Mood disorder mania

What Is It, Causes, Triggers, Symptoms & Treatment

Overview

What is mania?

Mania is a condition in which you have a period of abnormally elevated, extreme changes in your mood or emotions, energy level or activity level. This highly energized level of physical and mental activity and behavior must be a change from your usual self and be noticeable by others.

What's considered an “abnormal,” extreme change in behavior and what does it look like?

Abnormal manic behavior is behavior that stands out. It’s over-the-top behavior that other people can notice. The behavior could reflect an extreme level of happiness or irritation. For example, you could be extremely excited about an idea for a new healthy snack bar. You believe the snack could make you an instant millionaire but you’ve never cooked a single meal in your life, don’t know a thing about how to develop a business plan and have no money to start a business. Another example might be that you strongly disagree with a website “influencer” and not only write a 2,000 word post but do an exhaustive search to find all the websites connected to the influencer so you can post your letter there too.

Although these examples may sound like they could be normal behavior, a person with mania will expend a great deal of time and energy including many sleepless nights working on projects such as these.

What is a manic episode?

A manic episode is a period of time in which you experience one or more symptoms of mania and meet the criteria for manic episode (see “symptoms” and “diagnosis” sections). In some cases, you may need to be hospitalized.

Can I have a manic episode as its own condition or is it always part of another mental health condition?

Technically if you have a manic episode, you have a mental health condition. Mania can be a part of several mental health conditions including:

Bipolar I disorder (most common condition for mania to occur).
Seasonal affective disorder.
Postpartum psychosis.
Schizoaffective disorder.
Cyclothymia.

What is bipolar I disorder?

Bipolar I disorder is a mental health illness in which a person has major high and low swings in mood, activity, energy and ability to think clearly. To be diagnosed with bipolar I disorder, you have to have at least one episode of mania that lasts for at least seven days or have an episode that is so severe that it requires hospitalization.

Most people have both episodes of both mania and depression, but you don’t have to have depression to be diagnosed with mania. Many people with a bipolar I disorder diagnosis have recurring, back-to-back manic episodes with very few episodes of depression.

What are the triggers of manic episodes?

Manic episode triggers are unique to each person. You’ll have to become a bit of a detective and monitor your mood (even keeping a “mood diary”) and start to track how you feel before an episode and when it occurs. Ask family and close friends who you trust and have close contact with to help identify your triggers. As outside observers, they may notice changes from your usual behavior more easily than you do.

Knowing your triggers can help you prepare for an episode, lessen the effect of an episode or prevent it from happening at all.

Common triggers to be aware of include:

A highly stimulating situation or environment (for example, lots of noise, bright lights or large crowds).
A major life change (such as divorce, marriage or job loss).
Lack of sleep.
Substance use, such as recreational drugs or alcohol.

What happens after a manic episode?

After a manic episode you may:

Feel happy or embarrassed about your behavior.
Feel overwhelmed by all the activities you’ve agreed to take on.
Have only a few or unclear memories of what happened during your manic episode.
Feel very tired and need sleep.
Feel depressed (if your mania is part of bipolar disorder).

Symptoms and Causes

What are the symptoms of mania?

Symptoms of a manic episode

Having an abnormally high level of activity or energy.
Feeling extremely happy or excited — even euphoric.
Not sleeping or only getting a few hours of sleep but still feeling rested.
Having an inflated self-esteem, thinking you’re invincible.
Being more talkative than usual. Talking so much and so fast that others can’t interrupt.
Having racing thoughts — having lots of thoughts on lots of topics at the same time (called a “flight of ideas”).
Being easily distracted by unimportant or unrelated things.
Being obsessed with and completely absorbed in an activity.
Displaying purposeless movements, such as pacing around your home or office or fidgeting when you’re sitting.
Showing impulsive behavior that can lead to poor choices, such as buying sprees, reckless sex or foolish business investments.

Psychotic symptoms of a manic episode

Delusions. Delusions are false beliefs or ideas that are incorrect interpretations of information. An example is a person thinking that everyone they see is following them.
Hallucinations. Having a hallucination means you see, hear, taste, smell or feel things that aren’t really there. An example is a person hearing the voice of someone and talking to them when they’re not really there.

How long does a manic episode last?

