manic manifestations. Manic syndrome: development, types, manifestations, diagnosis, treatment. Causes of manic syndrome

Symptoms and treatment

What is manic-depressive psychosis? We will analyze the causes of occurrence, diagnosis and treatment methods in the article of Dr. E. V. Bachilo, a psychiatrist with an experience of 10 years.

Definition of disease. Causes of the disease

Affective insanity- chronic disease of the affective sphere. This disorder is currently referred to as bipolar affective disorder (BAD). This disease significantly disrupts the social and professional functioning of a person, so patients need the help of specialists.

This disease is characterized by the presence of manic, depressive, and mixed episodes. However, during periods of remission (improvement of the course of the disease), the symptoms of the above indicated phases almost completely disappear. Such periods of absence of manifestations of the disease are called intermissions.

The prevalence of BAD is on average 1%. Also, according to some data, on average, 1 patient per 5-10 thousand people suffers from this disorder. The disease begins relatively late. The average age of patients with BAD is 35-40 years. Women get sick more often than men (approximately in a ratio of 3:2). However, it is worth noting that bipolar forms of the disease are more common at a young age (up to about 25 years), and unipolar (the occurrence of either manic or depressive psychosis) - at an older age (30 years). There are no exact data on the prevalence of the disorder in childhood.

The reasons for the development of BAD have not been precisely established to date. The most common genetic theory of the origin of the disease.

It is believed that the disease has a complex etiology. This is evidenced by the results of genetic, biological studies, the study of neuroendocrine structures, as well as a number of psychosocial theories. It was noted that in first-line relatives there is an "accumulation" of the number of cases of BAD and.

The disease can occur for no apparent reason or after any provoking factor (for example, after infectious, as well as mental illness associated with any psychological trauma).

An increased risk of developing bipolar disorder is associated with certain personality traits, which include:

If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of manic-depressive psychosis

As noted above, the disease is characterized by phasicity. Bipolar disorder can manifest only as a manic phase, only as a depressive phase, or only as hypomanic manifestations. The number of phases, as well as their change, is individual for each patient. They can last from several weeks to 1.5-2 years. Intermissions ("light intervals") also have different durations: they can be quite short or last up to 3-7 years. The cessation of the attack leads to an almost complete restoration of mental well-being.

With BAD, there is no formation of a defect (as with), as well as any other pronounced personality changes, even in the case of a long course of the disease and frequent occurrence and change of phases.

Consider the main manifestations of bipolar affective disorder.

Depressive episode of bipolar disorder

The depressive phase is characterized by the following peculiarities:

the occurrence of endogenous depression, which is characterized by the biological nature of painful disorders involving not only mental, but also somatic, endocrine and general metabolic processes;
reduced mood background, slowing down of thinking and motor speech activity (depressive triad);
diurnal mood swings - worse in the morning (patients wake up in the morning with a feeling of melancholy, anxiety, indifference) and somewhat better in the evening (there is little activity);
loss of appetite, perversion of taste sensitivity (food seems to have "lost taste"), patients lose weight, menstruation may disappear in women;
possible psychomotor retardation;
the presence of longing, which is often felt as a physical feeling of heaviness behind the sternum (precordial longing);
decrease or complete suppression of libido and maternal instinct;
the occurrence of an “atypical variant” of depression is likely: appetite increases, hypersomnia occurs (wake intervals become shorter, and the sleep period is longer);
quite often there is a somatic triad (Protopopov's triad): tachycardia (rapid heartbeat), mydriasis (dilated pupil) and constipation;
the manifestation of various psychotic symptoms and syndromes - delusions (delusional ideas of sinfulness, impoverishment, self-accusation) and hallucinations (auditory hallucinations in the form of "voices" accusing or insulting the patient). The indicated symptoms can occur depending on the emotional state (mostly there is a feeling of guilt, sin, damage, impending disaster, etc.), while it is distinguished by a neutral theme (that is, it is incongruent with affect).

There are the following variants of the course of the depressive phase:

simple depression - manifested by the presence of a depressive triad and proceeds without hallucinations and delusions;
hypochondriacal depression - hypochondriacal delirium occurs, which has an affective coloring;
delusional depression - manifests itself in the form of "Cotard's syndrome", which includes depressive symptoms, anxiety, delusional experiences of nihilistic fantastic content, has a wide, grandiose scope;
agitated depression - accompanied by nervous excitement;
anesthetic depression (or "painful insensitivity") - the patient "loses" the ability to any feelings.

