What Is a Manic Phase?

Long-term observation during the course of mood disorders found that only manic or hypomanic authors are rare, and the family history, personality, biological characteristics, treatment principles, and prognosis of these patients are bipolar with both depressive episodes The obstacles are similar. Therefore, the International Classification System for Mental Illness (ICD-10) and the American Classification System (DSM-IV) have listed it as a bipolar disorder.

Guo Junhua	(Chief physician)	Department of Psychiatry, Beijing Anding Hospital, Capital Medical University
Wang Jianqin	(Deputy Chief Physician)	Department of Psychiatry, Beijing Anding Hospital, Capital Medical University

Mania is a stand-alone unit of Mood disorders in the Chinese Mental Illness Classification and Diagnostic Standards-3rd Edition (CCMD-3), and is juxtaposed with bipolar disorder. The main clinical phase is emotional rise or irritability, accompanied by vigorous energy, increased speech, increased activity, and severe symptoms with psychotic symptoms such as hallucinations, delusions, and tension. The duration of a manic episode lasts for more than a week, and it usually presents with a seizure course. After each episode, it enters a period of intermittent remission with normal mental state. Most patients have a tendency to have recurrent episodes.

Introduction to Mania Disease

Long-term observation during the course of mood disorders found that only manic or hypomanic authors are rare, and the family history, personality, biological characteristics, treatment principles, and prognosis of these patients are bipolar with both depressive episodes The obstacles are similar. Therefore, the International Classification System for Mental Illness (ICD-10) and the American Classification System (DSM-IV) have listed it as a bipolar disorder.

At present, there is no systematic epidemiological survey of mania and bipolar disorder in China. Epidemiological surveys in western countries in the 1990s show that the lifetime prevalence of bipolar disorder is 5.5% -7.8% (Angst, 1999), Goodwind et al. (1990) reported that the prevalence of bipolar I is 1%, and the prevalence of bipolar I is 1%. Combined with Type II to 3%, if added to the circumstance mood, it exceeds 4%. Hong Kong Special Administrative Region (1993) 1.5% for men and 1.6% for women. Therefore, bipolar disorder is a common mental disorder (see the differential diagnosis for bipolar I and II concepts). ^[1-2]

Causes and mechanisms of mania

Biological factors of mania

Neurobiology, psychopharmacology research and neurotransmitter metabolism research confirmed that patients had abnormal central neurotransmitter metabolism and corresponding changes in receptor function. Lack of serotonin (5-HT) functional activity may be the basis of bipolar disorder and a quality indicator of susceptibility to bipolar disorder; reduced norepinephrine (NE) functional activity may be related to depression, norepinephrine function Increased activity may be related to manic episodes; abnormal functional activity of dopamine (DA); -aminobutyric acid (GABA) is a central nervous system inhibitory neurotransmitter, and there may be abnormal functional activity, due to the resistance of this neurotransmitter Epilepsy drugs can be used as mood stabilizers to effectively treat mania and bipolar disorder. The second messenger is out of balance, the second messenger is an indispensable intermediary between extracellular information and intracellular effects; neuroendocrine dysfunction, mainly the hypothalamus-pituitary-adrenocortical axis and hypothalamus-pituitary-thyroid axis Dysfunction.

Genetic factors of mania

The pedigree survey found that the incidence of bipolar disorder in first-degree relatives of bipolar I type probands was several times higher than that in normal first-degree relatives. The closer the blood relationship, the higher the prevalence. In molecular genetics, many scholars have explored the marker genes that may be related to bipolar disorder, but there is no exact reproducible result. The susceptibility genes of bipolar disorder need further research. At present, the genetic mode of bipolar disorder tends to be polygenic.

Psychosocial factors of mania

Adverse life events and environmental stress events can trigger the onset of emotional disorders, such as unemployment, loss of love, poor family relationships, and long-term highly stressful living conditions. Genetic factors may lead to a susceptible quality in the onset of affective disorders, and people with this susceptible quality may develop the disease under certain environmental factors.

Classification of mania disorders

Diagnostic Classification Standards for Mental Illnesses Commonly Used in Clinical Practice: Chinese Mental Illness Classification and Diagnostic Standards-Third Edition (CCMD-3), International Classification System for Mental Illness (ICD-10), American Classification System (DSM-IV ). The classification of mania in the third edition of the Chinese Mental Disorder Classification and Diagnostic Standard (CCMD-3) is as follows:

Hypomania (hypomania): Mania without psychotic symptoms; mania with psychotic symptoms.

Recurrent mania: recurrent mania is currently mild mania; recurrent mania is currently a mania without psychotic symptoms; recurrent mania is currently a mania with psychotic symptoms. ^[3]

Clinical manifestations of mania

Common manifestations of mania

The core symptoms are unusually happy, relaxed, carefree, smiley, elated, and not difficult (emotions rise). Some people show little things or lose their temper at random (irritable), in severe cases Impulsive behavior may occur in irritable situations.

