type of this psychosis (

monopolar or bipolar

The diagnosis of mania or depression is based on the diagnostic criteria of the World Classification of Diseases (

) or based on the criteria of the American Psychiatric Association (

Criteria for manic and depressive episodes according to the ICD

Type of affective disorder	Criteria
Manic episode	increased activity; motor restlessness; "speech pressure"; rapid flow of thoughts or their confusion, the phenomenon of “jump of ideas”; decreased need for sleep; increased distractibility; increased self-esteem and reassessment of one’s own capabilities; ideas of greatness and special purpose can crystallize into delusions; in severe cases, delusions of persecution and high origin are noted.
Depressive episode	decreased self-esteem and sense of self-confidence; ideas of self-blame and self-deprecation; decreased performance and decreased concentration; disturbance of appetite and sleep; suicidal thoughts.

After the presence of an affective disorder has been established, the doctor determines the type of manic psychosis.

Criteria for psychosis

The American Psychiatric Association classifier identifies two types of bipolar disorder - type 1 and type 2.

Diagnostic criteria for bipolar disorder according toDSM

Type of psychosis	Criteria
Bipolar disorder first type	This psychosis is characterized by clearly defined manic phases, in which social inhibition is lost, attention is not maintained, and a rise in mood is accompanied by energy and hyperactivity.
Bipolar II disorder (may develop into type 1 disorder)	Instead of classic manic phases, hypomanic phases are present. Hypomania is mild degree mania without psychotic symptoms (no delusions or hallucinations that may be present with mania). Hypomania is characterized by the following: slight lift in mood; talkativeness and familiarity; feeling of well-being and productivity; increased energy; increased sexual activity and decreased need for sleep. Hypomania does not cause problems with work or daily life.

Cyclothymia A special variant of the mood disorder is cyclothymia. This is a state of chronic unstable mood with periodic episodes of mild depression and elation. However, this elation or, conversely, depression of mood does not reach the level of classic depression and mania. Thus, typical manic psychosis does not develop.

Such instability in mood develops at a young age and becomes chronic. Periods of stable mood occur periodically. These cyclical changes in the patient’s activity are accompanied by changes in appetite and sleep.

Various diagnostic scales are used to identify certain symptoms in patients with manic psychosis.

Scales and questionnaires used in the diagnosis of manic psychosis

Affective Disorders Questionnaire (Mood Disorders Questionnaire)	This is a screening scale for bipolar psychosis. Includes questions regarding the states of mania and depression.
Young Mania Rating Scale	The scale consists of 11 items, which are assessed during interviews. Items include mood, irritability, speech, and thought content.
Bipolar Spectrum Diagnostic Scale (Bipolar Spectrum Diagnostic Scale)	The scale consists of two parts, each of which includes 19 questions and statements. The patient must answer whether this statement suits him.
ScaleBeka (Beck Depression Inventory)	Testing is carried out in the form of a self-survey. The patient answers the questions himself and rates the statements on a scale from 0 to 3. After this, the doctor adds up the total and determines the presence of a depressive episode.

Treatment of manic psychosis How can you help a person in this condition?

Family support plays an important role in the treatment of patients with psychosis. Depending on the form of the disease, loved ones should take measures to help prevent exacerbation of the disease. One of the key factors of care is suicide prevention and assistance in timely access to a doctor.

Help for manic psychosis When caring for a patient with manic psychosis, the environment should monitor and, if possible, limit the patient's activities and plans. Relatives should be aware of possible behavioral abnormalities during manic psychosis and do everything to reduce the negative consequences. Thus, if the patient can be expected to spend a lot of money, it is necessary to limit access to material resources. Being in a state of excitement, such a person does not have time or does not want to take medications. Therefore, it is necessary to ensure that the patient takes the medications prescribed by the doctor. Also, family members should monitor the implementation of all recommendations given by the doctor. Taking into account the patient's increased irritability, tact should be exercised and support should be provided discreetly, showing restraint and patience. You should not raise your voice or shout at the patient, as this can increase irritation and provoke aggression on the part of the patient.

If signs of excessive agitation or aggression occur, loved ones of a person with manic psychosis should be prepared to ensure prompt hospitalization.

Family support for manic depression Patients with manic-depressive psychosis require close attention and support from those close to them. Being in a depressed state, such patients need help, since they cannot cope with the fulfillment of vital needs on their own.

Help from loved ones with manic-depressive psychosis includes the following:

• organization of daily walks;
• feeding the patient;
• involving patients in homework;
• control of taking prescribed medications;
• providing comfortable conditions;
• visiting sanatoriums and resorts (in remission).

Walking in the fresh air has a positive effect on the patient’s general condition, stimulates appetite and helps to distract from worries. Patients often refuse to go out, so relatives must patiently and persistently force them to go outside. Another important task when caring for a person with this condition is feeding. When preparing food, preference should be given to foods with a high content of vitamins. The patient's menu should include dishes that normalize intestinal activity to prevent constipation. Physical labor, which must be done together, has a beneficial effect. At the same time, care must be taken to ensure that the patient does not become overtired. Sanatorium-resort treatment helps speed up recovery. The choice of location must be made in accordance with the doctor's recommendations and the patient's preferences.

