Irritability and anxiety may not just be consequences of severe working week or any failures in your personal life. It may not just be problems with nerves, as many people prefer to think. If a person feels mental discomfort for a long time without any significant reason and notices strange changes in behavior, then it is worth seeking help from a qualified psychologist. Possibly psychosis.
Two concepts - one essence
In different sources and various medical literature devoted to mental disorders, one can find two concepts that at first glance may seem completely opposite in meaning. These are manic-depressive psychosis (MDP) and bipolar affective disorder (BD). Despite the difference in definitions, they express the same thing and talk about the same mental illness.
The fact is that from 1896 to 1993, mental illness, expressed in a regular change of manic and depressive phases, was called manic-depressive disorder. In 1993, in connection with the revision of the International Classification of Diseases (ICD) by the world medical community, MDP was replaced by another abbreviation - BAR, which is currently used in psychiatry. This was done for two reasons. Firstly, not always bipolar disorder accompanied by psychosis. Secondly, the definition of MDP not only frightened the patients themselves, but also alienated other people from them.
Statistical data
Manic-depressive psychosis is a mental disorder that occurs in approximately 1.5% of the world's inhabitants. Moreover, the bipolar variety of the disease is more common in women, and the monopolar type is more common in men. About 15% of patients treated in psychiatric hospitals suffer from manic-depressive psychosis.
In half of the cases, the disease is diagnosed in patients aged 25 to 44 years, in a third of cases - in patients over 45 years old, and in older people there is a shift towards the depressive phase. Quite rarely, the diagnosis of MDP is confirmed in people under 20 years of age, since in this period of life, rapid changes in mood with a predominance of pessimistic tendencies are the norm, since the adolescent’s psyche is in the process of formation.
Characteristics of TIR
Manic-depressive psychosis is a mental illness in which two phases - manic and depressive - alternate with each other. During the manic phase of the disorder, the patient experiences a huge surge of energy, he feels great, he strives to channel the excess energy into new interests and hobbies.
The manic phase, which lasts quite a short time (about 3 times shorter than the depressive phase), is followed by a “light” period (intermission) - a period of mental stability. During the period of intermission, the patient is no different from a mentally healthy person. However, the subsequent formation of the depressive phase of manic-depressive psychosis, which is characterized by depressed mood, decreased interest in everything that seemed attractive, and detachment from outside world, the occurrence of suicidal thoughts.
Causes of the disease
As with many other mental illnesses, the causes and development of MDP are not fully understood. There are a number of studies showing that this disease is transmitted from mother to child. Therefore, the presence of certain genes and hereditary predisposition are important factors for the onset of the disease. Also, a significant role in the development of MDP is played by disruptions in the endocrine system, namely an imbalance in the amount of hormones.
Often, such an imbalance occurs in women during menstruation, after childbirth, and during menopause. That is why manic-depressive psychosis is observed more often in women than in men. Medical statistics also show that women who have been diagnosed with depression after childbirth are more susceptible to the occurrence and development of MDP.
Among possible reasons development of a mental disorder is also the patient’s personality, its key features. People belonging to the melancholic or statothymic personality type are more susceptible to developing MDP than others. Their distinctive feature is a mobile psyche, which is expressed in hypersensitivity, anxiety, suspiciousness, fatigue, an unhealthy desire for orderliness, as well as for solitude.
Diagnosis of the disorder
In most cases, bipolar manic-depressive psychosis is extremely easy to confuse with other mental disorders, e.g. anxiety disorder or with some types of depression. Therefore, it takes a psychiatrist some time to confidently diagnose MDP. Observations and examinations continue at least until the patient’s manic and depressive phases and mixed states are clearly identified.
Anamnesis is collected using tests for emotionality, anxiety and questionnaires. The conversation is carried out not only with the patient, but also with his relatives. The purpose of the conversation is to consider the clinical picture and course of the disease. Differential diagnosis allows you to exclude mental illnesses in the patient that have symptoms and signs similar to manic-depressive psychosis (schizophrenia, neuroses and psychoses, other affective disorders).
Diagnostics also includes examinations such as ultrasound, MRI, tomography, and various blood tests. They are necessary to exclude physical pathologies and other biological changes in the body that could trigger the occurrence of mental disorders. This is, for example, the wrong job endocrine system, cancerous tumors, various infections.
Depressive phase of MDP
The depressive phase usually lasts longer than the manic phase and is characterized primarily by a triad of symptoms: depressed and pessimistic mood, slow thinking and inhibition of movements and speech. During the depressive phase, mood swings are often observed, from depressed in the morning to positive in the evening.
One of the main signs of manic-depressive psychosis during this phase is sudden weight loss (up to 15 kg) due to lack of appetite - food seems bland and tasteless to the patient. Sleep is also disturbed - it becomes intermittent and superficial. A person may experience insomnia.
As depressive moods increase, the symptoms and negative manifestations of the disease intensify. In women, a sign of manic-depressive psychosis during this phase may even be a temporary cessation of menstruation. However, the increase in symptoms is more likely to be a slowdown in the patient's speech and thought process. Words are difficult to find and connect with each other. A person withdraws into himself, renounces the outside world and any contacts.
At the same time, the state of loneliness leads to the emergence of such a dangerous set of symptoms of manic-depressive psychosis as apathy, melancholy, and extremely depressed mood. It can cause the patient to develop suicidal thoughts in his head. During the depressive phase, a person diagnosed with MDP needs professional medical help and support from loved ones.
Manic phase of MDP
Unlike the depressive phase, the triad of symptoms of the manic phase is directly opposite in nature. This is an elevated mood, vigorous mental activity and speed of movement and speech.
The manic phase begins with the patient feeling a surge of strength and energy, a desire to do something as soon as possible, to realize himself in something. At the same time, a person develops new interests, hobbies, and his circle of acquaintances expands. One of the symptoms of manic-depressive psychosis in this phase is a feeling of excess energy. The patient is endlessly cheerful and cheerful, does not need sleep (sleep can last 3-4 hours), and makes optimistic plans for the future. During the manic phase, the patient temporarily forgets past grievances and failures, but remembers the names of films and books, addresses and names, and telephone numbers that were lost in memory. During the manic phase, the effectiveness of short-term memory increases - a person remembers almost everything that happens to him at a given moment in time.
Despite the seemingly productive manifestations of the manic phase at first glance, they do not play into the patient’s hands at all. So, for example, a violent desire to realize oneself in something new and an unbridled desire for active activity usually does not end in something good. Patients during the manic phase rarely complete anything. Moreover, hypertrophied confidence in one’s own strengths and external luck during this period can push a person to take rash and dangerous actions. These include large bets in gambling, uncontrolled spending of financial resources, promiscuity, and even committing a crime for the sake of obtaining new sensations and emotions.
The negative manifestations of the manic phase are usually immediately visible to the naked eye. Symptoms and signs of manic-depressive psychosis in this phase also include extremely fast speech with swallowing of words, energetic facial expressions and sweeping movements. Even clothing preferences may change - they become more catchy, bright colors. During the culminating stage of the manic phase, the patient becomes unstable, the excess energy turns into extreme aggressiveness and irritability. He is unable to communicate with other people, his speech may resemble the so-called verbal hash, as in schizophrenia, when sentences are broken into several logically unrelated parts.