Thinking association speeds up, speech increases, word by word, exit, chapters, endless, rich content, witty and humorous (thinking and running), the patients themselves feel that their brains have become very sensitive, smart, and responsive. Feel good about yourself, exaggerate your abilities, financial resources, and status, and think that you have the ability to do big things and make big money (exaggerate delusions).

Patients have many activities, good communication, nosy business, to do big things, to do many things, to keep green (enhanced will behavior). Energetic, need less sleep and tirelessly. There is no end to what to do, and it is easy to be attracted by things that happen around you to divert attention (shifting with the border), and you are too optimistic about the outcome, hasty behavior, and disregarding the consequences. Spending money, pursuing pleasure, and squandering at will. Easy to conflict with the surroundings, resulting in impulsive behavior. Increased libido and recklessness.

In a manic state, the patient feels good about himself and usually has no ability to understand his or her condition, that is, he has no self-awareness of his own disease.

Emotional irritability or irritability is a characteristic manifestation of mania, accompanied by thoughtfulness and willful behavior. It is expressed as coordinated psychomotor excitement, that is, coordination between emotions, inner experiences, and behaviors, and coordination with the surrounding environment. In severe cases, it may show inconsistent symptoms, disordered speech, behavior disorder, hallucinations, delusions and other psychotic symptoms.

Course characteristics and typical manifestations of mania

The age of onset is early, mostly before the age of 45, and the first episode of mania often occurs in adolescence, and the onset is relatively rapid, which can develop into a disease state within a few days. Adults need to ask carefully if they have atypical, mild and transient depression, and if so, they should be diagnosed with bipolar disorder.

Typical seizures: a seizure course, normal interval, easy to relapse. During a manic episode, emotions rise, speech increases, and activity increases, that is, coordinated psychomotor excitement

Mania Disease Harm

Manic disorders are prone to recurrent episodes if not treated, resulting in chronic recurrent episodes, leading to chronic disease, personality changes and impaired social functions. Due to the pre-ill personality and disease symptoms, the incidence of alcohol dependence, substance abuse and drug dependence is high. In a manic state, due to irritability, weak impulsive control, and impaired judgment, irrational behaviors may occur, which may lead to reckless behavior and reckless consequences, splurge, blind investment, messy friends, sexual behavior, hurt Destroyed. Therefore, once a manic condition is diagnosed, aggressive treatment is avoided to avoid adverse consequences.

Diagnosis of Mania

Unlike many other diseases, because the etiology of mania is currently not fully elucidated, there are no exact laboratory tests or laboratory results to support clinical diagnosis. The evaluation of some scales and laboratory tests can be used as a reference for doctors to assist in diagnosis and determine the severity, and can be used as a basis for differential diagnosis, but cannot be used as an accurate diagnostic basis. The diagnosis is still based on medical history, psychiatric symptoms, and comprehensive consideration of the progress of the disease course.

According to the Chinese Mental Illness Classification and Diagnostic Standards-Third Edition (CCMD-3), the diagnosis of mood disorders is based on 4 main aspects: symptoms, severity, duration and exclusion criteria. Regardless of the diagnosis of bipolar disorder, depression, mania, and even circadian mood disorder and other mood disorders, the first must meet the diagnostic criteria of manic episodes and depressive episodes, respectively.

The diagnosis of mania must first meet the diagnostic criteria for manic episodes. details as follows:

Diagnostic criteria for manic episodes

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. In mild cases, there is no damage to social functions or only mild damage, and in severe cases, psychotic symptoms such as hallucinations and delusions may occur.

Mania symptoms criteria

Mainly emotional or irritable, and at least the following three (if only irritable, at least four):

inattention or diversion with the environment;

The amount of speech increases;

Thoughtfulness (rapid speech, rapid speech, etc.), an experience of accelerating or erratic thoughts;

Self-evaluation is too high or exaggerated;

Energetic, not tired, increased activity, difficulty in quiet, or constantly changing plans and activities;

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

Reduced need for sleep;

Hypersexuality.

Mania severity criteria

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

Mania course standard

Meeting the criteria for symptoms and severity for at least one week;

There may be some schizophrenic symptoms, but they do not meet the diagnostic criteria for schizophrenia. If the criteria for schizophrenia are also met, the criteria for manic episodes are met for at least one week after the schizophrenic symptoms have resolved.

Mania Exclusion Criteria

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

Diagnostic criteria for manic episodes

With the exception of non-impaired or mildly impaired social functioning, the episodes met the criteria for manic episodes.