It should be noted separately that in bipolar disorder (especially in the depressive phase) there is a fairly high level of suicidal activity in patients. So, according to some data, the frequency of parasuicides in bipolar disorder is up to 25-50%. Suicidal tendencies (as well as suicidal intentions and attempts) are an important factor in determining the need for a patient to be admitted to a hospital.

Manic episode of BAD

Manic syndrome can have varying degrees of severity: from mild mania (hypomania) to severe with the manifestation of psychotic symptoms. With hypomania, there is an elevated mood, formal criticism of one's condition (or its absence), and there is no pronounced social maladaptation. In some cases, hypomania can be productive for the patient.

A manic episode is characterized by: symptoms:

the presence of a manic triad (increased background of mood, acceleration of thinking, increased speech motor activity), opposite to the triad of a depressive syndrome.
patients become active, feel “a strong surge of energy”, everything seems to be “on the shoulder”, they start a lot of things at the same time, but do not finish them, productivity approaches zero, they often switch during a conversation, they cannot focus on something one, it is possible to constantly change from loud laughter to screaming, and vice versa;
thinking is accelerated, which is expressed in the emergence of a large number of thoughts (associations) per unit of time, patients sometimes “do not keep up” with their thoughts.

There are different types of mania. For example, the manic triad described above occurs in classic (happy) mania. Such patients are characterized by excessive cheerfulness, increased distractibility, superficiality of judgments, and unjustified optimism. Speech is slurred, sometimes to the point of complete incoherence.

Mixed BAR episode

This episode is characterized by the coexistence of manic (or hypomanic) and depressive symptoms that last at least two weeks or rather quickly (in a matter of hours) replace each other. It should be noted that the patient's disorders can be significantly expressed, which can lead to professional and social maladaptation.

The following manifestations of a mixed episode occur:

suicidal thoughts;
appetite disorders;
the various psychotic traits that are listed above;

Mixed states of BAR can proceed in different ways:

The pathogenesis of manic-depressive psychosis

Despite a large number of studies on bipolar disorder, the pathogenesis of this disorder is not completely clear. There are a large number of theories and hypotheses of the origin of the disease. To date, it is known that the occurrence of depression is associated with a violation of the exchange of a number of monoamines and biorhythms (sleep-wake cycles), as well as with dysfunction of the inhibitory systems of the cerebral cortex. Among other things, there is evidence of the participation of norepinephrine, serotonin, dopamine, acetylcholine and GABA in the pathogenesis of the development of depressive states.

The causes of the manic phases of BAD lie in the increased tone of the sympathetic nervous system, hyperfunction of the thyroid gland and pituitary gland.

In the figure below, you can see the cardinal difference in brain activity during the manic (A) and depressive (B) phases of bipolar disorder. Light (white) zones indicate the most active parts of the brain, and blue, respectively, vice versa.

Classification and stages of development of manic-depressive psychosis

Currently, there are several types of bipolar affective disorder:

bipolar course - in the structure of the disease there are manic and depressive phases, between which there are "bright gaps" (intermissions);
monopolar (unipolar) course - either manic or depressive phases occur in the structure of the disease. The most common type of flow occurs when only a pronounced depressive phase is present;
continual - phases succeed each other without periods of intermission.

Also, according to the DSM (American Classification of Mental Disorders) classification, there are:

Complications of manic-depressive psychosis

Lack of necessary treatment can lead to dangerous consequences:

Diagnosis of manic-depressive psychosis

The above symptoms are diagnostically significant in making a diagnosis.

Diagnosis of BAD is carried out according to the Tenth Revision of the International Classification of Diseases (ICD-10). So, according to ICD-10, the following diagnostic units are distinguished:

bipolar disorder with a current episode of hypomania;
bipolar disorder with a current episode of mania but no psychotic symptoms;
bipolar disorder with a current episode of mania and psychotic symptoms;
bipolar disorder with a current episode of mild or moderate depression;
bipolar disorder with a current episode of major depression but no psychotic symptoms;
bipolar disorder with a current episode of severe depression with psychotic symptoms;
BAR with a current mixed episode;
bipolar disorder in current remission;
Other BARs;
BAR, unspecified.