In severe depressive episodes, the patient may remain in a state of stupor for a long time. At such moments, you should not put pressure on the patient and encourage him to be active, as this can aggravate the situation. A person may have thoughts about his own inferiority and worthlessness. You should also not try to distract or entertain the patient, as this can cause greater depression. The task of the close environment is to ensure complete peace and qualified medical care. Timely hospitalization will help avoid suicide and other negative consequences of this disease. One of the first symptoms of worsening depression is the patient's lack of interest in the events and actions happening around him. If this symptom is accompanied by poor sleep and

lack of appetite

You must consult a doctor immediately.

Suicide Prevention When caring for a patient with any form of psychosis, those close to them should take into account possible suicide attempts. The highest incidence of suicide is observed in the bipolar form of manic psychosis.

To lull the vigilance of relatives, patients often use a variety of methods, which are quite difficult to foresee. Therefore, it is necessary to monitor the patient’s behavior and take measures when identifying signs that indicate a person has an idea of ​​suicide. Often people prone to suicidal ideation reflect on their uselessness, the sins they have committed or great guilt. The patient's belief that he has an incurable disease (

in some cases – dangerous for the environment

) disease may also indicate that the patient may attempt suicide. The sudden reassurance of the patient after a long period of depression should make loved ones worry. Relatives may think that the patient's condition has improved, when in fact he is preparing for death. Patients often put their affairs in order, write wills, and meet people they have not seen for a long time.

Measures that will help prevent suicide are:

• Risk assessment– if the patient takes real preparatory measures (gifts of favorite things, gets rid of unnecessary items, is interested in possible methods of suicide), you should consult a doctor.
• Taking all conversations about suicide seriously– even if it seems unlikely to relatives that the patient could commit suicide, it is necessary to take into account even indirectly raised topics.
• Limitation of capabilities– you need to keep piercing and cutting objects, medications, and weapons away from the patient. You should also close windows, doors to the balcony, and gas supply valve.

The greatest vigilance should be exercised when the patient awakens, since the overwhelming number of suicide attempts occur in the morning.

Moral support plays an important role in preventing suicide. When people are depressed, they are not inclined to listen to any advice or recommendations. Most often, such patients need to be freed from their own pain, so family members need to be attentive listeners. A person suffering from manic-depressive psychosis needs to talk more himself and relatives should facilitate this.

Often, those close to a patient with suicidal thoughts may feel resentful, powerless, or angry. You should fight such thoughts and, if possible, remain calm and express understanding to the patient. A person should not be judged for having thoughts of suicide, as such behavior can cause withdrawal or push one to commit suicide. You should not argue with the patient, offer unjustified consolations and ask inappropriate questions.

Questions and comments that should be avoided by relatives of patients:

• I hope you're not planning to commit suicide- this formulation contains a hidden answer “no”, which relatives want to hear, and there is a high probability that the patient will answer exactly that way. In this case, a direct question “are you thinking about suicide” is appropriate, which will allow the person to talk out.
• What do you lack, you live better than others- such a question will cause the patient even greater depression.
• Your fears are unfounded- this will humiliate a person and make him feel unnecessary and useless.

Preventing relapse of psychosis The assistance of relatives in organizing an orderly lifestyle for the patient will help reduce the likelihood of relapse, balanced nutrition, regular medication intake, proper rest. An exacerbation can be provoked by premature discontinuation of therapy, violation of the medication regimen, physical overexertion, climate change, and emotional shock. Signs of an impending relapse include not taking medications or visiting a doctor, bad dream, change in habitual behavior.

Actions that relatives should take if the patient's condition worsens include :

• contacting your doctor for treatment correction;
• elimination of external stress and irritating factors;
• minimizing changes in the patient's daily routine;
• ensuring peace of mind.

Drug treatment Adequate drug treatment is the key to long-term and stable remission, and also reduces mortality due to suicide.

The choice of medication depends on which symptom prevails in the clinic of psychosis - depression or mania. The main drugs in the treatment of manic psychosis are mood stabilizers. This is a class of drugs that act to stabilize mood. The main representatives of this group of drugs are lithium salts, valproic acid and some atypical antipsychotics. Among the atypical antipsychotics, the drug of choice today is aripiprazole.

Also used in the treatment of depressive episodes in the structure of manic psychosis

antidepressants

eg bupropion

Drugs from the class of mood stabilizers used in the treatment of manic psychosis

Name of the medication	Mechanism of action	How to take
Lithium carbonate	Stabilizes mood, eliminates symptoms of psychosis, and has a moderate sedative effect.	Orally in tablet form. The dose is set strictly individually. It is necessary that the selected dose ensures a constant concentration of lithium in the blood within the range of 0.6 - 1.2 millimoles per liter. So, with a dose of the drug of 1 gram per day, a similar concentration is achieved after two weeks. It is necessary to take the drug even during remission.
Sodium valproate	Smoothes mood swings, prevents the development of mania and depression. It has a pronounced antimanic effect, effective for mania, hypomania and cyclothymia.	Inside, after eating. The initial dose is 300 mg per day (divided into two doses of 150 mg). The dose is gradually increased to 900 mg (two times 450 mg), and in severe manic states - 1200 mg.
Carbamazepine	Inhibits the metabolism of dopamine and norepinephrine, thereby providing an antimanic effect. Eliminates irritability, aggression and anxiety.	Orally from 150 to 600 mg per day. The dose is divided into two doses. As a rule, the drug is used in combination therapy with other medications.
Lamotrigine	Mainly used for maintenance therapy of manic psychosis and prevention of mania and depression.	The initial dose is 25 mg twice a day. Gradually increase to 100 - 200 mg per day. Maximum dose– 400 mg.

