Basic clinical manifestations of mania
The basic clinical manifestations of mania are excessive emotions as the core and corresponding changes in thinking and behavior:
(1) in high spirits. The patient feels "very good" about himself, which he describes as "feeling great" and "couldn't be better". Conversation is full of joy and life seems completely carefree. Of course, different patients will have different performances. Especially for children, emotional changes can be a particularly irritable state. Irritability is characterized by a strong emotional response to minor stimuli. It can be losing your temper, or laughing wildly, or crying, and so on. But it is often fleeting. The patient doesn't care or care.
2 excessive boasting and exaggerating ideas. Patients often exaggerate their abilities and think that they shoulder a very important mission and have special talents. I am highly valued: I am about to become the leader of any organization, and I am ready to be the president, chairman or senior national position; Even in charge of world trade. Manic people exaggerate.
To the point of delusion. They will label themselves with various other majors or names that they think are commendable.
③ The patient's speech increased or he felt that he had to speak. They are eloquent and eloquent. Sometimes the answering machine changes, and the witty remarks make everyone laugh. Sometimes they are harsh and indignant, and they win applause. They are often thirsty and never stop. Coupled with the increase in behavioral movements, it is often singing and dancing, which is manifested as a state of excitement in speech movement. In public, patients are very willing to show off, give whatever they want, and often volunteer to perform or comment for everyone, which has become the focus of attention.
4 Lenovo growth rate or subjective experience thought escape. The patient's thinking speed is faster and the association is richer. The main experience of his thinking is described by some patients as "thinking too fast", "brain turns like oil" and "mouth can't keep up with the speed of brain thinking". Objective observation shows that patients speak much faster than normal people, and their choice of words has become more flexible and diverse than usual. When the patient's thinking speed is too fast, it is too late to express orally, and the external performance can be "discontinuous thinking" and aimless. However, careful analysis may reveal the connection clues between words.
⑤ Attention is easy to disperse. The patient's activities are easily interrupted by what happens next to him, and the topic of conversation will keep changing. It is difficult for them to concentrate on the tasks they are engaged in, to do things in an anticlimactic way, to constantly find new goals, and to invest in new activities or plans.
The need for sleep is reduced, and less sleep is needed. The patient showed obvious lack of sleep, sleeping only a few hours a day without feeling tired. You can work day and night. The patient was too busy to sleep. Purposeful activities have obviously increased, and patients are on the phone all the time, making appointments and running around. To accomplish its great plan or mission.
⑦ Patients may play recklessly and act impulsively. Can be manifested as sexual misconduct; Pursue sexual pleasure unscrupulously; It can be manifested in the purchase behavior: coming back from the street with a bunch of unnecessary things; It can be manifested as blind business investment: investing everywhere, signing contracts everywhere, and finally losing everything. It can also be manifested as alcoholism and drug abuse, and even lead to drug abuse, prostitution and illegality.
Patients with manic episodes didn't realize what was wrong with their behavior at that time. During the onset, most of them will not take the initiative to seek medical treatment. It is often to a serious extent that it is sent to the hospital by family or friends. Or worse, those who are in legal trouble because of deviant behavior or breach of contract are lucky to be found to have been treated. Therefore, the early detection and diagnosis of abnormal behavior can not be ignored. Knowledge and vigilance can save a person, a family or even more people's lives, property, health and even life.
Treatment of manic depression
There are many effective treatments for bipolar disorder, but none of them can completely eradicate the disease or prevent its recurrence. Drug therapy can block the course of bipolar disorder, reduce the risk of suicide, improve the level of life, production and social function, and enable 40%-75% patients to reach a certain employment status and live independently. Drug combined with appropriate family psychotherapy is the most effective treatment scheme to reduce the recurrence rate and improve the functional level.
There is evidence that the more patients have attacks, the more difficult it is to treat the next attack, and the more likely it is to have frequent attacks. Wrong, inappropriate or inadequate treatment may make the whole course more complicated and more difficult to treat. A patient was misdiagnosed as simple depression, ignoring the history of manic episode or the possibility of manic episode. Only receiving antidepressant treatment may make the disease go to the other extreme, induce manic episode and worsen the whole course of disease.
