Manic

Mania and bipolar affective disorder

Signs of mania include

1. Mood : irritability, euphoria, lability

2. Cognition : grandiosity, flight of ideas, racing thoughts, distractibility, poor concentration, confusion, lack of insight

3. Behaviour : Rapid speech, hyperactivity, insomnia, hypersexuality, extravagance

4. Psychotic : delusions, hallucinations

*Less severe state: hypomania
*Occur alternative with depression: bipolar affective disorder

Causes:

1. Physical: Infections, hyperthyroidism, SLE, thrombotic thrombocytopenic purpura, stroke, ECT

2. Drugs : Amphetamine, cocaine, antidepressants, cimetidine, captoril, steroids, L-dopa, baclofen

Treatment:

1. Olanzapine 10mg PO / sodium valproate 250mg/8h PO: acute moderate/severe mania

2. Lithium carbonate: prophylaxis

3. If lithium doesn’t give good control; consider lamotrigine (if mostly depression) or cabamazepine (if mostly manic)

Mnemonic for bipolar diagnosis: INSPIRE

I ncrease activity
N eed for sleep is reduced
S peed of thought increase
P ressure of words
I ncrease self-esteem / grandiosity
R educed inhibition
E asily distracted

Reference:

1. Oxford Handbook of Clinical Specialty

2. Mnemonics for Medical Undergraduates (PasTest)