F30.1 Mania without psychotic symptoms

Among affective disorders, also called mood disorders, there is a group of diseases whose characteristic feature is emotional upliftment. These are manic spectrum disorders.

Unlike depressive disorders, in which the mood is significantly reduced and the person loses interest in life and motivation to act, manic disorders, on the contrary, are characterized by a feeling of a surge of strength, fullness of life, and a high level of activity. And if a depressive state is perceived unambiguously as a disorder, an illness, a situation that requires correction, then manic disorders, at first, can be perceived as a wonderful, healthy state, the disclosure of all possibilities, life “to the fullest.” However, these manifestations are also painful in nature.

A person in such a state completely loses the ability to adequately assess what is happening. His joy and euphoria have no basis in fact. There is a tendency to rash, risky actions, a craving for alcohol and drugs. He begins to neglect social and moral norms, refusing to think about the consequences; he can not only harm himself and others, but also resort to dangerous, aggressive actions. Any persuasion and calls to change your mind will only provoke irritation and aggression.

Affective disorders of the manic spectrum include:

• hypomania;
• mania without psychotic symptoms;
• mania with psychotic symptoms.

This classification reflects both the features of the clinical picture of each disease and ranks them according to severity. All three disorders are characterized, to varying degrees of severity, by the following symptoms:

• increased emotional background;
• motor excitement;
• idiatory and mental arousal.

Among them, the most severe is mania with psychotic symptoms, in which a hallucinatory-delusional state develops.

Symptoms of the disease Mania without psychotic symptoms

The main difference from hypomania is that elevated mood affects changes in the norms of social functioning, manifests itself in inappropriate actions, speech pressure and increased activity are not controlled by the patient.
Self-esteem increases and individual ideas of one’s own importance and greatness are expressed. A subjective feeling of ease of associations arises, distractibility is increased, the colors of the surrounding world are perceived as brighter and more contrasting, and more subtle shades of sounds are distinguished. The pace of time accelerates and the need for sleep is significantly reduced. Tolerance and need for alcohol increase, sexual energy and appetite increase, and a craving for travel and adventure arises. There is a constant danger of contracting a sexually transmitted disease and getting involved in stories with unpredictable consequences. Thanks to the leap of ideas, many plans arise, the implementation of which is only just beginning. The patient strives for bright and catchy clothes, speaks in a loud and later hoarse voice, he makes a lot of debts and gives money to people he barely knows. He easily falls in love and is confident in the love of the whole world. Gathering many random people, he arranges holidays on credit. Clinical example: Patient S., 25 years old. University student. One morning, when I woke up, I discovered that the world had changed, became bright and rich. She talked a lot, and in an hour she did what she had been planning for a month. At the university, she attracted attention with her bright, catchy clothes, although she had not previously used cosmetics, but now she bought them for a large sum, borrowing money from her friends. She decided that she should marry a foreigner, conducted active correspondence on the Internet, and simultaneously invited 5 men who liked her to the same cafe. At parties she sang songs loudly and danced uncontrollably. Having borrowed money again, she bought flowers, which she presented to her teacher. She declared her love to everyone. At night I wrote poetry and decided to start a dissertation. Having failed the test, I went to another city to visit my friend, whom I had not seen for 2 years. Having learned that she was married, she tried to seduce her husband and got into a fight with her friend. The condition lasted 2 weeks.

What is mania?

More recently, we have dealt with depressive syndrome and learned about the main manifestations of this painful condition. The exact opposite of depression is manic syndrome, which is also characterized by behavioral personality changes.

How to recognize a manic state?

The following signs indicate the appearance of manic syndrome:

1. Hyperthymia, that is, a painful increase in mood, which is expressed by constant optimism, an easy attitude to everyday difficulties and everyday problems. The person is constantly cheerful, does not complain about anything, denies any problems and does not understand his painful condition. Feelings of melancholy and sadness are not observed even when it should be expected (for example, with unpleasant news).
2. Acceleration of thinking, which is manifested by speech pressure; a person expresses himself quickly, spasmodically, is constantly distracted, has difficulty returning to the previous topic, which is why he looks chaotic. Despite the fact that speech resembles verbal hash, a person in a state of mania talks a lot.
3. Motor agitation is expressed by the inability to sit in one place, a person wants to move as much as possible, he finds a lot of reasons to leave home, leave a meeting, etc.

In addition, mania leads to an overestimation of one’s qualities and abilities. The person seems incredibly attractive, handsome, smart, he tirelessly praises his talents and skills (demonstrates his vocal abilities, dancing abilities). In this state, they often begin to write poetry, draw pictures, and do handicrafts.

In a state of mania, desires intensify, for example, appetite and sexuality increase, and excessive addiction to alcohol may be observed. A person in a manic state cannot stand loneliness, he strives for communication, easily makes new acquaintances and enters into sexual relations. Even at a doctor’s appointment, he fails to maintain the accepted distance and switches to familiar expressions.

A lot of attention is also paid to appearance, women begin to wear excessive make-up and use an excessive amount of jewelry, clothing is designed to emphasize their sexuality and liberation. Men can decorate their image with badges, medals, and stripes. Interest in the opposite sex is especially pronounced; a manic person, without being embarrassed by the people around him, boldly makes compliments, immodest offers and confesses his love to the chosen object (even if he already has his own family).

Valentin Gubarev

A manic person easily and willingly spends money on unnecessary purchases. There are a lot of ideas and projects in his head, but none of them can be realized, as a whirlwind of new emotions and plans overwhelms his consciousness. If someone from the environment tries to prevent the fulfillment of desires, then they are faced with indignation, aggression, and irritation directed at them.

