Sinusitis

What is manic depressive psychosis in simple words. Manic-depressive psychosis: symptoms and signs

Under manic psychosis refers to a disorder of mental activity in which disturbances of affect predominate ( mood). It should be noted that manic psychosis is only a variant of affective psychoses, which can occur in different ways. So, if manic psychosis is accompanied by depressive symptoms, then it is called manic-depressive ( this term is most popularized and widespread among the masses).

Statistics

To date, there are no accurate statistics on the prevalence of manic psychosis among the population. This is due to the fact that from 6 to 10 percent of patients with this pathology are never hospitalized, and more than 30 percent are hospitalized only once in their lives. Thus, the prevalence of this pathology is very difficult to identify. On average, according to global statistics, this disorder affects from 0.5 to 0.8 percent of people. According to a study conducted under the leadership of the World Health Organization in 14 countries, the incidence rate has recently increased significantly.

Among patients with mental illness admitted to hospital, the incidence of manic psychosis varies from 3 to 5 percent. The difference in data explains the disagreement among authors in diagnostic methods, differences in understanding the boundaries of this disease, and other factors. An important characteristic of this disease is the likelihood of its development. According to doctors, this figure for each person is from 2 to 4 percent. Statistics show that this pathology occurs in women 3–4 times more often than in men. In most cases, manic psychosis develops between the ages of 25 and 44. This age should not be confused with the onset of the disease, which occurs at an earlier age. Thus, among all registered cases, the proportion of patients at this age is 46.5 percent. Pronounced attacks of the disease often appear after 40 years. Some modern scientists suggest that manic and manic-depressive psychosis is the result of human evolution. Such a manifestation of the disease as a depressive state can serve as a defense mechanism during severe stress. Biologists believe that the disease could have arisen as a result of human adaptation to the extreme climate of the northern temperate zone. Increased sleep, decreased appetite, and other symptoms of depression helped survive long winters. The affective state in the summer increased energy potential and helped to perform a large number of tasks within a short period of time.

Affective psychoses have been known since the time of Hippocrates. Then the manifestations of the disorder were classified as separate diseases and defined as mania and melancholia. As an independent disease, manic psychosis was described in the 19th century by scientists Falret and Baillarger.

One of the interesting factors about this disease is the connection between mental disorders and the patient’s creative skills. The first to declare that there is no clear line between genius and insanity was the Italian psychiatrist Cesare Lombroso, who wrote a book on this topic, “Genius and Insanity.” Later, the scientist admits that at the time of writing the book he himself was in a state of ecstasy. Another serious study on this topic was the work of the Soviet geneticist Vladimir Pavlovich Efroimson. While studying manic-depressive psychosis, the scientist came to the conclusion that many famous people suffered from this disorder. Efroimson diagnosed signs of this disease in Kant, Pushkin, and Lermontov.

A proven fact in world culture is the presence of manic-depressive psychosis in the artist Vincent Van Gogh. The bright and unusual fate of this talented person attracted the attention of the famous German psychiatrist Karl Theodor Jaspers, who wrote the book “Strindberg and Van Gogh.”
Among the celebrities of our time, Jean-Claude Van Damme, actresses Carrie Fisher and Linda Hamilton suffer from manic-depressive psychosis.

Causes of manic psychosis

Reasons ( etiology) manic psychosis, like many other psychoses, are unknown today. There are several compelling theories regarding the origin of this disease.

Hereditary ( genetic) theory

This theory is partially supported by numerous genetic studies. The results of these studies indicate that 50 percent of patients with manic psychosis have one of their parents suffering from some kind of affective disorder. If one of the parents suffers from a unipolar form of psychosis ( that is, either depressive or manic), then the risk for a child to acquire manic psychosis is 25 percent. If there is a bipolar form of disorder in the family ( that is, a combination of both manic and depressive psychosis), then the risk percentage for the child increases twofold or more. Studies among twins indicate that psychosis develops in 20–25 percent of fraternal twins and 66–96 percent of identical twins.

Proponents of this theory argue in favor of the existence of a gene that is responsible for the development of this disease. Thus, some studies have identified a gene that is localized on the short arm of chromosome 11. These studies were conducted in families with a history of manic psychosis.

Relationship between heredity and environmental factors
Some experts attach importance not only to genetic factors, but also to environmental factors. Environmental factors are, first of all, family and social. The authors of the theory note that under the influence of external unfavorable conditions, decompensation of genetic abnormalities occurs. This is confirmed by the fact that the first attack of psychosis occurs at that period of a person’s life in which some important events occur. It could be family problems ( divorce), stress at work or some kind of socio-political crisis.
It is believed that the contribution of genetic prerequisites is approximately 70 percent, and environmental - 30 percent. The percentage of environmental factors increases in pure manic psychosis without depressive episodes.

Constitutional Predisposition Theory

This theory is based on research by Kretschmer, who discovered a certain connection between the personality characteristics of patients with manic psychosis, their physique and temperament. So, he identified three characters ( or temperament) - schizothymic, ixothymic and cyclothymic. Schizotimics are characterized by unsociability, withdrawal and shyness. According to Kretschmer, these are powerful people and idealists. Ixothymic people are characterized by restraint, calmness and inflexible thinking. Cyclothymic temperament is characterized by increased emotionality, sociability and rapid adaptation to society. They are characterized by rapid mood swings - from joy to sadness, from passivity to activity. This cycloid temperament is predisposed to the development of manic psychosis with depressive episodes, that is, to manic-depressive psychosis. Today, this theory finds only partial confirmation, but is not considered as a pattern.

Monoamine theory

This theory has received the most widespread and confirmation. She considers deficiency or excess of certain monoamines in nervous tissue as a cause of psychosis. Monoamines are biologically active substances that are involved in the regulation of processes such as memory, attention, emotions, and arousal. In manic psychosis, monoamines such as norepinephrine and serotonin are of greatest importance. They facilitate motor and emotional activity, improve mood, and regulate vascular tone. An excess of these substances provokes symptoms of manic psychosis, a deficiency – depressive psychosis. Thus, in manic psychosis, there is an increased sensitivity of the receptors of these monoamines. In manic-depressive disorder, there is an oscillation between excess and deficiency.
The principle of increasing or decreasing these substances underlies the action of drugs used for manic psychosis.

Theory of endocrine and water-electrolyte shifts

This theory examines functional disorders of the endocrine glands ( for example, sexual) as a cause of depressive symptoms of manic psychosis. The main role in this case is played by the disruption of steroid metabolism. Meanwhile, water-electrolyte metabolism takes part in the origin of manic syndrome. This is confirmed by the fact that the main medicine in the treatment of manic psychosis is lithium. Lithium weakens the conduction of nerve impulses in brain tissue, regulating the sensitivity of receptors and neurons. This is achieved by blocking the activity of other ions in the nerve cell, for example, magnesium.

The theory of disrupted biorhythms

This theory is based on disorders of the sleep-wake cycle. Thus, patients with manic psychosis have a minimal need for sleep. If manic psychosis is accompanied by depressive symptoms, then sleep disturbances are observed in the form of its inversion ( change between daytime sleep and nighttime sleep), in the form of difficulty falling asleep, frequent waking up at night, or in the form of a change in sleep phases.
It is noted that in healthy people, disturbances in sleep periodicity, related to work or other factors, can cause affective disorders.

Symptoms and signs of manic psychosis

Symptoms of manic psychosis depend on its form. Thus, there are two main forms of psychosis - unipolar and bipolar. In the first case, in the clinic of psychosis, the main dominant symptom is manic syndrome. In the second case, manic syndrome alternates with depressive episodes.