Treatment of manic-depressive psychosis
The main goal of a psychiatrist in the treatment of a patient diagnosed with MDP is to achieve a period of stable remission. It is characterized by a partial or almost complete weakening of the symptoms of the existing disorder. To achieve this goal, it is necessary both to use special drugs (pharmacotherapy) and to turn to special systems of psychological influence on the patient (psychotherapy). Depending on the severity of the disease, the treatment itself can take place either on an outpatient basis or in a hospital setting.
- Pharmacotherapy.
Since manic-depressive psychosis is a fairly serious mental disorder, its treatment is not possible without medication. The main and most frequently used group of drugs during the treatment of patients with bipolar disorder is the group of mood stabilizers, the main task of which is to stabilize the patient’s mood. Normalizers are divided into several subgroups, among which those used mostly in the form of salts stand out.
In addition to lithium drugs, the psychiatrist, depending on the symptoms observed in the patient, may prescribe antiepileptic drugs that have a sedative effect. These are valproic acid, Carbamazepine, Lamotrigine. In the case of bipolar disorder, taking mood stabilizers is always accompanied by neuroleptics, which have an antipsychotic effect. They inhibit the transmission of nerve impulses in those brain systems where dopamine serves as a neurotransmitter. Antipsychotics are used primarily during the manic phase.
It is quite problematic to treat patients in MDP without taking antidepressants in combination with mood stabilizers. They are used to alleviate the patient's condition during the depressive phase of manic-depressive psychosis in men and women. These psychotropic drugs, influencing the amount of serotonin and dopamine in the body, relieve emotional stress, preventing the development of melancholy and apathy.
- Psychotherapy.
This type of psychological assistance, such as psychotherapy, consists of regular meetings with the attending physician, during which the patient learns to live with his illness like an ordinary person. Various trainings and group meetings with other patients suffering from a similar disorder help an individual not only better understand his illness, but also learn about special skills for controlling and relieving the negative symptoms of the disorder.
A special role in the process of psychotherapy is played by the principle of “family intervention”, which consists in the leading role of the family in achieving psychological comfort for the patient. During treatment, it is extremely important to establish an atmosphere of comfort and calm at home, to avoid any quarrels and conflicts, as they harm the patient’s psyche. His family and he himself must get used to the idea of the inevitability of manifestations of the disorder in the future and the inevitability of taking medications.
Prognosis and life with TIR
Unfortunately, the prognosis of the disease in most cases is not favorable. In 90% of patients, after the outbreak of the first manifestations of MDP, affective episodes recur again. Moreover, almost half of people suffering from this diagnosis for a long time go on disability. In almost a third of patients, the disorder is characterized by a transition from a manic phase to a depressive phase, with no “bright intervals.”
Despite the seeming hopelessness of the future with a diagnosis of MDP, it is quite possible for a person to live an ordinary normal life with it. Systematic use of mood stabilizers and other psychotropic drugs allows you to delay the onset of the negative phase, increasing the duration of the “bright period”. The patient is able to work, learn new things, get involved in something, lead an active lifestyle, undergoing outpatient treatment from time to time.
Many people have been diagnosed with MDP famous personalities, actors, musicians and just people connected with creativity in one way or another. These are famous singers and actors of our time: Demi Lovato, Britney Spears, Jim Carrey, Jean-Claude Van Damme. Moreover, these are outstanding and world-famous artists, musicians, historical figures: Vincent van Gogh, Ludwig van Beethoven and, perhaps, even Napoleon Bonaparte himself. Thus, the diagnosis of MDP is not a death sentence; it is quite possible not only to exist, but also to live with it.
General conclusion
Manic-depressive psychosis is a mental disorder in which depressive and manic phases replace each other, interspersed with the so-called light period - a period of remission. The manic phase is characterized by an excess of strength and energy in the patient, an unreasonably elevated mood and an uncontrollable desire for action. The depressive phase, on the contrary, is characterized by depressed mood, apathy, melancholy, retardation of speech and movements.
Women suffer from MDP more often than men. This is due to disruptions in the endocrine system and changes in the amount of hormones in the body during menstruation, menopause, and after childbirth. For example, one of the symptoms of manic-depressive psychosis in women is the temporary cessation of menstruation. The disease is treated in two ways: by taking psychotropic drugs and by conducting psychotherapy. The prognosis of the disorder, unfortunately, is unfavorable: almost all patients may experience new affective attacks after treatment. However, with proper attention to the problem, you can live a full and active life.
Manic-depressive psychosis (MDP) refers to severe mental illnesses that occur with a sequential change of two phases of the disease - manic and depressive. Between them there is a period of mental “normality” (a bright interval).
Table of contents: 1. Causes of manic-depressive psychosis 2. How manic-depressive psychosis manifests itself - Symptoms of the manic phase - Symptoms of the depressive phase 3. Cyclothymia - a mild form of manic-depressive psychosis 4. How MDP occurs 5. Manic-depressive psychosis at different periods of lifeCauses of manic-depressive psychosis
The onset of the disease is most often observed at the age of 25-30 years. Relative to common mental illnesses, the rate of MDP is about 10-15%. There are from 0.7 to 0.86 cases of the disease per 1000 population. Among women, pathology occurs 2-3 times more often than in men.
Note: The causes of manic-depressive psychosis are still under study. A clear pattern of inheritance transmission of the disease has been noted.
The period of pronounced clinical manifestations of pathology is preceded by personality traits - cyclothymic accentuations. Suspiciousness, anxiety, stress and a number of diseases (infectious, internal) can serve as a trigger for the development of symptoms and complaints of manic-depressive psychosis.
The mechanism of development of the disease is explained by the result of neuropsychic breakdowns with the formation of foci in the cerebral cortex, as well as problems in the structures of the thalamic formations of the brain. Dysregulation of norepinephrine-serotonin reactions caused by a deficiency of these substances plays a role.
Disorders of the nervous system in MDP were dealt with by V.P. Protopopov.
How does manic-depressive psychosis manifest?
Depends on the phase of the disease. The disease can manifest itself in manic and depressive forms.
Symptoms of the manic phase
The manic phase can occur in the classic version and with some peculiarities.
In the most typical cases, it is accompanied by the following symptoms:
- inappropriately joyful, exalted and improved mood;
- sharply accelerated, unproductive thinking;
- inappropriate behavior, activity, mobility, manifestations of motor agitation.
The beginning of this phase in manic-depressive psychosis looks like a normal burst of energy. Patients are active, talk a lot, try to take on many things at the same time. Their mood is high, overly optimistic. Memory sharpens. Patients talk and remember a lot. They see exceptional positiveness in all events that occur, even where there is none.
Excitement gradually increases. The time allocated for sleep is reduced, patients do not feel tired.
Gradually, thinking becomes superficial; people suffering from psychosis cannot focus their attention on the main thing, they are constantly distracted, jumping from topic to topic. In their conversation, unfinished sentences and phrases are noted - “language is ahead of thoughts.” Patients have to constantly return to the unsaid topic.
The patients' faces turn pink, their facial expressions are excessively animated, and active hand gestures are observed. There is laughter, increased and inadequate playfulness; those suffering from manic-depressive psychosis talk loudly, scream, and breathe noisily.
Activity is unproductive. Patients simultaneously “grab at” a large number of things, but do not bring any of them to a logical end, and are constantly distracted. Hypermobility is often combined with singing, dance movements, and jumping.
