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Manic psychosis is an extreme form of mania.

Bipolar Disorder: Signs, Symptoms & Treatment

People have psychotic symptoms that resemble schizophrenia. They may have extremely grandiose delusions, such as of being Jesus. Others may feel persecuted, such as being pursued by the FBI. Activity level increases markedly. People may race about and scream, swear, or sing. Mental and physical activity may be so frenzied that there is a complete loss of coherent thinking and behavior delirious mania , causing extreme exhaustion. People so affected require immediate treatment. Hypomania is not as severe as mania. People feel cheerful, need little sleep, and are mentally and physically active.


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For some people, hypomania is a productive time. They have a lot of energy, feel creative and confident, and often function well in social situations. They may not wish to leave this pleasurable state. However, other people with hypomania are easily distracted and easily irritated, sometimes resulting in angry outbursts. They often make commitments that they cannot keep or start projects that they do not finish.

They rapidly change moods. They may recognize such effects and be bothered by them, as are the people around them. When depression and mania or hypomania occur in one episode, people may momentarily become tearful in the middle of elation, or their thoughts may start racing in the middle of depression. Often, people go to bed depressed and wake early in the morning and feel elated and energetic.

The diagnosis of bipolar disorder is based on specific lists of symptoms criteria. However, people with mania may not accurately report their symptoms because they do not think anything is wrong with them. So doctors often have to obtain information from family members. People and their family members can use a short questionnaire to help them evaluate the risk of bipolar disorder see Mood Disorder Questionnaire. Doctors review the drugs being taken to check whether any could contribute to the symptoms. Doctors may also check for signs of other disorders that may be contributing to symptoms.

For example, they may do blood tests to check for hyperthyroidism and blood or urine tests to check for drug abuse. Doctors determine whether people are experiencing an episode of mania or depression so that the correct treatment can be given. For severe mania or depression, hospitalization is often required.

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Even if mania is less severe, people may need to be hospitalized if they are suicidal, try to hurt themselves or others, cannot care for themselves, or have other serious problems such as alcohol or substance abuse. Most people with hypomania can be treated as outpatients. People with rapid cycling are more difficult to treat. Without treatment, bipolar disorder recurs in almost all people. Drugs to stabilize mood mood stabilizers , such as lithium and some anticonvulsants drugs usually used to treat seizures.

Electroconvulsive therapy , which is sometimes used when mood stabilizers do not relieve depression.

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Treatment for Bipolar Disorder | Effective Health Care Program

Phototherapy , which can be useful in treating seasonal bipolar disorder. Lithium can lessen the symptoms of mania and depression. Lithium helps prevent mood swings in many people with bipolar disorder. Because lithium takes 4 to 10 days to work, a drug that works more rapidly, such as an anticonvulsant or a newer second-generation antipsychotic drug, is often given to control excited thought and activity.

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Lithium can have side effects. It can cause drowsiness, confusion, involuntary shaking tremors , muscle twitching, nausea, vomiting, diarrhea, thirst, excessive urination, and weight gain. It often worsens a person's acne or psoriasis. However, these side effects are usually temporary and are often lessened or relieved when doctors adjust the dose. Sometimes lithium must be stopped because of side effects, which then resolve.

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Doctors monitor the level of lithium in the blood with regular blood tests because if levels are too high, side effects are more likely. Long-term use of lithium can cause low levels of thyroid hormone hypothyroidism and can impair kidney function. Therefore, thyroid and kidney function must be monitored with regular blood tests, and the lowest effective dose is used. Lithium toxicity occurs when the level of lithium in the blood is very high. It causes persistent headaches, mental confusion, drowsiness, seizures, and abnormal heart rhythms. Toxicity is more likely to occur in the following:.

People who have lost a lot of sodium through vomiting, diarrhea, or use of diuretics which make the kidneys excrete more sodium and water in urine. Women who are trying to become pregnant must stop taking lithium because rarely, lithium can cause heart defects in a developing fetus. The anticonvulsants valproate and carbamazepine act as mood stabilizers. They may be used to treat mania when it first occurs or to treat mania and depression when they occur together mixed episode. Unlike lithium , these drugs do not damage the kidneys.