Monopolar manic psychosis

This type of psychosis usually begins between the ages of 35 and older. The clinical picture of the disease is very often atypical and inconsistent. Its main manifestation is the phase of a manic attack or mania.

Manic attack
This state is expressed in increased activity, initiative, interest in everything and high spirits. At the same time, the patient’s thinking accelerates and becomes galloping, fast, but at the same time, due to increased distractibility, unproductive. There is an increase in basic drives - appetite and libido increase, and the need for sleep decreases. On average, patients sleep 3–4 hours a day. They become overly sociable and try to help everyone with everything. At the same time, they make casual acquaintances and enter into chaotic sexual relationships. Often patients leave home or bring strangers into the house. The behavior of manic patients is absurd and unpredictable; they often begin to abuse alcohol and psychoactive substances. They often get involved in politics - they chant slogans with fervor and a hoarse voice. Such states are characterized by an overestimation of one’s capabilities.

Patients do not realize the absurdity or illegality of their actions. They feel a surge of strength and energy, considering themselves absolutely adequate. This state is accompanied by various overvalued or even delusional ideas. Ideas of greatness, high birth, or ideas of special purpose are often observed. It is worth noting that despite increased arousal, patients in a state of mania treat others favorably. Only occasionally are mood swings observed, which are accompanied by irritability and explosiveness.
Such a cheerful mania develops very quickly - within 3 to 5 days. Its duration ranges from 2 to 4 months. The reverse dynamics of this condition can be gradual and last from 2 to 3 weeks.

"Mania without mania"
This condition is observed in 10 percent of cases of unipolar manic psychosis. The leading symptom in this case is motor excitation without increasing the speed of ideation reactions. This means that there is no increased initiative or drive. Thinking does not speed up, but, on the contrary, slows down, concentration of attention remains ( which is not observed in pure mania).
Increased activity in this case is characterized by monotony and lack of a sense of joy. Patients are mobile, easily establish contacts, but their mood is dull. Feelings of a surge of strength, energy and euphoria that are characteristic of classic manias are not observed.
The duration of this condition can drag on and reach up to 1 year.

Course of monopolar manic psychosis
Unlike bipolar psychosis, unipolar psychosis may experience prolonged phases of manic states. So, they can last from 4 months ( average duration) up to 12 months ( protracted course). The frequency of occurrence of such manic states is on average one phase every three years. Also, such psychosis is characterized by a gradual onset and the same ending of manic attacks. In the first years, there is a seasonality of the disease - often manic attacks develop in the fall or spring. However, over time, this seasonality is lost.

There is a remission between two manic episodes. During remission, the patient’s emotional background is relatively stable. Patients do not show signs of lability or agitation. A high professional and educational level is maintained for a long time.

Bipolar manic psychosis

During bipolar manic psychosis, there is an alternation of manic and depressive states. The average age of this form of psychosis is up to 30 years. There is a clear connection with heredity - the risk of developing bipolar disorder in children with a family history is 15 times higher than in children without it.

Onset and course of the disease
In 60–70 percent of cases, the first attack occurs during a depressive episode. There is deep depression with pronounced suicidal behavior. After the end of a depressive episode, there is a long period of light - remission. It can last for several years. After remission, a repeated attack is observed, which can be either manic or depressive.
Symptoms of bipolar disorder depend on its type.

Forms of bipolar manic psychosis include:

bipolar psychosis with a predominance of depressive states;
bipolar psychosis with a predominance of manic states;
a distinct bipolar form of psychosis with an equal number of depressive and manic phases.
circulatory form.

Bipolar psychosis with a predominance of depressive states
The clinical picture of this psychosis includes long-term depressive episodes and short-term manic states. The debut of this form is usually observed at 20–25 years of age. The first depressive episodes are often seasonal. In half of the cases, depression is of an anxious nature, which increases the risk of suicide several times.

The mood of depressed patients decreases; patients note a “feeling of emptiness.” Also no less characteristic is the feeling of “mental pain”. A slowdown is observed both in the motor sphere and in the ideational sphere. Thinking becomes viscous, there is difficulty in assimilating new information and concentrating. Appetite can either increase or decrease. Sleep is unstable and intermittent throughout the night. Even if the patient managed to fall asleep, in the morning there is a feeling of weakness. A frequent patient complaint is shallow sleep with nightmares. In general, mood fluctuations throughout the day are typical for this condition - an improvement in well-being is observed in the second half of the day.

Very often, patients express ideas of self-blame, blaming themselves for the troubles of relatives and even strangers. Ideas of self-blame are often intertwined with statements about sinfulness. Patients blame themselves and their fate, being overly dramatic.

Hypochondriacal disorders are often observed in the structure of a depressive episode. At the same time, the patient shows very pronounced concern about his health. He constantly looks for diseases in himself, interpreting various symptoms as fatal diseases. Passivity is observed in behavior, and claims towards others are observed in dialogue.

Hysterical reactions and melancholia may also be observed. The duration of such a depressive state is about 3 months, but can reach 6. The number of depressive states is greater than manic ones. They are also superior in strength and severity to a manic attack. Sometimes depressive episodes can repeat one after another. Between them, short-term and erased manias are observed.

Bipolar psychosis with predominance of manic states
The structure of this psychosis includes vivid and intense manic episodes. The development of a manic state is very slow and sometimes delayed ( up to 3 – 4 months). Recovery from this state can take from 3 to 5 weeks. Depressive episodes are less intense and have a shorter duration. Manic attacks in the clinic of this psychosis develop twice as often as depressive ones.

The debut of psychosis occurs at the age of 20 and begins with a manic attack. The peculiarity of this form is that very often depression develops after mania. That is, there is a kind of twinning of phases, without clear gaps between them. Such dual phases are observed at the onset of the disease. Two or more phases followed by remission are called a cycle. Thus, the disease consists of cycles and remissions. The cycles themselves consist of several phases. The duration of the phases, as a rule, does not change, but the duration of the entire cycle increases. Therefore, 3 and 4 phases can appear in one cycle.

The subsequent course of psychosis is characterized by the occurrence of dual phases ( manic-depressive), and single ( purely depressive). The duration of the manic phase is 4 – 5 months; depressed – 2 months.
As the disease progresses, the frequency of the phases becomes more stable and amounts to one phase every year and a half. Between cycles there is a remission, which lasts on average 2 – 3 years. However, in some cases it can be more persistent and long-lasting, reaching a duration of 10–15 years. During the period of remission, the patient retains some lability in mood, changes in personal characteristics, and a decrease in social and labor adaptation.

Distinct bipolar psychosis
This form is characterized by a regular and distinct alternation of depressive and manic phases. The onset of the disease occurs between the ages of 30 and 35 years. Depressive and manic states last longer than other forms of psychosis. At the onset of the disease, the duration of the phases is approximately 2 months. However, the phases are gradually increased to 5 months or more. There is a regularity of their appearance - one to two phases per year. The duration of remission is from two to three years.
At the onset of the disease, seasonality is also observed, that is, the beginning of the phases coincides with the autumn-spring period. But gradually this seasonality is lost.
Most often, the disease begins with a depressive phase.

The stages of the depressive phase are:

initial stage– there is a slight decrease in mood, weakening of mental tone;
stage of increasing depression– characterized by the appearance of an alarming component;
stage of severe depression– all symptoms of depression reach a maximum, suicidal thoughts appear;
reduction of depressive symptoms– depressive symptoms begin to disappear.

