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A Clinician's Guide to Biological Treatments , page 3. The Journal of Clinical Psychiatry. Neuropsychiatry, neuropsychology, and behavioral neurology.
A Review of the Literature". The Journal of Neuropsychiatry and Clinical Neurosciences. Archives of General Psychiatry , 35 11 , Dialogues in clinical neuroscience.
Goodman Gilman's pharmacological basis of therapeuti Twelfth ed. The American Journal of Psychiatry. In Manji, H; Zarate, C. Behaviour Research and Therapy.
Neuroscience and Biobehavioral Reviews. Archived from the original on 10 March Retrieved 23 March American Journal of Psychiatry.
Journal of Clinical Pharmacology. Primary care companion to the Journal of Clinical Psychiatry. A Memoir of Mania.
Random House Trade Paperbacks. Abnormal psychology Sixth ed. Mood disorder F30—F39 , Goodwin Kay Redfield Jamison. Clinical psychology Electroconvulsive therapy Involuntary commitment Light therapy Psychotherapy Transcranial magnetic stimulation Cognitive behavioral therapy Dialectical behavior therapy.
Delirium Post-concussion syndrome Organic brain syndrome. Psychoactive substances, substance abuse and substance-related disorders.
Schizophrenia , schizotypal and delusional. Schizoaffective disorder Schizophreniform disorder Brief reactive psychosis. Disorganized hebephrenic schizophrenia Paranoid schizophrenia Simple-type schizophrenia Childhood schizophrenia Pseudoneurotic schizophrenia.
Neurotic , stress -related and somatoform. Adjustment disorder with depressed mood. Dissociative identity disorder Psychogenic amnesia Fugue state Depersonalization disorder.
Postpartum depression Postpartum psychosis. Adult personality and behavior. Sexual maturation disorder Ego-dystonic sexual orientation Sexual relationship disorder Paraphilia Voyeurism Fetishism.
Personality disorder Impulse control disorder Kleptomania Trichotillomania Pyromania Dermatillomania Factitious disorder Munchausen syndrome.
Disorders typically diagnosed in childhood. X-linked intellectual disability Lujan—Fryns syndrome. Catatonia False pregnancy Intermittent explosive disorder Psychomotor agitation Stereotypy Psychogenic non-epileptic seizures Klüver—Bucy syndrome.
Look up mania in Wiktionary, the free dictionary. Schizophrenia , schizotypal and delusional Psychosis and schizophrenia-like disorders Schizoaffective disorder Schizophreniform disorder Brief reactive psychosis.
Neurotic , stress -related and somatoform Anxiety disorder Phobia Agoraphobia Social anxiety Social phobia Anthropophobia Specific social phobia Specific phobia Claustrophobia.
Adult personality and behavior Gender dysphoria Sexual maturation disorder Ego-dystonic sexual orientation Sexual relationship disorder Paraphilia Voyeurism Fetishism.
Disorders typically diagnosed in childhood Intellectual disability X-linked intellectual disability Lujan—Fryns syndrome.
Symptoms and uncategorized Catatonia False pregnancy Intermittent explosive disorder Psychomotor agitation Stereotypy Psychogenic non-epileptic seizures Klüver—Bucy syndrome.
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Mania , also known as manic syndrome , is a state of abnormally elevated arousal, affect , and energy level, or "a state of heightened overall activation with enhanced affective expression together with lability of affect.
The symptoms of mania include heightened mood either euphoric or irritable ; flight of ideas and pressure of speech ; and increased energy, decreased need for sleep, and hyperactivity.
They are most plainly evident in fully developed hypomanic states; in full-blown mania, however, they undergo progressively severe exacerbations and become more and more obscured by other signs and symptoms, such as delusions and fragmentation of behavior.
Mania is a syndrome with multiple causes. Although the vast majority of cases occur in the context of bipolar disorder , it is a key component of other psychiatric disorders such as schizoaffective disorder , bipolar type and may also occur secondary to various general medical conditions, such as multiple sclerosis ; certain medications may perpetuate a manic state, for example prednisone ; or substances of abuse, such as caffeine , cocaine or anabolic steroids.
Mania is divided into three stages: This "staging" of a manic episode is very useful from a descriptive and differential diagnostic point of view.