Various regimens are used in the treatment of manic psychosis. The most popular is monotherapy (

one medication is used

) lithium preparations or sodium valproate. Other experts prefer combination therapy, when two or more drugs are used. The most common combinations are lithium (

or sodium valproate

) with an antidepressant, lithium with carbamazepine, sodium valproate with lamotrigine.

The main problem associated with the prescription of mood stabilizers is their toxicity. Most dangerous drug in this regard is lithium. Lithium concentration is difficult to maintain at the same level. A missed dose of the drug once can cause an imbalance in lithium concentration. Therefore, it is necessary to constantly monitor the level of lithium in the blood serum so that it does not exceed 1.2 millimoles. Exceeding the permissible concentration leads to toxic effects of lithium. The main side effects are associated with kidney dysfunction, heart rhythm disturbances and inhibition of hematopoiesis (

process of blood cell formation

). Other mood stabilizers also need constant

biochemical blood test

Antipsychotic drugs and antidepressants used in the treatment of manic psychosis

Name of the medication	Mechanism of action	How to take
Aripiprazole	Regulates the concentration of monoamines (serotonin and norepinephrine) in the central nervous system. The drug, having a combined effect (both blocking and activating), prevents both the development of mania and depression.	The drug is taken orally in tablet form once a day. The dose ranges from 10 to 30 mg.
Olanzapine	Eliminates symptoms of psychosis - delusions, hallucinations. Dulls emotional arousal, reduces initiative, corrects behavioral disorders.	The initial dose is 5 mg per day, after which it is gradually increased to 20 mg. A dose of 20 – 30 mg is most effective. Taken once a day, regardless of meals.
Bupropion	It disrupts the reuptake of monoamines, thereby increasing their concentration in the synaptic cleft and in brain tissue.	The initial dose is 150 mg per day. If the chosen dose is ineffective, it is raised to 300 mg per day.
Sertraline	Has an antidepressant effect, eliminating anxiety and restlessness.	The initial dose is 25 mg per day. The drug is taken once a day - in the morning or evening. The dose is gradually increased to 50 – 100 mg. The maximum dose is 200 mg per day.

Antidepressant drugs are used for depressive episodes. It must be remembered that bipolar manic psychosis is accompanied by the greatest risk of suicide, so it is necessary to treat depressive episodes well.

Prevention of manic psychosis What should you do to avoid manic psychosis?

To date, the exact cause of the development of manic psychosis has not been established. Numerous studies indicate that heredity plays an important role in the occurrence of this disease, and most often the disease is transmitted through generations. It should be understood that the presence of manic psychosis in relatives does not determine the disorder itself, but a predisposition to the disease. Under the influence of a number of circumstances, a person experiences disorders in the parts of the brain that are responsible for controlling the emotional state.

It is practically impossible to completely avoid psychosis and develop preventive measures.

Much attention is paid to early diagnosis of the disease and timely treatment. You need to know that some forms of manic psychosis are accompanied by remission at 10–15 years. In this case, regression of professional or intellectual qualities does not occur. This means that a person suffering from this pathology can realize himself both professionally and in other aspects of his life.

At the same time, it is necessary to remember high risk heredity in manic psychosis. Married couples where one of the family members suffers from psychosis should be instructed about the high risk of manic psychosis in unborn children.

What can trigger the onset of manic psychosis?

Various stress factors can trigger the onset of psychosis. Like most psychoses, manic psychosis is a polyetiological disease, which means that many factors are involved in its occurrence. Therefore, it is necessary to take into account a combination of both external and internal factors (

burdened anamnesis, character traits

Factors that can provoke manic psychosis are:

• character traits;
• disorders endocrine system;
• hormonal surges;
• congenital or acquired brain diseases;
• injuries, infections, various bodily diseases;
• stress.

The most susceptible to this personality disorder with frequent mood changes are melancholic, suspicious and insecure people. These individuals develop a state of chronic anxiety that debilitates them nervous system and leads to psychosis. Some researchers of this mental disorder assign a large role to such a character trait as an excessive desire to overcome obstacles in the presence of a strong stimulus. The desire to achieve a goal causes the risk of developing psychosis.

Emotional turmoil is more of a provoking than a causative factor. There is ample evidence that problems in interpersonal relationships and recent stressful events contribute to the development of episodes and relapses of manic psychosis. According to studies, more than 30 percent of patients with this disease have experiences of negative relationships in childhood and early suicide attempts. Attacks of mania are a kind of manifestation of the body’s defenses, provoked by stressful situations. The excessive activity of such patients allows them to escape from difficult experiences. Often the cause of manic psychosis is hormonal changes in the body during puberty or

menopause

Postpartum depression can also act as a trigger for this disorder.