Course of the manic phase
The manic phase is characterized by the presence of increased mood, motor agitation and accelerated ideational processes.

The stages of the manic phase are:

hypomania– characterized by a feeling of spiritual uplift and moderate motor excitement. Appetite moderately increases and sleep duration decreases.
severe mania– ideas of grandeur and pronounced excitement appear - patients constantly joke, laugh and build new perspectives; Sleep duration is reduced to 3 hours per day.
manic frenzy– excitement is chaotic, speech becomes incoherent and consists of fragments of phrases.
motor sedation– the elevated mood remains, but motor excitement goes away.
reduction of mania– mood returns to normal or even decreases slightly.

Circular form of manic psychosis
This type of psychosis is also called the continua type. This means that between the phases of mania and depression there are practically no remissions. This is the most malignant form of psychosis.

Diagnosis of manic psychosis

Diagnosis of manic psychosis must be carried out in two directions - firstly, to prove the presence of affective disorders, that is, psychosis itself, and secondly, to determine the type of this psychosis ( monopolar or bipolar).

The diagnosis of mania or depression is based on the diagnostic criteria of the World Classification of Diseases ( ICD) or based on the criteria of the American Psychiatric Association ( DSM).

Criteria for manic and depressive episodes according to the ICD

Type of affective disorder	Criteria
*Manic episode*	increased activity; motor restlessness; "speech pressure"; rapid flow of thoughts or their confusion, the phenomenon of “jump of ideas”; decreased need for sleep; increased distractibility; increased self-esteem and reassessment of one’s own capabilities; ideas of greatness and special purpose can crystallize into delusions; in severe cases, delusions of persecution and high origin are noted.
*Depressive episode*	decreased self-esteem and sense of self-confidence; ideas of self-blame and self-deprecation; decreased performance and decreased concentration; disturbance of appetite and sleep; suicidal thoughts.

After the presence of an affective disorder has been established, the doctor determines the type of manic psychosis.

Criteria for psychosis

Type of psychosis	Criteria
*Monopolar manic psychosis*	The presence of periodic manic phases, usually with a protracted course ( 7 – 12 months).
*Bipolar manic psychosis*	There must be at least one manic or mixed episode. The intervals between phases can reach several years.
*Circular psychosis*	One phase is replaced by another. There are no bright spaces between them.

The American Psychiatric Association classifier identifies two types of bipolar disorder - type 1 and type 2.

Diagnostic criteria for bipolar disorder according toDSM

Type of psychosis

Criteria

Bipolar disorder type 1

This psychosis is characterized by clearly defined manic phases, in which social inhibition is lost, attention is not maintained, and a rise in mood is accompanied by energy and hyperactivity.

Bipolar II disorder
(may develop into type 1 disorder)

Instead of classic manic phases, hypomanic phases are present.

Hypomania is a mild degree of mania without psychotic symptoms ( no delusions or hallucinations, which may be present with mania).

Hypomania is characterized by the following:

slight lift in mood;
talkativeness and familiarity;
feelings of well-being and productivity;
increased energy;
increased sexual activity and decreased need for sleep.

Hypomania does not cause problems with work or daily life.

Cyclothymia
A special variant of the mood disorder is cyclothymia. This is a state of chronic unstable mood with periodic episodes of mild depression and elation. However, this elation or, conversely, depression of mood does not reach the level of classic depression and mania. Thus, typical manic psychosis does not develop.
Such instability in mood develops at a young age and becomes chronic. Periods of stable mood occur periodically. These cyclical changes in the patient's activity are accompanied by changes in appetite and sleep.

Various diagnostic scales are used to identify certain symptoms in patients with manic psychosis.

Scales and questionnaires used in the diagnosis of manic psychosis

*Affective Disorders Questionnaire* *(Mood Disorders Questionnaire)*	This is a screening scale for bipolar psychosis. Includes questions regarding the states of mania and depression.
*Young Mania Rating Scale*	The scale consists of 11 items, which are assessed during interviews. Items include mood, irritability, speech, and thought content.
*Bipolar Spectrum Diagnostic Scale* (*Bipolar Spectrum Diagnostic Scale* )	The scale consists of two parts, each of which includes 19 questions and statements. The patient must answer whether this statement suits him.
*Scale* *Beka* (*Beck Depression Inventory* )	Testing is carried out in the form of a self-survey. The patient answers the questions himself and rates the statements on a scale from 0 to 3. After this, the doctor adds up the total and determines the presence of a depressive episode.

Treatment of manic psychosis

How can you help a person in this condition?

Family support plays an important role in the treatment of patients with psychosis. Depending on the form of the disease, loved ones should take measures to help prevent exacerbation of the disease. One of the key factors of care is suicide prevention and assistance in timely access to a doctor.

Help for manic psychosis
When caring for a patient with manic psychosis, the environment should monitor and, if possible, limit the patient's activities and plans. Relatives should be aware of possible behavioral abnormalities during manic psychosis and do everything to reduce the negative consequences. Thus, if the patient can be expected to spend a lot of money, it is necessary to limit access to material resources. Being in a state of excitement, such a person does not have time or does not want to take medications. Therefore, it is necessary to ensure that the patient takes the medications prescribed by the doctor. Also, family members should monitor the implementation of all recommendations given by the doctor. Taking into account the patient's increased irritability, tact should be exercised and support should be provided discreetly, showing restraint and patience. You should not raise your voice or shout at the patient, as this can increase irritation and provoke aggression on the part of the patient.
If signs of excessive agitation or aggression occur, loved ones of a person with manic psychosis should be prepared to ensure prompt hospitalization.

Family support for manic depression
Patients with manic-depressive psychosis require close attention and support from those close to them. Being in a depressed state, such patients need help, since they cannot cope with the fulfillment of vital needs on their own.

Help from loved ones with manic-depressive psychosis includes the following:

organization of daily walks;
feeding the patient;
involving patients in homework;
control of taking prescribed medications;
providing comfortable conditions;
visiting sanatoriums and resorts ( in remission).

Walking in the fresh air has a positive effect on the patient’s general condition, stimulates appetite and helps to distract from worries. Patients often refuse to go outside, so relatives must patiently and persistently force them to go outside. Another important task when caring for a person with this condition is feeding. When preparing food, preference should be given to foods with a high content of vitamins. The patient's menu should include dishes that normalize intestinal activity to prevent constipation. Physical labor, which must be done together, has a beneficial effect. At the same time, care must be taken to ensure that the patient does not become overtired. Sanatorium-resort treatment helps speed up recovery. The choice of location must be made in accordance with the doctor's recommendations and the patient's preferences.

In severe depressive episodes, the patient may remain in a state of stupor for a long time. At such moments, you should not put pressure on the patient and encourage him to be active, as this can aggravate the situation. A person may have thoughts about his own inferiority and worthlessness. You should also not try to distract or entertain the patient, as this can cause greater depression. The task of the immediate environment is to ensure complete peace and qualified medical care. Timely hospitalization will help avoid suicide and other negative consequences of this disease. One of the first symptoms of worsening depression is the patient's lack of interest in the events and actions happening around him. If this symptom is accompanied by poor sleep and lack of appetite, you should immediately consult a doctor.

Suicide Prevention
When caring for a patient with any form of psychosis, those close to them should take into account possible suicide attempts. The highest incidence of suicide is observed in the bipolar form of manic psychosis.