In this phase of manic-depressive psychosis, patients seek active communication, interfere in all matters, give advice and teach others, and criticize. They show a pronounced overestimation of their skills, knowledge and capabilities, which are sometimes completely absent. At the same time, self-criticism is sharply reduced.
Sexual and food instincts are enhanced. Patients constantly want to eat, sexual motives clearly appear in their behavior. Against this background, they easily and naturally make a lot of acquaintances. Women begin to use a lot of cosmetics to attract attention.
In some atypical cases, the manic phase of psychosis occurs with:
- unproductive mania– in which there are no active actions and thinking does not accelerate;
- solar mania– behavior is dominated by an over-cheerful mood;
- angry mania– anger, irritability, dissatisfaction with others come to the fore;
- manic stupor– manifestation of fun, accelerated thinking is combined with motor passivity.
Symptoms of the depressive phase
There are three main symptoms in the depressive phase:
- painfully depressed mood;
- sharply slow pace of thinking;
- motor retardation up to complete immobilization.
The initial symptoms of this phase of manic-depressive psychosis are accompanied by sleep disturbances, frequent awakenings at night, and inability to sleep. Appetite gradually decreases, a state of weakness develops, constipation and pain in the chest appear. The mood is constantly depressed, the patients' faces are apathetic and sad. Depression increases. Everything present, past and future is presented in black and hopeless colors. Some patients with manic-depressive psychosis have ideas of self-blame, patients try to hide in inaccessible places, and experience painful experiences. The pace of thinking slows down sharply, the range of interests narrows, symptoms of “mental chewing gum” appear, patients repeat the same ideas, in which self-deprecating thoughts stand out. Those suffering from manic-depressive psychosis begin to remember all their actions and attach ideas of inferiority to them. Some consider themselves unworthy of food, sleep, respect. They feel that doctors are wasting their time and unreasonably prescribing medications for them, as if they are unworthy of treatment.
Note: Sometimes it is necessary to transfer such patients to forced feeding.
Most patients experience muscle weakness, heaviness throughout the body, and they move with great difficulty.
With a more compensated form of manic-depressive psychosis, patients independently look for the dirtiest work for themselves. Gradually, ideas of self-blame lead some patients to thoughts of suicide, which they may well turn into reality.
Depression is most pronounced in the morning hours, before dawn. By evening, the intensity of her symptoms decreases. Patients mostly sit in inconspicuous places, lie on beds, like to lie under the bed, as they consider themselves unworthy to be in normal position. They are reluctant to make contact; they respond monotonously, slowly, without unnecessary words.
The faces bear the imprint of deep sorrow with a characteristic wrinkle on the forehead. The corners of the mouth are downturned, the eyes are dull and inactive.
Options for the depressive phase:
- asthenic depression– in patients with this type of manic-depressive psychosis, ideas of their own callousness in relation to loved ones dominate, they consider themselves unworthy parents, husbands, wives, etc.
- anxious depression– occurs with the manifestation of extreme degrees of anxiety and fear, leading patients to suicide. In this state, patients can fall into a stupor.
Almost all patients in the depressive phase experience Protopopov's triad - rapid heartbeat, constipation, dilated pupils.
Symptoms of disordersmanic-depressive psychosisfrom the internal organs:
- high blood pressure;
- dry skin and mucous membranes;
- lack of appetite;
- in women, disorders of the menstrual cycle.
In some cases, MDP is manifested by dominant complaints of persistent pain, discomfort in body. Patients describe the most varied complaints from almost all organs and parts of the body.
Note: Some patients try to resort to alcohol to alleviate complaints.
The depressive phase can last 5-6 months. Patients are unable to work during this period.
Cyclothymia is a mild form of manic-depressive psychosis
There are both a separate form of the disease and a milder version of TIR.
Cyclotomy occurs in phases:
- hypomania– the presence of an optimistic mood, an energetic state, active activity. Patients can work a lot without getting tired, have little rest and sleep, their behavior is quite orderly;
- subdepression– conditions with deterioration of mood, decline in all physical and mental functions, craving for alcohol, which disappears immediately after the end of this phase.
How does TIR proceed?
There are three forms of the disease:
- circular– periodic alternation of phases of mania and depression with a light interval (intermission);
- alternating– one phase is immediately replaced by another without a light interval;
- single-pole– identical phases of depression or mania occur in a row.
Note: Usually the phases last for 3-5 months, and light intervals can last several months or years.
In children, the onset of the disease may go unnoticed, especially if the manic phase is dominant. Young patients look hyperactive, cheerful, playful, which does not immediately make it possible to note unhealthy traits in their behavior compared to their peers.
In the case of the depressive phase, children are passive and constantly tired, complaining about their health. With these problems they get to the doctor faster.
In adolescence, the manic phase is dominated by symptoms of swagger and rudeness in relationships, and there is a disinhibition of instincts.
One of the features of manic-depressive psychosis in childhood and adolescence is the short duration of the phases (on average 10-15 days). With age, their duration increases.
Treatment measures are based on the phase of the disease. Severe clinical symptoms and the presence of complaints require treatment of manic-depressive psychosis in a hospital. Because, being depressed, patients can harm their health or commit suicide.
The difficulty of psychotherapeutic work lies in the fact that patients in the depression phase practically do not make contact. An important point in treatment during this period is the correct selection of antidepressants. The group of these drugs is diverse and the doctor prescribes them based on his own experience. Usually we are talking about tricyclic antidepressants.
If the state of lethargy is dominant, antidepressants with analeptic properties are selected. Anxious depression requires the use of drugs with a pronounced calming effect.
In the absence of appetite, treatment of manic-depressive psychosis is supplemented with restorative medications
During the manic phase, antipsychotics with pronounced sedative properties are prescribed.
In case of cyclothymia, it is preferable to use milder tranquilizers and antipsychotics in small dosages.
Note: quite recently, lithium salts were prescribed in all phases of treatment for MDP; at present, this method is not used by all doctors.
After exiting the pathological phases, patients must be included in various types of activities as early as possible; this is very important for maintaining socialization.
Explanatory work is carried out with patients' relatives about the need to create a normal psychological climate at home; a patient with symptoms of manic-depressive psychosis should not feel like an unhealthy person during light periods.
It should be noted that in comparison with other mental illnesses, patients with manic-depressive psychosis retain their intelligence and performance without degradation.
Interesting! From a legal point of view, a crime committed during the aggravation phase of TIR is considered not subject to criminal liability, and in the intermission phase it is considered criminally punishable. Naturally, in any condition, those suffering from psychosis are not subject to military service. In severe cases, disability is assigned.
Lotin Alexander, medical columnist
Affective insanity is a mental illness that manifests itself as periodically changing mood disorders. The social danger of the sick is expressed in the tendency to commit an offense in the manic phase and suicidal acts in the depressive phase.
Manic-depressive psychosis usually occurs in the form of alternating manic and depressive moods. A manic mood is expressed in an unmotivated, cheerful mood, and a depressive mood is expressed in a depressed, pessimistic mood.
Manic-depressive psychosis is classified as bipolar affective disorder. A milder form with less severe symptoms of the disease is called cyclotomy.