However, carbamazepine can greatly reduce the number of red and white blood cells. Rarely, valproate damages the liver primarily in children or severely damages the pancreas. With close monitoring by a doctor, these problems can be caught in time. While a formal assignment to a subcategory of bipolar disorder may in some circumstances be too difficult to achieve within the context of primary care, it is vital that the depressive phase of bipolar disorder is not misdiagnosed for major depressive disorder, as this would be likely to lead to poor therapeutic outcomes predominantly through the use of antidepressants rather than mood stabilizers.

Similarly, major depressions superimposed on cyclothymic oscillations may be confounded with borderline or other personality disorders. There is a high prevalence of comorbidities, including alcohol and substance abuse as well as anxiety states, among sufferers of bipolar disorder. The general practitioner should be vigilant to identify and treat the comorbidities as well as the primary pathology. An instrument to determine alcohol usage, such as the Alcohol Use Disorders Identification Test, may be useful. Mood stabilizers are the basis of therapy for bipolar disorder, and current guidelines recommend the use of a mood stabilizer in all phases of treatment.

Lithium is the most extensively studied of all the mood stabilizers, and has been used for both acute and prophylactic treatment of manic episodes of bipolar disorder. It has also traditionally been a first line choice for less severe bipolar depression. More recently, newer anticonvulsant mood stabilizers have emerged, such as lamotrigine. Analysis of marketing data suggests that antidepressants may be more commonly prescribed for use in bipolar disorder than mood stabilizers in some areas. Studies have suggested that antidepressants may have a role in the acute treatment of the depressive phase of bipolar disorder.

A retrospective cohort design study of elderly bipolar patients, found antidepressants use to be associated with a decreased rate of hospitalization. Curiously, in a study of mood patterns in 80 bipolar patients, 47 taking antidepressants and 33 not taking antidepressants, patients receiving antidepressants were measured as depressed twice as often as patients not receiving antidepressants and appeared to have a downshift in baseline mood. However, the further finding that the frequency and size of mood changes was similar in both groups suggests that patients in this study did not benefit from antidepressant use.


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  7. Studies of lithium maintenance therapy for bipolar disorder 25 - 29 and treatment for acute manic episodes 27 , 30 - 32 have commonly demonstrated robust benefits. In spite of these findings, there has been increasing concern that lithium's efficacy has been overestimated in the past or that there has been subsequent increasing patient resistance to lithium. The benefit of other mood stabilizers in this arena has not been well established. Three of the greatest concerns for patients receiving lithium therapy are regular monitoring of renal and thyroid function, and of lithium levels.

    Lithium therapy has been associated with an increased incidence of both goiter and hypothyroidism, and patients, therefore, require regular monitoring of thyroid function. In most expert consensus guidelines, divalproex is listed as the drug of choice for acute management of mixed manic states, and mania with a strong depressive component. Only one randomized controlled trial of divalproex as maintenance therapy has been conducted to date.

    In spite of the paucity of research demonstrating its efficacy in maintenance therapy, divalproex is more commonly prescribed in the USA for bipolar disorder than lithium. Divalproex carries a box warning for hepatotoxicity, teratogenesis and pancreatitis, and has been associated with blood dyscrasias.

    The risk of hepatotoxicity requires ongoing liver function monitoring. There have also been reports of polycystic ovarian syndrome with the use of valproate in the epileptic population, although this has not been confirmed to date in patients with mood disorders. Drugs that should be used with caution in patients taking divalproex include those on other anticonvulsants, such as phenytoin, lamotrigine and carbamazepine, and those taking aspirin, rifampin and benzodiazepines, among others.

    Although carbamazepine has demonstrated acute antimanic effects in several controlled studies, 56 , 57 its efficacy in bipolar depression has not been well established. Adverse effects of carbamazepine include dizziness, nausea, vomiting, sedation, diplopia, clumsiness, cognitive impairment and, rarely, hepatotoxicity and agranulocytosis and aplastic anemia. Other drugs that should be used with caution, as carbamazepine reduces their serum blood levels, include acetaminophen, some benzodiazepines, doxycycline, contraceptives, warfarin and other mood stabilizers.

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    Lamotrigine has been observed to improve mood, alertness and social interactions in some patients with epilepsy, 65 and these observations stimulated interest in lamotrigine's potential efficacy in bipolar disorder, and particularly depressive episodes in bipolar disorder.

    This is in stark contrast with the predominantly antimanic activity seen with other mood stabilizers, and the fact that depression is the dominant phase of the disorder with regard to morbidity and time. Lamotrigine is less likely than valproate and carbamazepine to cause fatigue, somnolence or weight gain.