Manic state: what is it and how to recognize it, types, treatment. Diagnosis and treatment of manic syndrome Manic look

Manic syndrome, what is it? It is difficult to find another disease in which a person would feel so great, as in a manic syndrome. In addition, the first manifestations of mania in most patients occur at the age of twenty, when people already live in constant euphoria and do not think about illness or death, but, on the contrary, believe in the infinity of their own lives.

The development of manic syndrome is caused by the following reasons:

1. Violation of the functioning of the areas of the brain responsible for the emotional background of a person and his mood.
2. genetic predisposition. And it is worth emphasizing that it is the predisposition, and not the pathology itself, that is transmitted from parents to children. That is, mania in the descendants of people suffering from such a disease may not develop. The environment in which a person grows and develops plays an important role here.
3. Hormonal imbalance, for example, lack of the hormone of happiness - serotonin.
4. According to some researchers, gender and age of people also matter. For example, a greater predisposition to manic syndrome is noted in men whose age is over thirty years.

Symptoms of the disease

A manic syndrome can be suspected if, for at least seven days, three or more times a day, the patient has the following symptoms:

1. An unreasonable feeling of overflowing with happiness, delight and optimism.
2. Sudden changes of fun to anger, rudeness, irritability.
3. Reduced need for sleep, increased energy.
4. Absent-mindedness.
5. Indefatigable talkativeness plus acceleration of the pace of speech.
6. The flow of new ideas.
7. Strengthening libido.
8. Constantly making grandiose plans that are mostly impossible to execute.
9. Making wrong decisions and making wrong judgments.
10. Excessively high self-esteem and belief in the possession of supernatural abilities.
11. Behavior dangerous to life and health.
12. With the transition to psychosis, development is possible. Interestingly, some well-known failures in science, business or art have all the hallmarks of mania. After all, people believe in their unique artistic abilities or infallible business ideas.

Varieties of pathology

The clinical characteristic of the manic syndrome implies the division of its manifestations into two main states:

1) Hypomania. It is the mildest form of manifestations, which may not turn into a disease. Hypomania gives a person only pleasant impressions - he feels good and works amazingly productively. Ideas come to mind in a continuous stream, shyness disappears, interest in things that previously seemed everyday appears. A person is overwhelmed with euphoria, strength and a sense of omnipotence. There is a desire to seduce and succumb to temptation.

2) Mania. Ideas gradually become so many and they rotate in the head so quickly that it is impossible to follow them and clarity is replaced by confusion. Forgetfulness, fear, anger, a feeling of being in some kind of trap appear. A manic paranoid syndrome is also distinguished, in which the patient has delusional ideas of persecution and attitude added to the main picture of the disease.

Treatment of the disease

The treatment of manic syndrome is carried out with the help of neuroleptics, - benzodiazepines or lithium salts, which contribute to the relief of excessive activity, hostility and irritability. In parallel, mood stabilizers are prescribed. Since, with pronounced manifestations of the manic syndrome, patients become unpredictable and begin to behave very risky, it becomes necessary to hospitalize them.

Video: An example of a manic syndrome

Inadequately elevated mood is a state that is exactly the opposite of depression. If it haunts a person for a sufficiently long time and is accompanied by other inadequate or illogical manifestations, then it is considered a mental disorder. This condition is referred to as manic and requires special treatment. Depending on the severity of the symptoms, consultation with a psychotherapist or psychiatrist may be required.

Features of the development of mania

In some cases, a tendency to mania can be a character trait, as well as a tendency to apathy. Increased activity, constant mental agitation, inappropriately high spirits, outbursts of anger or aggression are all symptoms of a manic syndrome. This is the name for a whole group of conditions that have different causes and sometimes different symptoms.

Both various life situations and incidents, and uncorrected pathological character traits lead to the development of mania. A person prone to manic behavior is very often obsessed with an idea, he strives to realize it, even if it is unrealistic. Often patients are driven by theories that have political, religious or scientific justifications. Quite often, patients show a tendency to active social and social activities.

A significant proportion of manic patients have so-called overvalued thoughts and ideas. Sometimes they can be global, sometimes they are ideas of the household level. From the outside, the behavior of patients talking about their ideas sometimes looks quite comical. If the overvalued thought is of a global nature, the patient, on the contrary, seems thoughtful and enthusiastic to those around him. Especially if he has enough education and erudition to justify his beliefs.