Symptoms of manic-depressive psychosis are more often found among women. The average prevalence of the disease is seven patients per 1,000 people. Patients with manic-depressive psychosis represent up to 15% of the total number of patients who were hospitalized in psychiatric hospitals. Researchers define manic-depressive psychosis as an endogenous psychosis. Compounded heredity can provoke manic-depressive psychosis. Up to a certain point, patients appear completely healthy, but after stress, childbirth, or a difficult life event, this disease can develop. Therefore, as a preventive measure, it is important to surround such people with a gentle emotional background, to protect them from stress and any stress.
In most cases, well-adapted, able-bodied people suffer from manic-depressive psychosis.
Manic-depressive psychosis causes
The disease is of an autosomal dominant type and often passes from mother to child, so manic-depressive psychosis owes its origin to heredity.
The causes of manic-depressive psychosis lie in the failure of higher emotional centers, which are located in the subcortical region. It is believed that disturbances in the processes of inhibition, as well as excitation in the brain, provoke the clinical picture of the disease.
The role of external factors (stress, relationships with others) is considered as associated causes diseases.
Manic-depressive psychosis symptoms
The main clinical signs of the disease are manic, depressive, and mixed phases, which change without a specific sequence. Characteristic difference They consider light interphase intervals (intermissions), in which there are no signs of illness and a complete critical attitude towards one’s painful state is noted. The patient retains his personal characteristics, professional skills and knowledge. Often attacks of the disease are replaced by intermediate full health. This classic course of the disease is rare, in which only manic or only depressive forms occur.
The manic phase begins with a change in self-perception, the emergence of vigor, a feeling of physical strength, a surge of energy, attractiveness and health. The sick person ceases to feel the sensations that previously bothered him. unpleasant symptoms associated with somatic diseases. The patient's consciousness is filled with pleasant memories, as well as optimistic plans. Unpleasant events from the past are repressed. The sick person is not able to notice expected and real difficulties. He perceives the world around him in rich, bright colors, while his olfactory and gustatory sensations are heightened. An increase in mechanical memory is recorded: the patient remembers forgotten telephone numbers, movie titles, addresses, names, and remembers current events. The speech of patients is loud and expressive; thinking is distinguished by speed and liveliness, good intelligence, but conclusions and judgments are superficial, very playful.
In a manic state, patients are restless, mobile, and fussy; their facial expressions are animated, the timbre of their voice does not match the situation, and their speech is accelerated. Patients are highly active, but sleep little, do not experience fatigue and desire constant activity. They make endless plans and try to implement them urgently, but do not complete them due to constant distractions.
Manic depressive psychosis is characterized by not noticing real difficulties. A pronounced manic state is characterized by disinhibition of drives, which manifests itself in sexual arousal, as well as extravagance. Due to severe distractibility and scattered attention, as well as fussiness, thinking loses focus, and judgments turn into superficial ones, but patients are able to show subtle observation.
The manic phase includes the manic triad: painfully elevated mood, accelerated thoughts, and motor agitation. Manic affect acts as a leading sign of a manic state. The patient experiences increased mood, feels happiness, feels good and is happy with everything. Pronounced for him is the aggravation of sensations, as well as perception, weakening of logical and strengthening of mechanical memory. The patient is characterized by ease of conclusions and judgments, superficiality of thinking, overestimation of one’s own personality, elevating one’s ideas to ideas of greatness, weakening of higher feelings, disinhibition of drives, as well as their instability and ease when switching attention. To a greater extent, those who are ill suffer from criticism of their own abilities or their successes in all areas. The desire of patients to be active leads to a decrease in productivity. Those who are sick eagerly take on new things, expanding their range of interests and acquaintances. Patients experience a weakening of higher feelings - distance, duty, tact, subordination. Patients become untied, dressing in bright clothes and using flashy cosmetics. They can often be found in entertainment establishments and are characterized by promiscuous intimate relationships.
The hypomanic state retains some awareness of the unusualness of everything that is happening and leaves the patient with the ability to correct behavior. In the climax period, the sick cannot cope with everyday and professional responsibilities and cannot correct their behavior. Often, sick people are hospitalized at the moment of transition from the initial stage to the culminating stage. Patients experience increased mood when reading poetry, laughing, dancing and singing. The ideational excitement itself is assessed by the sick as an abundance of thoughts. Their thinking is accelerated, one thought interrupts another. Thinking often reflects surrounding events, much less often memories from the past. Ideas of revaluation are manifested in organizational, literary, acting, linguistic, and other abilities. Patients read poetry with desire, offer help in treating other patients, and give instructions to health workers. At the peak of the climax stage (at the moment of manic frenzy), the sick do not make contact, are extremely agitated, and also viciously aggressive. At the same time, their speech is confused, semantic parts fall out of it, which makes it similar to schizophrenic fragmentation. Moments of reverse development are accompanied by motor calming and the emergence of criticism. The intervals of calm currents gradually increase and states of excitement decrease. Exit from phases in patients can be observed for a long time, and hypomanic short-term episodes are noted. After a decrease in excitement, as well as equalization of mood, all the patient’s judgments take on a realistic character.
The depressive phase of patients is characterized by unmotivated sadness, which is combined with motor retardation and slowness of thinking. Low mobility in severe cases can turn into complete stupor. This phenomenon is called depressive stupor. Often, inhibition is not expressed so sharply and is partial in nature, while being combined with monotonous actions. Depressed patients often do not believe in their own strengths and are prone to ideas of self-blame. Those who are ill consider themselves worthless individuals and incapable of bringing happiness to their loved ones. Such ideas are closely related to the danger of attempting suicide, and this, in turn, requires special observation from those closest to them.
A deep depressive state is characterized by a feeling of emptiness in the head, heaviness and stiffness of thoughts. Patients speak with a significant delay and are reluctant to answer basic questions. In this case, sleep disturbances and loss of appetite are observed. Often the disease occurs at the age of fifteen, but there are cases at more late period(after forty years). The duration of attacks ranges from a couple of days to several months. Some severe attacks last up to a year. The duration of depressive phases is longer than manic phases, this is especially noted in old age.
Diagnosis of manic-depressive psychosis
Diagnosis of the disease is usually carried out in conjunction with other mental disorders (psychopathy, neurosis, depression, schizophrenia, psychosis).
To exclude the possibility of organic brain damage after injury, intoxication or infection, the patient is sent for electroencephalography, radiography, and MRI of the brain. An error in the diagnosis of manic-depressive psychosis can lead to improper treatment and aggravate the form of the disease. Most patients do not receive appropriate treatment, since individual symptoms of manic-depressive psychosis are quite easily confused with seasonal mood swings.
Manic-depressive psychosis treatment
Treatment of exacerbations of manic-depressive psychosis is carried out in a hospital setting, where sedatives (psycholeptic) as well as antidepressant (psychoanaleptic) with a stimulating effect are prescribed. Doctors prescribe antipsychotic drugs, which are based on Chlorpromazine or Levomepromazine. Their function is to relieve excitement, as well as a pronounced sedative effect.
Haloperedol or lithium salts are additional components in the treatment of manic-depressive psychosis. Lithium carbonate is used, which helps in the prevention of depressive states, as well as helping to treat manic states. These medications are taken under the supervision of doctors due to possible development neuroleptic syndrome, which is characterized by tremors of the limbs, impaired movement, as well as general muscle stiffness.
How to treat manic depressive psychosis?