Mania varies in intensity, from mild mania hypomania to delirious mania, marked by such symptoms as disorientation, florid psychosis , incoherence, and catatonia.
Because mania and hypomania have also long been associated with creativity and artistic talent,  it is not always the case that the clearly manic bipolar person needs or wants medical help; such persons often either retain sufficient self-control to function normally or are unaware that they have "gone manic" severely enough to be committed or to commit themselves.
In a mixed affective state , the individual, though meeting the general criteria for a hypomanic discussed below or manic episode, experiences three or more concurrent depressive symptoms.
This has caused some speculation, among clinicians, that mania and depression, rather than constituting "true" polar opposites, are, rather, two independent axes in a unipolar—bipolar spectrum.
A mixed affective state, especially with prominent manic symptoms, places the patient at a greater risk for completed suicide. Depression on its own is a risk factor but, when coupled with an increase in energy and goal-directed activity, the patient is far more likely to act with violence on suicidal impulses.
Hypomania is a lowered state of mania that does little to impair function or decrease quality of life. In hypomania, there is less need for sleep and both goal-motivated behaviour and metabolism increase.
Though the elevated mood and energy level typical of hypomania could be seen as a benefit, mania itself generally has many undesirable consequences including suicidal tendencies, and hypomania can, if the prominent mood is irritable rather than euphoric, be a rather unpleasant experience.
A single manic episode, in the absence of secondary causes, i. Hypomania may be indicative of bipolar II disorder. Certain of " obsessive-compulsive spectrum" disorders as well as impulse control disorders share the name "mania," namely, kleptomania , pyromania , and trichotillomania.
Despite the unfortunate association implied by the name, however, no connection exists between mania or bipolar disorder and these disorders.
B 12 deficiency can also cause characteristics of mania and psychosis. Hyperthyroidism can produce similar symptoms to those of mania, such as agitation, elevated mood, increased energy, hyperactivity, sleep disturbances and sometimes, especially in severe cases, psychosis.
To be classed as a manic episode, while the disturbed mood and an increase in goal directed activity or energy is present at least three or four if only irritability is present of the following must have been consistently present:.
Though the activities one participates in while in a manic state are not always negative, those with the potential to have negative outcomes are far more likely.
If the person is concurrently depressed, they are said to be having a mixed episode. The World Health Organization 's classification system defines a manic episode as one where mood is higher than the person's situation warrants and may vary from relaxed high spirits to barely controllable exuberance, accompanied by hyperactivity, a compulsion to speak, a reduced sleep requirement, difficulty sustaining attention and often increased distractibility.
Frequently, confidence and self-esteem are excessively enlarged, and grand, extravagant ideas are expressed.
Behavior that is out of character and risky, foolish or inappropriate may result from a loss of normal social restraint. Some people also have physical symptoms, such as sweating, pacing, and weight loss.
In full-blown mania, often the manic person will feel as though his or her goal s trump all else, that there are no consequences or that negative consequences would be minimal, and that they need not exercise restraint in the pursuit of what they are after.
The hypomanic person's connection with the external world, and its standards of interaction, remain intact, although intensity of moods is heightened.
But those who suffer from prolonged unresolved hypomania do run the risk of developing full mania, and indeed may cross that "line" without even realizing they have done so.
One of the signature symptoms of mania and to a lesser extent, hypomania is what many have described as racing thoughts.
These are usually instances in which the manic person is excessively distracted by objectively unimportant stimuli.
Racing thoughts also interfere with the ability to fall asleep. Manic states are always relative to the normal state of intensity of the afflicted individual; thus, already irritable patients may find themselves losing their tempers even more quickly and an academically gifted person may, during the hypomanic stage, adopt seemingly "genius" characteristics and an ability to perform and articulate at a level far beyond that which would be capable during euthymia.
A very simple indicator of a manic state would be if a heretofore clinically depressed patient suddenly becomes inordinately energetic, cheerful, aggressive, or "over happy.
Individuals may also engage in out-of-character behavior during the episode, such as questionable business transactions, wasteful expenditures of money e.
These behaviours may increase stress in personal relationships, lead to problems at work and increase the risk of altercations with law enforcement.