A characteristic sign of mania is a decrease in sleep at night; a person flatly refuses to go to bed, continuing to go about his business, fussing and fidgeting at night. Sleep lasts only a couple of hours, in the morning he wakes up very early and resumes vigorous activity. He does not complain of weakness or lack of sleep; on the contrary, he claims that he sleeps enough and does not need additional rest.

Outwardly, patients with mania look healthy, even a little younger. Weight gain is often observed, but those whose physical activity is extremely high may also experience a decrease in body weight, despite an excessive appetite.

Typically, a person with manic syndrome bothers others, causing them a lot of inconvenience with his fussiness, importunity and hyperactivity, but, as a rule, does not pose a threat to their health.

Mild forms (hypomania) allow a person to understand that his inspiration is unnatural, delusional symptoms do not arise. Such a person makes a pleasant impression with his wit and complacency, but still, increased distractibility does not allow him to work fully.

Manic states occur with bipolar affective disorder (previously called manic-depressive psychosis), with schizophrenia, with hyperthyroidism (thyroid disease), sometimes with organic brain damage or drug use (cocaine, amphetamine, hallucinogens, etc.) and medications. The duration of mania varies and can last up to several months.

An experienced doctor can assess a person’s condition and make an accurate diagnosis. But along with this, there are also some questionnaires that help identify manic states: the Hypomania Checklist-32, abbreviated name HCL-32, the Young scale for assessing mania, the Altman self-rating mania scale, etc. .

Diagnosis of the disease Mania without psychotic symptoms

The main symptoms of mania are:

• 1. An elevated, expansive, irritable (angry) or suspicious mood that is unusual for the individual. The change in mood should be clear and last for a week.
• 2. At least three of the following symptoms must be present (and if the mood is only irritable, then four): 1) increased activity or physical restlessness;
• 2) increased talkativeness (“speech pressure”);
• 3) acceleration of the flow of thoughts or the subjective feeling of a “jump of ideas”;
• 4) a decrease in normal social control, leading to inappropriate behavior;
• 5) reduced need for sleep;
• 6) increased self-esteem or ideas of greatness (grandiosity);
• 7) distractibility or constant changes in activities or plans;
• rash or reckless behavior, the consequences of which the patient is not aware of, for example, carousing, stupid enterprise, reckless driving;
• 9) a noticeable increase in sexual energy or sexual promiscuity.

Differential diagnosis

Mania should be differentiated from affective disorders in diseases of addiction (euphoria when using cocaine, marijuana), with organic affective disorders and with manic-hebephrenic agitation in schizophrenia and schizoaffective disorders. With intoxicating euphoria as a result of cocaine use, along with manic excitement, somatic symptoms are noted: headaches, tendency to convulsions, rhinitis, increased blood pressure, tachycardia, mydriasis, hyperthermia, increased sweating. With intoxicating euphoria as a result of marijuana use, mania can occur with slurred speech, increased dryness of mucous membranes, tachycardia, depersonalization, and dilated pupils.

Organic mania occurs with a change in consciousness, neurological and somatic disorders, and other components of the psychoendocrine syndrome, such as cognitive decline, are detected.

The manic-hebephrenic state, in contrast to the manic state, is characterized by non-infectious fun, formal thinking disorders (fragmentation, amorphism, paralogical thinking), foolishness, and symptoms of instinctive regression (eating inedible things, distortion of sexual preference, cold aggressiveness).

Mental disorders: mania

Here are 25 of the most common and unusual manias common to many people.

1. Clinomaniacs struggle with an excessive desire to stay in bed, especially on Mondays. Moreover, the desire can be so strong and irresistible that a person can spend whole days in bed.

2. People who can never make a decision are considered abulomaniacs .

3. The formal term for a workaholic is ergomaniac .

4. People who are passionate about horses are called hippomaniacs .

5. Micromaniacs suffer from pathological self-abasement.

Manic syndrome

Manic syndrome (ancient Greek μανία - passion, madness, attraction) is a psychopathological syndrome characterized by a triad of symptoms: elevated mood such as hyperthymia, ideational and mental arousal in the form of acceleration of thinking and speech (tachypsychia), motor agitation. Manic syndrome is also characterized, but does not always manifest itself: increased instinctive activity (increased appetite, sexuality, increased self-protective tendencies), increased distractibility, overestimation of one’s own personality (sometimes reaching delusional ideas of grandeur).

There are several variants of manic syndrome.

Joyful mania is a classic manic syndrome with hyperthymia, tachypsychia, and motor agitation.

Angry mania is a manic syndrome characterized by short temper, irritability, aggressiveness, and a tendency to easily arise conflicts with others.

The manic-paranoid variant is a manic syndrome with the appearance of delusional ideas of relationship and persecution.

Delusional variant - in the structure of manic syndrome, the central place is occupied by persistent delusions of grandeur, of one’s own positive exclusivity. In manic syndrome, delusional ideas are devoid of absurdity and fantasticality, have a certain logical sequence, and their content is often associated with the professional activities of the patient.

Oneiric mania - at the height of the manic syndrome, disturbances of consciousness of the oneiric type appear with fantastic hallucinatory experiences.

Maniac (French maniaque, from Greek mania - madness, enthusiasm, passion) is a person obsessed with mania (pathological desire, attraction, passion for something), experiencing a strong, painful addiction to something.