Such a condition is not always a pathology, it can be individual characteristics of the psyche. Treatment is necessary if overvalued thoughts and ideas get out of control and absorb the entire life of the patient, in other words, they prevent him or others from living.

When do you need a doctor's help?

Manic syndrome is already a deviation from the norm, which is characterized by a number of symptoms that are more unpleasant for others than for the patient himself. This disease is manifested by disturbances in mental activity and the emotional sphere.

Usually the behavior of a manic patient is incomprehensible to others and looks at least strange.

There are certain symptoms that indicate the need for medical attention:

• Extremely high spirits, up to constant mental excitement and euphoria.
• Optimism inappropriate to the situation, the patient does not notice real problems and is not inclined to experience a bad mood appropriate to the occasion.
• Accelerated speech, accelerated thinking, lack of concentration on objects and phenomena that the patient is not interested in. Therefore, in mania, learning is often difficult when you have to pay attention to rather boring things.
• Increased mobility, active gestures and hyperbolic facial expressions.
• Extravagance, pathological generosity. The patient can spend all the savings in a minute, not realizing the responsibility for his actions.
• Lack of control over behavior. The patient does not realize that his high spirits are not appropriate everywhere.
• Hypersexuality, often with promiscuity (for example, a person who has never been prone to cheating before suddenly begins to flirt “indiscriminately”, enters into close relationships that he would never have dared to before, to the point that he starts several novels in parallel or starts in a series of "short non-committal relationships", about which later, after the episode of mania has passed, he will repent and feel shame and even disgust, sincerely not understanding "how this could happen").

Treatment is complicated by the fact that the patient himself often does not recognize himself as sick. He considers his condition normal, subjectively pleasant and does not understand why others do not like his behavior: after all, he feels good, like never before. It is difficult to send such a patient to see a doctor and persuade him to therapy.

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Symptoms and signs of the disease

In addition to the above signs, there are several characteristic symptoms that unite almost all manic states:

• Tendency to reckless waste of funds.
• Tendency to unprofitable transactions, gambling.
• Frequent violation of the law.
• Tendency to provoke fights and conflicts.
• Excessive alcohol consumption or addiction to other bad habits.
• Loose sexual behavior.
• Pathological sociability - the patient often meets strange, suspicious personalities and spends time in a variety of companies.

If these symptoms get out of control, qualified medical attention is needed. It is important to understand that such behavior is not promiscuity, but symptoms of a disease that needs to be treated. Appeal to common sense is useless.

In some cases, the patient has a specific mania - for example, a mania for a specific purpose. Then the patient is sincerely confident in his special mission and tries to fulfill it with all his might, despite the skepticism of those around him.

Varieties of manic states

There are several classifications, according to the manifestations of mania and according to their content.

• Mania of persecution - accompanied by paranoia. The patient is convinced that he is being persecuted, anyone can act as a persecutor - from relatives and friends to special services.
• Mania for a special purpose - the patient is sure that he needs to create a new religion, make a scientific discovery, save humanity.
• Delusions of grandeur - similar to the previous one. The main difference is that the patient does not have a goal, he simply considers himself the chosen one - the most intelligent, beautiful, rich.
• Mania of guilt, politeness, self-destruction, nihilistic - more rare situations. In patients prone to alcohol abuse, jealousy mania is often noted.

According to the emotional state of the manic syndrome is:

• Joyful mania - excitement, unreasonably elevated mood.
• Angry - irascibility, a tendency to create conflict situations.
• Paranoid - manifested by paranoia of persecution, paranoia of relationships.
• Oneiroid - accompanied by hallucinations.
• Manic-depressive syndrome is characterized by alternating mania and depression.

In a manic-depressive syndrome, intervals may alternate at equal intervals of time, or one type of behavior predominates. Sometimes the next phase may not come for years.

Treatment of manic states

Diagnosed mania is a condition that requires mandatory treatment. It is customary to carry out complex therapy: pharmacological and psychotherapeutic. Pharmaceutical preparations are selected to relieve symptoms: for example, a patient with increased excitability will receive a prescription for sedatives, antipsychotics help to relieve concomitant symptoms, and to prevent the development of the next phase - normotimics.