The significance of careful typing diagnosis is not only to avoid the above treatment mistakes, but also to provide the necessary basis for correctly selecting treatment methods and drugs and improving the curative effect. Bipolar disorder can have various clinical manifestations in patients' life: mixed state, rapid circulation and psychotic episode can all appear as a stage in the disease process. These factors will affect the choice and combination of drugs in different periods. Different targeted drugs need to be selected for treatment at different stages of the course.
At present, the main treatment methods include drug therapy, shock therapy and psychotherapy. Only a little knowledge can be outlined here. Specific treatment is a complicated process of observation and adjustment, involving a wide range. Please ask patients and guardians not to make a decision to change treatment based on a few sentences in this article.
Family and Psychotherapy for Manic Depression
Clinical psychological research in recent decades shows that appropriate family psychotherapy and drugs
The combination of physical therapy and drug therapy can improve the compliance rate of patients and increase their psychological and social work.
It can reduce the psychological burden of patients' families, delay the recurrence and reduce the recurrence rate. at present
The widely studied and applied treatment mode is family education therapy.
Drug treatment of manic depression and its side effects
The most commonly used drugs for the treatment of bipolar disorder are as follows, among which lithium salt is effective for various episodes of bipolar disorder and is one of the most commonly used drugs for the treatment of bipolar disorder. Many new drugs have been continuously developed, some of which have been approved by relevant drug regulatory agencies, such as the Food and Drug Administration of the United States. The efficacy and possible side effects of these new drugs
It needs comprehensive observation in clinical practice to get accurate evaluation.
Lithium salt: Lithium salt is a compound produced by the combination of chemical element lithium and acidification. The most commonly used inorganic salt in clinic is lithium carbonate. It can effectively treat acute manic episode, and can also be used for preventive maintenance treatment of typical bipolar episode, and has certain antidepressant effect. Although there is no systematic research report, clinical practice shows that its curative effect is not as good as the former in the cases of rapid cycle attack, mixed attack state, secondary bipolar disorder, drug abuse and drug abuse.
Lithium salt treatment must be handled with care. It is effective in a very narrow blood concentration range: about 0.8-1.1mmol/L-clinically called the therapeutic window. Beyond this range, the probability of toxic and side effects rises sharply. Below this range, treatment may be ineffective or the disease may recur. Because of the difference of individual sensitivity to drugs, and it takes 7- 10 days to take effect, it is not an easy operation to master the dosage of drugs to reach the appropriate therapeutic concentration without overdose. Clinical medical routine generally requires that medication should be carried out under the monitoring of blood drug concentration. Lithium salt has many side effects, and it is easy to reach China poison.
The amount of toxic reaction. According to statistics, 30%-50% may stop taking drugs because of acute side effects. However, the sudden withdrawal of drugs from the mental system will produce very dangerous neurological and mental symptoms. It is very taboo to stop taking drugs without authorization in clinic. This needs to attract widespread attention and attention.
The side effects of lithium salt often appear in the early stage of treatment, which easily leads to patients refusing to take medicine. Common side effects include: cognitive impairment, tremor (muscle trembling), acne, thirst and polyuria, muscle weakness and weight gain. Chronic side effects include thyroid dysfunction and renal dysfunction. Especially for patients with family history of kidney disease, it is necessary to monitor the kidney.
Function. Lithium salt may also cause teratogenesis. The imbalance between water and electrolyte can lead to poisoning. Eating too much lithium salt will kill people.
Many drugs can interact with lithium salts. This may lead to changes in the serum concentration of drugs that interact with lithium after blood. For example, aminophylline and calcium channel blockers can reduce blood lithium concentration, while most psychotropic drugs, such as thiopyridazine and monoamine oxidase inhibitors, etc. Can increase the concentration of lithium in the blood. Other drugs can interact with lithium salts to produce neurotoxicity. When taking medicine, you must consult a psychologist who knows your condition, and never add or subtract drugs, including types and doses. Don't blindly believe the "good advice" of people who have not received special training in psychotropic drug treatment.
General treatment takes at least 2-3 months. You should not stop taking medicine within four weeks after you start taking it. When it is really necessary to stop using lithium salt in clinic, stopping using lithium salt should be a gradual process. Patients and their families take it according to the doctor's advice and increase or decrease the dose.
