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Manic Depression

Manic Depression

BIBLIOGRAPHY

Many lay people use the name manic depression to refer to a disorder that is more formally called bipolar disorder within the diagnostic system of the American Psychiatric Association. In this formal diagnostic system, there are three forms of bipolar disorder. Bipolar I disorder, the most severe form, is defined by a single episode of mania. Manic episodes are characterized by a period of expansive, elevated, or irritable moods, along with such symptoms as diminished need for sleep, rapid speech, grandiosity, agitation or increased activity, racing thoughts, and increased engagement in pleasurable activities that have potential to cause trouble. The symptoms must last for at least one week and create severe impairment. Bipolar II disorder is a milder form of the disorder, defined on the basis of hypomania and recurrent depression. Hypomania is characterized by the same set of symptoms as mania, but symptoms must only last for four days and do not create severe impairment. Cyclothymia is defined by frequent ups and downs that are not severe enough to meet the criteria for hypomania or mania.

Two measures commonly used to verify diagnoses within research studies include Michael B. First and M. Gibbonss 2004 Structured Clinical Interview for DSM -IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.), and Jean Endicott and Robert L. Spitzers 1978 Schedule for Affective Disorders and Schizophrenia. No biological markers are available to aid with diagnosis.

About 1 percent of the population experiences bipolar I disorder; it was estimated in 2005 by Ronald C. Kessler et al. that bipolar II disorder also affects approximately 1 percent of the population. Cyclothymia may affect 4 percent of the population, according to a 2004 study by E. J. Regeer et al. The vast majority of people with a single episode of mania will experience another episode during their lifetime, many within five years, reported Michael J. Gitlin et al. in 1995. A 2002 report by Lewis L. Judd et al. said that mild symptoms lingering between episodes are common. The median time of onset for this disorder has been estimated at twenty-five years of age, according to the report by Kessler et al., but at least 25 percent of affected people report that episodes began by age seventeen.

It is well established that bipolar disorder is biologically based: heritability accounts for as much as 85 percent of whether people develop mania, according to a 2003 report from Peter McGuffin et al. Neurobiological research in 2003 by Craig A. Stockmeier suggests that a set of brain regions, modulated by dopamine and serotonin, are involved in the disorder. Psychosocial variables, including negative life events, negative cognition, and family hostility and criticism can increase the risk of depressive episodes within this disorder, per several reports (Butzlaff and Hooley 1998; Monroe et al. 2001; Alloy et al. 2000). Sleep loss and events involving goal attainment can predict increases in mania over time (Johnson 2005a, 2005b; Malkoff-Schwartz et al. 1998, 2000).

Historically, treatments for this disorder, including psychotherapy alone or hospitalization, were not very effective. The discovery of lithiums mood-stabilizing effects led to dramatic gains in outcome. The dominant treatment approach is mood-stabilizing medication. The first-line treatment recommendation remains lithium, but if side effects are difficult to tolerate, anticonvulsant medications are also useful mood stabilizers. Antidepressants are often added to combat depression, but not without a mood stabilizer because antidepressants can provoke manic symptoms when administered alone (Altshuler et al. 1995; Goldberg and Whiteside 2002). Antipsychotic medications can address psychotic or agitation symptoms. Research in 2004 by Sheri L. Johnson and Robert L. Leahy indicates that family or individual talk therapy can be helpful supplements to medication.

SEE ALSO Depression, Psychological; Manias

BIBLIOGRAPHY

Alloy, Lauren B., Lyn Y. Abramson, Michael E. Hogan, et al. 2000. The Temple-Wisconsin Cognitive Vulnerability to Depression Project: Lifetime History of Axis I Psychopathology in Individuals at High and Low Cognitive Risk for Depression. Journal of Abnormal Psychology 109: 403-418.

Altshuler, Lori L., Robert M. Post, Gabriele S. Leverich, et al. 1995. Antidepressant-induced Mania and Cycle Acceleration: A Controversy Revisited. American Journal of Psychiatry 152: 1130-1138.

American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders (DSM -IV-TR). 4th ed., text rev. Washington, DC: Author.

Butzlaff, Ronald L., and Jill M. Hooley. 1998. Expressed Emotion and Psychiatric Relapse: A Meta-analysis. Archives of General Psychiatry 55: 547-552.

Endicott, Jean, and Robert L. Spitzer. 1978. A Diagnostic Interview: The Schedule for Affective Disorders and Schizophrenia. Archives of General Psychiatry 35 (7): 837-844.

First, Michael B., and M. Gibbon. 2004. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). In Comprehensive Handbook of Psychological Assessment. Vol. 2: Personality Assessment, eds. Mark J. Hilsenroth and Daniel L. Segal, 134-143. Hoboken, NJ: Wiley.

Gitlin, Michael J., Joel Swendsen, Tracy L. Heller, and Constance Hammen. 1995. Relapse and Impairment in Bipolar Disorder. American Journal of Psychiatry 152: 1635-1640.

Goldberg, Joseph F., and Joyce E. Whiteside. 2002. The Association between Substance Abuse and Antidepressant-induced Mania in Bipolar Disorder: A Preliminary Study. Journal of Clinical Psychiatry 63: 791-795.

