Mania is a syndrome which is in some ways the reverse of depression. When manic symptoms occur without significant psychosocial impairment, the syndrome is called hypomania.
In mania the life-time risk of unbalanced episode is about 0.81%. Additionally, This disorder tends to occur in episodes lasting usually 3-4 months, followed by complete clinical recovery.
The future episodes can be unbalanced, depressive or mixed.
A unbalanced episode is typically characterized by the following features (which should last for at least one week and cause disruption in occupational and social activities).
This term refers to a state in which wild symptoms are present and noticeable, but they do not cause a serious degree of functional impairment.
Physical activity and speech are increased, mood is labile, mainly euphoric but at times irritable, ideas are expansive, and the patient often spends more than he can afford. By definition, there is significant social impairment in this and the other patterns of mania.
In brief, there is marked over-activity with pressure also disorganization of speech, the euphoric mood is increasingly interrupted by periods of irritability, hostility, and depression, and grandiose also other preoccupations may become delusional.
There is frenzied overactivity, thinking is incoherent and delusions become increasingly bizarre, and hallucinations are experienced. Very rarely, however, the patient becomes immobile and mute instead of overactive and talkative (in other words, wild stupor).
| Mood |
| ● Euphoria |
| ● Irritability |
| Appearance Behaviour |
| ● Overactivity |
| ● Distractibility |
| ● Socially inappropriate behaviour |
| ● Reduced sleep |
| ● Increased appetite |
| ● Increased libido |
| Thinking and speech |
| ● Flight of ideas |
| ● Expansive ideas |
| ● Grandiose delusions |
| ● Hallucinations |
| Impaired insight |
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree i.e.:
C. The symptoms do not meet criteria for a Mixed Episode.
D. A mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
E. The symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication, or other treatment) or a general medical condition (e.g. hyperthyroidism).
Milder wild episodes may treat as an outpatient, but more severe disorders with associated loss of judgement will almost always need initial treatment as an inpatient. When the disorder is more severe, compulsory admission is likely to need.
Almost all patients with a wild episode will need drug treatment (Anti-psychotic drugs). The clinical status should monitor frequently.
Progress is judge not only by the mental state and general behavior, but also by the pattern of sleep and by the regaining of any weight lost during the illness. As progress continues, anti-psychotic drug treatment is reduce gradually.
It is important, however, not to discontinue the drug too soon, otherwise relapse may occur. During treatment a careful watch should be kept for the appearance of depressive symptoms because transient but profound depressive mood change and depressive ideas are common among unbalanced patients.
In either case, suicidal ideas may appear. A sustained change to a depressive syndrome may require treatment, including with antidepressant drugs which should use cautiously to avoid precipitation of a unbalanced relapse.
Anti-psychotic drugs have an established place in the treatment of mania. An atypical anti-psychotic, such as olanzapine, quetiapine, or risperidone, is therefore usually the first-choice treatment.
Antipsychotics should generally not be used to control behavior because the doses required for this effect are high and adverse effects are therefore more likely.
A benzodiazepine such as lorazepam or diazepam should be used instead.
Lithium is effective in mania, but less so than anti-psychotic drugs, and it can be difficult to use safely in severely disturbed patients.
It is therefore used mainly in patients with milder unbalanced episodes, especially when it is intended to continue the treatment in the long term to prevent relapse.
It is also used in combination with anti-psychotics—caution is required when used in combination with haloperidol because extra-pyramidal effects occur commonly.
Valproate is effective in acute mania. It is slightly less effective than anti-psychotics, but causes fewer adverse effects.
Thus, it may be particularly useful in patients who are not currently taking a long-term mood stabilizer, and who have a mild wild illness without psychotic features.
An advantage of valproate over lithium in the acute phase is that a high loading dose can be given, which leads to a more rapid response and shorter hospital stays.
Carbamazepine is another anti-epileptic drug that can be used in mania.
Clinical experience indicates that ECT has a powerful therapeutic effect in mania.
Nevertheless, ECT is not a first-line treatment; its use is mainly in the uncommon cases when anti-psychotic drugs are ineffective and the patient is so seriously disturbed that to spend time trying further medication or awaiting natural recovery is not justified.
Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.
Which includes
A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.
A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?
The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.
The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.
The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.
So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath)
Mania is a syndrome which is in some ways the reverse of depression. When excited symptoms occur without significant psychosocial impairment, the syndrome is called hypomania.
Reference: Psychiatry, Fourth Edition – Oxford Medical Publications -SRG-by John Geddes, Jonathan Price, Rebecca McKnight
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