As for psychotherapeutic treatment, usually work with a specialist goes in the direction of cognitive and cognitive-behavioral therapy, as well as psychoeducation (targeted informing the patient about the disease and learning to recognize early signs (“markers”) of the phase change and respond promptly to them in order to prevent development of the next full-fledged depression or mania). In the course of psychotherapy, one can find and eliminate the cause of the disease, correct the behavior and way of thinking of the patient. On average, treatment takes about a year, but after improvement, dynamic monitoring is required, since the manic syndrome can recur.

Regardless of the patient's condition, it is important to start treatment when the first symptoms appear. Psychotherapists of the CELT clinic also work with manic states. Thanks to their serious experience and high qualifications, they will help restore mental health.

Manic syndrome is a mental disorder of a person's behavioral state, which is characterized by three types of symptoms: hyperthymia - causes high spirits, tachypsychia - rapid speech with expressive facial expressions, motor disinhibition with hyperactivity.

The disease is observed in both men and women, while adolescents have fewer cases than adults. In children, pathology is often observed during the period of hormonal changes, when boys and girls try to attract attention with vulgar clothes or shocking actions.

Manic syndrome is not a pathological disease, but without timely therapy and psychological assistance, it can transform from a borderline state into a clinical form or.

The disease is diagnosed after consultation with a psychologist. Treatment will depend on the causes that led to behavioral abnormalities. The prognosis of therapeutic measures is 100% positive.

Etiology

Conventionally, there are several causes of manic syndrome:

• inheritance by autosomal dominant type - a tendency to mental disorders is transmitted from parents to children;
• incorrect psychological upbringing of the child, which leads to failures in the picture of the world, when the child adopts the asocial behavioral reactions of the parents;
• hormonal changes in the body in adolescence, when a teenager takes various actions to stand out from the crowd.

Manic syndrome can act as a protective reaction to external factors with a pronounced negative connotation. In this situation, the human psyche is rebuilt, behavior changes, the bad is no longer perceived and ignored.

The syndrome is a consequence of bipolar affective disorder, can occur in the form of seizures, as it progresses, it can worsen. It can be caused by drugs, drugs, or alcohol addiction.

Classification

The manic syndrome is characterized by an unrelated increase in mood, motor excitation.

This condition can take several forms:

• Manic-paranoid type. It is characterized by the appearance of delusional ideas about intersexual relations. A patient with this kind of syndrome may pursue the object of his passion.
• Oneiroid mania. It is characterized by a change in consciousness associated with its violation, which causes various hallucinations. This is a dangerous type of deviation, as one ceases to understand what is real and what is an illusion.
• Brad type. Consists of megalomania, consists of delusional ideas that are logical and consistent. Pathology often refers to the professional activities of the individual. Delusions of grandeur can cause a person to commit wrongful acts in order to exalt himself.
• Joyful mania. Mental excitement captures physical activity, the pace of mental activity accelerates, the mood is always upbeat.
• Angry mania. Characterized by irritability, unreasonable aggression. A patient with this type of disorder is very conflicted, can swear on the street with strangers.
• Endogenous manic syndrome. With it, euphoria, unreasonable excitement is observed, reactions may be inadequate. The patient is prone to irritability, there may be a sharp transition from excessive joy to aggressive irritability.

Moreover, one of the symptoms can be expressed more strongly than usual, sometimes it can change to the opposite. Rarely, symptoms are mixed.

Symptoms

The first signs of a deviation from normal behavior can be noticed by the next of kin of the patient, who constantly talk with the patient, so it will be easier for them to identify behavioral deviations. The manic syndrome is characterized by a rapid aggravation of the state after some negative event, which was the impetus for change.

Symptoms of manic syndrome depend on the severity of the disease:

• - a person is not able to sit in one place, he is constantly in a hurry somewhere;
• the patient loses a lot of weight;
• there may be a slight increase in temperature (up to 37.5 degrees);
• plastic facial expressions appear;
• the patient has scattered attention, he can skip syllables or words when communicating;
• the flow of speech is quite fast, which causes difficulty in understanding;
• such people are immune to criticism, they often have delusions of grandeur.