Early signs (called “prodromal symptoms”) that you’re getting ready to have a manic episode can last weeks to months. If you’re not already receiving treatment, episodes of bipolar-related mania can last between three and six months. With effective treatment, a manic episode usually improves within about three months.

What causes mania?

Scientists aren’t completely sure what causes mania. However, there are several factors that are thought to contribute. Causes differ from person to person.

Causes may include:

Family history. If you have a family member with bipolar illness, you have an increased chance of developing mania. This isn't definite though. You may never develop mania even if other family members have.
A chemical imbalance in the brain.
A side effect of a medication (such as some antidepressants), alcohol or recreational drugs.
A significant change in your life, such as a divorce, house move or death of a loved one.
Difficult life situations, such as trauma or abuse, or problems with housing, money or loneliness.
A high level of stress and an inability to manage it.
A lack of sleep or changes in sleep pattern.
As a side effect of mental health problems including seasonal affective disorder, postpartum psychosis, schizoaffective disorder or other physical or neurologic condition such as brain injury, brain tumors, stroke, dementia, lupus or encephalitis.

Diagnosis and Tests

How is mania diagnosed?

Your healthcare provider will ask about your medical history, family medical history, current prescriptions and non-prescription medications and any herbal products or supplements you take. Your provider may order blood tests and body scans to rule out other conditions that may mimic mania. One such condition is hyperthyroidism. If other diseases and conditions are ruled out, your provider may refer you to a mental health specialist

To be diagnosed with mania, your mental health specialist may follow the criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, DSM-5. Their criteria for manic episode is:

You have an abnormal, long-lasting elevated expression of emotion along with a high degree of energy and activity that lasts for at least one week and is present most of the day, nearly every day.
You have three or more symptoms to a degree that they’re a noticeable change from your usual behavior (four symptoms if mood is only irritable). (See the symptoms section of this article for a list of the symptoms used as criteria.)
The mood disturbance is severe enough to cause significant harm to your social, work or school functioning or there’s a need to hospitalize you to prevent you from harming yourself or others, or you have psychotic features, such as hallucinations or delusions.
The manic episode can’t be caused by the effects of a substance (medications or drug abuse) or another medical condition.

Management and Treatment

How is mania treated?

Mania is treated with medications, talk therapy, self-management and family and friends support.

Medications

If you have mania only, your healthcare provider may prescribe an antipsychotic medication, such as ariprazole (Abilify®), lurasidone (Latuda®), olanzapine (Zyprexa®), quetiapine (Seroquel®) or risperridone (Risperdal®).

If you have mania as part of a mood disorder, your provider may add a mood stabilizer. Some examples include lithium, valproate (Depakote®) and carbamazepine (Tegretol®). (If you’re pregnant or plan to become pregnant, let your provider know. Valproate can increase the chance of birth defects and learning disabilities and shouldn’t be prescribed to individuals who are able to become pregnant.)

Sometimes antidepressants are also prescribed.

Talk therapy (psychotherapy)

Psychotherapy involves a variety of techniques. During psychotherapy, you’ll talk with a mental health professional who'll help you identify and work through factors that may be triggering your mania and/or depression (if you’re diagnosed with bipolar I disorder).
Cognitive behavioral therapy can be useful in helping you change inaccurate perceptions that you have about yourself and the world around you.
Family therapy is important since it’s very helpful for your family members to understand your behavior and what they can do to help.

Ask your provider for contact information for local support groups. You might find it helpful to talk with other people who have similar medical experiences and share problems, ideas for coping and strategies for living and caring for yourself.

Other treatments

Electroconvulsant therapy (ECT) may be considered in rare cases in individuals who have severe mania or depression (if bipolar). ECT involves applying brief periods of electric current to your brain.

Prevention

What steps can I take to better cope with or manage my mania?

Although episodes of mania can’t always be prevented, you can make a plan to better manage your symptoms and prevent them from getting worse when you feel a manic episode may be starting.

Some ideas to try during this time include:

Avoid stimulating activities and environment – such as loud or busy places or bright places. Instead choose calm and relaxing activities and environments.
Stick to routines. Go to bed at a set time, even if you’re not tired. Also, stick to the same times for eating meals, taking medications and exercising.

Limit the number of social contacts to keep you from getting too stimulated and excited.
Postpone making any major life decisions and big purchases.
Avoid people and situations that might tempt you to make poor or risky choices, such as taking recreational drugs or drinking alcohol.
Consider selecting someone to manage your finances during a manic episode.

