Mania

Mania ( ; also known as manic syndrome) is a psychiatric behavioral syndrome defined as a state of abnormally elevated mood with hyperactivity and risky behavior. During a manic episode, an individual will experience rapidly changing emotions and moods, highly influenced by surrounding stimuli. Although mania is often conceived of as a "mirror image" to depression, the heightened mood can be euphoric as well as dysphoric. The symptoms of mania include elevated mood (either euphoric or irritable), flight of ideas, pressure of speech, increased energy, decreased need for sleep, and hyperactivity. Persistent irritability is a symptom of both mania and depression. In severe manic episodes (characteristic of bipolar I disorder), psychotic symptoms may manifest, including delusions (such as grandiose delusions and paranoid delusions ) or hallucinations. The prevalence of psychosis in manic episodes is 57%; the rate in depressive episodes is 13%. Other psychotic symptoms include fragmentation of behavior and catatonia. For context, the rate of schizophrenia in bipolar disorder is 8%. More than 5% of the general human population has experienced mania or hypomania in some degree.

Mania ( ; also known as manic syndrome) is a psychiatric behavioral syndrome defined as a state of abnormally elevated mood with hyperactivity and risky behavior. During a manic episode, an individual will experience rapidly changing emotions and moods, highly influenced by surrounding stimuli. Although mania is often conceived of as a "mirror image" to depression, the heightened mood can be euphoric as well as dysphoric. The symptoms of mania include elevated mood (either euphoric or irritable), flight of ideas, pressure of speech, increased energy, decreased need for sleep, and hyperactivity. Persistent irritability is a symptom of both mania and depression. In severe manic episodes (characteristic of bipolar I disorder), psychotic symptoms may manifest, including delusions (such as grandiose delusions and paranoid delusions ) or hallucinations. The prevalence of psychosis in manic episodes is 57%; the rate in depressive episodes is 13%. Other psychotic symptoms include fragmentation of behavior and catatonia. For context, the rate of schizophrenia in bipolar disorder is 8%. More than 5% of the general human population has experienced mania or hypomania in some degree. ==Causes== Various triggers have been associated with switching from euthymic or depressed states into mania. One common trigger of mania is antidepressant therapy. Studies give widely varying estimates of the switching while on an antidepressant, with tricyclic antidepressants generally showing higher risk. Dopaminergic drugs such as reuptake inhibitors and dopamine agonists may also increase risk of switch. Other medications possibly include glutaminergic agents and drugs that alter the HPA axis. Lifestyle triggers include irregular sleep-wake schedules and sleep deprivation, as well as extremely emotional or stressful stimuli. Various genes that have been implicated in genetic studies of bipolar have been manipulated in preclinical animal models to produce syndromes reflecting different aspects of mania. CLOCK and DBP polymorphisms have been linked to bipolar in population studies, and behavioral changes induced by knockout are reversed by lithium treatment. Metabotropic glutamate receptor 6 has been genetically linked to bipolar, and found to be under-expressed in the cortex. Pituitary adenylate cyclase-activating peptide has been associated with bipolar in gene linkage studies, and knockout in mice produces mania like-behavior. Targets of various treatments such as GSK-3, and ERK1 have also demonstrated mania like behavior in preclinical models. Mania may be associated with strokes, especially cerebral lesions in the right hemisphere. Deep brain stimulation of the subthalamic nucleus in Parkinson's disease has been associated with mania, especially with electrodes placed in the ventromedial STN. A proposed mechanism involves increased excitatory input from the STN to dopaminergic nuclei. Mania can also be caused by physical trauma or illness. When the causes are physical, it is called secondary mania. In some individuals, manic symptoms are also correlated with the season of spring. In "bipolar I or genetically vulnerable individuals", non-clinical use of psychedelics elevates risk for mania. ==Diagnosis== Lithium is the classic mood stabilizer to prevent further manic and depressive episodes. A systematic review found that long term lithium treatment reduces the relative risk of bipolar manic relapse by 38%, "relative risk=0.62". Anticonvulsants such as valproate, oxcarbazepine, and carbamazepine are also used for prophylaxis; more recent drug solutions include lamotrigine and topiramate, both anticonvulsants as well. ==Etymology== The nosology of the various stages of a manic episode has changed over the decades. The word derives from the Ancient Greek μανία (manía), "madness, frenzy" and the verb μαίνομαι (maínomai), "to be mad, to rage, to be furious."

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