With manic syndrome, symptoms can grow like a snowball:

• behavior becomes cheeky and reckless;
• increased attraction to the opposite sex;
• obsession and delusional ideas are noted;
• the diet is disturbed - the patient is prone to overeating and gaining excess weight or losing weight;
• there are bouts of joy, anger, as well as irritability and conflict.

The most dangerous for the patient is oneiroid mania, since the patient is unable to disengage from hallucinations and he has a replacement for reality, and this entails unlawful immoral or violent actions.

Diagnostics

When determining the diagnosis, the doctor talks with the patient and his relatives, studies the medical history, and can conduct special testing to determine the degree of deviation and the features of its development.

It is very important for a psychiatrist to get a complete picture of the disease, to determine whether there are persons with mental disabilities in the family, it is important to find out the causes of the disease.

The manic syndrome has been sufficiently studied by psychiatry, so it will not be a problem for the doctor to establish the deviation and its degree.

Particular attention is paid to the following factors:

• experienced stress;
• unfavorable climate in the family;
• suicidal tendencies;
• drug addiction;
• alcoholism.

Additional studies may be prescribed to exclude pathological processes in the body that can cause similar symptoms. First of all, a biochemical blood test is performed. After confirming the diagnosis, the patient is prescribed therapy.

Treatment

Manic syndrome treatment involves using complex measures, and consists of a medication course with psychotherapeutic conversations. In a serious condition with attacks of aggression and disturbed sleep or hallucinations, the patient is hospitalized, as he can harm not only himself, but also those around him, because his actions are unpredictable. In such cases, antipsychotics, tranquilizers, sedatives, sleeping pills are selected.

Reception of neuroleptics begins with the maximum possible dosage, which is gradually reduced to nothing.

The duration of treatment can be up to six months. After the abolition of the drug course, the patient is reduced in dosage every day for a month. This is very important, since you cannot abruptly stop taking such funds.

• job change, ban on leadership positions;
• take prescribed drugs with an approaching relapse of the disease;
• do not overexert;
• avoid stress and conflict.

The prognosis of treatment is positive for the patient's life, but he may lose his ability to work. In such situations, it is better to find a hobby that will help to cope with nervous strain.

Possible Complications

If therapeutic measures are started on time, then the prognosis is positive. The only negative point is that the patient loses his social status, since he will be contraindicated in working as a leader, he cannot be trusted with responsible or dangerous work either, because it can adversely affect the patient's condition.

If the manic syndrome is not treated, then the disease can develop into schizophrenia, which poses a danger to both the patient and his environment.

Prevention

For the purpose of prevention, treatment of manic syndrome should be carried out at the first negative symptomatology. The patient must adhere to medical recommendations, have more rest, lead a healthy lifestyle, exclude alcohol, nicotine and drugs.

A psychologist may suggest relaxation or meditation techniques, relaxing massages, or herbal baths.

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Diseases with similar symptoms:

Inflammatory ailments, which are accompanied by the manifestation of constant pain in the joints, are called arthritis. In fact, arthritis is a disease that contributes to the thinning of the cartilage of the joints, changes in the ligaments and joint capsule. If the disease is not treated, then the process aggravates, leading to joint deformity.

Under manic psychosis refers to a disorder of mental activity in which affective disturbances predominate ( sentiments). It should be noted that manic psychosis is only a variant of affective psychoses, which can proceed in different ways. So, if a manic psychosis is accompanied by depressive symptoms, then it is called manic-depressive ( this term is the most popular and widespread among the general public).

Statistical data

Among hospitalized patients with mental illness, the incidence of manic psychosis varies from 3 to 5 percent. The difference in the data explains the disagreement of the authors in diagnostic methods, the difference 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 25 and 44 years of age. This age should not be confused with the onset of the disease, which occurs at an earlier age. Thus, among all registered cases, the proportion of patients at this age is 46.5 percent. Pronounced attacks of the disease often occur after 40 years. Some modern scientists suggest that manic and manic-depressive psychosis are the result of human evolution. Such a manifestation of the disease as a depressive state can serve as a defense mechanism in case of severe stress. Biologists believe that the disease could have arisen in the process of human adaptation to the extreme climate of the northern temperate zone. Increased sleep duration, decreased appetite and other symptoms of depression helped to get through the long winters. The affective state in the summer season increased the energy potential and helped to perform a large number of tasks in a short period of time.