To lull the vigilance of relatives, patients often use a variety of methods, which are quite difficult to foresee. Therefore, it is necessary to monitor the patient’s behavior and take measures when identifying signs that indicate a person has an idea of suicide. Often people prone to suicidal ideation reflect on their uselessness, the sins they have committed or great guilt. The patient's belief that he has an incurable disease ( in some cases – dangerous for the environment) disease may also indicate that the patient may attempt suicide. The sudden reassurance of the patient after a long period of depression should make loved ones worry. Relatives may think that the patient's condition has improved, when in fact he is preparing for death. Patients often put their affairs in order, write wills, and meet people they have not seen for a long time.

Measures that will help prevent suicide are:

Risk assessment– if the patient takes real preparatory measures ( gives favorite things, gets rid of unnecessary items, is interested in possible methods of suicide), you should consult a doctor.
Taking all conversations about suicide seriously– even if it seems unlikely to relatives that the patient could commit suicide, it is necessary to take into account even indirectly raised topics.
Limitation of capabilities– you need to keep piercing and cutting objects, medications, and weapons away from the patient. You should also close windows, doors to the balcony, and gas supply valve.

The greatest vigilance should be exercised when the patient awakens, since the overwhelming number of suicide attempts occur in the morning.
Moral support plays an important role in preventing suicide. When people are depressed, they are not inclined to listen to any advice or recommendations. Most often, such patients need to be freed from their own pain, so family members need to be attentive listeners. A person suffering from manic-depressive psychosis needs to talk more himself and relatives should facilitate this.

Often, those close to a patient with suicidal thoughts may feel resentful, powerless, or angry. You should fight such thoughts and, if possible, remain calm and express understanding to the patient. A person should not be judged for having thoughts of suicide, as such behavior can cause withdrawal or push one to commit suicide. You should not argue with the patient, offer unjustified consolations and ask inappropriate questions.

Questions and comments that should be avoided by relatives of patients:

I hope you're not planning to commit suicide- this formulation contains a hidden answer “no”, which relatives want to hear, and there is a high probability that the patient will answer exactly that way. In this case, a direct question “are you thinking about suicide” is appropriate, which will allow the person to talk out.
What do you lack, you live better than others- such a question will cause the patient even greater depression.
Your fears are unfounded- this will humiliate a person and make him feel unnecessary and useless.

Preventing relapse of psychosis
The assistance of relatives in organizing an orderly lifestyle for the patient, a balanced diet, regular medications, and proper rest will help reduce the likelihood of relapse. An exacerbation can be provoked by premature discontinuation of therapy, violation of the medication regimen, physical overexertion, climate change, and emotional shock. Signs of an impending relapse include not taking medications or visiting a doctor, poor sleep, and changes in habitual behavior.

Actions that relatives should take if the patient's condition worsens include :

contacting your doctor for treatment correction;
elimination of external stress and irritating factors;
minimizing changes in the patient's daily routine;
ensuring peace of mind.

Drug treatment

Adequate drug treatment is the key to long-term and stable remission, and also reduces mortality due to suicide.

The choice of medication depends on which symptom prevails in the clinical picture of psychosis - depression or mania. The main drugs in the treatment of manic psychosis are mood stabilizers. This is a class of drugs that act to stabilize mood. The main representatives of this group of drugs are lithium salts, valproic acid and some atypical antipsychotics. Among the atypical antipsychotics, the drug of choice today is aripiprazole.

Antidepressants are also used in the treatment of depressive episodes in the structure of manic psychosis ( for example, bupropion).

Drugs from the class of mood stabilizers used in the treatment of manic psychosis

Name of the medication	Mechanism of action	How to take
*Lithium carbonate*	Stabilizes mood, eliminates symptoms of psychosis, and has a moderate sedative effect.	Orally in tablet form. The dose is set strictly individually. It is necessary that the selected dose ensures a constant concentration of lithium in the blood within the range of 0.6 - 1.2 millimoles per liter. So, with a dose of the drug of 1 gram per day, a similar concentration is achieved after two weeks. It is necessary to take the drug even during remission.
*Sodium valproate*	Smoothes out mood swings, prevents the development of mania and depression. It has a pronounced antimanic effect, effective for mania, hypomania and cyclothymia.	Inside, after eating. The starting dose is 300 mg per day ( divided into two doses of 150 mg). The dose is gradually increased to 900 mg ( twice 450 mg), and for severe manic states – 1200 mg.
*Carbamazepine*	Inhibits the metabolism of dopamine and norepinephrine, thereby providing an antimanic effect. Eliminates irritability, aggression and anxiety.	Orally from 150 to 600 mg per day. The dose is divided into two doses. As a rule, the drug is used in combination therapy with other medications.
*Lamotrigine*	Mainly used for maintenance therapy of manic psychosis and prevention of mania and depression.	The initial dose is 25 mg twice a day. Gradually increase to 100 - 200 mg per day. The maximum dose is 400 mg.

Various regimens are used in the treatment of manic psychosis. The most popular is monotherapy ( one medication is used) lithium preparations or sodium valproate. Other experts prefer combination therapy, when two or more drugs are used. The most common combinations are lithium ( or sodium valproate) with an antidepressant, lithium with carbamazepine, sodium valproate with lamotrigine.

The main problem associated with the prescription of mood stabilizers is their toxicity. The most dangerous drug in this regard is lithium. Lithium concentration is difficult to maintain at the same level. A missed dose of the drug once can cause an imbalance in lithium concentration. Therefore, it is necessary to constantly monitor the level of lithium in the blood serum so that it does not exceed 1.2 millimoles. Exceeding the permissible concentration leads to toxic effects of lithium. The main side effects are associated with kidney dysfunction, heart rhythm disturbances and inhibition of hematopoiesis ( process of blood cell formation). Other mood stabilizers also need constant biochemical blood tests.

Antipsychotic drugs and antidepressants used in the treatment of manic psychosis

Name of the medication	Mechanism of action	How to take
*Aripiprazole*	Regulates the concentration of monoamines ( serotonin and norepinephrine) in the central nervous system. The drug, having a combined effect ( both blocking and activating), prevents both the development of mania and depression.	The drug is taken orally in tablet form once a day. The dose ranges from 10 to 30 mg.
*Olanzapine*	Eliminates symptoms of psychosis - delusions, hallucinations. Dulls emotional arousal, reduces initiative, corrects behavioral disorders.	The initial dose is 5 mg per day, after which it is gradually increased to 20 mg. A dose of 20 – 30 mg is most effective. Taken once a day, regardless of meals.
*Bupropion*	It disrupts the reuptake of monoamines, thereby increasing their concentration in the synaptic cleft and in brain tissue.	The initial dose is 150 mg per day. If the chosen dose is ineffective, it is raised to 300 mg per day.
*Sertraline*	Has an antidepressant effect, eliminating anxiety and restlessness.	The initial dose is 25 mg per day. The drug is taken once a day - in the morning or evening. The dose is gradually increased to 50 – 100 mg. The maximum dose is 200 mg per day.

Antidepressant drugs are used for depressive episodes. It must be remembered that bipolar manic psychosis is accompanied by the greatest risk of suicide, so it is necessary to treat depressive episodes well.

Prevention of manic psychosis

What should you do to avoid manic psychosis?

To date, the exact cause of the development of manic psychosis has not been established. Numerous studies indicate that heredity plays an important role in the occurrence of this disease, and most often the disease is transmitted through generations. It should be understood that the presence of manic psychosis in relatives does not determine the disorder itself, but a predisposition to the disease. Under the influence of a number of circumstances, a person experiences disorders in the parts of the brain that are responsible for controlling the emotional state.