If you ever have thoughts of harming yourself, tell family or friends, call you healthcare provider or contact the National Suicide Prevention Lifeline at 800-273-(TALK) (1-800-273-8255). Counselors are available 24/7.

Outlook / Prognosis

What outcome can I expect if I’ve been diagnosed with mania?

If your mania is related to a diagnosis of bipolar I disorder, this is a lifelong disease. Although there’s no cure for mania, medication and talk therapy (psychotherapy) can manage your condition in most cases.

Living With

How can I involve family and friends in understanding my mania?

It’s important to have an honest conversation with your family and closest friends.

Let your family and friends know what you do and don’t find helpful. For example, if you’d appreciate a friendly reminder about taking your daily medications or a question about if you are getting enough sleep, let them know. On the other hand, if you don’t like always being asked if your current state of happiness is a sign you’re having a manic episode, discuss this.
Ask your family and friends if they can help identify your triggers if you can’t. They may be able to spot triggers that you can’t spot yourself. Ask what they’ve noticed or any patterns they may see around the times of your episodes. As soon as you recognize an early sign, make an appointment to see your healthcare provider. You may or may not need a medication adjustment. However, it’s good to be on the alert since your symptoms could rapidly change.
Describe how your symptoms feel to you. Your family and friends will have a better understanding of your condition.
Let family and friends know what type of help you’d like from them and when you’d like it. There may be times when you feel you can cope on your own. Knowing the difference will be helpful for everyone.

Frequently Asked Questions

What is acute mania?

Acute mania is the manic phase of bipolar I disorder. It is defined as an extremely unstable euphoric or irritable mood along with excess activity or energy level, excessively rapid thought and speech, reckless behavior and feeling of invincibility.

What is unipolar mania?

Unipolar mania is a disorder in which only excitement, excess activity or energy level and euphoric symptoms are seen. This is a rare condition.

What’s the difference between mania and hypomania?

Hypomania is a less severe form of mania. The criteria that healthcare professionals use to make the diagnosis of either hypomania or mania is what sets them apart. The differences between these two conditions is as follows:

	Mania	Hypomania
How long the episode lasts.	At least one week.	At least four consecutive days.
Severity of episode.	Causes severe impact on social or work/school functioning.	Not severe enough to significantly affect social or work/school functioning.
Need for hospitalization.	Possibly.	No.
Psychotic symptoms present (delusions or hallucinations).	Is among possible symptoms.	Can’t be present for a diagnosis of hypomania.

Can my diagnosis change between bipolar I disorder and bipolar II disorder?

No. Once you have a diagnosis of bipolar I disorder — even if you never have another manic episode or a psychotic event (delusions or hallucinations) — your diagnosis can never be changed to bipolar II disorder. You’ll always have a bipolar I disorder diagnosis.

A note from Cleveland Clinic

Problems can develop in your social life, work/school functioning and home life when you have symptoms of mania, which include mood swings and an abnormal level of energy and activity. You may require hospitalization if you have severe hallucinations or delusions, or to prevent you from harming yourself or others. It’s important to have a good understanding of mania, mania symptoms, your particular triggers and ways to better manage your manic episodes. Medications, talk therapy and support groups as well as support from your family and friends can help manage your mania. Stay in close contact with all your healthcare providers, especially during times of manic episodes. Your provider will want to see you and may need changes to your medications or dose.

Schizoaffective Disorder: Schizophrenia, Mood Disorder, Treatment

Overview

What is schizoaffective disorder?

Schizoaffective disorder is a serious mental health condition. It has features of two different disorders:

“Schizo” means the psychotic symptoms of schizophrenia. This brain disorder changes how a person thinks, acts and expresses emotions. It also affects how someone perceives reality and relates to others.
“Affective” refers to a mood disorder, or severe changes in a person’s mood, energy and behavior.

There’s no cure for schizoaffective disorder. But treatment can help people manage symptoms and improve their quality of life.

What are the types of schizoaffective disorder?