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

One of the interesting factors about this disease is the relationship of 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 the book “Genius and Insanity” on this topic. 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 the signs of this disease in Kant, Pushkin, 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

hereditary ( genetic) theory

Proponents of this theory argue in favor of the existence of a gene that is responsible for the development of this disease. So some studies have identified a gene that is localized on the short arm of chromosome 11. These studies were conducted in families with a burdened 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 adverse conditions, decompensation of genetic anomalies occurs. This is confirmed by the fact that the first attack of psychosis falls on that period of a person's life in which some important events take place. It could be family issues divorce), stress at work or some kind of socio-political crisis.
It is believed that the contribution of genetic prerequisites is about 70 percent, and environmental - 30 percent. The percentage of environmental factors increases in pure manic psychosis without depressive episodes.

The theory of constitutional predisposition

Monoamine theory

Theory of endocrine and water-electrolyte shifts

Theory of disturbed biorhythms

Symptoms and signs of manic psychosis

Monopolar manic psychosis

manic attack
This state is expressed in increased activity, initiative, interest in everything and in high spirits. At the same time, the patient's thinking accelerates and becomes jumping, fast, but at the same time, due to increased distractibility, unproductive. An increase in basic drives is observed - appetite, libido increase, and the need for sleep decreases. On average, patients sleep 3-4 hours a day. They become overly sociable, trying to help everyone and everything. At the same time, they make casual acquaintances, enter into chaotic sexual relationships. Often patients leave home or bring strangers into the house. The behavior of manic patients is ridiculous and unpredictable, they often begin to abuse alcohol and psychoactive substances. Often they "hit" politics - they chant slogans with heat and hoarseness in their voices. Such states are characterized by an overestimation of their 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 crazy ideas. Ideas of greatness, high origin, or ideas of a special purpose are often observed. It should be noted that despite the increased excitement, patients in a state of mania treat others favorably. Only occasionally there are mood swings, which are accompanied by irritability and explosiveness.
Such a fun mania develops very quickly - within 3 to 5 days. Its duration is from 2 to 4 months. The reverse dynamics of this state 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 an increase in the rate of ideational reactions. This means that there is no increased initiative or drives. Thinking does not speed up, but, on the contrary, slows down, concentration of attention is maintained ( which is not observed in 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 differs in fading. Feelings of a surge of strength, energy and euphoria, which are characteristic of classical mania, are not observed.
The duration of this condition can be delayed and reach up to 1 year.

The course of monopolar manic psychosis
Unlike bipolar psychosis, with monopolar psychosis, protracted phases of manic states can be observed. So, they can last from 4 months ( average duration) up to 12 months ( lingering course). The frequency of occurrence of such manic states averages one phase in three years. Also, such a psychosis is characterized by a gradual onset and the same end of manic attacks. In the early years, there is a seasonality of the disease - often manic attacks develop in autumn or spring. However, over time, this seasonality is lost.

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

bipolar manic psychosis

Onset and course of the disease
In 60 to 70 percent of cases, the first attack occurs during a depressive episode. There is a deep depression with pronounced suicidal behavior. After the end of the depressive episode, there is a long light period - remission. It may continue for several years. After remission, there is a relapse, which can be either manic or depressive.
The symptoms of bipolar disorder depend on its form.

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.

The mood of depressed patients decreases, patients note a "feeling of emptiness." Also no less characteristic is the feeling of "mental pain". There is a slowdown both in the motor sphere and in the ideational one. Thinking becomes viscous, there is difficulty in assimilation of new information and in concentration. Appetite can either increase or decrease. Sleep is unstable and intermittent during the night. Even if the patient managed to fall asleep, then in the morning there is a feeling of weakness. A frequent complaint of the patient is superficial sleep with nightmares. In general, mood swings throughout the day are typical for such a state - 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-accusation are often intertwined with statements about sinfulness. Patients blame themselves and their fate, overly dramatizing at the same time.