It is practically impossible to completely avoid psychosis and develop preventive measures.
Much attention is paid to early diagnosis of the disease and timely treatment. You need to know that some forms of manic psychosis are accompanied by remission at 10–15 years. In this case, regression of professional or intellectual qualities does not occur. This means that a person suffering from this pathology can realize himself both professionally and in other aspects of his life.

At the same time, it is necessary to remember the high risk of heredity in manic psychosis. Married couples where one of the family members suffers from psychosis should be instructed about the high risk of manic psychosis in unborn children.

What can trigger the onset of manic psychosis?

Various stress factors can trigger the onset of psychosis. Like most psychoses, manic psychosis is a polyetiological disease, which means that many factors are involved in its occurrence. Therefore, it is necessary to take into account a combination of both external and internal factors ( complicated anamnesis, character traits).

Factors that can provoke manic psychosis are:

character traits;
endocrine system disorders;
hormonal surges;
congenital or acquired brain diseases;
injuries, infections, various bodily diseases;
stress.

The most susceptible to this personality disorder with frequent mood changes are melancholic, suspicious and insecure people. Such individuals develop a state of chronic anxiety, which depletes their nervous system and leads to psychosis. Some researchers of this mental disorder assign a large role to such a character trait as an excessive desire to overcome obstacles in the presence of a strong stimulus. The desire to achieve a goal causes the risk of developing psychosis.

Emotional shocks are more of a precipitating than a causative factor. There is ample evidence that problems in interpersonal relationships and recent stressful events contribute to the development of episodes and relapses of manic psychosis. According to studies, more than 30 percent of patients with this disease have experiences of negative relationships in childhood and early suicide attempts. Attacks of mania are a kind of manifestation of the body's defenses provoked by stressful situations. The excessive activity of such patients allows them to escape from difficult experiences. Often the cause of manic psychosis is hormonal changes in the body during puberty or menopause. Postpartum depression can also act as a trigger for this disorder.

Many experts note the connection between psychosis and human biorhythms. Thus, the development or exacerbation of the disease often occurs in spring or autumn. Almost all doctors note a strong connection in the development of manic psychosis with previous brain diseases, endocrine system disorders and infectious processes.

Factors that can provoke an exacerbation of manic psychosis are:

interruption of treatment;
disruption of daily routine ( lack of sleep, busy work schedule);
conflicts at work, in the family.

Treatment interruption is the most common cause of a new attack in manic psychosis. This is due to the fact that patients quit treatment at the first signs of improvement. In this case, there is no complete reduction of symptoms, but only their smoothing. Therefore, at the slightest stress, the condition decompensates and a new and more intense manic attack develops. In addition, resistance is formed ( addictive) to the selected drug.

In case of manic psychosis, adherence to a daily routine is no less important. Getting enough sleep is just as important as taking your medications. It is known that sleep disturbance in the form of a decrease in the need for it is the first symptom of an exacerbation. But, at the same time, its absence can provoke a new manic or depressive episode. This is confirmed by various studies in the field of sleep, which have revealed that in patients with psychosis the duration of various phases of sleep changes.

Any person is prone to developing low or high mood. However, if a person does not have good reasons for this, the mood itself either falls or rises, the person cannot control the processes, then we can talk about pathological changes in mood - manic-depressive psychosis (or bipolar disorder). The causes lie in many areas of human life, the symptoms are divided into two variations of opposite phases that require treatment.

Often a person does not realize what is happening to him. He can only watch how his mood either becomes excitable or passive, sleep either quickly appears (drowsiness) or disappears completely (insomnia), energy is there, then it is not there. Therefore, here only relatives can take the initiative to help a person recover from his disease. Although everything may seem normal at first glance, in fact the two phases - mania and depression - gradually progress and deepen.

If manic-depressive disorder is not clearly expressed, then we are talking about cyclotomy.

What is manic-depressive psychosis?

Manic-depressive psychosis is a mental disorder in which a person experiences sudden mood swings. Moreover, these sentiments are opposite to each other. During the manic phase, a person experiences a surge of energy and an unmotivated, cheerful mood. During the depressive phase, a person falls into a depressed state without good reason.

In mild forms, manic-depressive disorder is not even noticed by the person. Such people are not hospitalized; they live among ordinary people. However, the danger may lie in the rash actions of the patient, who may commit an illegal violation during the manic phase or commit suicide during depression.

Manic-depressive psychosis is not a disease that makes people sick. Everyone at least once in their life fell into either a depressed state or an elevated state. Because of this, a person cannot be called sick. However, with manic-depressive psychosis, mood swings occur as if by themselves. Of course, there are external factors that contribute to this.

Experts say that a person must be genetically predisposed to sudden mood swings. However, this disorder may not manifest itself unless external factors contribute to it:

Childbirth.
Parting with a loved one.
Losing a job you love. Etc.

Manic-depressive psychosis can develop in a person through constant exposure to negative factors. You can become mentally abnormal if a person is constantly exposed to certain external circumstances or human influence, in which he is either in euphoria or falls into a depressive state.

Manic-depressive psychosis can manifest itself in various forms:

First there are two phases of mania with remission, and then depression sets in.
First comes, and then mania, after which the phases repeat.
There are no periods of normal mood between interphases.
Between individual interphases there are remissions, but in other cases they are absent.
Psychosis can manifest itself in only one phase (depression or mania), and the second phase occurs for a short period of time, after which it quickly passes.

Causes of manic-depressive psychosis

While the specialists of the psychiatric help site cannot provide a complete list of all the causes of manic-depressive psychosis. However, among the known factors are the following:

A genetic defect that is passed from parents to child. This reason explains 70-80% of all episodes.
Personal qualities. It is noted that manic-depressive disorder occurs in individuals with a developed sense of responsibility, consistency and order.
Abuse of drugs and alcohol.
Copy of parental behavior. You don't have to be born into a family of mentally ill people. Manic-depressive psychosis may be a consequence of copying the behavior of parents who behave in one way or another.
The influence of stress and mental trauma.

The disease develops equally in men and women. Men are more likely to suffer from bipolar disorder, while women are more likely to suffer from unipolar disorder. Predisposing factors for the development of manic-depressive disorder in women are childbirth and pregnancy. If a woman experiences mental disorders within 2 weeks after giving birth, then the chance of bipolar psychosis increases by 4 times.

Signs of manic-depressive psychosis

Manic-depressive psychosis is characterized by symptoms that change dramatically in one phase or another. As noted above, the disease has several forms of manifestation:

Unipolar (monopolar) depressive – when a person faces only one phase of psychosis – depression.
Monopolar manic - when a person experiences only a drop into the manic stage.
A distinctly bipolar disorder is when a person falls either into a phase of mania or into a phase of depression “according to all the rules” and without distortions.
Bipolar disorder with depression - when a person experiences both phases of the disease, but depression is predominant. The manic phase may generally proceed sluggishly or not bother the person.
Bipolar disorder with a predominance of mania - when a person spends more often and longer in the manic phase, and the depressive stage proceeds easily and without special worries.

Correctly intermittent disease is called psychosis, where depression and mania replace each other, with periods of intermission occurring between them - when the person returns to a normal emotional state. However, there is also an irregularly intermittent disease, when after depression depression can occur again, and after mania - mania, and only then the phase switches to the opposite.