There are two types of schizoaffective disorder: bipolar schizoaffective disorder and depressive schizoaffective disorder. The two types are based on the associated mood disorder the person has:

Bipolar disorder type: This condition features one or two types of different mood changes. People with bipolar disorder have severe highs (mania) alone or combined with lows (depression).
Depressive type: People who have depression have feelings of sadness, worthlessness and hopelessness. They may have suicidal thoughts. They may also experience concentration and memory problems.

How does schizoaffective disorder affect people?

This lifelong illness can affect all areas of a person’s life. A person with schizoaffective disorder can find it difficult to function at work or school. It also affects people’s relationships with family, friends and loved ones.Many people with schizoaffective disorder have periodic episodes. There are times when their symptoms surface and times when their symptoms might disappear for a while.

Who gets schizoaffective disorder?

The condition usually begins in the late teens or early adulthood, up to age 30. It rarely occurs in children. Studies suggest the disorder is more likely to occur in women than men.

How common is schizoaffective disorder?

Schizoaffective disorder is rare. Research estimates that 3 in every 1000 people (0.3%) will develop schizoaffective disorder in their lifetime.Still, it’s difficult to know exactly how many people have the condition because of the challenging diagnosis. People with schizoaffective disorder have symptoms of two different mental health conditions. Some people might get misdiagnosed with schizophrenia. Others might get misdiagnosed with a mood disorder.

Symptoms and Causes

What causes schizoaffective disorder?

Researchers don’t know the exact cause of schizoaffective disorder. They believe several factors are involved:

Genetics: Schizoaffective disorder might be hereditary. Parents may pass down the tendency to develop the condition to their children. Schizoaffective disorder can also occur in several members of an extended family.
Brain chemistry: People with the disorder may have an imbalance of brain chemicals called neurotransmitters. These chemicals help nerve cells in the brain communicate with each other. An imbalance can throw off these connections, leading to symptoms.
Brain structure: Abnormalities in the size or composition of different brain regions (such as the hippocampus, thalamus) may be associated with developing schizoaffective disorder.
Environmental factors: Certain environmental factors may trigger schizoaffective disorder in people who inherited a higher risk. Factors may include highly stressful situations, emotional trauma or certain viral infections.
Drug use: Using psychoactive drugs, such as marijuana, may lead to the development of schizoaffective disorder.

What are the symptoms of schizoaffective disorder?

Symptoms of schizoaffective disorder vary from one person to the next. They can range from mild to severe.

Someone with schizoaffective disorder experiences psychotic symptoms. They also experience severe mood changes, with symptoms of depression, mania or both. A person with schizoaffective disorder will have psychotic symptoms that occur alone and with mood changes.

Psychotic symptoms:

Delusions (false beliefs with no basis in reality that the person won’t give up, even if given evidence to the contrary).
Hallucinations (perceived sensations that aren’t real, such as hearing voices or seeing shadows).
Inability to tell real from imaginary.
Disorganized speech (difficulty producing clear and coherent sentences).
Unclear thinking.
Odd or unusual behavior.
Paranoia.
Lack of emotion in facial expression and speech.
Poor motivation.
Slow movements or inability to move.

Depression symptoms:

Low or sad mood
Thoughts of death or suicide.
Feelings of worthlessness or hopelessness.
Guilt or self-blame.
Lack of energy and low mood
Loss of interest in usual activities.
Poor appetite.
Changes in sleeping patterns (sleeping a little or a lot).
Trouble thinking or concentrating.
Weight loss or gain.

Mania symptoms:

Agitation.
Distractibility.
Increased or rapid talking.
Increased work, social and sexual activity.
Inflated self-esteem.
Not sleeping much.
Rapid or racing thoughts.
Self-destructive or dangerous behavior (spending sprees, reckless driving, unsafe sex).

Diagnosis and Tests

How is schizoaffective disorder diagnosed?

If someone is showing symptoms of schizophrenia and a mood disorder, see a healthcare provider. The provider will do a medical history and physical examination. There are no lab tests to diagnose schizoaffective disorder. But the provider may use X-rays and blood tests to rule out other illnesses that may be causing the symptoms.

If there is no physical cause for the symptoms, the provider may refer the person to a psychiatrist or psychologist. These professionals specialize in diagnosing and treating conditions tied to mental and behavioral health.

How does a psychiatrist or psychologist diagnose schizoaffective disorder?

Mental health professionals use specially designed interview and assessment tools to diagnose psychotic disorders. They listen to the person (or a loved one) describe the symptoms. They also watch the person’s speech, movement and behavior.

