Mania

Question 1

Biological symptoms of mania (2)

Answer 1

Decreased need for sleep
Increased energy (can lead to physical exhaustion)

Question 2

Cognitive symptoms of mania (4)

Answer 2

Elevated sense of self-esteem or grandiosity
Poor concentration
Accelerated thinking (with pressure of speech)
Impaired judgement and insight

Question 3

Psychotic symptoms of mania (3)

Answer 3

Disordered thought form:

• Circumstantial speech
• Tangential speech
• Flight of ideas
• Sometimes loosening of association, neologisms and thought blocking

Mood congruent abnormal beliefs

• Grandiose delusions
• Persecutory delusions

Perceptual disturbance

• Hyperacusis (sounds louder)
• Visual hyperaesthesia (colours brighter)
• Sometimes auditory hallucinations

Question 4

Circumstantial speech

Answer 4

Over-inclusive with unnecessary detail, but eventually gets to the end of the story

Question 5

Tangential speech

Answer 5

Diverts from the initial train of thought and never gets back to the point - more indicative of psychopathology than circumstantial speech

Question 6

Ddx of a manic episode

Answer 6

• Secondary to a medical condition or psychoactive substance
• Mood disorders: hypomanic, manic or mixed affective episodes, BPAD, cyclothymia, depression
• Psychotic disorders: schizoaffective, schizophrenia
• Personality/neurodevelopmental disorders - will be continuous hypomanic behaviour, not discrete episode
• Delirium/dementia

Question 7

ICD-10 degrees of severity for a manic episode (3)

Answer 7

Hypomania - elevated/irritable/labile mood with considerable interference with work or social activities

Mania - elevated/irritable/labile mood with complete disruption to work or social activities

Mania with psychotic features

(NB no required no. of symptoms, as for depression)

Question 8

When can you diagnose BPAD in a patient currently experiencing a manic episode?

Answer 8

If they have had a previous episode of mood disturbance - regardless of whether this was depressive or manic

Question 9

Cyclothymia

Answer 9

Alternating periods of mild elation or depression that begin in early adulthood and continue throughout life

Question 10

In what 3 instances can depression appear as mania?

Answer 10

1. Agitated depression - prominent irritable mood with psychomotor agitation
2. Initial transient response to antidepressants or ECT
3. Recently resolved depression - patient may mistake euthymia for hypomania