Manic-depressive psychosis has its own symptoms, which replace each other. One phase can last from a few months to a couple of years, and then transition to another phase. Moreover, the depressive phase differs in its duration from the manic phase, and is also considered the most dangerous, since it is in a state of depression that a person breaks off all social connections, thinks about suicide, withdraws, and his performance decreases.

The manic phase is characterized by the following symptoms:

In the first hypomanic stage:

Active verbose speech.
Increased appetite.
Distractibility.
Increased mood.
Some insomnia.
Cheerfulness.

At the stage of severe mania:

Strong speech stimulation.
Inability to concentrate, jumping from topic to topic.
Outbursts of anger that quickly fade away.
Minimum need for rest.
Motor excitement.
Megalomania.

During the stage of manic frenzy:

Erratic jerky movements.
The intensity of all symptoms of mania.
Incoherent speech.

At the motor calming stage:

Speech stimulation.
Increased mood.
Decreased motor excitation.

Reactive stage:

Decreased mood in some cases.
Gradual return to normal.

It happens that the manic phase is marked only by the first (hypomanic) stage. In the phase of depressive manifestations, the following stages of symptom development are noted:

At the initial stage:

Weakening of muscle tone.
It's hard to sleep.
Decreased performance.
Deterioration of mood.

At the stage of increasing depression:

Insomnia.
Slow speech.
Decreased mood.
Decreased appetite.
Significant deterioration in performance.
Retardation of movements.

At the stage of severe depression:

Quiet and slow speech.
Refusal to eat.
Self-flagellation.
Feelings of anxiety and melancholy.
Staying in one position for a long time.
Thoughts about suicide.
Monosyllabic answers.

At the reactive stage:

Decreased muscle tone.
Restoring all functions.

A depressive state can be supplemented by vocal hallucinations, which will convince a person of the hopelessness of his situation.

How to treat manic-depressive psychosis?

Manic-depressive psychosis can be treated together with a doctor, who will first identify the disorder and differentiate it from brain lesions. This can be done by undergoing radiography, electroencephalography, or MRI of the brain.

Treatment of psychosis is carried out in an inpatient setting in several directions at once:

Taking medications: antidepressants and sedatives (Levomepromazine, Chlorpromazine, Lithium salts, Haloperedol). Need medication to stabilize mood.
Consumption of omega-3 polyunsaturated fatty acids, which help improve mood and eliminate relapses. They are found in spinach, camelina, flaxseed and mustard oils, fatty sea fish, and seaweed.
Psychotherapy in which a person is taught to control their emotional states. Family therapy is possible.
Transcranial magnetic stimulation is the effect on the brain of non-invasive magnetic impulses.

It is necessary to be treated not only during periods of exacerbation of phases, but also during intermission - when a person feels well. If additional disorders or deterioration in health are observed, then medications are prescribed to eliminate them.

Bottom line

Manic-depressive disorder can be considered a common mood swing, when a person is in a good and bad mood. Should I start taking medication because of this? It should be understood that each person experiences this condition in his own way. There are people who have learned to cope with their mood swings by making the most of their abilities.

For example, during a manic phase, a person usually begins to come up with a lot of ideas. He becomes very creative. If, in addition to words, you also make efforts, then at the stage of a large amount of energy you can create something new, transform your life.

During the depression stage, it is important to give yourself rest. Since a person feels the need to retire, you can use this time to think about your life, plan further actions, relax and gain strength.

Manic-depressive psychosis manifests itself in various forms. And here it is important not to become a hostage to your mood. Usually a person does not analyze what contributes to the appearance of his mood, but simply reacts and acts on emotions. However, if you understand your condition, you can even take control of a pathological disorder.

The human brain is a complex mechanism that is difficult to study. The root of psychological deviations and psychoses lies deep in a person’s subconscious, destroys life and interferes with functioning. Manic-depressive psychosis is by its nature dangerous not only for the patient, but also for the people around him, so you should immediately contact a specialist.

Manic-depressive syndrome, or, as it is also known, bipolar personality disorder, is a mental illness that manifests itself as a constant change in behavior from unreasonably excited to complete depression.

Causes of TIR

No one knows exactly the origins of this disease - it was known back in Ancient Rome, but doctors of that time clearly distinguished between manic psychosis and depression, and only with the development of medicine was it proven that these were stages of the same disease.

Manic-depressive psychosis (MDP) is a severe mental illness

It may appear due to:

suffered stress;
pregnancy and menopause;
disruption of brain function due to tumors, trauma, chemical exposure;
the presence of this psychosis or other affective disorder in one of the parents (it has been scientifically proven that the disease can be inherited).

Due to mental instability, women are more often susceptible to psychosis. There are also two peaks in which manic disorder can occur: menopause and 20-30 years. Manic-depressive psychosis has a clearly defined seasonal nature, as exacerbations most often occur in the fall and spring.

Manic-depressive psychosis: symptoms and signs

MDP expresses itself in two main stages, which appear for a certain period of time and replace each other. They are:

Manic-depressive psychosis and its varieties

Bipolar personality disorder is sometimes understood as a synonym for MDP, but in reality it is just one type of general psychosis.

The usual course of the disease involves the following stages:

manic;
intermission (when a person returns to his normal behavior);
depressive.

The patient may be missing one of the stages, which is called unipolar disorder. In this case, the same stage can alternate several times, changing only occasionally. Double psychosis also occurs, when the manic phase immediately turns into a depressive phase without intermediate intermission. The changes should be monitored by a doctor who will recommend appropriate treatment appropriate for the individual's condition.

The disease can manifest itself in manic and depressive forms

The difference between manic-depressive syndrome and other diseases

Inexperienced doctors, as well as loved ones, may confuse MDP with ordinary depression. This usually occurs due to short observation of the patient and rapid conclusions. One stage can last up to a year, and most people rush into treatment for depression.

It is worth knowing that in addition to loss of strength and lack of desire to live, patients with MDP also experience physical changes:

The person has inhibited and slow thinking, and an almost complete lack of speech. It's not a matter of wanting to be alone - during this stage the weakness can be so severe that it is difficult for a person to move his tongue. Sometimes this condition turns into complete paralysis. At this moment the patient especially needs help.
During a manic episode, people often report dry mouth, insomnia or very little sleep, racing thoughts, shallow judgment, and a reluctance to think about problems.

The dangers of manic-depressive psychosis

Any psychosis, no matter how minor or insignificant, can radically change the life of the patient and his loved ones. In the depressive stage, a person is able to:

The mechanism of development of the disease is explained by the result of neuropsychic breakdowns with the formation of foci in the cerebral cortex

commit suicide;
die of hunger;
develop bedsores;
fall out of society.

While in the manic stage the patient may:

commit a rash act, up to and including murder, because the cause-and-effect relationship is broken;
endanger your own or others' lives;
start having promiscuous sex.

Diagnosis of TIR

It often happens that the patient is diagnosed incorrectly, which complicates treatment, so the patient must undergo a full set of studies and tests - radiography, MRI of the brain and electroencephalography.

At the time of diagnosis, a complete picture is needed to exclude other mental disorders, infections and injuries.

Treatment of manic-depressive psychosis

The doctor usually prescribes a hospital stay. This makes it much easier to track changes in stages, identify patterns, and help the patient in case of suicide or other unjustified actions.

If the state of lethargy is dominant, antidepressants with analeptic properties are selected

Often prescribed:

antipsychotics with a sedative effect during the manic period;
antidepressants during the depressive stage;
Lithium therapy in the manic stage;
electroconvulsive therapy for prolonged forms.