Providers figure out if these symptoms and behaviors match a specific disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The American Psychiatric Association publishes the DSM-5. It’s considered the reference book for mental health conditions.

According to the DSM-5, a person has schizoaffective disorder if they have:

Periods of uninterrupted mental illness, such as having symptoms of depression or another mood disorder for a long time.
Episode of mania, major depression or both while also having symptoms of schizophrenia.
At least two weeks of psychotic symptoms (such as delusions or hallucinations) without mood symptoms.
No evidence of a substance use disorder or medications that may be causing the symptoms.

Management and Treatment

How is schizoaffective disorder treated?

Treatment for schizoaffective disorder involves medication combined with psychotherapy and skills training. The medication helps stabilize the person’s mood and treats the psychotic symptoms. The therapy and skills training help improve their relationships and coping skills.

What medications treat schizoaffective disorder?

The provider will figure out the right medicine based on the type of mood disorder the person has:

Antipsychotics: This is the primary medicine used to treat the psychotic symptoms that come with schizophrenia — for example, delusions, hallucinations and disordered thinking.
Antidepressants: An antidepressant or mood stabilizer such as lithium can help treat mood-related symptoms. Sometimes, a person needs both an antidepressant and an antipsychotic.

How does psychotherapy treat schizoaffective disorder?

During therapy, the person talks to a trained mental health professional. The goal of psychotherapy is for the person to:

Learn about the illness.
Establish goals.
Manage everyday problems related to the disorder.

Family therapy can also help. A therapist can help families learn how to cope with the illness and support their loved one. Family therapy helps improve symptoms and quality of life for the person with the disorder.

How does skills training help a person with schizoaffective disorder?

This type of counseling helps a person manage their everyday lives better. It often focuses on:

Day-to-day activities, such as money and home management.
Grooming and hygiene.
Social skills.
Work.

Does someone with schizoaffective disorder need to be hospitalized?

Most people with this disorder can get outpatient treatment. They go to a clinic or hospital for treatment during the day and then return home. Sometimes, people have severe symptoms, though, or they’re in danger of harming themselves or others. They may need to be hospitalized to stabilize their condition.

Are there side effects of schizoaffective treatment?

The medications may cause side effects.

Side effects of lithium:

Dizziness.
Hand tremors.
Loss of appetite.
Low thyroid hormone.
Mild diarrhea.
Nausea.

Side effects of antidepressants (varies depending on the type of antidepressant):

Constipation or diarrhea.
Dry mouth.
Headache.
Sexual problems (including delayed orgasm or erectile dysfunction).
Sleepiness or trouble sleeping.
Sweating.
Weight gain or loss.

Side effects of antipsychotic medications:

Drowsiness.
Increased cholesterol and triglycerides.
Increased risk of diabetes.
Slow movements.
Weight gain.

Prevention

Can schizoaffective disorder be prevented?

There’s no way to prevent schizoaffective disorder. But make sure to get an early diagnosis and treatment if you start noticing symptoms, either in yourself or a loved one. Prompt treatment helps avoid or reduce frequent relapses and hospitalizations. It can also decrease the disruption to the person’s life, family and relationships.

What other conditions might a person with schizoaffective disorder have?

A person with schizoaffective disorder may have other mental health conditions as well, including:

Anxiety disorder.
Substance use disorder.
Attention-deficit hyperactivity disorder (ADHD).
Post-traumatic stress disorder (PTSD).

Outlook / Prognosis

What’s the outlook for schizoaffective disorder?

There’s no cure for schizoaffective disorder. But treatment can help. The right combination of medication and therapy can:

Help the person cope with the disorder.
Improve social functioning.
Lessen symptoms.

Living With

How should I take care of myself (or a loved one) when it comes to schizoaffective disorder?

Perhaps you’ve noticed signs of schizoaffective disorder in yourself or a loved one. Those symptoms may include prolonged hallucinations, delusions, depression or manic episodes. The first step is to talk to a healthcare provider. Getting diagnosis and treatment as soon as possible helps improve symptoms and promote a good quality of life. Be sure to follow your provider’s treatment instructions:

Attend therapy sessions, including individual and family therapy.
Stay in contact with your provider, who can help manage and adjust your treatments as necessary.
Take medications as directed. Talk to your provider to help manage side effects from the medications.
Treat substance use disorders, if necessary.

