The topic on which today I will let you know is the Mania. It is a mood disorder that we see commonly in our OPD. Day by day the number of patients of mania are increasing. We will cover basics of mania like, what is mania ? Why does it happen ? Symptoms, treatment etc. So let’s discuss in detail.
Mania is the state of mood disorder in which a patient is presented with a variety of symptoms ( syndrome ) specially with self importance ideas. The patient is over active in this disorder and consider himself as the most important personality in his surroundings. He also believes himself to be worshipped by the people like god.
Causes ( Etiology )
Increased dopamine and norepinephrine in the brain is the key reason behind mania. It may be due to dopamine agonists drugs, dopamine receptors blockers or due to itself without any external or exogenous cause. The most important pathophysiology behind the mania is the increased dopamine in the brain. Other theories that support the pathophysiology of mania are
- Genetical cause
- Increased level of neurotransmitters
- Environmental factors
- Childhood trauma
- GSK 3 over activity
- Protein kinase C over activity
- Increase arachidonic acid turnover
- Increase cytokines synthesis
- Sleep deprivation
- Sleep – wake cycle disturbance
- High emotional stress
As I already said that Mania is a mood disorder in which a person’s mood changes simultaneously many times in very short time. It is also considered as bipolar affective disorder or bipolar mood disorder. Bipolar disorder covers both depression and mania, but here we will only discuss about mania.
To remember the sign & symptoms of mania you should use this short hint that I have made for ease of understanding which is ‘DIGFAST’.
1. D – Distractibility
It’s general meaning is to be deviated or not paying attention what is being said or done. In the OPD when we ask the patients about their problem they suddenly respond to unimportant stimuli after looking at nearby objects. For example many patients react like this when ask about the problem – Hey doctor your goggles is very good, where did you get it from ? You know doctor your watch is looking good. Your watch belongs to which company ? Doctor please tell me price of this watch etc. This is called the distractibility.
2. I – Indiscretion
It refers to the condition of patient in which the patient becomes more extravagant. He spends a lot of money on shopping of those products that he already owns. He has already lot of same products at home but despite that he shops again and again for same products. Making improbable business plans has also been seen in mania patients. Even he starts to offer money to friends without their demand. Third thing he becomes more sexual attractive. He does sex many times a day without taking a break. So the patient becomes sexually hyperactive.
3. G – Grandiosity
Grandiosity in simple means the fake beliefs or superstition in a particular field of aspects. We commonly see two types of grandiosity. One is religious grandiosity and another is political grandiosity.
A) Religious grandiosity
The patient claims himself as the angel of god. They also say that they have supernatural powers. They claim they have a direct connection with god. If they want they can destroy the world at once. If anybody ask about their name they slap and say you fool, don’t you know ‘ Sherawali Maa’ ?
B) Political grandiosity
Patient claims that they have ruled over the country and it’s their government. This government is doing well and running only because of me. All reputed ministers come to me for taking ideas and to discuss how to run a country. You can’t imagine about the people who approach me. So such delusions also seen in mania patient.
4. F – Flight of ideas
This is the most important characteristic sign of mania patient. Flight of ideas means no co-ordination or association in the ideas. The mania patient changes the topic very suddenly while he speaking on a particular topic. For example if they are talking about religious belief. Suddenly they change the topic to politics without completing the previous one. Then change to business plans, daily routine and so on. These are called racing thoughts. Manic patient have so many ideas, they keep on thinking about various topics. Their speed of voice is also very fast. Clang association is also seen in manic patient. May times patient shows rhythmic connection ( similar sounds ) between sentence in place of logical connection. Pressure of speech is an important sign in mania.
5. A – Activity
Patient is very very active in every situation. Spontaneous speech is often present. May be a patient start talking without asking anything to him. In mania a patient can travel by foot for many kilometres without getting tired. Even he was not used to it earlier. He becomes more active for the tasks he was not used to it. Patient becomes more religious, political, social etc in which he was not included earlier. Manic patients are very argumentative. Patient also believes that others can’t measure their talent. They are the beginning and they are the end. Patient also clarifies If you have no value for my talent then you are nothing to me. If you have any problem come to me I will provide you peace.
6. S – Sleep
Paying attention towards the sleep patterns is also an important diagnosis in mania patient. The duration of sleep of manic patient is very less. Even then patient feel fresh and reset after 3-4 hours of sleep. We all know if we sleep less at night the next day would be very lazy for us and mood will be totally changed, lethargic and irritable. But in manic patient it is opposite. Manic patient says that 3-4 hour sleep is more than enough for him.
He claims he can do more better if he doesn’t sleep at all. He has to sleep in compulsion because everyone is sleeping. Such patients becomes more active at night and wake up at early night and start doing their activities. Due to this all other members also get disturb. We all know we mus sleep at least for 7-8 hours every 24 hours. This is enough sleep pattern for us.
7. T – Talkativeness
Over talkativeness is one of the characteristic sign of mania. Patient talks a lot without taking a break and without consent of listener. He doesn’t stop at all while speaking and doesn’t wait for your response too. Pressure of speech output increases so much which makes them difficult to understand and sometimes incoherent. No logical association is seen in their topic. Manic patient sometimes start talking to strangers. They stop anybody on the way and start talking. They don’t feel shy to talk with them at all. This is known as expansive mood.
If 3 or 4 sign of symptoms present out of 7 ( DIGFAST ) for atleast 1 week or more or any duration then hospitalization is required. As I already mentioned above that mania is a mood disorder. Mood symptoms ( Euphoria, Elevated / Expansive mood / irritable mood ) are necessary to make the diagnosis of mania.
Treatment of mania
Today we have the best medicines that treat the mania with quick action over it. In many cases mania is a self limiting disorder. After occurence of symptoms for 3-5 months mania goes away itself. But just imagine the condition of the patient for 4-5 months with above symptoms.
To assess the severity of mania, we use YMRS ( Youngs Mania Rating Scale ). We examine the patient and classified him as mild, moderate or severe manic scale. Mania is 100% treatable mental disorder. In the treatment includes :
- Mood stabilizers ( Lithium carbonate, Sodium valproate, Carbamazapine etc. )
- Antipsychotic ( Olanzapine, Risperidone, Quetiapine, Aripiprazole, Clozapine etc )
- Benzodiazepine ( sleeping pills )
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