During moments of activity, a patient with manic syndrome is capable of harming himself due to self-confidence, as well as endangering other people, so conversations with a psychologist who can reassure the patient are very important.

Also at the moment of depression, a person needs constant care, since he has no appetite, is taciturn and often immobile.

How to live with manic-depressive psychosis?

3-5% of people admitted to hospital are diagnosed with MDP. With quality treatment of both stages, constant prevention and conversations with a psychiatrist, it is possible to live a normal and ordinary life. Unfortunately, few people think about recovery and make plans for life, so there should always be close people next to such a person who, in the event of an exacerbation, can forcibly put the patient on treatment and support him in every possible way.

Why is it worth treating manic-depressive psychosis?

Many people diagnosed with MDP express themselves through creativity. For example, the famous impressionist artist Vincent Van Gogh was also a hostage to this disease, while remaining a talented person, although not capable of socialization. The life path of this artist can serve as a good example for people who do not want to go to the hospital or solve a problem. Despite his talent and boundless imagination, the great impressionist committed suicide during one of his depressive stages. Due to problems with socialization and people, Vincent never sold a single painting in his entire life, but gained fame quite by accident, thanks to people who knew him.

Depressive syndrome is a mental disorder with active suppression of the mental activity of the cerebral cortex. To diagnose the condition, it is enough to identify a specific triad - lack of joy with impaired thinking, pessimism in relation to current events, inhibition of the motor sphere.

Depressive syndrome - what is it, how does it differ from psychosis?

Experts classify depressive syndrome as an affective disorder in which the active psycho-emotional background is suppressed, the person becomes lethargic, apathetic and motionless. Constant anxiety, restlessness and irritability are conditions that haunt a person throughout his life.

Various psycho-emotional factors in the disease were described by many ancient healers. Hippocrates also used the terms “mania” and “melancholy” to describe depressive syndrome. The definition was applied to people who were constantly in a stage of anxiety, apathy, and despondency.

The human psycho-emotional background is quite diverse. Changes in mood are specific to a person, so it is difficult to consider a patient who is constantly irritated, anxious, and aggressive towards people around him to be considered healthy.

Other medieval healers used other synonyms to describe depression - blues, depression, melancholy, melancholy and sadness.

Famous poets also described the disease - “sadness and melancholy eats me up,” “a drop of hope will flash, and then a sea of despair will rage.” Close attention to nosology is explained by the specific behavior of a person. Anxiety, irritability, and negative mood are the “golden triad” of depressive disorder.

If you tell us what depressive syndrome is, you need to rely not only on the abnormal emotional sphere, anxiety, but also on the peculiarities of the functioning of the cerebral cortex. For the development of pathology, the formation of a stable focus of inhibition of nerve impulse transmission is required.

A person’s psycho-emotional state will never become stable. Too many external events affect the quality of functioning of the mental sphere. Problems at work, bad relationships in the family, unpleasant stock market reports - all these factors affect the functioning of the cerebral cortex.

Negative external circumstances - divorce from a husband, death of close relatives - can affect a person’s quality of life. Coping with the blows of fate is not easy, but with optimal functioning of the cerebral cortex, within 3 days fear should disappear and calmness should form.

With correct behavior of the cerebral cortex, no foci of inhibition are formed. If anxiety and irritability continue for more than 2 weeks, there is a high probability of developing a depressive syndrome, which will require consultation with a psychiatrist. Depending on the stage of severity, the specialist makes a decision regarding the need for inpatient or outpatient treatment of the person.

Manic-depressive syndrome (MDS) is a serious mental disorder characterized by alternating periods of deep depression and excessive excitement, euphoria. These psycho-emotional states are interrupted by remissions - periods of complete absence of clinical signs that cause damage to the patient’s personality. Pathology requires timely examination and persistent treatment.

Healthy people's mood changes for a reason. There must be real reasons for this: if a misfortune happens, a person is sad and sad, and if a joyful event occurs, he is happy. In patients with MDS, sudden changes in mood occur constantly and without obvious reasons. Manic-depressive psychosis is characterized by spring-autumn seasonality.

MDS usually develops in people over 30 years of age who have a flexible psyche and are easily susceptible to various suggestions. In children and adolescents, the pathology occurs in a slightly different form. The syndrome most often develops in individuals of the melancholic, statothymic, schizoid type with emotional and anxious-hypochondriac instability. The risk of MDS increases in women during menstruation, menopause and after childbirth.

The causes of the syndrome are currently not fully understood. In its development, hereditary predisposition and individual personality characteristics are important. This pathological process is caused by nervous overstrain, which negatively affects the condition of the whole organism. If you do not pay attention to the symptoms of this fairly common disease and do not seek medical help from specialists, severe mental disorders and life-threatening consequences will occur.

Diagnosis of MDS is based on anamnestic data, results of psychiatric tests, conversations with the patient and his relatives. Psychiatrists treat the disease. It consists of prescribing the following medications to patients: antidepressants, mood stabilizers, antipsychotics.

Etiology

Etiological factors of MDS:

dysfunction of brain structures that regulate the psycho-emotional sphere and mood of a person;
hereditary predisposition - this disorder is genetically determined;
hormonal imbalance in the body - a lack or excess of certain hormones in the blood can cause sudden mood swings;
socio-psychological reasons - a person who has experienced shock plunges into work or begins to lead a chaotic lifestyle, drink, take drugs;
the environment in which a person lives.

MDS is a bipolar disorder caused by hereditary and physiological factors. Often the syndrome occurs for no reason.

The development of this disease is promoted by:

stress, anxiety, loss,
problems with the thyroid gland,
acute cerebrovascular accident,
poisoning of the body,
taking drugs.

Severe or prolonged nervous overstrain leads to disruption of biochemical processes that affect the human autonomic nervous system.

Types of MDS:

The first “classic” type manifests itself with pronounced clinical signs and is characterized by clearly visible phases of mood changes - from joy to despondency.
The second type occurs quite often, but manifests itself with less severe symptoms and is difficult to diagnose.
A separate group includes a special form of pathology - cyclothymia, in which periods of euphoria and melancholy are smoothed out.

Symptoms

The first symptoms of MDS are subtle and nonspecific. They are easily confused with clinical signs of other psychiatric disorders. The disease rarely has an acute form. First, the harbingers of the disease appear: an unstable psycho-emotional background, rapid mood swings, an overly depressed or overly excited state. This borderline state lasts for several months and even years, and in the absence of proper treatment it develops into MDS.

Stages of development of MDS:

initial - minor mood swings,
culmination - maximum depth of defeat,
stage of reverse development.

All symptoms of pathology are divided into two large groups: those characteristic of mania or depression. At first, patients are very impulsive and energetic. This condition is characteristic of the manic phase. Then they worry for no reason, become sad over trifles, their self-esteem decreases and suicidal thoughts appear. The phases replace each other within a few hours or last for months.

Symptoms of a manic episode:

Inadequate, overestimated assessment of one's own abilities.
Euphoria is a sudden, overwhelming feeling of happiness and delight.
An unreasonable feeling of joy.
Increased physical activity.
Hasty speech with swallowing words and active gestures.
Excessive self-confidence, lack of self-criticism.
Refusal of treatment.
Addiction to risk, passion for gambling and dangerous tricks.
Inability to focus and concentrate on a specific topic.
Lots of things started and abandoned.
Inappropriate antics with the help of which patients attract attention to themselves.
High degree of irritability, reaching outbursts of anger.
Weight loss.