Hypochondriacal disorders are often observed in the structure of a depressive episode. In this case, the patient shows a very pronounced concern about his health. He is constantly looking for diseases in himself, interpreting various symptoms as fatal diseases. Passivity is observed in behavior, in dialogue - claims to others.

Hysteroid reactions and melancholy can also be observed. The duration of such a depressive state is about 3 months, but it can reach 6. The number of depressive states is more than manic. In strength and severity, they also surpass the manic attack. Sometimes depressive episodes can recur one after another. Between them, short-term and erased manias are observed.

Bipolar psychosis with a predominance of manic states
In the structure of this psychosis, vivid and intense manic episodes are observed. The development of a manic state is very slow and sometimes delayed ( up to 3 - 4 months). Recovery from this state can last from 3 to 5 weeks. Depressive episodes are less intense and short-lived. Manic attacks in the clinic of this psychosis develop twice as often as depressive ones.

The debut of psychosis falls on the age of 20 and begins with a manic attack. A feature of this form is that very often depression develops after mania. That is, there is a kind of phase doubling, without clear gaps between them. Such dual phases are observed at the onset of the disease. Two or more phases followed by a 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 may appear in one cycle.

The subsequent course of psychosis is characterized by the occurrence of both dual phases ( manic-depressive) and single ones ( purely depressive). The duration of the manic phase is 4-5 months; depressive - 2 months.
As the disease progresses, the frequency of phases becomes more stable and is one phase in a year and a half. Between cycles, there is a remission, which lasts an average of 2-3 years. However, in some cases it can be more persistent and long-term, reaching a duration of 10-15 years. During the period of remission, the patient retains a certain lability in mood, a change in personality traits, and a decrease in social and labor adaptation.

Distinct bipolar form of psychosis
This form is distinguished by a regular and distinct change of depressive and manic phases. The onset of the disease occurs at the age of 30-35 years. Depressive and manic states are characterized by a longer duration than in 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 or more months. There is a regularity of their appearance - one - two phases per year. The duration of remission is from two to three years.
At the beginning 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, a weakening of mental tone;
• stage of growing 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.

The stages of the manic phase are:

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

Diagnosis of manic psychosis

The diagnosis of mania or depression is based on the World Classification of Diseases diagnostic criteria ( ICD) or American Psychiatric Association criteria ( DSM).

Criteria for a manic and depressive episode according to the ICD

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

Criteria for psychoses

Diagnostic criteria for bipolar disorder according toDSM

To identify certain symptoms in patients with manic psychosis, various diagnostic scales are used.

Scales and questionnaires used in the diagnosis of manic psychosis

Treatment of manic psychosis

How can you help a person in this condition?

Help with manic psychosis
When caring for a patient with manic psychosis, the environment should monitor and, if possible, limit the activity and intentions of the patient. Relatives should be aware of the likely deviations in behavior in manic psychosis and do everything to reduce the negative consequences. So, if a 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 medication. Therefore, it is necessary to ensure that the patient takes the medicines prescribed by the doctor. Also, family members should monitor the implementation of all recommendations given by the doctor. Given the increased irritability of the patient, tact and support should be discreet, showing restraint and patience. You can not raise your voice and shout at the patient, as this can increase irritation and provoke aggression on the part of the patient.
If signs of excessive arousal or aggression appear, loved ones of a person with manic psychosis should be ready to ensure that he is quickly hospitalized.

Support for family members with manic-depressive psychosis
Patients with manic-depressive psychosis require close attention and support from their close environment. Being in a depressed state, such patients need help, since they cannot cope with the implementation of vital needs on their own.

The help of loved ones with manic-depressive psychosis is as follows:

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

In a severe depressive episode, the patient may be in a state of stupor for a long time. At such moments, one should not put pressure on the patient and encourage him to be active, since in this way the situation can be aggravated. 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 more oppression. The task of the close environment is to ensure complete peace and qualified medical care. Timely hospitalization will help to 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 taking place around him. If this symptom is accompanied by poor sleep and lack of appetite, you should immediately consult a doctor.

