mania

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Classification according to ICD-10
F30.0 Hypomania
F30.1 Mania without psychotic symptoms
F30.2 Mania with psychotic symptoms
F30.8 Other manic episodes
F30.9 Manic episode, unspecified
ICD-10 online (WHO version 2019)

A mania (from ancient Greek μανία maníā , German 'frenzy, anger, madness' ) is an affective disorder that usually runs in episodes. Drive, mood and activity are in a mania far above normal.

Mania is probably multifactorial in its development and maintenance. Genetic factors and psychosocial stress are assumed to be the causes. At the neurochemical level, disorders in serotonin , catecholamine and GABA metabolism are discussed.

Sleep is reduced during mania. Overuse of areas of the brain occurs which, if not treated, can trigger psychotic symptoms . A weakened form of mania, which, however, is still well above the normal fluctuations in mood, is called hypomania .

Symptoms and characteristics

In many ways, mania can be called the "opposite of depression ". The symptoms appear in practically all areas of life and affect almost all mental functions:

drive

The drive and the mood are far above normal - sometimes raised to the extreme extreme - at the limit. There is strong excitement and inner drive, restless activity and restlessness. Even if those affected still perceive the overstimulation, they exhaust themselves completely, although they are aware that this can have harmful consequences.

Mood

There is an intense, but unfounded, upscale and cheerful mood, but sometimes also irritability or disgruntled activity.

Social behavior

In mania, sociability and talkativeness are greatly increased. Patients often show completely inappropriate, distant behavior; For example, strangers are simply addressed and involved in conversations that are far beyond social conventions. Affected people show a lack of sensitivity for the needs and feelings of their immediate fellow human beings and tend to behave unrestrainedly and uncritically.

Others cannot prevent the person concerned from these behaviors, a manic can hardly or not at all be stopped or instructed. Violent disputes with loud and serious insults against people close to them are usually the result.

All of these actions can be completely alien to personality, which can be extremely stressful for family members or friends. Often this leads to the breaking of close, long-standing - and very important for the person concerned - bonds, which significantly worsens the person’s overall condition.

sexuality

The libido is increased; those affected can become completely uninhibited and lose control over themselves. Sexually suggestive behaviors and frequent and indiscriminate sexual contact with strangers are also common . Often there is also the conviction that one can have voluntary sexual contact with any desired person, if only this were desired.

Cognitive symptoms

Those affected are constantly running new ideas through their heads; this ranges from a proliferation of thoughts to a flight of ideas . Difficulty means that when talking about a topic, the person concerned repeatedly strays from the original train of thought, to which he can only find his way back with difficulty. In the case of the flight of ideas, the considerations follow one another at breakneck speed, the person concerned gets from the "hundredth to the thousandth", the associations can be relaxed. The thoughts remain logically one after the other, but it is hardly possible for the person concerned to answer a further question, as he does not find his way back to the goal of his narrative or keeps wandering. This is also expressed in logorrhea , a strong urge to talk; in extreme cases, the words roll over so much that the listener is hardly or no longer able to understand something.

Perception of reality

Self-confidence can be increased to the limit; Loss of reality and megalomania ( megalomania ) are possible. Other delusions , which are sometimes defended and developed as "reality" over several weeks to months, occur (however, like hallucinations only in so-called manias with psychotic symptoms - mania can also exist without delusions). Hallucinations are possible, but an intensified, intensive perception of colors and impressions is typical, even waking dreams, which can greatly reduce attention.

Sleep and hygiene

Excessive preoccupation with pleasant things is typical; One area is exercised fanatically and excessively, while other, often more important things, are completely neglected. There is a greatly reduced need for sleep, often grinding of teeth, smacking and talking in sleep. Sometimes neglect of food intake and personal hygiene can also be observed.

handling money

Often those affected spend more and faster than usual. Local rounds are given in restaurants, money and valuables are given away to strangers. Sometimes sick people during a mania even do a lot of business due to their size ideas, which can have very unpleasant consequences such as high debt for those affected and their relatives.

Lack of insight

People with mania typically have no problem understanding at all during the manic phase; they “feel great”. Relatives or experts of the disorder, however, are able to recognize it. When the phase has subsided, those affected sometimes sit in front of a large pile of broken glass and are full of feelings of shame about their behavior. The overestimation of oneself can also lead to self-endangering behavior and even suicide; There is seldom a danger to others, which can be increased by the increased strength, endurance and resistance (e.g. to some sedatives) of acute manics.

species

The overall picture of mania differs from case to case, and often from episode to episode in a single patient. A distinction can be made between classic mania (with a predominant increase in drive and elevated mood) and irritable mania (with angry-irritable mood). When thinking and speaking are extremely accelerated, a confused mania is possible, an appearance that can be very similar to a state of confusion, such as occurs in mental disorders caused by organically induced brain organisms. Depending on its severity, mania can be very stressful for the person affected and the relatives and have serious social consequences. In addition to pure manias, a mixed phase (mixed state) can also occur: in addition to manic symptoms, depressive symptoms also occur. The driven nature of mania shows itself with the bad feeling of depression; In this state, suicidality plays a major role, because the "force" that arises from mania can provide the drive to actually put into practice a suicide wish or decision to commit suicide caused by the depression. For this reason, the mixed states are considered to be by far the most dangerous episodes of bipolar disorder, and these patients must be cared for / monitored as closely as possible to prevent this.

