Saturday, May 11, 2013


Mania or first episode mania to be precise is a psychiatric disorder in which a person has persistent and abnormal elevated or irritable mood lasting more than a week or less if the disruption is such that patient needs hospitalization. 
To seal the diagnosis of mania the patient should have at-least 3 of following symptoms if mood is elevated or 4 if mood is irritable
1.     Pressure of speech or increased talkativeness
2.      Disinhibit ion or lack of social inhibitions
3.      Decreased need for sleep
4.      Increased self-esteem or grandiosity
5.      Distractibility
6.      Reckless behavior like reckless spending or reckless driving
7.      Increased sexual energy
8.   Increased activity
9.   Flight of ideas
The disorder of mania can be without or with psychotic symptoms such as delusions and hallucinations

Causes of mania-

No definitive evidence has been found but a disturbance in neurotransmitters like dopamine and serotonin; hormones like thyroid, growth hormone are implicated.
Risk factors for mania-
a)      Genetic factors
b)      Family history
c)      Stressful environment
d)      Stressful life events
e)      Certain personalities
Mania should be differentiated from hypo-mania in which there is no hospitalization, socio-occupational dysfunction and no psychotic symptoms with symptoms lasting less than 4 days.
Course and prognosis
Average duration of maniac episode can be anywhere between 2-4 months. It is a self-limiting illness but chances of relapse are high.

Treatment of mania

Why should mania be treated if it is a self-limiting illness?
      a)      It should be treated because severe socio-occupational dysfunction caused by it and threat to patient and others lives.
      b)      Prevent relapses.
When does a patient need hospitalization?
      1.      Threat to patient’s and other lives and property due to excessive violence.
      2.      Not talking care
      3.      Not willing to take medicines
      4.      Not enough family support
Scales which can be applied for progress of success of treatment include young mania rating scale.
Drugs used in treatment of mania are
      1.      Mood stabilizers such as  lithium, valproate,carbamazepine
      2.      Anti-psychotics
      3.      Benzodiazepines
Usual duration for treatment of mania is 1 year.
Wishing you a long and healthy life
Dr Hitesh Sharma
MBBS, MD (Psychiatry) 
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