At the same time, it is necessary to take into account a number of clinical signs that may indicate a bipolar affective disorder:

the presence of any organic pathology of the central nervous system (tumors, previous injuries or operations on the brain, etc.);
the presence of pathology of the endocrine system;
substance abuse;
the absence of clearly defined full-fledged intermissions / remissions throughout the course of the disease;
lack of criticism of the transferred state during periods of remission.

Bipolar affective disorder must be distinguished from a range of conditions. If there are psychotic disorders in the structure of the disease, it is necessary to separate bipolar disorder from schizophrenia and schizoaffective disorders. Type II bipolar disorder must be distinguished from recurrent depression. You should also differentiate BAD from personality disorders, as well as various addictions. If the disease developed in adolescence, it is necessary to separate bipolar disorder from hyperkinetic disorders. If the disease developed at a later age - with affective disorders that are associated with organic diseases of the brain.

Treatment of manic-depressive psychosis

Bipolar affective disorder should be treated by a qualified psychiatrist. Psychologists (clinical psychologists) in this case will not be able to cure this disease.

cupping therapy - aimed at eliminating existing symptoms and minimizing side effects;
maintenance therapy - preserves the effect obtained at the stage of stopping the disease;
anti-relapse therapy - prevents relapses (appearance of affective phases).

For the treatment of bipolar disorder, drugs from different groups are used: lithium preparations, antiepileptic drugs ( valproates, carbamazepine, lamotrigine), neuroleptics ( quetiapine, olanzapine), antidepressants and tranquilizers.

It should be noted that BAD therapy is carried out for a long time - from six months or more.

Psychosocial support and psychotherapeutic measures can significantly help in the treatment of bipolar disorder. However, they cannot replace drug therapy. To date, there are specially developed techniques for the treatment of ARBs that can reduce interpersonal conflicts, as well as somewhat “smooth out” cyclical changes in various environmental factors (for example, daylight hours, etc.).

Various psychoeducational programs are carried out in order to increase the patient's awareness of the disease, its nature, course, prognosis, as well as modern methods of therapy. This helps to establish a better relationship between the doctor and the patient, adherence to the therapy regimen, etc. In some institutions, various psychoeducational seminars are held, at which the above issues are discussed in detail.

There are studies and observations showing the effectiveness of the use of cognitive-behavioral psychotherapy in conjunction with drug treatment. Individual, group or family forms of psychotherapy are used to reduce the risk of relapse.

Today there are cards for self-registration of mood swings, as well as a self-control sheet. These forms help to quickly track changes in mood and timely adjust therapy and consult a doctor.

Separately, it should be said about the development of BAD during pregnancy. This disorder is not an absolute contraindication for pregnancy and childbirth. The most dangerous is the postpartum period, in which various symptoms can develop. The question of the use of drug therapy during pregnancy is decided individually in each case. It is necessary to evaluate the risk/benefit of the use of drugs, carefully weigh the pros and cons. Also, psychotherapeutic support for pregnant women can help in the treatment of ARBs. If possible, drugs should be avoided during the first trimester of pregnancy.

Forecast. Prevention

The prognosis of bipolar affective disorder depends on the type of course of the disease, the frequency of phase changes, the severity of psychotic symptoms, as well as the patient's adherence to therapy and control of his condition. So, in the case of well-chosen therapy and the use of additional psychosocial methods, it is possible to achieve long-term intermissions, patients adapt well socially and professionally.

Manic syndrome (mania) is defined as a severe mental illness, which is characterized by a triad of defining symptoms - increased hyperarousal mood, motor activity and the presence of accelerated thinking and speech function.

Often cycles with depressed mood. So, when 4 different periods appear, which are classified depending on the type and intensity of symptoms.

This mental illness occurs in about 1% of the adult population. It may be signaled by certain warning signs, but not always. The first symptoms indicating a manic syndrome may occur as early as puberty or in early adulthood.

Causes and etiology of the disease

To date, the exact cause of manic syndrome has not been determined. Most often, a complex of factors is involved in the development of mania, which together form a picture of the disease.

Most often, manic syndrome manifests itself in a framework (the so-called manic depressive syndrome or psychosis), which is characterized by a recurrence in a family history, therefore, most likely, there is a genetic predisposition to this disease.