Treatment of manic-depressive psychosis in its protracted form is carried out with electroconvulsive therapy in combination with fasting diets, as well as therapeutic fasting and sleep deprivation for several days.
Manic-depressive psychosis can be successfully treated with antidepressants. Prevention of psychotic episodes is carried out with the help of mood stabilizers, which act as mood stabilizers. The duration of taking these drugs significantly reduces the manifestations of signs of manic-depressive psychosis and delays the approach of the next phase of the disease as much as possible.
manic psychosis understood as a disorder 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
Statistical data 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 world 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. Important characteristic of this disease is the probability 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.
Interesting Facts
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 in case of strong
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 duration, decreased appetite and other symptoms
depression
helped to 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 The causes (etiology) of manic psychosis, like many other psychoses, are currently unknown. 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. This 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 personal characteristics 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. For manic psychosis highest value have monoamines such as norepinephrine and serotonin. They facilitate motor and emotional activity, improve mood, 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 considers functional disorders 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 disorders
in the form of its inversion (
change nap and night
), in the form of difficulty falling asleep, frequent waking up at night, or in the form of changes 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, the main dominant symptom in the psychosis clinic 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 condition is expressed in increased activity, initiative, interest in everyone and in 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. Patients often leave home or are brought into the home strangers. 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 accelerate, but, on the contrary, slows down, concentration of attention is maintained (which is not observed with 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 with monopolar, protracted phases of manic states may be observed. So, they can last from 4 months (average duration) 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. Average age This form of psychosis lasts 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 like fatal diseases. Passivity is observed in behavior, and claims towards others are observed in dialogue.
Hysterical reactions and melancholy 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 can be very slow and sometimes drags on (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 that 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 personal properties, decreased 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 there are practically no remissions between the phases of mania and depression. This is the most malignant form 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 (
) or based on the criteria of the American Psychiatric Association (
Criteria for manic and depressive episodes according to the ICD
| View affective disorder | Criteria |
| Manic episode |
|
| Depressive episode |
|
After the presence of an affective disorder has been established, the doctor determines the type of manic psychosis.
Criteria for psychosis
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 that may be present in mania). Hypomania is characterized by the following:
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 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. |
| ScaleBeka (Beck Depression Inventory) |
Testing is carried out in the form of a self-survey. The patient answers the questions himself and evaluates the statements on a scale from 0 to 3. After this, the doctor summarizes total amount 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. Pay attention to increased irritability patient, one should be tactful and provide support 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 such a disease, feeding is necessary. 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. Helps speed up recovery Spa treatment. 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 must consult a doctor immediately.
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 (gifts of 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 will feel resentment, feelings of powerlessness, or anger. You should fight such thoughts and, if possible, remain calm and express understanding to the patient. You cannot condemn a person for having thoughts about suicide, as such behavior can cause withdrawal or push them to commit suicide. You should not argue with the patient, offer unjustified consolations, or 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 clinic 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, aripiprazole is the drug of choice today.
Also used in the treatment of depressive episodes in the structure of manic psychosis
antidepressants
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 use |
| 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 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 initial dose is 300 mg per day (divided into two doses of 150 mg). The dose is gradually increased to 900 mg (two times 450 mg), and in 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. 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 test
Antipsychotic drugs and antidepressants used in the treatment of manic psychosis
| Name of the medication | Mechanism of action | How to use |
| 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 early diagnosis diseases 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 a large role is given to such a character trait as an excessive desire to overcome obstacles in the presence of a strong incentive. 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 the development 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 (addiction) to the chosen drug is formed.
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 revealed that in patients with psychosis the duration of various phases of sleep changes.
- Reasons for the development of TIR
- Symptoms of manic-depressive psychosis
- Treatment of manic-depressive psychosis
What is manic-depressive psychosis?
Manic-depressive psychosis is a complex disease mental appearance, occurring in a two-phase form. One of them, the manic form, has a highly excited mood, the other, the depressive form, is determined by the patient’s depressed mood. Between them there is a time period when the patient shows completely adequate behavior - mental disorders fade away, and the main personal qualities the patient's psyche is preserved.
The states of mania and depression were known to doctors back in the days of the Ancient Roman Empire, but the sharp difference between the phases from each other over a long period served as the basis for considering them to be different diseases. Only at the end of the 19th century, the German psychiatrist E. Kraepelin, as a result of observations of patients suffering from attacks of mania and depression, made a conclusion about two phases of one disease, consisting of extremes - cheerful, excited (manic) and melancholic, depressed (depressive).
Reasons for the development of TIR
This mental illness has hereditary and constitutional origins. It is transmitted genetically, but only to those who have suitable anatomical and physiological nature, i.e., a suitable cyclothymic constitution. Today, a connection has been established between this disease and impaired transmission of nerve impulses in certain areas of the brain, and more specifically in the hypothalamus. Nerve impulses are responsible for the formation of feelings - the main reactions of the mental type. MDP in most cases develops in young people, with a much higher percentage of cases among women.
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Symptoms of manic-depressive psychosis
In most cases, the depressive phase prevails over the manic phase in terms of frequency of manifestation. The state of depression is expressed by the presence of melancholy and a view of the world around us only in black. Not a single positive circumstance can influence the psychological state of the patient. The patient's speech becomes quiet, slow, the mood prevails in which he immerses himself inside himself, his head is constantly bowed down. The patient’s motor functions slow down, and the retardation of movements at times reaches the level of depressive stupor.
Often, the feeling of melancholy develops into bodily sensations (pain in the chest area, heaviness in the heart). The emergence of ideas about guilt and sins can lead the patient to suicidal attempts. At the peak of depression, manifested by lethargy, the possibility of committing suicide is difficult due to the difficulty of translating thoughts into real action. For this phase, characteristic physical indicators are an increased heartbeat, dilated pupils and spastic constipation, the presence of which is caused by spasms of the muscles of the gastrointestinal tract.
The symptoms of the manic phase are the exact opposite of the depressive phase. They are composed of three factors that can be called basic: the presence of manic affect (pathologically elevated mood), excitement in speech and movements, acceleration of mental processes (mental arousal). Explicit manifestation of the phase is rare; as a rule, it has an erased appearance. The patient’s mood is at the peak of positivity, ideas of greatness are born in him, all thoughts are filled with an optimistic mood.
The process of increasing this phase leads to confusion in the patient’s thoughts and the emergence of frenzy in movements; sleep lasts a maximum of three hours a day, but this does not become an obstacle to vigor and excitement. MDP can occur against the background of mixed conditions, where any symptoms inherent in one phase are replaced by symptoms of another. The course of manic-depressive psychosis in a blurred form is observed much more often than the traditional course of the disease.
The appearance of MDP in a milder form is called cyclothymia. With it, the phases proceed in a smoothed version, and the patient can even remain able to work. Hidden forms of depression are noted, the basis for which is long-term illness or exhaustion. The pitfall of erased forms is their inexpressiveness; when the depressive phase is left unattended, it can lead the patient to attempt suicide.
Treatment of manic-depressive psychosis
Treatment of this psychosis consists of drug therapy prescribed after examination by a psychiatrist. Depression with mental retardation and motor function is treated with stimulants. For a depressive state of melancholy, psychotropic medications are prescribed. You can stop manic excitability with aminazine, haloperidol, tizercin, injecting them into the muscle. These drugs reduce arousal and normalize sleep.