Suicide Prevention
When caring for a patient with any form of psychosis, the close environment should take into account possible suicide attempts. The highest frequency 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 behavior of the patient and take measures when identifying signs that indicate that a person has ideas about suicide. Often, people prone to suicidal ideas reflect on their uselessness, their sins or great guilt. The patient's belief that he has an incurable ( in some cases - dangerous for the environment) disease may also indicate that the patient may attempt suicide. To make loved ones worry should be a sharp calming of the patient after a long period of depression. It may seem to relatives that the patient's condition has improved, when in fact he is preparing for death. Often patients put their affairs in order, write wills, meet people whom they have not seen for a long time.

Steps to help prevent suicide include:

• Risk assessment- if the patient takes real preparatory measures ( gives favorite things, gets rid of unnecessary items, is interested in possible methods of suicide), you should consult a doctor.
• Taking all talk of suicide seriously- even if it seems unlikely to relatives that the patient can commit suicide, it is necessary to take into account even indirectly touched topics.
• Restriction of opportunities- you need to keep piercing and cutting objects, medicines, weapons away from the patient. You should also close windows, doors to the balcony, gas supply valve.

It is not uncommon for people close to a patient with suicidal thoughts to experience resentment, feelings of powerlessness, or anger. Such thoughts should be fought and, if possible, remain calm and express understanding to the patient. A person should not be judged for suicidal ideas, as such behavior can cause withdrawal or push to commit suicide. You should not argue with the patient, offer unjustified consolations and ask incorrect questions.

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

• I hope you don't plan on killing yourself- such a wording contains a hidden answer “no”, which relatives want to hear, and it is likely that the patient will answer in this way. In this case, a direct question “are you contemplating suicide” is appropriate, which will allow the person to speak out.
• What do you lack, because you live better than others- such a question will cause even more depression in the patient.
• Your fears are unfounded- this will humiliate a person and make him feel unnecessary and useless.

Actions to be taken by relatives when the patient's condition worsens include :

• an appeal to the attending physician for correction of treatment;
• elimination of external stressful and irritating factors;
• minimizing changes in the patient's daily routine;
• providing peace of mind.

Medical treatment

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 whose action is aimed at stabilizing mood. The main representatives of this group of drugs are lithium salts, valproic acid and some atypical antipsychotics. Of the atypical antipsychotics, aripiprazole is currently the drug of choice.

Antidepressants are also used in the treatment of depressive episodes in the structure of manic psychosis ( e.g. bupropion).

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

The main problem associated with the appointment of mood stabilizers is their toxicity. The most dangerous drug in this regard is lithium. The lithium concentration is difficult to maintain at the same level. A single missed dose of the drug can cause an imbalance in the concentration of lithium. 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 the toxic effects of lithium. The main side effects are associated with kidney dysfunction, cardiac arrhythmias, and inhibition of hematopoiesis ( process of blood cell formation). The rest of the normotimics also need a constant biochemical blood test.

Antipsychotics and antidepressants used in the treatment of manic psychosis

Prevention of manic psychosis

What should be done to avoid manic psychosis?

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. It is necessary to know that some forms of manic psychosis are accompanied by remission in 10-15 years. At the same time, there is no regression of professional or intellectual qualities. 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 the high risk of heredity in manic psychosis. Couples where one of the family members suffers from psychosis should be instructed about the high risk of manic psychosis in future children.

What can trigger manic psychosis?

Factors that can trigger manic psychosis are:

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

Emotional upheavals are more of a provocative than a causal factor. There is ample evidence that interpersonal relationship problems and recent stressful events contribute to the onset and relapse of manic psychosis. According to studies, more than 30 percent of patients with this disease have experience 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. Excessive activity of such patients allows them to escape from difficult experiences. Often the cause of the development 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 of psychosis with human biorhythms. So, the development or exacerbation of the disease often occurs in spring or autumn. Almost all doctors note a great connection in the development of manic psychosis with past brain diseases, endocrine system disorders and infectious processes.

Factors that can trigger an exacerbation of manic psychosis are:

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

With manic psychosis, compliance with the daily routine is no less important. Getting enough sleep is just as important as taking medication. 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 revealed that in patients with psychosis, the duration of various phases of sleep changes.

A pathological condition in which a person feels an unreasonable increase in mood, mental and ideational excitation in the form of tachypsia, as well as motor excitation, is called a manic syndrome. Characteristic signs of the condition, however, not in all cases, are the following manifestations:

• Strengthening instinctive activity - an increase in appetite, sexual desire, self-defense reflex;
• Megalomania;
• Increased distractibility.

