What Is a Manic Episode?

Manic episodes are dominated by rising moods, which are not commensurate with their situation, and can range from happy to ecstatic. Some cases are mainly irritable. Its main manifestations are rising emotions, thinking freely, and psychomotor excitement.

Manic episode

Introduction to Mania

Manic episode concept

Its onset forms: mild mania, mania without psychotic symptoms, mania with psychotic symptoms, and recurrent mania. In mild cases, there is no damage to social function or only mild damage, and in severe cases, psychotic symptoms such as hallucinations and delusions may occur.

Manic episode symptoms criteria

Mainly emotional or irritable, and at least the following 3 (if it is only irritable, at least 4):

(1) Inattention or diversion with the border;

(2) the amount of speech increases;

(3) Thoughtfulness (rapid speech, urged speech, etc.), association speedup or idea drifting experience

(4) The self-evaluation is too high or exaggerated;

(5) Energetic, not tired, increased activity, difficulty in quiet, or constantly changing plans and actions;

(6) Reckless behavior (such as profligate, irresponsible, or reckless behavior, etc.);

(7) Reduced need for sleep;

(8) Hypersexuality.

Manic episode severe criteria

Seriously damage social functions or cause danger or adverse consequences to others.

Manic episode diagnosis

Manic episode standard

(1) Meets the criteria for symptoms and severity for at least 1 week;

(2) Some schizophrenic symptoms may exist, but they do not meet the diagnostic criteria for schizophrenia. If the symptoms of schizophrenia are met at the same time, after the remission of schizophrenia, the criteria for manic episodes will be met for at least 1 week.

[] Manic episode [exclusion criteria]

Eliminate organic mental disorders, or mania caused by psychoactive substances and non-addictive substances.

[Explanation] This standard for manic episodes is only applicable to the diagnosis of a single episode.

20.1 Hypomania (hypomania) [F30.0]

Except that there was no damage to social function or only mild damage, the episodes met the 30 manic episode criteria.

20.2 Mania without psychotic symptoms [F30.1]

Except for the 30-manic symptom criteria, which added "no hallucinations, delusions, or psychiatric symptoms such as nervous syndrome", the rest met the criteria.

20.3 Mania with psychotic symptoms [F30.2]

Except for the 30 symptoms of manic episodes, which add "psychiatric symptoms such as hallucinations, delusions, or tension syndrome", the rest meet the criteria.

20.4 Recurrent mania [F30.8 Other manic episodes]

[] Manic episode [diagnostic criteria]

(1) The current episode meets one of the above-mentioned types of mania, and at least 2 months before the interval, one episode meets the above-mentioned type of mania;

(2) Never have a depressive disorder that meets any of the criteria for type 1 depression, bipolar disorder, or circular affective disorder;

(3) Eliminate organic mental disorders, or manic episodes caused by psychoactive substances and non-addictive substances.

20.41 Recurrent mania, currently hypomania [F30.8 Other manic episodes]

It meets the diagnostic criteria for 30.4 recurrent mania, and the current episode meets the criteria for 30.1 light mania.

20.42 Recurrent mania, currently a mania without psychotic symptoms [F30 .8 Other manic episodes]

It meets the diagnostic criteria for 30.4 recurrent mania, and the current episode meets the criteria for 30.2 mania without psychotic symptoms.

20.43 Recurrent mania, currently a mania with psychotic symptoms [F30 .8 Other manic episodes]

It meets the diagnostic criteria for 30.4 recurrent mania, and the current episode meets the criteria for 30.3 mania with psychotic symptoms.

20.9 Other or to be classified mania [F30.8; F30.9]

Treatment of manic episodes

Manic episode medication

1.lithium carbonate

(1) Indications and contraindications: It is currently the drug of choice for the treatment of manic episodes. It is mainly used for acute episodes of mania and to prevent the recurrence of mania or depression in patients with two-way affective disorder. The total effective rate is more than 80%. Patients with acute and chronic nephritis, renal insufficiency, severe cardiovascular disease and central nervous system organic disease with acute infection, electrolyte disturbance, and low-salt diet are contraindicated. Use with caution in elderly frail, pregnant and lactating women, and children under 12 years of age.

(2) Usage and dosage: Oral is the only route of administration. Generally, 0.25 is given 3 times a day, and the dose is increased every 1-2 days, and the therapeutic dose is 1.5-2.0 g per day within 7-10 days. Take in divided doses. Lithium salt treatment is generally effective within 7-10 days. After the blood lithium concentration reaches 2-4 weeks after treatment, the condition does not improve, and other treatments should be replaced.

The poisoning dose of lithium salt is close to the treatment dose, and its efficacy and adverse reactions are closely related to the blood lithium concentration. In addition to closely monitoring the disease changes and treatment response during the treatment, the blood lithium concentration should be monitored. The dose can be adjusted accordingly to determine the presence of No poisoning and degree of poisoning. Measured once a week at the beginning of treatment, and thereafter 1-2 times every half month or one month depending on the dose and treatment response. In neutral acute cases, the lithium concentration should be maintained at 0.6-1.2 ol / L. Above 1.4ol / L, it is prone to poisoning reactions, especially in the elderly and patients with organic diseases. In order to compare the values of lithium concentration in each blood, it is required to determine the blood lithium in each blood sample 12 hours after taking the medicine In advance or more than 12 hours, it can affect the value of blood lithium concentration, thus losing the significance of comparison.

The dosage must be individualized and adjusted according to the patient's age, weight, illness, adverse reactions, and blood lithium concentration. Increasing the dosage should be slow, and the daily dose should be taken in divided doses to reduce the occurrence of adverse reactions. Patients should be treated with salt during treatment. diet. Encourage patients to drink more water and pay attention to the treatment of poisoning reactions.

(3) Maintenance treatment: lithium carbonate maintenance treatment can prevent recurrence. Double-blind experiments have shown that lithium salts can reduce the number of relapses and the severity of emotional illness. The maintenance treatment amount is half of the treatment amount, that is, 0.75-1.0 per day, and the maintenance lithium concentration should not be lower than 0.6ol / L. The course of treatment is at least 1 year.

(4) Adverse reactions: Adverse reactions of lithium carbonate are positively correlated with blood lithium concentration. Usually occurs 1-2 weeks after taking the drug, and some appear later. Adverse reactions such as the digestive system, nervous system, urinary system, cardiovascular system, hematopoietic system, endocrine system and lithium poisoning can be completely eliminated after reduction and withdrawal.

2. Other drugs

(1) Antiepileptic drugs: represented by carbamazepine, a second-line antimanic drug commonly used in clinical practice, which is suitable for patients who have failed to treat with lithium carbonate. In addition, valproate is also a common antimanic drug, especially for patients who are ineffective, intolerant, and rapidly circulating bipolar mania.

(2) Antipsychotics: chlorpromazine and haloperidol can control manic episodes faster and better, but they are generally not used alone and are often used in combination with lithium carbonate.

(3) Other drugs: such as clonazepam, clonidine, and verapamil. Although studies have found that such drugs are effective, the efficacy of treatment is not as good as lithium salts, carbamazepine, and sodium valproate *.

Manic episode (2) electroconvulsive therapy

Electroconvulsive therapy has a certain therapeutic effect on severe mania, and its mechanism of action may be the same as that of drugs, that is, to correct the metabolic abnormalities of central neurotransmitters. In the case of intensive monitoring measures, drug treatment can be applied alone or in combination. If concomitant drug treatment, the dose should be reduced.