Many experts note the connection between psychosis and human biorhythms. Thus, the development or exacerbation of the disease often occurs in spring or autumn. Almost all doctors note a strong connection in the development of manic psychosis with previous brain diseases, endocrine system disorders and infectious processes.

Factors that can provoke an exacerbation of manic psychosis are:

• interruption of treatment;
• disruption of daily routine (lack of sleep, busy work schedule);
• conflicts at work, in the family.

Interruption of treatment is the most common cause a new attack in manic psychosis. This is due to the fact that patients quit treatment at the first signs of improvement. In this case, there is no complete reduction of symptoms, but only their smoothing. Therefore, at the slightest stress, the condition decompensates and a new and more intense manic attack develops. In addition, resistance (addiction) to the chosen drug is formed.

In case of manic psychosis, adherence to a daily routine is no less important. Full sleep is as important as taking medications. It is known that sleep disturbance in the form of a decrease in the need for it is the first symptom of an exacerbation. But, at the same time, its absence can provoke a new manic or depressive episode. This is confirmed by various studies in the field of sleep, which have found that in patients with psychosis the duration of various phases of sleep changes.

• Reasons for the development of TIR
• Symptoms of manic-depressive psychosis
• Treatment of manic-depressive psychosis

What is manic-depressive psychosis?

Manic-depressive psychosis is a complex mental illness that occurs in a two-phase form. One of them, the manic form, has a highly excited mood, the other, the depressive form, is determined by the patient’s depressed mood. Between them, a time period is formed when the patient shows completely adequate behavior - mental disorders fade away, and the basic personal qualities of the patient’s psyche are preserved.

The states of mania and depression were known to doctors back in the days of the Ancient Roman Empire, but the sharp difference between the phases from each other over a long period served as the basis for considering them various diseases. Only at the end of the 19th century, the German psychiatrist E. Kraepelin, as a result of observations of patients suffering from attacks of mania and depression, made a conclusion about two phases of one disease, consisting of extremes - cheerful, excited (manic) and melancholic, depressed (depressive).

Reasons for the development of TIR

This mental illness has hereditary and constitutional origins. It is transmitted genetically, but only to those who have suitable qualities of an anatomical and physiological nature, that is, a suitable cyclothymic constitution. Today, a connection has been established between this disease and impaired transmission of nerve impulses in certain areas of the brain, and more specifically in the hypothalamus. Nerve impulses are responsible for the formation of feelings - the main reactions of the mental type. MDP in most cases develops in young people, with a much higher percentage of cases among women.

Found an error in the text? Select it and a few more words, press Ctrl + Enter

Symptoms of manic-depressive psychosis

In most cases, the depressive phase prevails over the manic phase in terms of frequency of manifestation. The state of depression is expressed by the presence of melancholy and a view of the world around us only in black. Not a single positive circumstance can influence the psychological state of the patient. The patient's speech becomes quiet, slow, the mood prevails in which he immerses himself inside himself, his head constantly bows down. The patient’s motor functions slow down, and the retardation of movements at times reaches the level of depressive stupor.

Often, the feeling of melancholy develops into bodily sensations (pain in the chest area, heaviness in the heart). The emergence of ideas about guilt and sins can lead the patient to suicidal attempts. At the peak of depression, manifested by lethargy, the possibility of committing suicide is difficult due to the difficulty of translating thoughts into real action. For this phase, characteristic physical indicators are an increased heartbeat, dilated pupils and spastic constipation, the presence of which is caused by spasms of the muscles of the gastrointestinal tract.

The symptoms of the manic phase are the complete opposite of the depressive phase. They are composed of three factors that can be called basic: the presence of manic affect (pathologically elevated mood), excitement in speech and movements, acceleration of mental processes (mental arousal). Explicit manifestation of the phase is rare; as a rule, it has an erased appearance. The patient’s mood is at the peak of positivity, ideas of greatness are born in him, all thoughts are filled with an optimistic mood.

The process of increasing this phase leads to confusion in the patient’s thoughts and the emergence of frenzy in movements; sleep lasts a maximum of three hours a day, but this does not become an obstacle to vigor and excitement. MDP can occur against the background of mixed conditions, where any symptoms inherent in one phase are replaced by symptoms of another. The course of manic-depressive psychosis in a blurred form is observed much more often than the traditional course of the disease.

The appearance of MDP in a milder form is called cyclothymia. With it, the phases proceed in a smoothed version, and the patient can even remain able to work. Marked hidden forms depression caused by long-term illness or exhaustion. The pitfall of erased forms is their inexpressiveness; when the depressive phase is left unattended, it can lead the patient to attempt suicide.

Treatment of manic-depressive psychosis

Treatment of this psychosis consists of drug therapy prescribed after examination by a psychiatrist. Depression with mental retardation and motor functions treated with stimulants. For a depressive state of melancholy, psychotropic medications are prescribed. Manic excitability can be stopped with aminazine, haloperidol, tizercin, injecting them into the muscle. These drugs reduce arousal and normalize sleep.

A large role in monitoring the patient’s condition is assigned to people close to him, who can notice the initial signs of depression in time and take the necessary measures. It is important in the treatment of psychosis to protect the patient from various stresses that can become the impetus for a relapse of the disease.