A large role in monitoring the patient’s condition is assigned to people close to him, who can notice the initial signs of depression in time and take the necessary measures. It is important in the treatment of psychosis to protect the patient from various stresses that can become the impetus for a relapse of the disease.
in modern psychiatry are a very common diagnosis affecting humanity. Their appearance is associated with global cataclysms, personal problems of people, environmental influences and other factors.
People, under the pressure of problems, can fall not only into a depressive state, but also into a manic state.
Etymology of the disease
What is manic-depressive psychosis can be explained in simple words: this is what is commonly called the periodically alternating state of idle and full depression.
In psychiatry, experts call this a disease that is characterized by the appearance in a person of two periodically alternating polar states that differ in psychosomatic indicators: mania and depression (positive is replaced by negative).
This disease is often referred to in the literature on psychiatry, which also studies MDP, as “manic depression” or “bipolar disorder”.
Types (phases)
Flows in two forms:
– depressive phase,
- manic phase.
Depressive phase is accompanied by the appearance of a depressed pessimistic mood in the sick person, and manic phase bipolar disorder is expressed by an unmotivated cheerful mood.
Between these phases, psychiatrists allocate a time interval - intermission
, during which the sick person retains all his personality traits.
Today, according to many experts in the field of psychiatry, manic-depressive psychosis is no longer a separate disease. In its turn bipolar disorder is an alternation of mania and depression, the duration of which can range from one week to 2 years. The intermission separating these phases can be long - from 3 to 7 years - or it can be completely absent.
Causes of the disease
Psychiatrists classify manic-depressive psychosis as autosomal dominant type
. Most often, an illness of this nature is hereditary a disease passed from mother to child.
Causes
psychosis lies in the disruption of the full activity of emotional centers located in the subcortical region. Malfunctions of the processes of excitation and inhibition occurring in the brain can provoke the appearance of bipolar disorder in a person.
Relationships with others and being in a stressful state can also be considered as causes of manic-depressive psychosis.
Symptoms and signs
Manic-depressive psychosis most often affects women than men. Statistics of cases: per 1000 healthy people there are 7 patients in psychiatric clinics.
In psychiatry, manic depressive psychosis has a number of symptoms manifested in the phases of the disease. In teenagers the signs are the same, sometimes more pronounced.
The manic phase begins in a person with:
– changes in self-perception,
– appearance of vivacity literally out of nowhere,
– tide physical strength and unprecedented energy,
- discoveries second wind,
– disappearance of previously oppressive problems.
A sick person who had any diseases before the onset of the phase suddenly miraculously gets rid of them. He begins to remember all the pleasant moments from his life that he lived in the past, and his mind is filled with dreams and optimistic ideas. The manic phase of bipolar disorder displaces all negativity and thoughts associated with it. 
If a person has difficulties, he simply does not notice them.
For the patient, the world appears in bright colors, his sense of smell is heightened and taste buds. A person’s speech also changes, it becomes more expressive and louder, he has a vivid thinking and an improvement in mechanical memory.
The manic phase changes human consciousness so much that the patient tries to see only exclusively positive things in everything, he is satisfied with life, is constantly cheerful, happy and excited. He reacts negatively to outside criticism, but easily takes on any task, expanding the range of his personal interests and acquiring new acquaintances in the course of his activities. Patients who prefer to live an idle and cheerful life, love to visit places of entertainment, and they change sexual partners quite often. This phase is more typical for adolescents and young people with pronounced hypersexuality.
The depressive phase does not proceed so brightly and colorfully. In patients staying in it, a melancholy state suddenly appears, which is not motivated by anything, it is accompanied by retardation of motor function and slowness thought processes. In severe cases, a sick person may fall into a depressive stupor (complete numbness of the body).
People may experience the following: symptoms:
- sad mood
– loss of physical strength,
- emergence of suicidal thoughts,
– a feeling of one’s own unworthiness for others,
– absolute emptiness in the head (lack of thoughts).
Such people, feeling useless for society, not only think about committing suicide, but often they end their mortal existence in this world in exactly this way.
Patients are reluctant to make verbal contact with other people and are extremely reluctant to answer even the simplest questions.
Such people refuse sleep and food. Quite often the victims of this phase are teenagers who have reached the age of 15; in more rare cases, people over 40 years of age suffer from it.
Diagnosis of the disease
A sick person must undergo a full examination, which includes the following: methods, How:
1. electroencephalography;
2. MRI of the brain;
3. radiography.
But it is not only these methods that are used to carry out examinations. 
The presence of manic-depressive psychosis can be calculated by polls And tests.
In the first case, specialists try to draw up an anamnesis of the disease from the patient’s words and identify a genetic predisposition, and in the second, based on tests, bipolar personality disorder is determined.
A test for bipolar disorder will help an experienced psychiatrist identify the patient’s degree of emotionality, alcohol, drug or other addiction (including gambling addiction), determine the level of attention deficit ratio, anxiety, and so on.
Treatment
Manic-depressive psychosis includes the following treatment:
- Psychotherapy. This treatment is carried out in the form of psychotherapeutic sessions (group, individual, family). This kind of psychological help allows people suffering from manic-depressive psychosis to realize their illness and completely recover from it.
Manic-depressive psychosis is an outdated name for an endogenous mental illness, which in the international classification is defined as bipolar disorder. The original name of this disorder is circular psychosis, which reflects the main symptom of the disease or a change in mood phases. The disease has two opposite phases - mania or abnormally elevated mood and depression. The phases can alternate, replacing each other immediately or through a light interval called intermission.
Sometimes the same person has manifestations of both phases at the same time, or one phase is fully expressed and the other partially expressed. At the height of mood disorder, persistent hallucinatory-delusional structures can form. Some patients end up in psychiatric hospital once and get by with a certificate of incapacity for work, others become disabled forever.
Is manic-depressive psychosis treatable? Unfortunately, complete recovery is impossible. However, regular use of potent psychotropic drugs allows a person to remain in society and live a relatively normal life for many years.
They have not been definitively established, although there are indisputable statistical data. The reasons for the development of manic-depressive psychosis are:
Several studies carried out in different countries have proven that in 80% the cause is a genetic defect. The study of bipolar disorder was conducted on identical twins, which excludes random factors. This means that the twins who lived in different conditions and countries, showed the same clinical picture at the same age. Defects were found in different parts of the 18th and 21st chromosomes. Hereditary factor is considered decisive.
The influence of family and environment in MDP ranges from 7 to 20%. These include living together with mentally unstable individuals, severe social upheavals, armed conflicts, man-made and natural disasters.
Provoking factors
The frequency distribution of bipolar psychosis in people of both sexes is approximately the same, but biphasic disorder develops more often in men, and single-phase disorder in women. Women's psychiatric disorders are more pronounced and are often provoked by changes hormonal status– menstrual cycle, pregnancy, childbirth, menopause. Occurs in women postpartum depression subsequently classified as the onset of bipolar disorder, the diagnosis is established retrospectively.
It is believed that any psychiatric disorder that occurs within 14 days after birth almost always transforms into full-blown psychosis. Bipolar disorder can also develop after childbirth in a woman who has ever suffered from any psychiatric disorder.
In practice, there is a connection between the depressive phase and traumatic events. A person initially develops reactive depression in response to some event, and then transforms into major psychosis. There is no such connection with regard to the manic phase; mania develops according to its own endogenous laws.