When should I go to the emergency room?

If you or a loved one seems in danger of harming themselves or others, get help right away. Go to an emergency room, call 911, or call the National Suicide Prevention Lifeline at 800.273.8255. This national network of local crisis centers provides free, confidential emotional support to people in suicidal crisis or emotional distress. It’s available 24/7.

What else should I ask my healthcare provider?

If you or a loved one has schizoaffective disorder, ask your provider:

What medication will help?
What other therapy can help?
Will this disorder ever go away?
How long will treatment continue?
Is there a higher risk for other conditions or disorders?

A note from Cleveland Clinic

Schizoaffective disorder is a serious mental health condition. It has features of both schizophrenia and a mood (affective) disorder. Schizoaffective symptoms may include symptoms of mania, depression and psychosis. It’s important to get treatment as soon as possible. If you notice symptoms of schizoaffective disorder, talk to a healthcare provider. Treatment for schizoaffective disorder includes medication and therapy. While there’s no cure for this disorder, treatment helps improve people’s symptoms and quality of life.

Bipolar Disorder | Symptoms, complications, diagnosis and treatment

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). Episodes of mood swings may occur infrequently or several times a year.

When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When the mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, alertness, judgment, behavior, and the ability to think clearly. nine0003

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medication and psychological counseling (psychotherapy).

Symptoms

There are several types of bipolar and related disorders. These may include mania, hypomania, and depression. The symptoms can lead to unpredictable changes in mood and behavior, leading to significant stress and difficulty in life. nine0003

Bipolar disorder I. You have had at least one manic episode, which may be preceded or accompanied by hypomanic or major depressive episodes. In some cases, mania can cause a break with reality (psychosis).
Bipolar disorder II. You have had at least one major depressive episode and at least one hypomanic episode, but never had a manic episode.

Cyclothymic disorder.

Other types. These include, for example, bipolar and related disorders caused by certain drugs or alcohol, or due to health conditions such as Cushing's disease, multiple sclerosis, or stroke. nine0018

Bipolar II is not a milder form of Bipolar I but is a separate diagnosis. Although bipolar I manic episodes can be severe and dangerous, people with bipolar II can be depressed for longer periods of time, which can cause significant impairment.

Although bipolar disorder can occur at any age, it is usually diagnosed in adolescence or early twenties. Symptoms can vary from person to person, and symptoms can change over time. nine0003

Mania and hypomania

Mania and hypomania are two different types of episodes, but they share the same symptoms. Mania is more pronounced than hypomania and causes more noticeable problems at work, school, and social activities, as well as relationship difficulties. Mania can also cause a break with reality (psychosis) and require hospitalization.

Both a manic episode and a hypomanic episode include three or more of these symptoms:

Abnormally optimistic or nervous
Increased activity, energy or excitement
Exaggerated sense of well-being and self-confidence (euphoria)
Reduced need for sleep
Unusual talkativeness
Distractibility
Poor decision-making - for example, in speculation, in sexual encounters, or in irrational investments

Major depressive episode

Major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in daily activities such as work, school, social activities, or relationships. Episode includes five or more of these symptoms:

Depressed mood, such as feeling sad, empty, hopeless, or tearful (in children and adolescents, depressed mood may manifest as irritability)
Marked loss of interest or feeling of displeasure in all (or nearly all) activities
Significant weight loss with no diet, weight gain, or decreased or increased appetite (in children, failure to gain weight as expected may be a sign of depression)
Either insomnia or sleeping too much
Either anxiety or slow behavior
Fatigue or loss of energy
Decreased ability to think or concentrate, or indecisiveness
Thinking, planning or attempting suicide

Other features of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorder may include other signs such as anxiety disorder, melancholia, psychosis, or others. The timing of symptoms may include diagnostic markers such as mixed or fast cycling. In addition, bipolar symptoms may occur during pregnancy or with the change of seasons. nine0003

When to see a doctor

Despite extreme moods, people with bipolar disorder often do not realize how much their emotional instability disrupts their lives and the lives of their loved ones and do not receive the necessary treatment.

