Mania

Question 1

HYPOMANIA

- several features consistent w elevated mood and increased activity.

Answer 1

• persistent abn. in mood and behaviour.(persistence outwith cyclothymia)
• persistent elevation in mood
• increased energy
• increased activity
• marked feeling of well being
• mental and physical efficiency
• decreased need for sleep
• increased sexual energy
• increased sociability, overfamiliarity, talkativeness.
• impaired concentration and attention
• no severe disruption to social activity.

Question 2

DDx(Hypomania):

Answer 2

1. cyclothymia
2. mania
3. early states of agitated depression
4. hyperthyroidism and anorexia nervosa
   - due to increased activity(may have W loss) and restlessness
5. Obsessional disorder
   - awake at night for cleaning rituals but affect completely opposite

Question 3

MANIA WITHOUT PSYCHOSIS

• several symptoms for at least 1w
• disrupts ordinary work and social activities
• first episode usually 15-30y but any age from late childhood until 80s

Answer 3

• Elevated mood disproportionate to circumstances
• High self-esteem
• grandiose and over-optimism freely expressed
• social disinhibition
• impaired attention
• inappropriate aggression, amorous and facetious.
• pressure of speech
• decreased need for sleep, increased energy

Question 4

MANIA WITH PSYCHOTIC SYMPTOMS

Answer 4

• boosted self-esteem and grandiosity develop into delusions
• irritability and suspiciousness develop into delusions of persecution.
• flight of ideas and pressure of speech result in patient being incomprehensible
• sustained excitement and physical activity result in self-neglect

Question 5

DDx(Mania with Psychotic Sx)

Answer 5

• Schizophrenia(delusions, incomprehensible speech and violent excitement may obscure disturbance of affect)
• Schizoaffective disorder
• patients with mania responding to neuroleptic medication

Question 6

CLINICAL FEATURES:

1. Biological Sx.
2. Cognitive Sx.
3. Psychotic Sx.(2/3 experience this compared to 1/3 during depressive episode)

Answer 6

1. a) Decreased need for sleep(81%)
   - usually without associated fatigue

b) Increased energy
- psychomotor excitation on MSE
- goal-directed activity with impaired judgement ie spending sprees, risky business ventures, increased promiscuity
- when severe, can have manic stupor with physical exhaustion.

2. a) Grandiosity(78%)
   b) Poor concentration
   - highly distractible(68%)
   c) Accelerated thinking(71%)
   - pressure of speech
   - flight of ideas(thoughts rapidly associating in a stream of connected but not always relevant concepts)
   d) Impaired judgement and insight
   - may have indiscretions
3. a) Disordered thought form
   - cirumstantiality, tangentiality, flight of ideas, pun or clang association.
   b) Abnormal beliefs
   - Mood-congruent delusions
   - Usually delusion of grandeur, can have persecutory delusions(people trying take advantage of exalted status)
   - May have overvalued ideas(not psychotic feature)
   c) Perceptual disturbance
   - sounds become louder
   - colours seem brighter

Question 7

DDx(Patient with elevated mood):

Answer 7

1. Mood disorders
   - Hypomania, mania, mixed affective episode(cyclothymia, bipolar)
   - Depression(agitated depression, in response to antidepressants or ECT, misidentified euthymia by patient with recently resolved depressive episode)
2. General medical condition
   - Cerebral neoplasms, trauma, infections, Cushing’s, Huntington’s, Hyperthyroidism, MS, SLE, Renal failure, B12 and niacin deficiency, TL epilepsy
3. Psychoactive substance use
   - Hallucinogens, legal highs, amfetamines, cocaine
   - Prescribed medication: Anabolic steroids, antidepressants, corticosteroids, dopaminergic agents(L-dopa, selegiline, bromocriptine)
4. Psychotic disorders:
   - Schizoaffective disorder
   - Schizophrenia
5. Personality/neurodevelopmental disorder
   - impulsivity, labile mood in BPD/ADHD
   - more stable behaviour patterns whereas bipolar affective episodes have discrete episodes
6. Delirium/dementia

Question 8

DISTINGUISHING HYPOMANIA FROM MANIA

- degree of psychosocial impairment

Answer 8

• Considerable interference with social circumstances => hypomania
• complete disruption to social circumstances => mania

Question 9

CYCLOTHYMIA

Answer 9

Instability of mood alternating between mild elation and mild depression, but not satifying criteria for hypomanic/depressive episode

Question 10

MANIA VS SCHIZOPHRENIA:

1. Thought form
2. Delusions
3. Speech
4. Biological Sx.
5. Psychomotor fn.

Answer 10

1. Circumstantiality, tangentiality, flight of ideas vs loosening of associations, thought blocking, neologisms
2. Mood-congruent, Grandiosed, persecutory vs Mood-incongruent, bizarre, delusions of passivity
3. Pressured vs often hesitant or halting
4. Decreased need for sleep, increased energy vs less sleep disturbance and less hyperactive
5. Agitation vs agitation, catatonic/negative Sx.