Bipolar I Disorder
Bipolar I disorder, also known as manic-depressive disorder, affects about 1 percent of the population. The disorder consists of distinct periods of mania and depression, often with long stretches of normal moods in between. At least one manic episode must occur in order to meet the diagnostic criteria. Depressive episodes are not required for the diagnosis, though most people with Bipolar I do have long periods of depression.
Bipolar Disorder Mania State
A manic episode lasts at least a week, unless treatment cuts it short. An essential feature is lack of sleep combined with decreased need for sleep and greatly increased energy. Insomnia is a very common complaint in the general population, but it is usually accompanied by fatigue, not excess energy.
Mood can be elevated. Patients might feel extreme elation. Often mood is irritable and sometimes outright dysphoric. Mania, therefore, is not synonymous with happiness by any means.
The patient also has rapid speech and flight of ideas. He or she will jump so quickly from one thought to another that other people can’t keep up. Often these thoughts, which seem to the patient like grand ideas, make no sense to anyone else.
The bipolar disorder mania state is often accompanied by grandiosity. Patients feel that they can do anything. They might think they rule the world, that they possess magical powers, and that they can fly. They often feel they have a special understanding of existence above that of normal people.
Feeling impervious can be dangerous, as the patient might attempt to fly off the roof.
Judgment and Insight
During a manic state, patients have minimal insight into the condition. They don’t think they are sick, don’t understand the need for treatment and might have to be hospitalized against their will. Poor judgment puts patients at risk of harming themselves. They might, for example, gamble away all their money or engage in unprotected sex with strangers. Most gambling does not occur in the context of mania–the other features of mania must be present for this to be considered a consequence of a manic state.
The first step in evaluating a patient with mania, especially the first episode, is to rule out any underlying medical disorder. Many medications including antidepressants and steroids can induce mania. Though the symptoms are identical, this is referred to as medication-induced mania and not the beginning of Bipolar I disorder. Other conditions, such as a brain tumor, may present with mania.
The patient with mania is almost invariably hospitalized in an inpatient psychiatric unit. The mainstay of treatment consists of starting the patient on a mood stabilizer, which is usually taken for life. Lithium is considered the gold standard of treatment. Valproate is a widely used alternative. During the acute manic phase the patient often requires more sedation, and if he or she is psychotic, a short term course of antipsychotic medications is used. Examples of adjunct medications used to treat mania include olanzapine and clonazepam.
“Kaplan and Sadock’s Comprehensive Textbook of Psychiatry”; Benjamin Sadock, Virginia Sadock and Pedro Ruiz (eds.); 2009.
“Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR”; American Psychiatric Association; 2000.