Questionnaires

There are different questionnaires for recording manifest symptoms in self-assessment or in external assessment:

  • MD scale
  • Altman Self-Rating-Mania Scale (ASRM)
  • General Depression and Mania Scale (ADMS)
  • Self-Rating Mania Inventory (SRMI)
  • Mania Self-Assessment Scale (MSS)
  • Young Mania Rating Scale (YMRS)
  • Internal State Scale (ISS)
  • Hypomania self-rating scale (HSRS)
  • Hypomania Checklist-32 (HCL-32), Hypomania Checklist-16 (HCL-16)
  • Hypomania Interpretations Questionnaire (HIQ)

For questionnaires on depressive symptoms, see Depression .

Differentiation from bipolar disorder

In the context of bipolar disorder , formerly known as manic depression or manic-depressive illness , both manic episodes and depressive episodes occur. The manic episodes are usually shorter than the depressive episodes; the former usually last a few weeks, the latter a few months. However, these episodes can be significantly shorter if the person is treated with medication and / or psychotherapy .

With regard to the frequency of manic and depressive episodes, the following distribution can be found:

A major problem is that it often takes a long time to properly diagnose (e.g., pre-existing hypomania ) before adequate treatment is provided. There is evidence that if there have been many episodes beforehand, the periods in between become shorter and the outbreaks may become more violent. Sometimes they cannot be completely prevented even by medication, and residual conditions can also remain.

causes

It is currently believed that there is a temporary disruption of neurotransmitters in the brain. Four genes that are relevant to bipolar disorder have also been located so far. However, these can also be changed in the same way in those who are not affected, so that other components must also be added in order to become bipolar - manic and depressive.

Crisis episodes are often triggered by significant events in life such as a wedding, divorce or a change of job. Experiences of loss such as the death of a close relative, the breakup of a relationship, unemployment, etc. are also stressful events that can trigger episodes if the person is prepared for this disorder. However, episodes of the disorder can also occur without external causes. Dysfunctional mitochondria come into question as a possible pathophysiological cause and potential therapeutic target .

The exact causes have not yet been clarified and are the subject of intensive research.

treatment

Lithium preparations , anti-epileptic drugs or neuroleptic drugs are used to treat acute mania . The latter reduce the effect of various neurotransmitters, in particular dopamine and serotonin, and are increasingly used in therapy. The mode of action of lithium or anti-epileptic drugs such as valproic acid is far less researched, but they have a clear anti-manic effect, but have a weaker effect against depressive phases. Lamotrigine is better at alleviating depression in bipolar disorder, but should only be administered with caution in patients with a clear tendency to manic phases, as hypomania or mania may be favored. Depending on the severity and severity of the disease, combinations of the above-mentioned drugs are also used. In the acute phase of the disorder, sedatives can be helpful to dampen the patient's agitation or to allow them to sleep. Benzodiazepines or weakly potent neuroleptics are usually used for this purpose .

prophylaxis

Lithium salts such as B. lithium carbonate , but also carbamazepine , valproate and lamotrigine also have a phase prophylactic effect, d. That is, they reduce the likelihood of recurrence of the disease and can in some cases prevent them entirely. Long-term use is a prerequisite.

Cognitive behavioral therapy or psychoeducation tailored to the disorder has also proven itself . Above all, one can learn to recognize early warning symptoms in oneself and counteract them through anti-manic behavior such as stimulus shielding and more consistent retention of structures such as bedtime. If this happens in good time, you can possibly prevent or weaken a phase. Additional medication is usually recommended.

Dealing with those affected

Dealing with people who are in a manic phase can be very stressful; often the relatives are at the end of their tether after a short time.

Since many of those affected show little or no understanding of the problem, sometimes all that remains is forced admission to a psychiatric facility. The prerequisite for this, however, is a judicially confirmed, acute risk to yourself or others in accordance with the requirements of the country-specific law (often the law on mental health problems or PsychKG or similar).

After a compulsory admission, which from a medical point of view is primarily intended to shield the person concerned from stimulating stimuli, in extreme cases compulsory treatment can occur. However, this may only take place in inpatient psychiatric facilities; it must be approved by a judge and, if possible, by a second doctor.

However, there are also those affected who retain their understanding of the problem in manic phases, but still show an excessive level of productivity. For example, many artists are said to have bipolar disorder. In such cases, it is important that the person concerned receives, in addition to appropriate medication, a balanced daily structure and sleeps well. An excessive fixation on a professional project, for example, can have a negative effect on the further course of the disorder.

If the person concerned has understanding, psychotherapeutic treatment can also be carried out ( psychoeducation and behavioral therapy ). However, further care by a specialist and regular medication are essential.