In this regard, there are suggestions regarding the existence of genes for bipolar disorder. However, if the manic disorder were caused only by genetic factors, then among the identical twins, one of whom suffers from the disorder, the other twin would inevitably also be ill. But this fact has not been confirmed by medical research.

On the other hand, the likelihood of disease in such cases is significantly increased.

Research shows that, as with other mental disorders, manic syndrome (and bipolar disorder) is not the result of a single gene lesion, but a combination of genes that, together with environmental factors (drugs and drugs, surgery, physical illness, etc.) .) and cause the development of mania.

Risk factors

In addition to genetic predisposition, there are other factors that can cause a manic state. These include:

strong emotions (shock, sadness, mental anguish, fear, etc.);
physical and mental exhaustion;
season;
taking certain medications (, corticosteroids, etc.);
the use of narcotic substances (cocaine, hallucinogenic substances, opiates).

Clinical picture

Manic-depressive syndrome is manifested by significant mood swings - from unusually "good" to irritation, sadness, and even hopelessness. Such fluctuations can be cyclically repeated. The period of an episode of "elevated" mood is called mania, an episode of sad mood is characterized by depression.

Symptoms that manifest manic syndrome:

Manic tendencies are present if an excessively good mood, combined with at least 3 other symptoms, persists for a week (at least).

What does a manic person look like?

The patient may also be prescribed drugs that have ancillary effects, such as for insomnia, etc.

The main drugs used in therapy:

Mood stabilizers: a group of drugs intended for preventive treatment. Their long-term use reduces the risk of recurrence of depression or mania. The drugs of this group are also used in the acute course of mania or depression.
Antipsychotics (neuroleptics): drugs used to treat mania or depression. Some of the newer antipsychotics have also been shown to be effective in long-term, prophylactic use, thus mimicking mood stabilizers.

Additional (auxiliary) drugs:

used to treat depression. The use of drugs in this group without a mood stabilizer is not recommended - this can lead to a worsening of the disease.
sleeping pills and intended only for short-term use in the treatment of insomnia, anxiety, in case of tension or excitement.

Why is a maniac dangerous for himself and for people?

In about half of the cases, there is an increase in the consumption of alcohol or drugs by the manic person.

Manic syndrome also carries various social risks. A person can cause inconvenience to himself, for example, inappropriate jokes, arrogant behavior. The public, as a rule, is not sufficiently informed about the mental state of a person, and such behavior is associated with the peculiarities of his character. This significantly complicates the personal and social life of a manic person.

The significant financial loss that accompanies reckless behavior in the manic phase often leads to subsequent social problems, logically related to partnerships or marital relationships, which can also be adversely affected by this mental disorder.

Mania refers to mental disorders that, unfortunately, cannot be prevented, because. such disorders are mainly associated with hereditary transmission.

A healthy lifestyle, sufficient physical activity, avoidance of stressful and emotionally difficult situations and factors, regular and high-quality sleep, avoidance of alcohol and other psychoactive substances (marijuana, LSD, cocaine, methamphetamine, etc.) can bring certain benefits.

The life of any person consists of joys and sorrows, happiness and misfortune, to which he reacts accordingly - such is our human nature. But if the "emotional swings" are pronounced, that is, episodes of euphoria and deep depression appear very clearly, and, for no reason, and periodically, then we can assume the presence of manic-depressive psychosis (MDP). It is now commonly referred to as bipolar affective disorder (BAD), a decision made by the psychiatric community so as not to injure patients.

This syndrome is a specific mental illness requiring treatment. It is characterized by alternating depressive and manic periods with intermission - a completely healthy state in which the patient feels great and no mental or physical pathologies are observed in him. It should be noted that there are no personality changes, even if the change of phases occurs frequently, and he has been suffering from the disorder for quite a long time. This is the uniqueness of this mental illness. At one time, such famous personalities as Beethoven, Vincent van Gogh, actress Virginia Woolf suffered from it, which was quite strongly reflected in their work.

According to statistics, almost 1.5% of the human population of the world is affected by TIR, and among the female half of its cases, there are four times more cases than the male.

Types of BAR

There are two types of this syndrome:

Bipolar type I. Since in this case periods of mood changes can be traced very clearly, it is called classical.
Bipolar type II. Due to the weak severity of the manic phase, it is more difficult to diagnose, but it occurs much more often than the first. It can be confused with various forms of depressive disorders, including:

clinical depression;
postpartum and other female depressions, seasonal, etc.;
the so-called atypical depression with such pronounced signs as increased appetite, anxiety, drowsiness;
melancholia (insomnia, lack of appetite).