Manic syndrome, or mania, is a condition in which there is a combination of mental activity at an accelerated pace with elevated mood. Added to this is the enhanced motor activity. These disorders have a very wide range. For example, a mild case of the disease has a name.

It is quite difficult to give a correct assessment of this condition. To some people around them, such people seem to be active individuals who are always cheerful and sociable, although they have some scattered behavior. They seem cheerful, have a good sense of humor, and give the impression of self-confident people.

Such individuals have very animated facial expressions, lively speech and fast movements, which makes others think that they are younger than they actually are. The full severity of these manifestations becomes apparent when hypomania changes to depression, or the symptoms of the manic triad deepen.

Behavior of people with manic syndrome

In individuals who have a distinct manic state, unshakable optimism is combined with an always heightened joyful mood. If there are emotions and experiences, they all have a favorable connotation. For such people there are no worries or problems; any trouble in the past is forgotten very quickly. Events occurring in the present time that have a negative meaning are not perceived at all. When a patient with manic syndrome thinks about the future, everything is seen only in the brightest colors.

Sometimes such a great mood can be replaced by irritation and anger, if there are certain external reasons for this. This may be a conflict situation with others, and so on. But this condition is short-lived and quickly disappears; it is enough to start a dialogue with the patient in a peaceful and humorous tone.

Patients with manic syndrome always feel in excellent physical shape, they are energetic, and they believe that their possibilities are limitless. Such people are confident that there are no obstacles that can stop them.

Cause of manic syndrome

Psychologists say that the main cause of this mental disorder is genetic predisposition, and a constitutional factor also plays a role. The fact is that such patients always have an exorbitantly inflated sense of their own superiority and dignity. They always significantly overestimate their capabilities, both physically and professionally. Some people can be convinced and proven that they are wrong by assessing their capabilities to such an extent. But mostly, their faith in their talents is unshakable.

How to treat manic syndrome?

When manic syndrome is diagnosed, experts suggest the use of complex method. It includes cognitive psychotherapy and medications. But first of all, treatment is based on removing the causes of manic syndrome, because this disease represents a certain facet of another psychological illness. Therapy should also be aimed at accompanying mental disorders.

That is, if a person has it, then in addition to this, a manic syndrome may be observed, as well as psychoses, neuroses, a depressive state, and obsessive fears. Thus, in order to save a patient from manic syndrome, the doctor must take into account a complete diagnostic picture that covers all existing diseases.

Manic state is a pathology characterized by psychomotor agitation, unreasonably elevated mood up to euphoria, and an accelerated pace of thinking. (Greek - passion, madness, attraction) has been known to people since ancient times, when any state accompanied by screaming and chaotic movements was taken for it.

In the Middle Ages, the disease was classified as a manifestation, since the latter is also manifested by noisy behavior attracting attention to itself. In modern psychiatry, mania is classified as a group of affective disorders and is identified as a separate condition under the code F 30.

Manic syndrome is a condition that occurs:

Risk factors

Risk factors for developing mania include:

• genetic predisposition;
• characterological personality traits – cycloid, melancholic, neurasthenic types;
• hormonal changes during puberty, after menopause;
• diseases of the endocrine system;
• brain injuries and diseases.

Types of manias

There are more than 142 known types of manic episodes. The most common of them are presented in Table 1.

Table 1. Types of manic episodes

Type of mania	Characteristic
Agoramania	Attraction to open spaces
Bibliomania	Unhealthy hobby of reading
Hydromania	Irrational desire for water
	Obsession with writing
	Uncontrollable wandering
Zoommania	Crazy love for animals
Gambling addiction	Craving for games
	Attraction to theft
	Abnormal tendency toward grandiose behavior
Persecution mania	A condition in which a person feels like they are being watched
Addiction	Uncontrollable cravings for drugs
	Uncontrollable urge to set fires
Substance abuse	Painful attraction to poisons

According to severity they are distinguished:

A milder form of manic syndrome - which is characterized by increased performance, high spirits, not beyond the bounds of reason. It is believed that it was in this state of mind that discoveries were made, brilliant ideas came to mind, and the wildest dreams came true. This is a transitory state in which every person has been at least once. They say about hypomania: “the soul sings.”

Depending on the presence or absence of psychotic symptoms, the disease is of two types.

Mania without psychotic symptoms

These forms are not accompanied by delusions and hallucinations:

• classic - manic triad - acceleration of thinking and speech, increased mood, motor agitation;
• angry – in the triad the mood changes to irritability, conflict, and a tendency to aggression;
• manic stupor - motor retardation is present in the triad;
• unproductive – in the triad – slowing down of thinking;
• joyful – euphoria, restlessness, motor excitement;
• confused - chaotic acceleration of associations, “jump of ideas”;
• hypochondriacal – a combination with hypochondria (fear of contracting fatal diseases).

Mania with psychotic symptoms

For manic syndrome with psychotic symptoms characterized by the presence of delusions and hallucinations. Delusions of grandeur are often stated, corresponding (congruent) and inappropriate (incongruent) to the mood. When hallucinations are added, manic-hallucinatory-delusional syndrome is diagnosed.

Oneiric mania is accompanied by a dreamlike disturbance of consciousness with hallucinations.