It has long been noted that affective disorders develop in those whose personality has special features. These are melancholic people who never see anything good in the events of life.
Also at risk are overly ordered and responsible people who eliminate all spontaneity and unpredictability from their lives. Those at risk are those who quickly become exhausted and cannot endure difficulties and troubles. Schizoids are always in danger - people are formulas, prone to theorizing.
Classification of manic-depressive psychosis
Manic-depressive psychosis is the second most common endogenous mental illness after schizophrenia. The polymorphism of symptoms, delusional inclusions, social maladaptation, rapid change of phases make this disease difficult to diagnose. According to statistics, an average of 10 years pass from the onset of the disease to the final diagnosis.
In ICD-10, bipolar disorder is coded under categories F31 and F33. In practice, the type of course of the disease matters:
A certain pattern was noted between the type of course and age of manifestation of the disease. According to statistical data, at the onset of the disease before the age of 25, a classic bipolar course develops; after 30 years, the unipolar course is more common.
Symptoms of manic-depressive psychosis
What is MDP and how does manic-depressive psychosis manifest? This is a kind of “swing” of mood, with endless fluctuations of which a person has to live.
The manic phase is a combination of three symptoms: abnormally elevated mood, accelerated thinking and high physical activity. Clinically, the phase develops gradually, incrementally: if at first a sick person can be mistaken for a confident optimist, then at the height of the phase it is a riot that does not recognize any boundaries.
The mood begins to improve first, and no objective reasons for this purpose no. A person realizes that everything in his life is great, there are no obstacles, the future is cloudless, and his abilities and capabilities exceed those of everyone else. A logical continuation is delusions of grandeur, when the patient feels like a god or the arbiter of destinies. Behavior changes - values and acquisitions that took the whole previous life are given away, career and family collapse. There is no longer any need to eat and sleep - there is so much happiness that everything else does not matter.
Undoubtedly, such behavior leads to personality degradation. The patient requires inpatient treatment that limits his movements and actions.
The depressive phase carries with it the threat of suicide, especially in adolescence. The danger is that not only the mood decreases, but the way of thinking changes - the person believes that life has reached a dead end with no way out. From depression, having no life experience and not knowing how to withstand the blows of fate. Not a single country or city, not even Moscow, can completely cope with teenage suicides.
The depressive phase can also culminate in delusion, but its content is different: the patient may be convinced that not only is his life wasted, but his body is being destroyed - eaten by worms, burned from the inside, or turned into jelly.
Depressive disorders are extremely dangerous if a person has never been treated. There are known cases of extended suicide, when a parent, wanting to save their child from the inevitable end of the world, passes away with him.
In less severe cases, a person loses interest in life so much that they refuse food due to a change in its taste (“like grass”), stop taking care of themselves, do not change clothes and do not wash. Women in the depressive phase often stop having periods.
Diagnostics
The nosological affiliation does not immediately become clear. The manic phase, especially if it occurs in the form of hypomania, is often not perceived as a painful condition by either the patient himself or his relatives. The short phase, if it was interrupted before the patient had time to commit reckless acts, is perceived as an episode of a vibrant life.
The following methods are used to diagnose manic-depressive psychosis:
Treatment of manic-depressive psychosis
How is manic-depressive psychosis treated? Requires true skill and extensive experience. A restrictive regime, sometimes strict supervision, medications, and psychotherapy are used.
On an outpatient basis, only cyclothymia or an erased version of bipolar disorder can be treated, in which social adaptation person is not violated. All other forms of manic-depressive disorder are treated in a hospital in a closed psychiatric department. Hospitalization is carried out in accordance with current legislation, the patient gives informed consent to treatment.
If the patient’s condition does not allow him to assess everything that is happening around him, the medical commission makes a decision on involuntary hospitalization at the request of the next of kin. Staying in a closed department is the main condition for achieving remission, when the patient is ensured safety and regular medication intake.
Treatment of the first episode is most effective. With all subsequent exacerbations, susceptibility to medications decreases, and the quality of intermission deteriorates.
Drug treatment
In the treatment of manic-depressive psychosis, drugs from the following groups are used:
This is a typical set of drugs, which is expanded according to individual indications. The goal of treatment is to interrupt the current phase and resist its inversion, that is, a change to the opposite one. To do this, high doses of drugs are used, combining them depending on the patient’s condition. How to treat manic-depressive psychosis is decided by the attending physician.
No folk remedies stop or change the course of the disease. It is allowed to use soothing and restorative preparations during periods of calm.
Psychotherapeutic treatments
The capabilities of this method are limited and are used only in intermission. From exacerbation to exacerbation, the patient’s personality disorders worsen, and this narrows the doctor’s range of options. Chronic disorder requires changes in approach throughout treatment.
The following methods are effective:
An important part of a psychotherapist’s work is increasing the patient’s confidence in the doctor, developing a positive attitude towards treatment, and psychological support during long-term medication use.
Prognosis and prevention
The prognosis after treatment of manic-depressive psychosis depends entirely on the duration of the phases and their severity. Patients who become ill for the first time with a short period of hospital stay are issued a certificate of temporary incapacity for work with a rehabilitation diagnosis. Some harmless disease is indicated - a reaction to stress, etc.
If a person is in a hospital for a long time, a disability group is established - third, second or first. Patients in the third disability group have limited ability to work - they can perform light work or their number of hours is reduced, night shift work is prohibited. If the condition is stabilized and intelligence is preserved, the disability group can be removed.
If a sick person commits a crime, a forensic psychiatric examination is ordered. If the court establishes the fact of insanity at the time of the crime, compulsory treatment is prescribed. Prevention of disease is the use of medications prescribed by a doctor and a calm, measured life.
Manic-depressive psychosis is a mental illness characterized by the development of two polar states in one person, which replace each other: euphoria and deep depression. The mood is changeable and has big swings.
In this article we will look at the symptoms, signs, and methods of treating this mental disorder.
general characteristics
Patients experience a period of intermission and the immediate course of the disease. Usually the disorder manifests itself only as one of the phases of psychosis during a certain period. In the pauses between active manifestations of the disease, a moment comes when the individual leads completely normal, habitual life activities.
In medicine, the concept of bipolar affective disorder is sometimes used, and the acute phases of its manifestation are called psychotic episodes. If the disease occurs in milder forms, then it is called cyclothymia.
This psychosis is seasonal. Basically, the difficult periods are spring and autumn. Both adults and children suffer from it, starting from adolescence. As a rule, it is formed by the person’s thirtieth birthday.
According to statistics, the disease is more common in women. According to general data, 7 out of 1000 people suffer from manic-depressive syndrome. Almost 15% of patients in psychiatric clinics have this diagnosis.
Usually the first symptoms developing disease manifest themselves weakly, they can be easily confused with other problems of growing up during puberty, or at the age of 21-23.
Genetic theory of the development of the disorder
Today, the theory that explains the origin of manic-depressive state is genetic, which studies hereditary factors.
Statistics have repeatedly shown that this disorder is transmitted genetically in 50 percent of cases. That is, there is a family continuity of the disease. It is important to diagnose the disease in a timely manner in a child whose parents suffer from this syndrome in order to eliminate complications. Or we can accurately establish whether there are characteristic manifestations, or whether the children managed to avoid the disease.