If the depressive and manic phases are mild in nature - their manifestations are dim, smoothed, then such a bipolar psychosis is called "cyclotomy".

According to clinical manifestations, MDP is divided into types:

with a preponderance of the depressive phase;
with the predominance of the manic period;
with alternating euphoria and depression, interrupted by periods of intermission;
the manic phase changes the depressive one without intermission.

What causes bipolar disorder

The first signs of manic-depressive syndrome appear in adolescents of 13-14 years old, but it is quite difficult to diagnose during this period, since this pubertal age is characterized by special mental problems. Until the age of 23, when a personality is formed, it is also problematic to do this. But by the age of 25, psychosis is finally formed, and in the period of 30-50 years, its characteristic symptoms and development can already be observed.

There are also difficulties in determining the causes of bipolar disorder. It is believed that it is inherited with genes, and may also be associated with the characteristics of the nervous system. That is, it is a congenital disease.

However, there are also such biological "impulses" to the development of this psychosis:

oncological diseases;
head injury;
hormonal disorders, imbalance of the main hormones;
intoxication of the body, including drug use;
thyroid dysfunction.

TIR can also provoke socio-psychological reasons. For example, a person has experienced a very strong shock, from which he tries to recover by promiscuity, drunkenness, fun, or by plunging headlong into work, resting only a few hours a day. But after a while the body is exhausted and tired, the described manic state is replaced by a depressed, depressive one. This is explained simply: due to nervous overstrain, biochemical processes fail, they negatively affect the autonomic system, and this, in turn, affects human behavior.

At risk of getting bipolar affective disorder are people whose psyche is mobile, subject to extraneous influence, unable to adequately interpret life events.

The danger of BAD is that it gradually makes a person's mental state worse. If treatment is neglected, this will lead to problems with loved ones, finances, communication, etc. As a result - suicidal thoughts, which is fraught with sad consequences.

Groups of symptoms

Bipolar psychosis, dual by definition, is also defined by two groups of symptoms characteristic of depressive and manic disorders, respectively.

Characteristics of the manic phase:

Active gesticulation, hurried speech with "swallowed" words. With a strong passion and the inability to express emotions in words, just waving your arms happens.
Unsupported optimism, misjudgment of the chances of success - investing in dubious enterprises, participating in the lottery with confidence in a big win, etc.
The desire to take risks - to commit a robbery or a dangerous trick for the sake of pleasure, participation in gambling.
Hypertrophied self-confidence, ignoring advice and criticism. Disagreeing with a certain opinion can cause aggression.
Excessive excitement, energy.
Strong irritability.

Depressive symptoms are diametrically opposed:

Discomfort in the physical sense.
Complete apathy, sadness, loss of interest in life.
Distrustfulness, isolation in oneself.
Sleep disturbance.
Deceleration of speech, silence.
Loss of appetite or, conversely, voracity (rarely).
Decreased self-esteem.
Desire to end life.

This or that period can last several months or hourly.

The presence of the above symptoms and their alternation suggests the presence of manic-depressive psychosis. It is necessary to immediately contact a specialist for advice. Treatment of MDP in the early stages will stop the disorder and prevent complications from developing, prevent suicide, and improve the quality of life.

Medical assistance should be sought if:

mood changes for no reason;
sleep duration changes unmotivated;
sudden increase or decrease in appetite.

As a rule, the patient himself, believing that everything is in order with him, does not go to the doctor. For him, this is done by all the close people who see from the outside, concerned about the inappropriate behavior of a relative.

Diagnostics and therapy

As mentioned above, bipolar syndrome is difficult to diagnose due to its similarity with other mental disorders. To achieve this, one has to observe the patient for some time: this makes it possible to make sure that there are manic attacks and depressive manifestations, and they are cyclical.

The following will help identify manic-depressive psychosis:

testing for emotionality, anxiety, dependence on bad habits. Also, the test will determine the coefficient of attention deficit;

thorough examinations - tomography, laboratory blood tests, ultrasound. This will determine the presence of physical pathologies, cancerous tumors, malfunctions of the endocrine system;
specially designed questionnaires. The patient and his relatives are asked to answer questions. So you can understand the history of the disease and the genetic predisposition to it.