Identification of mania disorders

Mania schizophrenia

Differentiation between puberty and manic episodes of schizophrenia, the former also onset in adolescence, showing excitement, talk and activity. However, the main features are disordered speech, weird behaviors such as weirdness, clutter, stupidity, and naivety, uncoordinated thinking, emotions, and behaviors, and excitement for uncoordinated psychomotor activity. A manic episode is a coordinated psychomotor excitement that occurs on the basis of an emotional upsurge that is pleasant, high, and infectious. Manic episodes can be accompanied by psychotic symptoms, and attention should be paid to identification. Manic episodes are dominated by the manifestation of emotional disorders and throughout the course of the disease. Emotional rise is accompanied by changes in thinking and behavior, and the interval between episodes is normal. The main manifestations of schizophrenia are hallucinations, delusions, and thinking logic disorders, which are not consistent with the inner experience and the surrounding environment, and there are many levels of social dysfunction remaining in the interval between attacks.

Secondary manic episodes of mania

Manic episodes can be caused by cerebral organic diseases, physical diseases, certain drugs and psychoactive substances (such as alcohol, methamphetamine, etc.). The identification points of the two are as follows: secondary manic episodes should have clear cerebral organic diseases History, history of physical diseases, history of use of drugs and psychoactive substances; physical examination and laboratory tests have corresponding changes, and consciousness, memory, and intelligence problems can occur; emotional symptoms improve with the improvement of the primary disease, and with the primary disease The condition gets worse and worse.

Differentiating Mania from Bipolar Mania

Care should be taken to ask if there is any previous atypical, mild and transient depression, and if so, bipolar disorder should be diagnosed. Biphasic type I: Manic episodes are obvious and severe, with severe depressive episodes; Biphasic type II: Manic episodes are generally mild, and their depressive episodes are pronounced and severe; Bipolar other types: Manic or depressive episodes are not serious.

Mania personality disorder

Emotional change is a personality problem or a disease. Note that personality is a person's consistent emotional and behavioral pattern. Manic episodes have a significant onset time. Pathological emotions need to last for a certain period of time.

Mania illness treatment

Mania Treatment Principles

Early identification, early treatment, full course of foot treatment, full course of treatment. Take comprehensive treatment, including medication, physical therapy, psychosocial intervention, and crisis intervention to improve treatment compliance. Long-term treatment, the recurrence rate of manic episodes is very high, and the concept of long-term treatment needs to be established; Patients and their families participate in the treatment together, because the family needs to provide support and help to the patient.

Mania medication

Mood stabilizer is the main treatment. Mood stabilizer can treat and prevent seizures. Based on mood stabilizer, it can be combined with other drugs according to the needs of the disease. Monitor the effects and side effects of drugs in a timely manner, and adjust drugs according to the situation. Pay attention to the interaction between drugs; a mood stabilizer is the first choice for manic conditions, and the underlying condition requires a timely combination of drugs, another mood stabilizer, or an antipsychotic, or a benzodiazepine; mood There are two types of stabilizers commonly used: lithium carbonate and anticonvulsants. Anticonvulsants include sodium valproate, magnesium valproate, carbamazepine, and lamotrigine. Antipsychotic drugs are mainly new atypical antipsychotic drugs (Such as quetiapine, olanzapine, risperidone, aripiprazole, ziprasidone, etc.); sedative hypnotics benzodiazepines (such as diazepam).

Mania psychotherapy

Add psychotherapy to drug therapy. Identify and improve patients' poor cognitive, emotional, and behavioral patterns, provide crisis interventions, and promote disease knowledge to patients and their families to improve treatment efficacy, social adaptability and social function, improve compliance, and reduce recurrence.

Mania Treatment Course

Establish the concept of long-term treatment and adopt comprehensive treatment. Control the acute excitement during the acute treatment period. Course of treatment: Usually 6-8 weeks; Consolidate the treatment effect in the acute phase to prevent symptoms from fluctuating. Course of treatment: From 2-3 months, the dosage of the drug is generally kept the same. Prevent relapse and maintain social function during maintenance treatment period. Gradually reduce the dose of non-mood stabilizer under careful observation. How long maintenance treatment should last is inconclusive. The dosage and duration of maintenance treatment depends on the patient's specific situation, and varies from person to person. The treatment plan is individualized. Authors who have sent many times can reduce the dose of the drug and gradually stop the drug while observing the interval of 2-3 cycles of previous episodes or after 2-3 years of maintenance treatment. If there is any sign of relapse during the withdrawal period, the original treatment plan should be restored in time, and a longer maintenance treatment period should be given after remission. The age of onset is early, and those with a positive family history should maintain treatment.

Prognosis of mania disease

Manic episodes are seizures, and the relief between episodes is normal. If you can treat them actively, you can maintain a stable condition. However, without effective and maintenance treatment, the relapse rate is high. Long-term recurrent attacks cause more frequent attacks, shortened the normal intermittent period, rapid circulation, difficult to treat, residual symptoms, chronic state, personality changes, and impairment of social functions. Therefore, the concept of long-term treatment and comprehensive treatment needs to be established to prevent recurrence.

