Manic episode

Manic episode – Bipolar affective disorder is less common than anxiety disorders. Early recognition of the disease is possible if the underlying illness causing the patient mood conditions is recognized. These disorders are classified into Bipolar I and Bipolar II. Accordingly in unipolar disorder there is either mania alone or more commonly depression alone.

While bipolar is diagnosed when a person has experienced one or more depressive situations and at least I hypomaniac one, but has never had a manic or mixed type while cyclothymia is a chronic fluctuating mood disturbance. In Bipolar disorders not otherwise specified (NOS) the illness.

Adopted from diagnostic and statistical manual of mental disorders – DSM-IV-TR does not meet defined diagnostic criteria for any of the other bipolar disorders.

Manic episode

First degree relatives of patients suffering from bipolar affective disorder have an increased risk of manic depressive illness but not those with unipolar illness.

Manic episode is characterized by mood elation, restlessness, increased irritability, excessive energy and over activity with grandiose ideas. There is disturbance of sleep, patient suffers from sleeplessness and there may be mild to moderate weight loss.

The person is often distracted and becomes socially dis inhibited. Auditory or more uncommonly visual hallucinations may occur. Some become paranoid and develop religious delusions.

On the other hand, hypomania refers to a mild form of mania where there is euphoria, over activity and dis inhibition.

It can develop suddenly and there may be risks to the patient or to others from impulsive behavior. These can be recognized by typical early signs such as:

(a) Increased goal directed activity

(b) Changes in patients sleep pattern

(c) Increased social intrusiveness

(d) Impulsivity and

(e) Irritability

When ymptoms involve a depressive one there are features of grandiosity, goal directed hyperactivity, racing thoughts, decreased need for sleep, pressured speech, severe irritability and hyper sexuality.

Criteria for normal and Hypomanic Episodes (DSM-IV-TR)

Manic episode

1. Distinct period of abnormally and persistently elevated expansive or irritable mood lasting at least one week.

2. During the above period, presence to a significant degree of 3 or more of the following:  Inflated self esteem or grandiosity, Decreased need for sleep, Greater talkativeness, Flight of ideas, Distractibility, Psychomotor agitation and Excessive involvement in pleasurable activities that have a high potential for painful consequences.

3. Not a mixed one

4. Severe enough to cause marked impairment

5. Not the result of schizophrenia, delusional or psychotic disorders.

Hypo – manic Episode

Same criteria is for this condition but with a duration of 4 days or longer without Psychotic features and not severe enough to cause marked impairment in functioning.

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