And if you are like people with bipolar disorder, you can enjoy feelings of euphoria and be more productive. However, this euphoria is always accompanied by an emotional disaster that can leave you depressed and possibly in financial, legal, or other bad relationships. nine0003

If you have symptoms of depression or mania, see your doctor or mental health professional. Bipolar disorder does not improve on its own. Getting mental health treatment with a history of bipolar disorder can help control your symptoms.

Bipolar disorder - Official website of the FGBUZ KB No.

85 FMBA of Russia

General brief information

Bipolar disorder, also known as bipolar affective disorder (BAD) and formerly as manic-depressive psychosis (PMD). It is a set of mood disorders characterized by marked fluctuations in mood, thinking, behaviour, energy and ability to perform daily activities. nine0003

A person suffering from this disorder alternates his state of mind between mania or hypomania - a phase of joy, exaltation, euphoria and grandiosity and depression, with sadness, inhibition and ideas of death.

Four types of bipolar disorder were defined by severity and alternation of moods over time:

Bipolar I disorder
Bipolar disorder type II
Cyclothymia
Non-specific bipolar disorder

Because bipolar disorder occurs in young people, it has a high social cost. It is the second leading cause of disability worldwide. In addition, those who suffer from it pose a higher risk than the general population of deaths from suicide, homicide, accidents, and natural causes such as cardiovascular disease.

In type 1, the person alternates between depressive episodes with full manic episodes, and in type 2, he alternates between depressive episodes and hypomanic (less severe) episodes. nine0003

The symptoms of this disorder are severe, different from the normal highs and lows of mood. These symptoms can lead to relationship problems, work, school, or even suicide.

During the depression phase a person may experience:

Negative perception of life.
Inability to feel the pleasure of life.
No energy
Self-criticism.
In extreme cases, suicide.

During a manic phase, a person may experience:

Denial that there is a problem.
Sudden change of mood.
Irrational financial decisions.
Feeling of great enthusiasm
Don't think about the consequences of your actions.
Lack of sleep

Although childhood onset occurs, the normal age of onset for type 1 is 18 years and for type 2 is 22 years.

About 10% of bipolar 2 cases develop into type 1.

Although the causes are unclear, genetic and environmental factors (stress, childhood abuse) are involved.

Treatment usually includes psychotherapy, medication, sometimes electroconvulsive therapy may be helpful.

Symptoms

Signs and symptoms of the depressive phase of bipolar disorder include:

Persistent sadness
Lack of interest in engaging in pleasurable activities. nine0018
Apathy or indifference.
Anxiety or social anxiety.
Chronic pain or irritability.
Lack of motivation
Guilt, hopelessness, social isolation.
Lack of sleep or appetite.
Suicidal thoughts
In extreme cases, there may be psychotic symptoms: delusions or hallucinations are usually unpleasant.

Manic symptoms

Mania can occur in different degrees:

Hypomania

This is the least severe degree of mania and lasts at least 4 days. This does not result in a noticeable decrease in a person's ability to work, communicate, or adapt.

He also does not require hospitalization and does not have psychotic characteristics.

In fact, general functioning may improve during a hypomanic episode and is considered a natural anti-depression mechanism.

If the event of hypomania is not accompanied by or precedes depressive episodes, it is not considered a problem if the state of mind is uncontrollable. nine0003

Symptoms may last from several weeks to several months.

It is characterized by:

Great energy and activity.
Some people may be more creative, while others may be more irritable.
A person may feel so good that he denies that he is experiencing a state of hypomania.

Mania

Mania is a period of euphoria and high mood for at least 7 days. If left untreated, a manic episode can last 3 to 6 months. nine0003

It is characterized by displaying three or more of the following behaviors:

Talk quickly and smoothly.
Accelerated thoughts.
Agitation.
Light condition.
Impulsive and risky behavior.
Excessive cash expenses
Hypersexuality.
A person with mania may also feel sleep deprivation and inadequate judgment.
On the other hand, maniacs may have problems with alcohol or other substance abuse. nine0018

In extreme cases, they may experience psychosis, so that contact with reality is broken, having a high state of mind.

It is something common that a manic person feels incomparable or indestructible and feels chosen to realize a goal.

Approximately 50% of people with bipolar disorder experience hallucinations or delusions, which can lead to violent behavior or admission to a psychiatric hospital.

mixed episodes

In bipolar disorder, a mixed episode is a condition in which mania and depression occur simultaneously.