Good prognostic factors include: good personality before illness, good social adaptability, acute onset, short duration, significant psychosocial stress or physical illness before onset, late onset of age, early treatment, good treatment outcome, family and The social support system is good, there is no history of recurrent episodes, no family history of mental illness, and no combined personality disorder, anxiety disorder, drug dependence, psychoactive substance dependence, physical illness, etc. Otherwise the prognosis is poor.

Mania disease prevention

Psychosocial factors play an important role in the onset and recurrence. It is necessary to pay attention to psychological adjustment: Learn mental health knowledge, master psychological debugging methods, cultivate optimistic, positive and healthy personality, improve the ability to adapt to the environment, and maintain a good Mentality; Correct bad behavior patterns, such as impulsive blindness and disregard of consequences; Avoid bad social and psychological factors, avoid living in a state of high tension, irregular life, and often stay up late for a long time, and decompress and relax appropriately.

Early detection, early treatment, and prevention of relapse Pay attention to identifying bad emotions such as anxiety, depression, anger, and boredom, pay attention to identifying the early manifestations of the disease, early detection, early consultation, and early treatment if you are sick; Mania is easy to recur and establish The concept of long-term treatment, learn to monitor your own emotional changes and coping strategies, and master the management ability of the disease; regular outpatient review, communicate with doctors, monitor the condition and side effects of drugs, maintain stable condition and prevent recurrence; avoid recurrence of the condition, cause The disease is difficult to treat and care, and the function is impaired.

Mania illness care

Respect, understand, accept, care, support, and help patients; Correctly recognize the disease, support patients to actively treat, and treat as soon as possible, and repeatedly send the author to establish the concept of long-term treatment, regular outpatient review, communicate with doctors, monitor the condition and side effects To maintain a stable condition and prevent recurrence; When the condition is unstable, pay attention to prevent suicide, impulse to hurt people, seek medical treatment early, and do psychological counseling. Avoid conflicts and irritate patients when in a state of agitation and severe mania; Learn disease and treatment knowledge to help patients observe the condition, respond to changes in the condition in a timely manner, adopt correct coping strategies, and avoid harm to themselves and others; weekdays Pay attention to help patients develop a good personality, correct poor cognitive and behavioral patterns, learn methods of psychological adjustment, avoid bad social and psychological factors, and avoid being in a state of high tension for a long time.

Tips for Mania Experts

Don't believe in eradication treatment for mania

The etiology of manic episodes is complex. In general, the etiology is not very clear. Therefore, the current level of medical treatment can only be symptomatic, and cannot reach the root cause of the treatment. Manic episodes have various forms of seizures, and patients can have a normal intermittent period of long-term performance. ; In fact, we have many diseases such as hypertension and diabetes, which are symptomatic treatments, not root removal treatments. Do not panic because the disease cannot eradicate the root; Chronic disease, it is understandable to seek treatment, but it is forbidden to go to the doctor to terminate the regular treatment.

Mania knows psychiatric drugs correctly

Many family members and patients believe that psychiatric drugs can eat people stupid or have some serious adverse reactions, and do not accept psychiatric drugs, causing delays in treatment. In fact, the damage caused by the disease far exceeds that of psychiatric drugs. Regular outpatient treatment, drug adjustment, and selection of appropriate drugs can avoid serious adverse reactions.

Mania correctly recognizes mental illness

Each of us does not want to get sick, no matter what the illness is. However, getting sick is a natural phenomenon, we ca nt choose not to get sick or get sick, and we ca nt avoid it; When everyone encounters a major or serious illness, he and his relatives have to go through several psychological stages: surprise, panic, Overwhelmed; nervous, afraid, denying; believing and doubtful, seeking medical treatment; guilt, self-blame and blame, regret, and remorse, accompanied by anxiety, depression, inferiority, and pessimism; fear, fear; and finally, various chronic adaptations, acceptances, and confrontations ; In fact, there may be problems and diseases in all systems of our body. Psychology or spirit is also the same. It is a very important system of our body. There are also problems and diseases that cannot be avoided. When you encounter mental illness and psychological problems, you do nt need to be panic and pessimistic. The rapid development has brought about the rapid development of disease treatment. As long as we actively face it, most of the prognosis is good, and the treatment is neither complicated nor difficult. Even if it is difficult to treat for a while, as long as you don't give up, a good therapeutic relationship and therapeutic alliance will be established between patients, family members, and doctors to jointly cope with the disease and receive regular treatment systematically, and it will be improved or even cured; Many of our patients and family members, in In the process of confronting and defeating diseases, I have accumulated a lot of valuable experience and gained good results. After recovering, many of our patients work, study, and live like normal people.