MANIA AND MANIC EPISODE

Bipolar Disorders

Manic episode

is characterized by a period of abnormally and persistently elevated mood, expansive or irritable, lasting at least a week. There should also be three symptoms out of a list of 7, which includes:

excessive self-esteem or delusions of grandeur;

reduced need for sleep;

more talkative than usual, or push to keep talking;

flight of ideas;

distractibility (attention too easily diverted by unimportant or irrelevant external stimuli);

psychic and motor agitation;

excessive involvement in activities with sometimes harmful consequences such as purchases, unseemly sexuality, investments, etc.

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Mania also causes marked impairment in social or occupational functioning and interpersonal relationships.
The symptoms of mania consist of: feeling of well-being, increased energy which is expressed with a reduced need for sleep, increased appetite and sexual drive, increased interpersonal relationships, a tumultuous increase in projects and initiatives in various fields (economic, work, sentimental, sexual, etc.) including those clearly inappropriate or risky due to the excessive enthusiasm, reckless superficiality and reduced criticism with which they are undertaken. The patient lacks critical awareness of his illness, because he is persuaded by a subjective feeling of well-being, and is therefore convinced that he is in good mental health. Typical of mania is the high mood, to the point of euphoria, which is expressed with joy, jokes and jokes, puns, contagious expansiveness and communicativeness, irrepressible talkativeness to the point of logorrhea. The expanded mood and the related behaviors do not take long to become disproportionate or in contrast with the environment, disturbing, irreverent or frankly annoying. The patient is unable, if not for a while, to control himself, having also lost the sense of proportion and respect for the needs of others, despite his exalted communication skills. Sadness and irritability take over from euphoria if the patient is contradicted or restrained in his manifestations or continuous requests, to the point of becoming hostile, bullying, quarrelsome, insulting or demanding, with outbursts of anger which can be associated with aggressive behaviors. They can break out suddenly and transiently. outbursts of tears, moments of sadness or true depression, which also includes the transition to impulsive gestures and, even if rarely, suicide. fatigue even at night, since the patient, excited and sleepless, cannot stop, wants to do more things at the same time and use all the time available to him (for example, a housewife can devote herself to household cleaning or to the preparation of food at night and at the same time singing or listening to the radio at high volume.) Due to disinhibition, I am freque nti risk behaviors such as reckless driving, the use of substances, transgressions in general of rules and conventions, which are considered by the patient himself with sufficiency or annoyance and as an unfair brake on his own exuberant initiatives. Speech is accelerated, to the point of logorrhea, with a high tone of voice. Often it becomes difficult for the patient to keep up with the speed of production of ideas (flight of ideas), and even reaches "incoherence or silence due to the impossibility of articulating words with speed adequate to that of the formulation of thoughts." The facial expression is on, the appearance and clothing are flashy, provocative or seductive, in tune with the exaltation of mood and instinct. There is an increase in self-esteem with an exaggerated and unrealistic evaluation of one's own resources and skills, a lack of criticism towards one's own limits and an "absent awareness of the disease that severely limits or completely compromises the patient's willingness to treat himself. There is a great tendency to get distracted, with little or no capacity for attention and concentration, and difficulty remembering what happens to him during the manic period.
The contents of the thought include, in about half of the cases, also delusions, especially of greatness and increased self-esteem (megalomanic delusions), which refer to the belief of increasing one's value, power, knowledge, physical strength, wealth, or of having a special relationship with a deity or a famous person. Patients believe that they possess extraordinary artistic, scientific or inventive strength or qualities (for example, having discovered the cure for AIDS or cancer), that they belong to an important family, that they are the object of falling in love with them. of well-known or illustrious personalities (erotomanic delirium), to have great wealth, to be destined by divine will to carry out a special mission (mystical or religious delusions). Auditory and visual hallucinations may also be present.
The lower need for sleep is evident (3 hours per night are often sufficient), up to total insomnia for a few days, the increase in appetite and sexual drive, with infidelity, promiscuity, possible risks of sexually contagious diseases and compromise of the stability of the couple (abandonment, separation, divorce). The lack of criticism and the overestimation that the patient gives to his own abilities can push him to behaviors that cause risks for physical health, "safety, heritage and for" marital and family union.
The resolution of the manic episode occurs over a period ranging from a few days to 3-4 months, but in some cases a major depressive episode or a mixed state may occur.