The manic phase of the illness is characterized by a persistent, abnormally elevated mood Table 01. Manic episodes tend to arise over a period of days to weeks. The person often seems to be euphoric, but may instead be intensely agitated. Affected individuals usually experience increased energy, with rapid, loud speech, a reduced need for sleep, and distractibility. The person may afterwards describe racing thoughts or ideas that seemed to take flight. During an episode, he or she may feel that even mundane conversations or ordinary details are intensely interesting. The person may make wild plans and take action on them, such as flying out of the country without adequate preparation, making crazy business investments, or going on extensive shopping sprees to the point of debt. The manic individual typically does not realize that thoughts are irrational, and will deny having a problem. In milder cases or early in the episode, activities may be channeled productively into work or creative pursuits. Oftentimes, however, thoughts progress too rapidly, irrationally, and chaotically to be constructive. If untreated, an episode may last for weeks, or even as long as a year.
A depressive phase usually follows the manic episode. When present, symptoms are identical to those of unipolar depression. Depressive episodes may follow the manic episode. During a depressive episode, an overwhelmingly sad mood and profound loss of interest in activities takes over. Physical symptoms, such as changes in sleep and eating habits, are common, and the person may have thoughts of death and suicide.
Severe states of mania or depression may involve psychotic symptoms in which the individual is unable to separate fantasy from reality. During manic or depressive episodes, a person may experience delusions (for example, beliefs of communicating with aliens or of having god-like powers) or hallucinations (such as hearing imaginary voices or seeing things that aren't there). Psychotic symptoms often provoke anxiety, and may involve fears of being harmed by others. When such symptoms are present, the disease resembles schizophrenia, and may respond to medications used for treating schizophrenia.
The frequency and duration of episodes of mania and depression vary among individuals. The manic and depressive episodes of each cycle typically occur within three months of each other. Between these cycles, most people feel well, and will have no symptoms. Some people experience many cycles of mania and depression each year. People with rapid cycles should be checked carefully for underlying thyroid disease or a drug-induced cause.
Table 1. Signs and Symptoms of Manic and Depressive Episodes
Manic episodes Depressive episodes Increased energyEuphoric feelingsAgitationLess need for sleepInflated beliefs in abilitiesPoor judgmentIncreased sex driveDenial that problem exists Sad or empty moodLoss of interest in normal activitiesFeelings of guilt, worthlessness, or hopelessnessDifficulty concentratingRestlessness or irritabilitySleep disturbances (can be too much or too little)Changes in appetiteThoughts of death or suicide
People with a family history of bipolar disorder have an increased risk for the disease. More than two-thirds of people with bipolar disorder have a close relative with the disorder, or with depression. Genetic and twin studies have both shown that bipolar disorder is at least partially heritable.
Having certain co-existing medical conditions, or taking certain medications, may increase your risk for a manic syndrome Table 02. Thyroid disease, kidney problems, AIDS, and stroke may cause manic symptoms. High levels of digoxin, a common heart and blood pressure medication, can also give rise to mania. Antidepressants and stimulant medications, including drugs such as amphetamines and cocaine, can also cause or mimic a manic episode.
Table 2. Medical Conditions that May Cause Manic Symptoms
Neurological disorders Metabolic disorders Other disorders Extrapyramidal diseases (e.g., Huntington's, postencephalic Parkinson's)Central nervous system infections (general paresis, viral encephalitis)Cerebral neoplasmsCerebral traumaCerebrovascular accidentsKleine-Levin syndromeKlinefelter's syndromeMultiple sclerosisPick's diseaseTemporal lobe epilepsyThalamotomy Wilson's diseaseVitamin B12 deficiency Carcinoid syndromeDialysis dementiaHyperthyroidismPellagraPostpartum maniaUremia and hemodialysis
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