TO severe forms Acute manic states are classified as paraphrenic (fantastic) delusions. Somatic disorders are added. Consciousness is darkened. Hyperacute mania is characteristic of organic brain damage.

How to recognize manic syndrome

What is manic behavior (condition)? How to distinguish increased performance, irrepressible energy in a manic patient from a healthy workaholic?

• a patient with mania takes on everything at once, but never finishes what he starts, his activity is superficial;
• he often writes poetry, tends to rhyme everything, the rhymes are based on adjacent associations or consonance, they have no meaning;
• he makes grandiose plans, but is unable to implement them;
• you can’t trust his promises, he immediately forgets everything;
• there is impulsiveness and inconsistency in decision making;
• when performing tasks, there is a decrease in concentration;
• overestimation of their own capabilities does not allow such people to carry out useful activities.

In the somatic sphere, manic individuals experience: increased heart rate, palpitations, periodic increases in A/D; increased libido; increased appetite up to gluttony; low need for sleep.

What does a manic personality look like?

Signs by which one cannot help but notice a manic personality:

A shy, insecure person in a state of manic excitement changes by 180 degrees: now he is a disinhibited person who is “sea on his knees.”

Differential diagnosis with other diseases

The peculiarities of manifestation in adolescence are expressed in the fact that the disinhibition of drives - sexual, food - is not at the forefront. Despite the gluttony, the teenager loses weight because he spends an exorbitant amount of energy.

Frequent leaving home and connections with criminal groups are motivated only by the search for new experiences and the inability to analyze one’s actions. Ideas of greatness, grandiose plans for the future, and an aggressive attitude towards peers and elders are characteristic. A manic teenager is distinguished from a hyperthymic personality type by transient, unstable symptoms that quickly pass; motives are completely different from those of their peers with delinquent behavior.

Mania is often confused with hysterical manifestations, which are characterized by demonstrativeness, theatricality, and playing to the public. A woman with hysteria always carefully monitors herself, the assessment of others is important to her, all behavior is aimed at the end result - the choice of place, time and position for falling during a “hysterical attack.” A manic personality does everything thoughtlessly and impulsively.

It is difficult to distinguish megalomania from delusions in schizophrenia and other psychoses. Anamnesis (preconditions that led to the disease, a long history of the development of schizophrenia), and the presence of other symptoms of psychopathology help in the differential diagnosis.

Manias are mistaken for obsessions in neuroses. The difference is that obsessions are persistent, the patient cannot get rid of them for years, and manic ideas quickly arise and fade away just as quickly.

What happens after you come out of a manic state?

The duration of the condition depends on the etiology, severity and time of initiation of treatment. Acute conditions lasts 2 weeks, sluggish mania can be observed throughout the year.

If patients did not have time to take actions that would have irreversible consequences, they remember this period as a feeling of bliss and the absence of problems.

If, in a fit of madness, manic individuals have insulted someone, caused moral or physical harm, lost their job, the support of loved ones, family, they cannot get rid of the feeling of guilt, often they simply cannot live with it. When they come out of a state of euphoria, they are faced with a “gray” reality. Such patients fall into deep depression and often attempt suicide.

Diagnostics

According to the international classification of diseases ICD-10, to make a diagnosis, three of the following criteria must be present, persisting for at least 4 days in a row:

The presence and severity of manic symptoms, in addition to an objective examination, is determined using special scales and tests.

The Altman scale was developed at the University of Illinois and consists of 5 items that meet the diagnostic criteria of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders in the United States) - mood, self-esteem, need for sleep, speech and activity.

The Young Rating Scale is one of the main tools for determining the severity of manic symptoms. Consists of 11 items that the patient fills out after completing the clinical interview. The interpretation is based on information about the condition over the last 48 hours, the results of the conversation and answers to the questions on the scale.

Rorschach test (“Rorschach Blots”) - helps to determine the mental characteristics of a person. The patient is asked to interpret 10 ink spots (blots), located symmetrically about the vertical axis. The subject's free associations are used to judge his emotional state, belonging to one or another personality type, tendency to mania.

Therapy methods

Treatment of manic syndromes includes medication and psychotherapy.

Psychotic mania is grounds for hospitalization. Relief of psychopathology is carried out with psychotropic drugs - tranquilizers, sedatives, neuroleptics, mood stabilizers. Lithium salts have a specific effect on the disease. In some cases, homeopathy preparations are used.

Psychotherapy is carried out in parallel with medication treatment.

Three directions are applied:

1. Cognitive-behavioral – the patient understands the essence of his disease, what led to it; learns how to avoid relapse ().
2. Interpersonal – helps to understand relationships with others, learn to constructively solve problems and find a way out of conflict situations.
3. Family – work with both the patient and his family members. Focused on improving family relationships, informing family members about the disease, teaching the correct behavior with a manic patient.

Mania is not a death sentence

The course of manic syndrome is cyclical. Attacks are replaced by remissions. The duration of remission depends on the etiology of the disease, the correctly chosen treatment tactics, the character of the patient and the efforts of his relatives. Outside of attacks - this is ordinary person with adequate behavior, adapted to society.

If the patient follows all the doctor’s recommendations, healthy image life without the use of alcohol, drugs, eats right, does not overwork, is trained to manage stressful situations, and most importantly, has the desire to get rid of this illness - he is able to delay the next attack for years.