According to geneticists, the risk of illness in a child is 25% if only one of the parents is sick. There is evidence that identical twins are susceptible to the disease with a 25% probability, and in fraternal twins the risk increases to 70-90%.
Researchers who adhere to this theory suggest that the gene for manic psychosis is contained on chromosome 11. The information, however, has not yet been proven. Clinical trials indicate a possible localization of the disease in the short arm. The subjects were patients with a confirmed diagnosis, therefore the reliability of the information is quite high, but not one hundred percent accurate. Genetic predisposition these patients have not been studied.
Main Factors
Researchers give significant influence to the following factors:
- Unfavorable environmental conditions. They stimulate the active development of pathology, although experts are considering the possibility of compensating for hereditary defects.
- Unhealthy food. Products containing preservatives, flavors, and carcinogens can provoke mutations and diseases.
- Modified products. Their consumption affects not the person who uses such products, but his children and subsequent generations.
Experts note that genetic factors are only 70% of the likelihood of a person developing manic-depressive syndrome. 30% - the above factors, as well as the environmental situation and other possible etiological issues.
Minor causes of psychosis
Manic-depressive psychosis has been poorly studied, so there are still no clear reasons for its occurrence.
In addition to genetic and the above factors, the occurrence of a disorder in a child's fetus is influenced by the stress experienced by the pregnant mother, as well as how her childbirth proceeds. Another feature is the functioning of the nervous system in an individual individual. In other words, the disease is provoked by disturbances in the functioning of nerve impulses and the neural system, which are located in the hypothalamus and other basal areas of the brain. They appear due to changes in activity chemical substances– serotonin and norepinephrine, which are responsible for the exchange of information between neurons.
Most of the reasons influencing the appearance of manic-depressive disorder can be classified into two groups:
- Psychosocial
- Physiological
The first group is those reasons that are caused by the individual’s need to seek protection from severe stressful conditions. A person unnecessarily strains his mental and physical efforts at work, or, on the contrary, goes on a merry spree. Promiscuous sex, risky behavior - everything that can stimulate the development of bipolar disorder. The body wears out and gets tired, which is why the first signs of depression appear.
The second group is disruption of the thyroid gland and other problems associated with the processes of the hormonal system. As well as traumatic brain injuries, severe head diseases, tumors, drug and alcohol addiction.
Types and symptoms
Sometimes in the clinical picture of various patients only one type of disorder is observed - depressive. The patient suffers from deep despondency and other manifestations typical of this type. In total, there are two bipolar disorders with manic psychosis:
- Classic – the patient has certain symptoms that affect different mood phases;
- The second type is difficult to diagnose, in which the signs of psychosis are weak, due to which confusion may occur with the usual course of seasonal depression, a manifestation of melancholy.
There are signs that experts consider for a manic-depressive state: those that are characteristic only of manic psychosis and those that appear only in depressive psychosis.
So, what are the symptoms of manic-depressive psychosis? In medicine, they are combined into the general concept of “sympathicotonic syndrome.”
All patients in phase manic disorder, characterized by increased excitability, activity and dynamism. People can be described like this:
- They are too talkative
- They have high self-esteem
- Active gestures
- Aggressiveness
- Expressive facial expressions
- Pupils are often dilated
- Blood pressure is higher than normal
- Irritable, vulnerable, react sharply to criticism
Patients have decreased sweating and a lot of emotion on their face. They think they have a fever, signs of tachycardia, problems with the gastrointestinal tract, and insomnia. Mental activity may remain unchanged.
Patients in the manic phase experience a desire to take risks in various areas, from gambling to committing crimes.
At the same time, people feel unique, omnipotent, very lucky, and they have an unprecedented faith in their own abilities. Therefore, patients quite easily succumb to financial scams and frauds in which they are drawn. They spend their last savings on lottery tickets and place sports bets.
If the disease is in the depressive phase, then such patients are characterized by: apathy, taciturnity and quiet, inconspicuous behavior, a minimum of emotions. They are slow in their movements and have a “sorrowful mask” on their face. Such a person complains of breathing problems and a feeling of pressure in the chest. Sometimes patients refuse to eat food, water, and stop taking care of their appearance.
Patients with depressive disorder often think about suicide, or even commit it. At the same time, they do not tell anyone about their desires, but think through the method in advance and leave suicide notes.
Diagnostics
We mentioned above that bipolar disorder is difficult to diagnose because the signs and symptoms of manic-depressive psychosis sometimes coincide with other mental conditions of the person.
In order to establish an accurate diagnosis, doctors interview patients and their close relatives. Using this method, it is important to determine whether a person has a genetic predisposition or not.
The patient takes a series of tests, based on the results of which the level of his anxiety is determined, addictions, propensity to them, and emotional state are indicated.
In addition, if a person is suspected of manic-depressive psychosis, he is prescribed EEG studies, radiography, and MRI of the head. They are used to exclude the presence of tumors, brain injuries, and intoxication consequences.
When the full picture is established, the patient receives appropriate treatment.
Treatment for bipolar disorder
Manic-depressive psychosis is sometimes treatable. Specialists prescribe medications, psychotropic drugs, antidepressants - those drugs that stabilize the general emotional state and mood.
One of the main components that has a positive effect on the treatment of the disease is lithium salt. It can be found in:
- Micalita
- Lithium carbonate
- Lithium oxybutyrate
- And in other similar drugs
However, it should be borne in mind that such medications are contraindicated in patients with kidney and gastrointestinal diseases and hypotension.
In especially difficult situations, patients are prescribed tranquilizers, antipsychotics (Aminazine, Galaperidol, as well as thioxanthene derivatives), antiepileptic drugs (Carbamazepine, Finlepsin, Topiramate, etc.).
In addition to medical therapy, for effective comprehensive care, the patient should also undergo a course of psychotherapy. But visiting this specialist is possible only during the period of stabilization and intermission.
In addition, to consolidate the effect of drug therapy, the patient must additionally work with a psychotherapist. These classes begin after the patient’s mood has stabilized.
The psychotherapist allows the patient to accept his illness and realize where it stems from, and what its mechanisms and symptoms are. Together, they build a behavioral strategy for periods of exacerbation and work on ways to control emotions. Often, the patient’s relatives are also present at the sessions, so that they can calm him down during attacks; the classes will also help loved ones prevent exacerbation situations and control them.
Preventive measures
In order to avoid frequent episodes of psychosis, a person must provide himself with a state of peace, reduce the amount of stress, be able to always seek help, and talk to someone significant during difficult periods. Medicines based on lithium salts help delay the acute phase of manic-depressive syndrome, but here the dosage prescribed by the doctor must be followed; it is selected in each case separately, and it depends on the degree of development of the disease.
But sometimes patients, after they have safely overcome acute period, they forget or refuse medications, which is why the disease returns with a vengeance, sometimes with much more severe consequences. If the medication continues, according to the doctor’s instructions, then the affective phase may not occur at all. Dosage medications however, it can remain the same for many years.
Forecasting
It should be noted that a complete cure for manic-depressive disorder is almost impossible. Having experienced the symptoms of psychosis once, a person runs the risk of having a repeated experience of the acute experience of the disease.
However, it is within your power to stay in remission as long as possible. And go without attacks for many months and years. It is important to strictly adhere to the prescribed doctor's recommendations.