Johnson, Sheri L. 2005a. Life Events in Bipolar Disorder: Towards More Specific Models. Clinical Psychology Review 25: 1008-1027.

Johnson, Sheri L. 2005b. Mania and Dysregulation in Goal Pursuit. Clinical Psychology Review 25: 241-262.

Johnson, Sheri L., and Robert L. Leahy, eds. 2004. Psychological Treatment of Bipolar Disorder. New York: Guilford.

Judd, Lewis L., Hagop S. Akiskal, Pamela J. Schettler, et al. 2002. The Long-Term Natural History of the Weekly Symptomatic Status of Bipolar I Disorder. Archives of General Psychiatry 59: 530-537.

Kessler, Ronald C., Wai Tat Chiu, Olga Demler, and Ellen E. Walters. 2005. Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62 (6): 617-627.

Malkoff-Schwartz, Susan, Ellen Frank, Barbara Anderson, et al. 1998. Stressful Life Events and Social Rhythm Disruption in the Onset of Manic and Depressive Bipolar Episodes: A Preliminary Investigation. Archives of General Psychiatry 55: 702-707.

Malkoff-Schwartz, Susan, Ellen Frank, Barbara Anderson, et al. 2000. Social Rhythm Disruption and Stressful Life Events in the Onset of Bipolar and Unipolar Episodes. Psychological Medicine 30: 1005-1016.

McGuffin, Peter, Fruhling Rijsdijk, Martin Andrew, et al. 2003. The Heritability of Bipolar Affective Disorder and the Genetic Relationship to Unipolar Depression. Archives of General Psychiatry 60: 497-502.

Monroe, Scott M., Kate Harkness, Anne D. Simons, and Michael E. Thase. 2001. Life Stress and the Symptoms of Major Depression. Journal of Nervous and Mental Disease 189: 168-175.

Regeer, E. J., M. ten Have, M. L. Rosso, et al. 2004. Prevalence of Bipolar Disorder in the General Population: A Reappraisal Study of the Netherlands Mental Health Survey and Incidence Study. Acta Psychiatrica Scandinavica 110 (5): 374-382.

Stockmeier, Craig A. 2003. Involvement of Serotonin in Depression: Evidence from Postmortem and Imaging Studies of Serotonin Receptors and the Serotonin Transporter. Journal of Psychiatric Research 37: 357-373.

Sheri L. Johnson

Christopher Miller

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Manic episode

Manic episode

Definition

A discrete period lasting a week or more during which a person experiences mania, an abnormally elevated, cheerful, or euphoric mood.

Description

A person experiencing a manic episode shows persistent and often inappropriate enthusiasm which may involve taking on new projects for which he or she is ill suited. It might also involve engaging strangers in detailed conversations, acting without concern for consequences of one's actions, or increased sexual activities. Less commonly, a person may be abnormally irritable during a manic episode. On average, the episodes begin before age 25. This means that some individuals experience their first episode while in their teens and others during middle age.

Psychiatrists use five criteria to identify someone in the midst of this type of mood episode. First, the period of abnormal behavior must persist for at least one week unless the person is admitted to a hospital. Typically, the episodes last from a few weeks to a few months. Second, the diagnosis requires three additional symptoms if the mood change results in expansive behavior, or four if it results in unnatural irritability. These symptoms include an unwarranted sense of self-importance, a tendency to be easily distracted, a decreased need for sleep, a rapid flow of ideas with one replacing another before the first is acted upon, an inability to sit still or increased activity directed at achieving some goal, an irrepressible need to talk, and finally, a devotion to some activity the patient finds pleasurable but could be harmful. The third criterion is that the symptoms do not qualify the patient for a diagnosis of mixed episode . Fourth, the patient can not function normally at home or at work, or shows signs of psychosis . The fifth and last criterion is that the cause of the episode can not be attributed to side effects from any drug abuse, medication, medical treatment, or medical condition.

Many of these symptoms are also present in a hypomanic episode. A hypomanic episode is similar to a manic episode, but the symptoms may be experienced to a lesser extent. The main differences between a manic and hypomanic episode are the following:

  • A hypomanic episode may only last four days, whereas a manic episode, by definition, lasts one week.
  • In a manic episode, psychotic features (hallucinations and delusions ) may be present, but in a hypomanic episode, they cannot be.
  • A manic episode significantly impairs the affected person's functions, but a hypomanic episode does not.

Both of these kinds of episodes may be seen in patients with bipolar disorder .

Dean A. Haycock, Ph.D.

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manic depression

manic depression (bipolar disorder) Mental illness featuring recurrent bouts of depression, possibly alternating with periods of mania. Depressive and manic symptoms may alternate in a cyclical pattern, be mixed or be separated by periods of remission and disturbances of thought and judgement.

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manic depression

man·ic de·pres·sion • n. another term, esp. formerly, for bipolar disorder. DERIVATIVES: man·ic-de·pres·sive adj. & n.

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manic depression

manic depression n. a former (but still quite commonly used) term for bipolar affective disorder.

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manic-depressive disorder

manic-depressive disorder or manic-depression: see bipolar disorder.

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