There is a high risk of impulsively taking part in activities potentially harmful to self and others.
Although "severely elevated mood" sounds somewhat desirable and enjoyable, the experience of mania is ultimately often quite unpleasant and sometimes disturbing, if not frightening, for the person involved and for those close to them, and it may lead to impulsive behaviour that may later be regretted.
It can also often be complicated by the sufferer's lack of judgment and insight regarding periods of exacerbation of characteristic states.
Manic patients are frequently grandiose, obsessive, impulsive, irritable, belligerent, and frequently deny anything is wrong with them.
Because mania frequently encourages high energy and decreased perception of need or ability to sleep, within a few days of a manic cycle, sleep-deprived psychosis may appear, further complicating the ability to think clearly.
Racing thoughts and misperceptions lead to frustration and decreased ability to communicate with others. In stages II and III mania, however, the patient may be extraordinarily irritable, psychotic or even delirious.
Various triggers have been associated with switching from euthymic or depressed states into mania. One common trigger of mania is antidepressant therapy.
Studies show that the risk of switching while on an antidepressant is between percent. Dopaminergic drugs such as reuptake inhibitors and dopamine agonists may also increase risk of switch.
Other medication possibly include glutaminergic agents and drugs that alter the HPA axis. Lifestyle triggers include irregular sleep wake schedules and sleep deprivation, as well as extremely emotional or stressful stimuli.
Various genes that have been implicated in genetic studies of bipolar have been manipulated in preclinical animal models to produce syndromes reflecting different aspects of mania.
CLOCK and DBP polymorphisms have been linked to bipolar in population studies, and behavioral changes induced by knockout are reversed by lithium treatment.
Metabotropic glutamate receptor 6 has been genetically linked to bipolar, and found to be under-expressed in the cortex.
Pituitary adenylate cyclase-activating peptide has been associated with bipolar in gene linkage studies, and knockout in mice produces mania like-behavior.
Targets of various treatments such as GSK-3 , and ERK1 have also demonstrated mania like behavior in preclinical models.
Mania may be associated with strokes, especially cerebral lesions in the right hemisphere. Deep brain stimulation of the subthalamic nucleus in Parkinson's disease has been associated with mania, especially with electrodes placed in the ventromedial STN.
A proposed mechanism involves increased excitatory input from the STN to dopaminergic nuclei. Mania can also be caused by physical trauma or illness.
When the causes are physical, it is called secondary mania. The mechanism underlying mania is unknown, but the neurocognitive profile of mania is highly consistent with dysfunction in the right prefrontal cortex, a common finding in neuroimaging studies.
Meta analysis of neuroimaging studies demonstrate increased thalamic activity, and bilaterally reduced inferior frontal gyrus activation.
Reduced functional connectivity between the ventral prefrontal cortex and amygdala along with variable findings supports a hypothesis of general dysregulation of subcortical structures by the prefrontal cortex.
Manic episodes may be triggered by dopamine receptor agonists, and this combined with tentative report of increased VMAT2 activity, measured via PET scans of radioligand binding, suggest a role of dopamine in mania.
Decreased cerebrospinal fluid levels of the serotonin metabolite 5-HIAA have been found in manic patients too, which may be explained by a failure of serotonergic regulation and dopaminergic hyperactivity.
Limited evidence suggests that mania is associated with behavioral reward hypersensitivty, as well as with neural reward hypersensitivity.
Electrophysiological evidence supporting this comes from studies associating left frontal EEG activity with mania. As left frontal EEG activity generally though to be a reflection of behavioral activation system activity, this is thought to support a role for reward hypersensitivity in mania.
Tentative evidence also comes from one study that reported an association between manic traits and feedback negativity during receipt of monetary reward or loss.
Neuroimaging evidence during acute mania is sparse, but one study reported elevated orbitofrontal cortex activity to monetary reward, and another study reported elevated striatal activity to reward omission.
The latter finding was interpreted in the context of either elevated baseline activity resulting in a null finding of reward hypersensitivity , or reduced ability to discriminate between reward and punishment, still supporting reward hyperactivity in mania.
In the ICD there are several disorders with the manic syndrome: Before beginning treatment for mania, careful differential diagnosis must be performed to rule out secondary causes.
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