That is, an integrated approach is required for the diagnosis of MDP. It involves collecting as much information about the patient as possible, as well as analyzing the duration of his behavioral disturbances and their severity. It is necessary to observe the patient, make sure that there are no physiological pathologies, drug addiction, etc.

Experts do not tire of reminding: the timely determination of the clinical picture and the development of a treatment strategy guarantees a positive result in a short time. The modern techniques available in their arsenal are able to effectively deal with attacks of psychosis, extinguish them, and gradually nullify them.

Pharmaco- and psychotherapy for manic-depressive psychosis

This psychosis is very difficult to treat, because the doctor deals with two opposite conditions at once, which require a completely different approach.

Medicines and doses are selected by a specialist very carefully: the drugs should gently bring the patient out of the attack, without making him depressed after the manic period and vice versa.

The goal of treating bipolar disorder with medications is to use antidepressants that reuptake serotonin (a chemical, a hormone present in the human body that is associated with mood and behavior). Commonly used is Prozac, which has proven effective in this psychosis.

Lithium salt, which is found in drugs such as contemnol, lithium carbonate, lithium hydroxybutyrate, etc., stabilizes the mood. They are also taken to prevent the recurrence of the disorder, but people with hypotension, problems with the kidneys and the gastrointestinal tract should be used with caution.

Lithium is replaced by antiepileptic drugs and tranquilizers: carbamezapine, valproic acid, topiramate. They slow down nerve impulses and prevent the mood from “jumping”.

Antipsychotics are also very effective in the treatment of bipolar disorder: galapedrol, chlorpromazine, tarasan, etc.

All of the above drugs have a sedative effect, that is, among other things, reduce the reaction to external stimuli, so it is not recommended to drive a vehicle while taking them.

Together with drug treatment, psychotherapy is also necessary to manage the patient's condition, control it and maintain long-term remission. It is possible only after the patient's mood has stabilized with the help of drugs.

Psychotherapeutic sessions can be individual, group and family. The following goals are set for the specialist who conducts them:

to achieve the patient's awareness that his condition is non-standard emotionally;
to develop a strategy for the patient's behavior for the future, if there is a relapse of any phase of psychosis;
to consolidate the successes gained in obtaining by the patient the ability to control his emotions and, in general, his state.

Family psychotherapy involves the presence of the patient and people close to him. During the sessions, cases of attacks of bipolar disorder are worked out, and relatives learn how to prevent them.

Group sessions help patients understand the syndrome more deeply, as they are attended by people suffering from the same problem. Seeing from the outside the desire of others to gain emotional stability, the patient has a strong motivation for treatment.

In the case of rare attacks, interspersed with long "healthy" phases, the patient can lead a normal life, work, but be treated on an outpatient basis - undergo preventive therapy, take medication, visit a psychologist.

In especially severe cases of circular pathology, the patient may be assigned a disability (Group 1).

With bipolar disorder, if it is recognized in time, it is quite possible to live normally, knowing how to manage it. For example, actors Catherine Zeta Jones, Jim Carrey, Ben Stiller were diagnosed with it, which does not prevent them from successfully acting in films, having a family, etc.

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

The main cause of manic syndrome is considered to be a genetic predisposition. People who subsequently become ill with mania are characterized by increased conceit before the disease, they feel superior to others, often consider themselves unrecognized geniuses.

Manic syndrome is not a diagnosis, but a manifestation of various diseases. Manic manifestations can be with such diseases:

A patient with a first manic episode requires careful examination, since a change in mental state may be a consequence of a disease of the body.

Classification

According to the ICD-10, the manic syndrome is encoded in the following headings:

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

classic mania

Manic syndrome or "pure" mania manifests itself as follows:

An elevated mood is in no way connected with the events of real life, it does not change even during tragic events.
Acceleration of thinking reaches such a degree that it turns into a jump of ideas, while superficial, far apart events or concepts are connected by one association. The logical continuation of this way of thinking is delusions of grandeur, when the patient considers himself the ruler of the world, a great scientist, god or an outstanding commander. Behavior corresponds to the existing delirium. The patient feels that he has no equal in the world, emotions are bright and magnificent, there are no doubts and troubles, and the future is bright and beautiful.
Impulsions and movements are accelerated so much that a person exhibits a vigorous activity that does not reach a certain 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 another favorite thing.

