Mania

Question 1

Hypomania (hypomanic episode) - define

Answer 1

• 3+ characteristic Sx’s lasting at least 4 days
• By definition: not severe enough to interfere with social or occupational functioning
• Doesn’t include psychotic features

Question 2

Hypomania (hypomanic episode) - CFs

Answer 2

• Mildly elevated, expansive or irritable mood
• Increased energy/activity
• Increased self-esteem
• Marked feelings of well-being, physical and mental efficiency
• Sociability
• Talkativeness
• Over-familiarity
• Increased libido
• Reduced need for sleep
• Difficulty focussing on one task

Question 3

DDx hypomania

Answer 3

• OCD + other anxiety disorders, agitated depression, substance misuse/physical illness/medication
• Psychiatric: Psychoses, schizoaffective disorder, anxiety disorders/PTSD, ADHD, Alcohol or drug misuse (stimulants, hallucinogens)
• Physical: hyperthyroid (+ hypo), cushing’s, SLE, MS, neurosyphilis…
• Medications: anti-depressants, BDZs, anti-psychotics, lithium combined w/ TCA, levodopa…

Question 4

Define mania (manic episode)
(4)

Answer 4

• A distinct period of abnormally + persistently elevated, expansive, or irritable mood w/ 3 or more characteristic symptoms of mania
• Lasting >1 week
• Impairment of occupational and social functioning
• Psychotic features may be present

Question 5

CFs mania

Answer 5

• Elevated mood
• ^ energy: overactivity, pressured speech, racing thoughts, reduced need for sleep
• ^ self-esteem: over-optimistic, grandiosity, reduced social inhibitions, over-familiarity, facetiousness
• Increased distractibility
• Risk taking behaviour: spending spree, sexual promiscuity/risky behaviour, gambling
• Other: excitement, irritability, aggressiveness, suspiciousness
• Disruption of work, family life, usual social activities

Question 6

Mnemonic mania CFs

Answer 6

I’D DIG FASTER
•	Irritability
•	Distractibility
•	Disinhibition (Sexual, social, spending)
•	Insight impaired + increased libido
•	Grandiose delusions
•	Flight of ideas
•	Activity/appetite increased
•	Sleep decreased
•	Talkative (pressure of speech)
•	Elevated mood/energy increased
•	Reduced concentration/reckless behaviour

Question 7

What psychotic symptoms do you get in mania

Answer 7

Grandiose delusions (e.g. religious, special powers)
suspiciousness (persecutory delusions)
irritability/aggression
catatonic behaviour (manic stupor)
total loss of insight

Question 8

DDx mania

Answer 8

• Psychiatric: Psychoses, schizoaffective disorder, anxiety disorders/PTSD, ADHD, Alcohol or drug misuse (stimulants, hallucinogens)
• Physical: hyperthyroid (+ hypo), cushing’s, SLE, MS, neurosyphilis…
• Medications: anti-depressants, BDZs, anti-psychotics, lithium combined w/ TCA, levodopa…

Question 9

Rx of acute manic episode

Answer 9

• Exclusion of other causes of Sx’s (Ix)
• 1st line: second generation/atypical anti-psychotics (risperidone) → why not mood stabilisers 1st line? As anti-psychotics have RAPID onset
• 2nd line: mood stabiliser (lithium → sodium valproate)
• Also: BDZs to aid sleep
• Severe/life-threatening manic episode: ECT