There are the following types of manic syndrome:

• Manic-paranoid - the patient has crazy ideas about relationships with the opposite sex, he is able to pursue the object of his passion;
• Oneiroid mania - at the peak of the syndrome, a disturbance of consciousness of the oneiroid type is manifested, accompanied by hallucinations;
• Delusional variant - megalomania, usually manifested in delusional ideas that have a certain logical sequence related to the patient's professional activities;
• Joyful mania - in addition to the symptoms of the classic manic syndrome, motor excitation, tachypsychia and hyperthymia are observed;
• Angry mania - usually manifested by a tendency to sudden aggression, irritability, temper and conflict with others.

To diagnose manic syndrome, the Altman scale, or the so-called mania test, is used.

Causes of manic syndrome

Often, the condition is a consequence of bipolar affective disorder, occurs paroxysmal, with characteristic stages of development and various symptoms that vary depending on the stage of progression of the disease.

Also, the causes of manic syndrome can be infectious, organic and toxic psychoses, it can be induced by drugs and some medications, which include:

• antidepressants;
• Teturam;
• Levopoda;
• Bromides;
• corticosteroids;
• Psychostimulants;
• Opiates;
• Hallucinogens.

Symptoms of a manic syndrome

It can be noted that people with manic syndrome are often in a state of painful mood elevation, combined with unreasonable optimism, excessive talkativeness and motor activity. Patients greatly overestimate their capabilities, sometimes their self-esteem reaches megalomania, they tend to take on a lot of things, however, due to increased distractibility, they do not bring anything to the end.

Aggravation of memory and speed of thinking are also manifestations of a manic syndrome, as well as the desire to constantly establish contacts and expand the circle of friends. Most often, patients commit rash and completely senseless acts, spend large sums of money on something that a normal person would not think of buying. In many cases, manic syndrome is manifested by an increase in sexuality, and in women there may be changes in the menstrual cycle (delay or shift).

At the peak of the state, it is impossible to communicate with such patients, since their conflict, tactlessness and irritability become unbearable. People suffering from a manic syndrome do not tolerate comments and objections, they strive to lead any process, and their orders are often completely ridiculous. If the patient feels resistance from the people around him to his plans, he becomes aggressive, is able to start fights and quarrels.

Manic Syndrome: Diagnosis

When diagnosing a manic syndrome, a clinical method is used, the main place in which is occupied by an objective observation of the patient's behavior and a detailed questioning. Based on observation and dialogue with the patient, as well as by studying medical records and conversations with the patient's relatives, the doctor forms a subjective anamnesis and reveals clinical facts that determine the patient's psychological state.

The purpose of diagnosing a manic syndrome, in particular, taking an anamnesis, is to obtain reliable data on:

• The presence in the family of relatives with mental illness;
• Mental state;
• Features of development, family and social status, behavior, traumas and reactions to various life situations.

When taking an anamnesis, the doctor should pay special attention to the presence of the following risk factors:

• Stressful changes in life circumstances;
• Affective disorders in the patient's family history and past;
• suicide attempts;
• drug dependence or alcoholism;
• Chronic somatic diseases.

Additionally, in the diagnosis of manic syndrome, biochemical and clinical blood tests are performed.

Manic syndrome: treatment

After the diagnosis is confirmed, the doctor, depending on the patient's condition, will prescribe either medication or psychotherapeutic conversations. If the patient's condition is accompanied by groundless aggression, irritability, conflict, sleep disturbances, inpatient treatment of manic syndrome is necessary. In such cases, the limitation of the mental and physical activity of the patient, and the appointment of sedatives, antipsychotics or tranquilizers are shown.

Special attention should be paid to situations in which a person is in an unconditioned state of elevated mood, motor, mental or ciator excitation. Especially if such people demonstrate megalomania and persecution, obsessions and increased distractibility.

The treatment of manic syndrome can be medication and proceed in a hospital, or be carried out in the form of psychotherapeutic conversations, the purpose of which is to identify the causes that have served to develop the disease, as well as to correct the existing manifestations of the syndrome.

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