People who experience this condition may have thoughts of grandiosity while having depressive symptoms such as suicidal thoughts or feelings of guilt.

People who are in this state are at high risk of committing suicide because they confuse depressive emotions with mood swings or difficulty controlling impulsivity. nine0003

Causes

The exact causes of bipolar disorder are unclear, although they are thought to be largely genetic and environmental.

Genetic factors

It is believed that 60-70% of the risk of developing bipolarity depends on genetic factors.

Several studies have shown that certain genes and chromosomal regions are associated with susceptibility to develop the disorder, with each gene being more or less important. nine0003

The risk of bipolar disorder in people with family members with the same diagnosis is 10 times higher than in the general population.

Research indicates heterogeneity, meaning that different genes are involved in different families.

Environmental factors

Research shows that environmental factors play an important role in the development of bipolar disorder, and psychosocial variables may interact with genetic dispositions.

Recent life events and interpersonal relationships contribute to manic and depressive episodes. nine0003

30-50% of adults diagnosed with bipolar disorder have been found to report abuse or trauma in childhood, which is associated with an earlier onset of the disorder and more suicide attempts.

Evolutionary factors

From evolutionary theory one might think that the negative effects that bipolar disorder can have on adaptability cause genes not to be selected by natural selection.

However, there is still a high incidence of BD in many populations, so there may be some evolutionary benefit. nine0003

Doctors of evolutionary medicine suggest that high rates of BR throughout history suggest that the change between depressive and manic states suggested some evolutionary advantage in ancestral humans.

In highly stressed people, depressed mood can serve as a defense strategy to escape external stress, store energy, and increase sleep hours.

Mania could benefit from its relationship with creativity, confidence, high energy levels and greater productivity. nine0003

Physiological, neurological and neuroendocrine factors

Brain imaging studies have shown differences in the volume of various brain areas between patients with bipolar disorder and healthy patients.

An increase in the volume of the lateral ventricles and an increase in the rate of white matter hyperintensity were found.

Magnetic resonance studies have shown that there is an abnormal modulation between the abdominal prefrontal region and the limbic regions, especially the amygdala. This will contribute to poor emotional regulation and mood-related symptoms. nine0003

On the other hand, there is evidence of an association between early stressful experiences and dysfunction of the hypothalamic-pituitary-adrenal axis, leading to hyperactivation.

A less common bipolar disorder may result from trauma or a neurological condition: brain injury, stroke, HIV, multiple sclerosis, porphyria, and temporal lobe epilepsy.

The neurotransmitter responsible for regulating mood, dopamine, has been found to increase its transmission during the manic phase and decrease during the depressive phase. nine0003

Glutamate increases in the left dorsolateral prefrontal cortex during the manic phase.

Diagnosis

A patient must have at least two episodes of affective disorder to be diagnosed with bipolar disorder. At the same time, at least one of them must be either manic or mixed. For the correct diagnosis, the psychiatrist must take into account the characteristics of the patient's history, information received from his relatives. Currently, it is believed that the symptoms of bipolar disorder are characteristic of 1% of people, and in 30% of them the disease becomes a severe psychotic form. Determination of the severity of depression is carried out using special scales. The manic phase of bipolar disorder must be differentiated from arousal caused by the use of psychoactive substances, lack of sleep, or other causes, and the depressive phase from psychogenic depression. Psychopathy, neurosis, schizophrenia, as well as affective disorders and other psychoses due to somatic or nervous diseases should be excluded. nine0003

Methods of treatment

The main goal of the treatment of bipolar disorder is to normalize the mental state and mood of the patient, to achieve long-term remission. In severe cases of the disease, patients are hospitalized in the psychiatric department. Mild forms of the disorder can be treated on an outpatient basis. Antidepressants are used to relieve a depressive episode. The choice of a specific drug, its dosage and frequency of administration in each case is determined by a psychiatrist, taking into account the age of the patient, the severity of depression, and the possibility of its transition to mania. If necessary, the appointment of antidepressants is supplemented with mood stabilizers or antipsychotics. Antidepressants help to stop depressive states in bipolar disorder. Drug treatment of bipolar disorder in the stage of mania is carried out by normotimics, and in severe cases of the disease, antipsychotics are additionally prescribed. In the stage of remission, psychotherapy (group, family and individual) is shown.