To understand what a manic syndrome is, you can turn to fiction. For example, the locksmith Polesov from Ilf and Petrov's The Twelve Chairs clearly suffered from hypomania.

“The reason for this was his overly ebullient nature. It was an ebullient lazybones. He was constantly foaming. Customers did not find Viktor Mikhailovich. Viktor Mikhailovich was already in charge somewhere. He wasn't up to work."

Kinds

The constituent parts of the manic syndrome can be expressed to varying degrees, as well as combined with other psychotic manifestations. Depending on this, the following types of mania are distinguished:

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

manic-paranoid - a delusional structure joins, most often a delusion of relationship and persecution;
delusional mania - delirium "grows" from those events that are really present in the patient's life, but exaggerated so much that they are completely detached from reality (for example, megalomania based on professional skills);
oneiroid - delusions are joined by hallucinations of fantastic content, incredible pictures of unreal events.

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

Self-diagnosis of mania

In order to delimit a mental disorder from temporary psychological problems, there is an Altman scale. This is a questionnaire consisting of 5 sections - about mood, self-confidence, need for sleep, speech and vitality. Each section has 5 questions that you need to answer honestly. Answers are evaluated in points from 0 to 4. 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 ensure that a person consults a doctor on time. The result of the survey is not a diagnosis, but it is highly accurate. In psychiatry, this questionnaire corresponds to the Young mania scale, which serves to confirm (verify) the diagnosis.

Rorschach spots

This is a test that was introduced at the beginning of the last century by the Swiss psychiatrist Hermann Rorschach. The stimulus material consists of 10 cards with monochrome and color symmetrical spots.

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

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

Patients with hypomania or mania often see moving figures, although the images are static. Associations that often arise when working with a test can tell about hidden conflicts, complex relationships, and changes much more than a direct conversation. You can identify the needs of the individual, long-term psychological trauma, aggressive or suicidal aspirations.

Treatment

A manic syndrome that has arisen for the first time is subject to treatment in a closed psychiatric unit (if it is not a complication of a somatic illness in a patient who is in a hospital). It is impossible to predict how the patient's condition will change, how he will react to medications, how the symptoms will be transformed.

At any moment, the state can become depressive-manic, depressive, psychopathic, or something else. A patient in an unstable state, with manifestations of a manic syndrome, is a danger both to himself and to others.

Feeling boundless happiness and the absence of barriers, the patient can commit acts, the consequences of which are difficult or impossible to correct: donate or distribute movable and immovable property, make many sexual contacts, destroy his family, use a lethal dose of the drug. The transition from a manic phase to a depressive phase can occur within a few hours, which is fraught with suicide.

The relief of manic syndrome is exclusively medical. Preparations based on lithium salts, neuroleptics, mood stabilizers, nootropic drugs, tranquilizers, mineral-vitamin complexes are used.

Endogenous mental illnesses proceed according to their own internal laws, and it is not possible to shorten the duration of the disease. Due to the long duration of treatment, 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, refers to endogenous or hereditary nature. No one is to blame for its occurrence. Mankind has been living for more than two thousand years, and a pathological gene from ancestors can manifest itself in any family.

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

It is impossible to refuse hospitalization, it can irreparably harm a sick person. It is not necessary to disclose the fact of treatment, especially since at the request of the patient or his relatives, a rehabilitation diagnosis is indicated on the disability certificate - neurosis, grief reaction or something like that.

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

Treat the mentally ill in exactly 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-depressive psychosis (MDP) refers to severe mental illness that occurs with a succession of two phases of the disease - manic and depressive. Between them there is a period of mental "normality" (light interval).

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Causes of manic-depressive psychosis

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

Note:the causes of manic-depressive psychosis are still under study. A clear pattern of transmission of the disease by inheritance was 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 the 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. The dysregulation of norepinephrine-serotonin reactions, caused by a deficiency of these substances, plays a role.

V.P. Protopopov.

How does manic-depressive psychosis manifest?

Symptoms of manic-depressive psychosis depend on the phase of the illness. The disease can manifest itself in a manic and depressive form.

The manic phase can proceed in the classic version and with some features.

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

inadequately joyful, exalted and improved mood;
sharply accelerated, unproductive thinking;
inadequate behavior, activity, mobility, manifestations of motor excitation.