Manic syndrome is pathological condition psyche, in which there is a triad of symptoms: elevated mood, reaching the level of hyperthymia (persistently elevated mood), sharp acceleration of thinking and speech, motor agitation. In the case where the severity of symptoms does not reach the level of psychosis, it is diagnosed (insufficiently pronounced mania). This condition is completely opposite to depression. When a person is kept within generally accepted limits, hospitalization is not always required.

The main cause of manic syndrome is considered to be a genetic predisposition. People who subsequently develop mania are characterized by increased self-esteem before the disease, feel superior to others, and often consider themselves unrecognized geniuses.

Manic syndrome is not a diagnosis, but a manifestation of various diseases. Manic syndrome can manifest itself in the following diseases:

A patient with a new-onset manic episode requires careful evaluation because changes mental state may be the result of a disease in the body.

Classification

According to ICD-10, manic syndrome is coded in the following categories:

In the event that manic syndrome is complicated by somatic diseases, they are coded in the appropriate sections.

Classic mania

Manic syndrome or “pure” mania manifests itself as follows:

1. Elevated mood is in no way connected with real life events and does not change even during tragic events.
2. The acceleration of thinking reaches such a degree that it turns into a race of ideas, while superficial events or concepts that are far apart from each other are connected by one association. A logical continuation of this way of thinking is delusions of grandeur, when the patient considers himself the ruler of the world, a great scientist, a god, or an outstanding commander. The behavior corresponds to the existing delusion. The patient feels that he has no equal in the world, emotions are bright and magnificent, there are no doubts or troubles, and the future is rosy and wonderful.
3. The impulses and movements accelerate so much that the person exhibits vigorous activity that does not achieve a specific goal. A person strives to urgently satisfy all possible needs - he eats a lot, drinks a lot of alcohol, has a lot of sexual contacts, uses drugs or does other favorite things.

To understand what manic syndrome is, you can turn to fiction. For example, the mechanic Polesov from “The Twelve Chairs” by Ilf and Petrov clearly suffered from hypomania.

“The reason for this was his overly ebullient nature. He was an ebullient lazy man. He was constantly foaming. The customers could not find Viktor Mikhailovich. Viktor Mikhailovich was already giving orders somewhere. He had no time for work.”

Species

The components of manic syndrome can be expressed in varying degrees, and also be combined with other psychotic manifestations. Depending on this, the following types of mania are distinguished:

The combination of mania with other mental disorders produces the following syndromes:

• manic-paranoid – a delusional structure is added, most often delusions of relationship and persecution;
• delusional mania - delusion “grows” from those events that are actually present in the patient’s life, but are exaggerated so much that they are completely divorced from reality (for example, megalomania based on professional skills);
• oneiroid - delirium is accompanied by hallucinations of fantastic content, incredible pictures of unreal events.

Somatic manifestations of mania are an accelerated pulse, dilated pupils and constipation.

Self-diagnosis of mania

In order to distinguish a mental disorder from temporary psychological problems, there is the Altman scale. This is a questionnaire consisting of 5 sections - about mood, self-confidence, need for sleep, speech and vital activity. Each section contains 5 questions that must be answered honestly. Answers are scored from 0 to 4. By summing up all the points received, you can get the result. Scores from 0 to 5 correspond to health, from 6 to 9 - hypomania, from 10 to 12 - hypomania or mania, more than 12 - mania.

The Altman scale is designed to help a person see a doctor on time. The survey result is not a diagnosis, but is highly accurate. In psychiatry, this questionnaire corresponds to the Young Mania Scale, which serves to confirm (verify) the diagnosis.

Rorschach blots

This is a test that was introduced into use at the beginning of the last century by the Swiss psychiatrist Hermann Rorschach. The stimulus material consists of 10 cards on which monochrome and colored symmetrical spots are located.

The spots themselves are amorphous, that is, they do not carry any specific information. Looking at spots stimulates in a person some emotion from his life and intellectual control of what is happening. The combination of these two factors – emotions and intelligence – provides almost comprehensive information about the patient’s personality.

Psychology often uses non-standard approaches to studying personality, and this is one of the most successful. The Rorschach test reveals the deeply hidden fears and desires of a person, which for some reason are in a suppressed state.

Patients with hypomania or mania often see moving figures even though the images are static. Associations that often arise when working with a test can tell about hidden conflicts, difficult relationships, and changes much more than a direct conversation. It is possible to identify individual needs, long-standing psychological trauma, aggressive or suicidal tendencies.

Treatment

Manic syndrome that occurs for the first time is subject to treatment in a closed psychiatric department (if it is not a complication of a somatic illness in a patient in a hospital). It is impossible to predict how the patient’s condition will change, how he will react to medications, or how the symptoms will transform.

At any moment, the state can become depressive-manic, depressive, psychopathic, or some other type. A patient in an unstable condition, with manifestations of manic syndrome, poses a danger both to himself and to others.

Feeling boundless happiness and the absence of obstacles, the patient can commit actions, the consequences of which are difficult or impossible to correct: donate or distribute movable and immovable property, have many sexual contacts, destroy his family, take a lethal dose of a drug. The transition from manic to depressive phase can occur within a few hours, which can lead to suicide.

