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unknown2u's Etiology: long discourse without circuitous thought patterning, agitation and aggression: dementia, schizophrenia, personality disorder including paranoia, disruptive traits including inappropriate anger, suspiciousness, and threats of self-harm or harm to others are common presentations.
Mania — The American Psychiatric Association's diagnostic criteria for mania include the following.
- A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week (or any duration if hospitalization is necessary)
- During the period of mood disturbance, at least three or more of the following symptoms are present: inflated self esteem or grandiosity; decreased need for sleep; more talkative than usual; racing thoughts or flight of ideas; distractibility; increase in goal-directed activity; and excessive involvement in pleasurable activities that have a high potential for painful consequences, such as spending money or sexual indiscretions
- The mood disturbance leads to significant impairment in social or occupational functioning. The symptoms are not directly due to substance use or a general medical illness.
- The most common behavioral symptoms associated with manic episodes include pressured speech, hyperverbosity, physical hyperactivity and agitation, decreased need for sleep, hypersexuality, and extravagance. Less common features include violence, religiosity, pronounced regression, and catatonia.
- Impaired insight is a frequent component of the manic state and may impair compliance with medications. Patients with mania may experience depression, irritability, expansiveness, or mood lability during an episode of mania as often as they experience euphoria. A "mixed episode" is characterized by a sufficient number of depressive symptoms to meet the criteria for a major depressive episode while also meeting the criteria for mania.
Differential diagnoses suggest: Schizophrenia, schizoaffective disorder, posttraumatic stress disorder, abuse of alcohol, cocaine, or amphetamines, and personality disorders such as narcissistic, borderline and histrionic personalities may mimic bipolar disorder, and at times coexist with the illness. In addition, in the primary care setting, clinicians may be confronted with medical illness with symptoms that resemble manic episodes including thyrotoxicosis, partial complex seizures, systemic lupus erythematosus, cerebrovascular accident, human immunodeficiency virus, tertiary syphilis, or steroid-induced mood symptoms.
Evaluation: Evaluation should include a mental status examination, clinical history, physical examination (including a neurologic evaluation), vital signs, review of all medications, and laboratory studies including complete blood count, liver function tests, thyroid stimulating hormone, and routine chemistries. It is critical to obtain information from family or other caregivers since the patient with dementia, delirium, or psychosis may not be able to supply their own history. Family members should be encouraged to bring in all medications to which the patient has access. The Folstein Mini-Mental State Examination (MMSE) is a fast and easy screen for cognitive dysfunction.
Rx: The treatment of bipolar disorder can be organized into three distinct phases depending upon the current state of illness:
- The acute phase of treatment focuses upon containing the presenting level of symptoms and often includes establishing safety with the patient. The patient in the acute phase may be suicidal, psychotic, or displaying such poor judgment as to pose an imminent risk to themselves. Hospitalization is often necessary until the severity of symptoms lessens.
- The continuation phase may last weeks to months with a goal to reach full remission of symptoms and restoration of functioning.
- The maintenance phase of treatment aims to sustain remission and lasts at least one year after the resolution of symptoms. Long-term or lifetime maintenance is recommended for patients who have suffered three or more manic episodes
What's your diagnosis Dr. AKA2D91'? Dr. DSTChaos? Dr. OtterOX?
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