If the medication is suddenly stopped, you may feel cold and chills . In addition, by stopping medication too early and too quickly, those affected can get into a bad mixed state in which the danger to themselves and others is highest. In addition, it is not uncommon for them to have a severe relapse, which then necessitates another stay in the clinic for weeks or months.

Living with the mania

With insight from the person concerned, a regulated and stress-reduced life, regular medication and dealing with problems in psychotherapy, they can lead a completely normal life. However, bipolar disorder - present in most cases of mania - is one of the ten diseases that contribute most to lifelong disability worldwide. The far increased risk of suicide indicates that life is often unbearable for those affected if there are further outbreaks of the disorder and the associated depressive phases.

If he knows the signs of an incipient mania, the person affected can sometimes take countermeasures through his or her behavior (immediate specialist doctor, possibly additional medication, adequate sleep, stress reduction) so that a pronounced mania does not have to arise again in the first place.

For those affected, a mania is always an overwhelming experience and can be experienced as a kind of enlightenment, so that something develops out of it like a “falling in love” with the mania or a longing for the mania, especially when one is concerned with the uncomfortable state of deep depression White.

It is therefore all the more important to recognize one's own limitations and finiteness, also to accept the average and inconspicuous, because depression almost always occurs after a rash towards mania. By striving to keep the pendulum swings lower, the suffering can be alleviated, which can be an argument in favor of a target in the direction of “average”.

It helps if the patient sees the mania as part of themselves . It is usually inherent in the character before the onset of mania that these people are very quickly enthusiastic about new things and there is sometimes a "manic statement" for what has come up short in life, which one might have to integrate more into life . However, the behavior of manics in mania can also be completely alien.

If those affected stick to the medication and / or counteract this with their behavior in the event of early warning signs, new outbreaks can be prevented or weakened. However, if several phases were previously experienced, residual symptoms may remain and the prognosis may increasingly worsen after accumulating phases.

See also

literature

  • Volker Faust: Mania. A general introduction to the diagnosis, therapy and prophylaxis of pathological high spirits. Enke-Verlag, 1997, ISBN 3-432-27861-6
  • Andreas Erfurth (Editor): White Paper Bipolar Disorders in Germany, State of Knowledge - Deficits - What needs to be done? Short version: ISBN 3-8311-4520-2 , long version: ISBN 3-8311-4521-0
  • Thomas D. Meyer, Martin Hautzinger: Manic-depressive disorders. Beltz PVU, Weinheim 2004, ISBN 3-621-27551-7 .
  • Ursula Plog, Klaus Dörner, Christine Teller, Frank Wendt: Irren is human, textbook of psychiatry and psychotherapy, Psychiatrie-Verlag, Bonn 2004, ISBN 3-88414-400-6 .

Web links

Wiktionary: mania  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ Bernd Röhrle, Franz Caspar, Peter F. Schlottke: Textbook of clinical-psychological diagnostics . Kohlhammer Verlag, 2008, ISBN 978-3-17-022768-2 ( google.de [accessed July 7, 2020]).
  2. ↑ Jules Angst: Handbook of Bipolar Disorders: Basics - Diagnostics - Therapy . W. Kohlhammer Verlag, 2006, ISBN 978-3-17-018450-3 ( google.de [accessed July 7, 2020]).
  3. ↑ Bernd Röhrle, Franz Caspar, Peter F. Schlottke: Textbook of clinical-psychological diagnostics . Kohlhammer Verlag, 2008, ISBN 978-3-17-022768-2 ( google.de [accessed July 7, 2020]).
  4. ↑ Issues in Mental Health Research and Practice: 2011 Edition . ScholarlyEditions, 2012, ISBN 978-1-4649-6556-2 ( google.de [accessed July 7, 2020]).
  5. ↑ Emma Williams: A CBT Approach to Mental Health Problems in Psychosis . Taylor & Francis, 2017, ISBN 978-1-351-70693-3 ( google.de [accessed July 7, 2020]).
  6. ↑ Hayley Clay, Stephanie Sillivan, Christine Konradi: Mitochondrial Dysfunction and Pathology in Bipolar Disorder and Schizophrenia . In: International journal of developmental neuroscience: the official journal of the International Society for Developmental Neuroscience . tape 29 , no. 3 , May 2011, ISSN  0736-5748 , p. 311-324 , doi : 10.1016 / j.ijdevneu.2010.08.007 , PMID 20833242 , PMC 3010320 (free full text).
  7. ↑ Mitochondrial dysfunction in bipolar disorder: Evidence, pathophysiology and translational implications . In: Neuroscience & Biobehavioral Reviews . tape 68 , September 1, 2016, ISSN  0149-7634 , p. 694–713 , doi : 10.1016 / j.neubiorev.2016.06.040 .
  8. ↑ Sandeep Grover, Susanta Kumar Padhy, Chandi Prasad Das, Rakesh Kumar Vasishta, Pratap Sharan: Mania as a first presentation in mitochondrial myopathy . In: Psychiatry and Clinical Neurosciences . tape 60 , no. 6 , November 15, 2006, p. 774-775 , doi : 10.1111 / j.1440-1819.2006.01599.x ( onlinelibrary.wiley.com ).
  9. ↑ taz.de