mania

what is mania?

an extreme mood state lasting at least 7 days - which causes severe functional impairment in social and work settings

what is hypomania?

a lesser version of mania:

a persistent mood state lasting 3-4 days (<7) - which does not impair functional capacity in social or work settings - can be high functioning

what is a mixed episode?

a mixture or rapid alteration between manic and depressive symptoms for at least 2 weeks

what is a key difference between the symptoms of mania vs hypomania?

mania - may have psychotic symptoms

hypomania - no psychotic symptoms

what are the psychotic symptoms potentially seen in mania?

- mood congruent delusions (grandiose)

- hallucinations

mood congruent delusions?

delusions or hallucinations that are consistent with a person's mood

what would be the mood congruent delusions in mania?

beliefs that they are extremely powerful, attractive etc.

what type of hallucinations are most common in mania (and all mood disorders)?

second person auditory hallucinations

what is an example of a second person auditory hallucination?

voices in your head telling you what to do directly

what are the core symptoms of mania?

- elated mood

- energetic

- new activities/contacts

what are speech and thought changes in mania?

- pressure of speech

- flight of ideas

- poor attention

what are the cognitive symptoms of mania?

- high self esteem

- optimism

- disinhibition

what are the biological symptoms?

- reduced need for sleep

- high libido

what is the difference between a reduced need for sleep and insomnia?

insomnia - trouble with falling or staying asleep and still tired

decreased need for sleep - energy is always high so does not need sleep

what are the risk behaviours that could indicate mania?

- reckless driving

- high-risk sex

- substance use

- gambling

- overspending

- aggression

how many symptoms are needed along with elevated mood to diagnose mania?

3

how many symptoms are needed along with irritability to diagnose mania?

4

what are the causes of mania?

- genetic

- drugs

- physical disorders

- social

what drugs can cause mania?

- stimulants

- antidepressants

- steroids

what physical disorders can cause mania?

- Cushing's

- hyperthyroidism

- head injury

- MS

what social changes can cause mania?

- flying across timezones

- childbirth

- sleep deprivation

what is the first line management of mania?

stop medications that may be causing episode

what is the first line medical management of mania?

start an antipsychotic - haloparidol

once mood is controlled what medication should be started?

mood stabiliser + consider short term benzodiazepines

what is the referral for hypomania?

routine referral to community mental health team (CMHT)

what is the referral for mania?

urgent referral to CMHT