Persons with manic disorders have unstable emotions. The mood does not worsen even when receiving unpleasant news. Patients are sociable, talkative, easily make contact, get to know each other, have fun, sing a lot, and gesticulate. Accelerated thinking leads to psychomotor agitation, “jumps of ideas,” and overestimation of one’s capabilities leads to delusions of grandeur.

Patients have a special appearance: shiny eyes, a red face, moving facial expressions, especially expressive gestures and postures. They have increased eroticism, due to which patients often have sexual intercourse with various partners. Their appetite reaches extreme levels of gluttony, but they do not gain weight. Patients sleep 2-3 hours a day, but do not get tired or fatigued, being constantly on the move. They are tormented by visual and auditory illusions. The manic phase is characterized by rapid heartbeat, mydriasis, constipation, weight loss, dry skin, increased blood pressure, and hyperglycemia. It lasts 3-4 months.

There are 3 degrees of severity of mania:

Mild degree – good mood, psychophysical productivity, increased energy, activity, talkativeness, absent-mindedness. In sick men and women, the need for sex increases and the need for sleep decreases.
Moderate mania – a sharp rise in mood, increased activity, lack of sleep, ideas of grandeur, difficulty in social contacts, absence of psychosomatic symptoms.
Severe mania - violent tendencies, incoherent thinking, racing thoughts, delusions, hallucinosis.

Such signs indicate the need to immediately contact specialists.

Signs of depressive disorder:

Complete indifference to current events.
Lack of appetite or gluttony – bulimia.
Jet lag - insomnia at night and drowsiness during the day.
Physical malaise, retardation of movements.
Loss of interest in life, complete withdrawal into oneself.
Suicidal thoughts and suicide attempts.
Negative emotions, delusional ideas, self-flagellation.
Loss of senses, impaired perception of time, space, sensory synthesis, depersonalization and derealization.
Deep retardation to the point of stupor, riveted attention.
Anxious thoughts are reflected in his facial expression: his muscles are tense, his gaze unblinking at one point.
Patients refuse to eat, lose weight, and often cry.
Somatic symptoms are fatigue, loss of energy, decreased libido, constipation, dry mouth, headache and pain in various parts of the body.

Persons with depressive disorder complain of excruciating melancholy and squeezing pain in the heart, heaviness behind the sternum. Their pupils dilate, their heart rhythm is disturbed, the muscles of the gastrointestinal tract spasm, constipation develops, and menstruation disappears in women. The mood of patients in the morning drops to melancholy and despondency. It is impossible to cheer up or entertain patients in any way. They are silent, withdrawn, distrustful, inhibited, inactive, answer questions quietly and monotonously, remain uninitiated and indifferent to the interlocutor. Their only desire is to die. The imprint of deep sorrow is constantly present on the faces of patients, a characteristic wrinkle lies on the forehead, the eyes are dull and sad, the corners of the mouth are downturned.

Patients do not feel the taste of food and satiety, bang their heads against the wall, scratch and bite themselves. They are overcome by delusional ideas and thoughts about their own futility, leading to suicidal attempts. Patients with depression need constant medical supervision and family monitoring of their actions. Depressive episodes last about six months and occur much more often than manic episodes.

Mixed conditions of MDS form its atypical form, in which timely diagnosis is difficult. This is due to the confusion between the symptoms of manic and depressive phases. The patient's behavior often remains normal or becomes extremely inappropriate. Frequent changes in mood indicate different phases of the disease.

In children under 12 years of age, MDS presents differently. The child has disturbed sleep, nightmares, chest pain and abdominal discomfort. Children turn pale, lose weight, and get tired quickly. They lose their appetite and become constipated. Isolation is combined with frequent whims, crying for no reason, and reluctance to contact even close people. Schoolchildren begin to experience difficulties with their studies. As the manic phase sets in, children become uncontrollable, disinhibited, often laugh, and speak quickly. A sparkle appears in the eyes, the face turns red, movements accelerate. The syndrome often drives children to suicide. Thoughts about death are associated with melancholy and depression, anxiety and boredom, and apathy.

Diagnostics

Difficulties in diagnosing MDS are due to the fact that sick people do not perceive their illness and rarely seek help from specialists. In addition, this illness is difficult to distinguish from a number of similar mental disorders. To make a correct diagnosis, it is necessary to carefully and for a long time observe the behavior of patients.

Psychiatrists interview the patient and his relatives, find out the history of life and illness, paying special attention to information about genetic predisposition.
Then patients are asked to take a test that allows the doctor to determine the patient’s emotionality and her dependence on alcohol and drugs. In the course of such work, the attention deficit coefficient is calculated.
Additional examination consists of studying the functions of the endocrine system, identifying cancers and other pathologies. Patients are prescribed laboratory tests, ultrasound and tomography.

Early diagnosis is the key to positive treatment results. Modern therapy eliminates attacks of MDS and allows you to completely get rid of it.

Therapeutic measures

Treatment of moderate and severe MDS is carried out in a mental hospital. Mild forms are usually treated on an outpatient basis. During the treatment of MDS, biological methods, psychotherapy or sociotherapy are used.

Goals of therapeutic interventions:

normalization of mood and mental state,
rapid elimination of affective disorders,
achieving stable remission,
preventing recurrence of pathology.

Drugs prescribed to patients with MDS:

antidepressants - Melipramine, Amitriptyline, Anafranil, Prozac;
neuroleptics - “Aminazine”, “Tizercin”, “Haloperidol”, “Promazine”, “Benperidol”;
lithium salt – “Mikalit”, “Lithium Carbonta”, “Contemnol”;
antiepileptic drugs - Topiramate, Valproic acid, Finlepsin;
neurotransmitters – “Aminalon”, “Neurobutal”.

If there is no effect from drug therapy, electroconvulsive treatment is used. Using an electric current, specialists forcefully induce convulsions while under anesthesia. This method helps to effectively get rid of depression. Treatment for terminal conditions has a similar effect: patients are deprived of sleep or food for several days. Such a shake-up for the body helps improve the general mental state of patients.

The support of loved ones and relatives is extremely necessary during the treatment of MDS. To stabilize and long-term remission, sessions with a psychotherapist are indicated. Psychotherapeutic sessions help patients understand their psycho-emotional state. Specialists develop a behavioral strategy individually for each patient. Such classes are carried out after the patient’s mood has become relatively stabilized. Psychotherapy also plays an important role in disease prevention. Sanitary education, medical and genetic counseling and a healthy lifestyle are the main measures to prevent the next exacerbation of the disease.

Forecast

The prognosis for MDS is favorable only if the treatment regimen and dosage of drugs are selected exclusively by the attending physician, taking into account the characteristics of the course of the disease and the general condition of the patient. Self-medication can lead to serious consequences for the life and health of patients.

Timely and correct therapy will allow a person with MDS to return to work and family, and lead a full life. The support of family and friends, peace and a friendly atmosphere in the family plays an invaluable role in the treatment process. The prognosis of MDS also depends on the duration of the phases and the presence of psychotic symptoms.

Frequently recurring attacks of the syndrome cause certain social difficulties and cause early disability in patients. The main and most terrible complication of the disease is schizophrenia. This usually occurs in 30% of patients with a continuous course of the syndrome without clear intervals. Losing control over one's own behavior can lead a person to commit suicide.

MDS is dangerous not only for the patient himself, but also for the people around him. If you don't get rid of it in time, everything can end in tragic consequences. Timely identification of signs of psychosis and the absence of aggravation from concomitant illnesses allow a person to return to normal life.