Sedative: For patients with acute manic episode and psychotic symptoms, strong sedatives are used to control restlessness symptoms in clinic, so as to achieve the purpose of controlling symptoms as soon as possible. There are two commonly used drugs: antipsychotics (psychodynamic drugs) and some antiepileptic drugs. The former includes phenazine (chlorpromazine, etc.). ), butyl benzene (haloperidol) and
Thianthracene (methimazole) and other drugs. It is mainly used to control acute restlessness, and it reacts faster than lithium salt. After controlling acute symptoms, switch to lithium salt or other antidepressants. Carbamazepine -CBZ and some benzodiazepines (lorazepam, clonazepam) are the main antiepileptic drugs used to treat bipolar disorder. CBZ is mainly used to treat acute manic episode, mixed episode and secondary bipolar disorder. It may not be so effective for rapid cycling bipolar disorder. The antidepressant effect of CBZ is weak, and it is mainly used for patients who are ineffective in lithium salt treatment. Benzodiazepine is a weak sedative, and the newly developed drug has many clinical applications. Among them, it has been found to have anti-mania effect.
shock therapy
Shock therapy includes electric shock (ECT) and drug shock, such as hypoglycemic shock therapy. The latter is a complicated and expensive treatment, which is not widely used. Only ECT treatment is introduced here. Shock therapy is effective for manic and depressive episodes. It is also used for other serious mental disorders, including severe simple depression and schizophrenia.
Effectiveness of drug therapy for manic depression
Generally speaking, classic bipolar disorder with less than three episodes per year responds well to lithium salt treatment. DVPX and CBZ are also effective for it. The clinical manifestation of rapid circulation can be a stage or a type of bipolar disorder. It may be caused by antidepressants, especially tricycles, and the sudden interruption of medication for bipolar disorder. Mixed seizures respond better to DVPX and CBZ than lithium salt. ECT treatment is mainly used in cases where drug treatment is ineffective or clinical treatment is very difficult. Some new drugs need further double-blind controlled studies to obtain enough clinical data for objective evaluation.
Diagnostic criteria of manic depression
For the diagnosis of manic depression, psychiatrists and scholars all over the world have formulated a variety of detailed and operable diagnostic standard systems. The diagnostic criteria we introduce here refer to ICD- 10 and DSM-IV. This paper briefly introduces the widely accepted basic framework.
To diagnose bipolar disorder, we must first make sure that the patient's symptoms meet the diagnostic criteria of affective disorder: mania or depression? Or mixed attacks. Then make the diagnosis of bipolar disorder and subtypes according to the course of disease and medical history. The diagnosis process must include detailed differential diagnosis, excluding other mental and physical diseases or drugs and treatments.
The possibility of seizure-like performance. The specific diagnostic criteria for affective disorder attacks are as follows:
Manic episode: Abnormal and persistent high mood or irritability during a certain period. For at least a week (if it is serious enough to require hospitalization, it doesn't have to last for a week). During the period of emotional abnormality, the following symptoms continue to show more than three kinds and reach a significant level. If the mood is irritable, you need more than four symptoms.
(1) excessive boasting and exaggerating ideas.
(2) The demand for sleep is reduced and less sleep is needed.
(3) increase the amount of speech or feel the need to speak.
(4) Associative growth or subjective experience thought escape.
⑤ Attention is easily diverted or distracted.
⑥ Increase the excitement of purposeful activities or speech movements.
All landowners unrestrained playful reckless and impulsive behavior (such as:
8 Unlimited shopping, sexual curiosity, or stupid investment]
Severity standard: emotional disorder is serious enough to affect work, social communication and interpersonal relationship; Or they must be hospitalized to prevent them from hurting themselves or others; Or characterized by mental illness.
Severe depressive episode
Within two weeks, five or more of the following symptoms occurred at the same time, including at least one of depression, loss of interest or pleasure. (not including other medical conditions clearly caused; Or symptoms caused by psychopathic delusions and hallucinations. 〕
(1) Indulge in depression most of the day, almost every day, either judged by subjective reports (sadness, emptiness) or observed by others (sad face, eyes full of tears); Among young children, they may be irritable.
(2) obviously losing interest or pleasure in all or almost all activities (or subjective reports or observations of others) for most of the day.
3 do not diet to lose weight; Or the weight has increased significantly (the change exceeds 5% in one month); Or this appetite is increasing or decreasing almost every day. Children can show that their weight gain is not up to normal standards.