Relief of manic syndrome is exclusively medicinal. Drugs based on lithium salts, antipsychotics, mood stabilizers, nootropic drugs, tranquilizers, mineral and vitamin complexes.

Endogenous mental illnesses proceed according to their own internal laws, and it is not possible to reduce the duration of the disease. Due to the long treatment period, many patients are assigned a disability group. Endogenous processes have a chronic course, few patients can return to work.

Bipolar disorder, within which mania develops, is endogenous or of a hereditary nature. No one is to blame for its occurrence. Humanity has lived for more than two thousand years, and a pathological gene from ancestors can appear in any family.

If you suspect manic syndrome, you should urgently seek advice from a psychiatrist. Precisely to a psychiatrist, and not to a psychologist or neurologist. A psychologist deals with the problems of healthy people, and a psychiatrist treats mental illness.

It is impossible to refuse hospitalization; this can irreparably harm the sick person. It is not necessary to disclose the fact of treatment, especially since the certificate of incapacity for work, at the request of the patient or his relatives, indicates a rehabilitation diagnosis - neurosis, grief reaction or something similar.

After discharge, it is mandatory to take supportive treatment; this is the only way to curb mental illness and keep it under control. Relatives should always be on guard, and in case of minimal changes in behavior, contact the attending physician. The main thing that relatives must understand is that the disease will not go away on its own, only regular persistent treatment can improve the condition of the sick person.

A mentally ill person should be treated in the same way as someone suffering from any other illness. There are restrictions, but if you do not go beyond what is permitted, then the chances of living a calm, long life are great.

Manic syndrome or mania is a condition characterized by three symptoms, also called the manic triad: elevated mood, mental arousal, which is expressed by accelerated speech and thinking, and motor agitation. People suffering from manic syndrome have animated facial expressions, fast emotional speech and energetic movements, which often makes others mistaken and mistake such people for just active, energetic and sociable individuals. But over time, this behavior develops into depression, or the symptoms become stronger, and then the pain becomes obvious.

Reasons

The causes of mania are associated with disturbances in the parts of the brain responsible for a person’s emotions and mood.

Manic syndrome is determined genetically, i.e. is inherited, but it is worth noting that only a predisposition to the disease is transmitted, i.e. in people whose parents suffered from mania, signs of the disease may not appear. It all depends on the environment in which a person lives and develops.

It is believed that men over the age of thirty are more predisposed to developing manic syndrome. But the reasons may also be emotional instability, melancholic character type or postpartum depression in women.

Hormone imbalances can also be a cause of the disease. For example, unstable mood may be associated with a lack of serotonin (the hormone of happiness) or norenopinephrine in the body.

Symptoms

Manic syndrome develops very quickly. In addition to the manic triad: permanently elevated mood, accelerated pace of thinking and psychomotor agitation, usually the person becomes very active, constantly in a euphoric state. Signs of the disease may also include excessive irritability, aggressiveness and hostility.

A person may experience scattered attention, superficiality in judgment, a person becomes tireless and constantly craves activity. This syndrome is also expressed in the inability to concentrate on one thing, inflated self-esteem and selfishness.

In a severe stage of the disease, the patient experiences an increase in activity, both physical and mental, and unreasonable agitation occurs, also called delirious mania. Such symptoms can be fatal as the person may die due to exhaustion. Manic syndrome also manifests itself in increased unreasonable cheerfulness, incoherent thought processes and confused speech. Symptoms may also include a persistently rapid heartbeat, rapid pulse, and increased salivation.

People with manic syndrome do not realize or often do not want to realize their illness, so treatment can often be forced.

Types of manic syndrome

There are several types of manic syndrome:

• joyful mania - manifests itself in hyperthymia, tachypsychia and motor agitation;
• angry mania is a manic syndrome that manifests itself in hot temper, aggressiveness and conflict without any real reason;
• manic-paranoid syndrome is a manic syndrome, which is complemented by the appearance of paranoia, i.e., obsessive ideas about persecution, wrong attitude, etc.;
• oneiric mania - oneiric disturbance of consciousness manifests itself, the result of which is the appearance of hallucinations.

Treatment

Treatment of manic syndrome should begin at early stages disease, otherwise a person has little chance of completely curing all the symptoms and irreversible changes may occur in the psyche.

The main treatment is complex: with the help pharmacological agents and cognitive psychotherapy. Medicines are selected strictly by the doctor depending on the patient’s condition. For example, if symptoms include excessive agitation and activity, the patient is prescribed sedatives, in the opposite case, when the predominant symptoms are lethargy, stimulant drugs are prescribed. Drug treatment can also be carried out with the help of antipsychotic drugs, which help relieve the symptoms of the disease.

Cognitive therapy is aimed at removing the cause of the disease. To achieve a complete cure, therapy and drug treatment takes place on average for a year, after which the patient will be required to be constantly monitored by the attending physician to prevent the recurrence of the syndrome.

If the patient's condition is serious, he may be hospitalized in order to keep him under control and prevent risky behavior. Also, if normal, complex treatment does not help, a course of shock therapy may be prescribed.

Whatever the patient's condition, treatment should be prescribed as early as possible, only then will it have the best result.