The beginning of this phase in manic-depressive psychosis looks like a normal burst of energy. Patients are active, talk a lot, try to take on many things at the same time. Their mood is upbeat, overly optimistic. Memory sharpens. Patients talk and remember a lot. In all the events that take place, they see an exceptional positive, even where there is none.

Excitation gradually increases. The time allotted for sleep decreases, 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 constantly return to the unsaid topic.

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

The activity is unproductive. Patients simultaneously "grab" a large number of cases, but none of them is brought to a natural end, they are constantly distracted. Hypermobility is often combined with singing, dancing, jumping.

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

Increased sexual and food instincts. 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 are beginning to use a lot of cosmetics to attract attention to themselves.

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

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

In the depressive phase, there are three main signs:

painfully depressed mood;
sharply slowed down pace of thinking;
motor retardation up to complete immobilization.

The initial symptoms of this phase of manic-depressive psychosis are accompanied by sleep disturbance, frequent nocturnal awakenings, and the inability to fall asleep. Appetite gradually decreases, a state of weakness develops, constipation, pain in the chest appear. The mood is constantly depressed, the face of patients is apathetic, sad. The depression is on the rise. Everything present, past and future is presented in black and hopeless colors. Some patients with manic-depressive psychosis have ideas of self-accusation, patients try to hide in inaccessible places, 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. Suffering from manic-depressive psychosis, they begin to remember all their actions and give them ideas of inferiority. Some consider themselves unworthy of food, sleep, respect. It seems to them that doctors are wasting their time on them, unreasonably prescribing them medicines, as unworthy of treatment.

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. Gradually, the ideas of self-accusation lead some patients to thoughts of suicide, which they can fully translate into reality.

Most pronounced in the morning, before dawn. By evening, the intensity of her symptoms decreases. Patients mostly sit in inconspicuous places, lie on beds, like to go under the bed, because they consider themselves unworthy of being in a normal position. They are reluctant to make contact, they respond monotonously, with a slowdown, without further ado.

On the faces there is an imprint of deep sorrow with a characteristic wrinkle on the forehead. The corners of the mouth are lowered down, the eyes are dull, inactive.

Options for the depressive phase:

asthenic depression– patients with this type of manic-depressive psychosis are dominated by ideas of their own soullessness in relation to relatives, they consider themselves unworthy parents, husbands, wives, etc.
anxious depression- proceeds with the manifestation of an extreme degree of anxiety, fears, bringing patients to. In this state, patients may fall into a stupor.

In almost all patients in the depressive phase, the Protopopov triad occurs - palpitations, dilated pupils.

Symptoms of disordersmanic-depressive psychosisfrom the internal organs:

dry skin and mucous membranes;
lack of appetite;
in women, disorders of the monthly cycle.

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

Note:some patients try to mitigate complaints to resort to alcohol.

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 lighter version of TIR.

Cyclotomy proceeds with phases:

How does TIR work?

There are three forms of the course 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 gap;
unipolar- the same phases of depression or mania go in a row.

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

Manic-depressive psychosis in different periods of life

In children, the onset of the disease may go unnoticed, especially if the manic phase dominates. Juvenile patients look hyperactive, cheerful, playful, which does not immediately allow us to notice unhealthy traits in their behavior against the background of their peers.

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

In adolescence, the manic phase is dominated by symptoms of swagger, 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 (average 10-15 days). With age, their duration increases.

Treatment of manic-depressive psychosis

Therapeutic measures are built depending on the phase of the disease. Severe clinical symptoms and the presence of complaints require the 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 phase of depression practically do not make contact. An important point of treatment during this period is the correct selection antidepressants. The group of these drugs is diverse and the doctor prescribes them, guided by his own experience. Usually we are talking about tricyclic antidepressants.

With dominance in the status of lethargy, antidepressants with analeptic properties are selected. Anxious depression requires the use of drugs with a pronounced calming effect.

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

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

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

Note:quite recently, lithium salt preparations were prescribed in all phases of MDP treatment; at present, this method is not used by all doctors.

After leaving the pathological phases, patients should be included in various activities as early as possible, this is very important for maintaining socialization.

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

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 in the TIR aggravation phase is considered not subject to criminal liability, and in the intermission phase - criminally punishable. Naturally, in any state suffering from psychosis are not subject to military service. In severe cases, disability is assigned.