④ Insomnia or lethargy almost every day.
⑤ Almost every day, verbal actions are exciting or slow.
6. I am tired almost every day or listless and lack of energy all day.
⑦ I feel useless, useless or guilty almost every day (it can be a delusion of self-guilt, not just self-blame or self-blame due to illness).
8 I can't make up my mind almost every day, and my thinking or concentration ability declines (or subjective report or observation by others).
Pet-name ruby recurring thoughts of death (not fear of death), suicidal thoughts without specific plans; Or a suicide attempt; Or want to commit suicide.
Severity standard: symptoms lead to major clinical problems or affect work, society or other important functions.
Exclusion diagnostic criteria: symptoms are not the direct physiological effects of something (such as drugs and drugs). ); Nor is it caused by some other physical disease state (such as hypothyroidism).
Symptoms cannot be explained by the loss of relatives; Symptoms last for more than two months or have obvious dysfunction, pathological self-deprecation, suicidal ideation, psychotic symptoms, or speech retardation.
Mixed seizure
In the past at least one week, I have encountered symptoms of manic and depressive episodes almost every day (except the time standard).
Meet the severity standards of both: emotional disorder is serious enough to affect work, social interaction and interpersonal relationships; Or they must be hospitalized to prevent them from hurting themselves or others; Or characterized by mental illness.
Meet the criteria of exclusion diagnosis: symptoms are not the direct physiological effects of something (such as drugs, drugs or other treatment measures); It is also not caused by some other medical conditions (such as hyperthyroidism).
Mild manic episode
Abnormal mood and persistent high or irritability for a certain period of time. The duration is at least four days. Emotional expression and non-depressed state are obviously different. During the period of emotional abnormality, the following symptoms continue to show more than three kinds and reach a significant level. If the mood is irritable, you need more than four symptoms.
(1) brag and exaggerate ideas
(2) The demand for sleep is reduced and less sleep is needed.
(3) increase the amount of speech or feel the need to speak.
(4) Associative growth or subjective experience thought escape.
⑤ Attention is easily diverted or distracted.
⑥ Increase the excitement of purposeful activities or speech movements.
All landowners unrestrained reckless play (such as:
8 Unlimited shopping, sexual curiosity, or stupid investment]
Depression is a common disease, but most patients with first-episode depression failed to seek medical treatment in time. This not only brings a lot of pain to patients, but also causes difficulties for future treatment, and may also lead to some unnecessary sacrifices. Some people only discovered that he was suffering from depression before his death after committing suicide, and depression was the chief culprit leading to his suicide. One of the reasons for these situations is that people with depression and most people around them lack basic understanding of this common disease. Many people don't know that depression is a very common mental illness, and its basic symptoms are depression and depression that everyone has experienced.
Not only lack of knowledge, but also many people make all kinds of wrong guesses based on their own experience, which delays the opportunity for patients to seek medical treatment. For example, some people think that depression is just an emotional reaction caused by unpleasant things. How can it be sick? In fact, the depression of depressed patients is generally not caused by verifiable unpleasant things. Normal people who have experienced unpleasant events and are depressed may be grateful for well-meaning comfort and support, while depressed patients may not respond positively to this. If there are bad stimuli before illness, the intensity and duration of emotional response of patients with depression are significantly higher than that of ordinary people to similar stimuli.
Besides depression, patients with depression may have the following eight manifestations: 1. There is no obvious reason for continuous fatigue, and it is difficult to recover after rest. 2. The activity is slow, and sometimes it may become easy to lose your temper over trifles. 3. I often blame myself, or feel guilty, and my self-evaluation is too low. 4. If the thinking speed slows down, the patient may feel stupid. 5. Insomnia, including difficulty in falling asleep, shallow and unstable sleep, especially early awakening, that is, the last awakening time of sleep is obviously ahead of schedule. 6. Loss of appetite, reduced food intake and possible significant weight loss. 7. Loss of libido and lack of interest in the opposite sex. 8. Repeated suicidal thoughts and even suicidal behaviors are the most serious symptoms of depression.
For those depressed patients who can't be solved by others and don't match the situation, consider whether they have depression. Especially those who have one of the above eight manifestations should consult a psychologist as soon as possible, so as to eliminate the disease in time and reduce unnecessary pain and sacrifice.