TREATMENT
MANIA
Dr. L.R. KHAN INTRODUCTION
Mood refers to the internal emotionl state fo an individual; affect,to the external experssion of emotional content.Mood may be normal,elevated,or depessed.A normal individual experiences a wide range of moods and has an equally large reportoire of affecive experssions he feels in control of his moods and affects.Patient of mania demostrae expeansivencess,flight of ides,decrased sleep,heightened self-esteem,and randiose ideas.This disorder vartually always results in impaired interpersonal,social and occupational function.
Incidence The lifetime expectancy of developing mania is abut 1 percent in both men and women.In mania the prevalence is only very slightly higher in females(about 1.2 to 1)Mania begins somewhat earlier,the range being from childhood to 50 years with mean age of 30.Mania may be more common in devorced and single individuals than among married persons. There appears to be a higher incidence among the upper socioecnomic classes.
SYMPTOMS
* Adistinct period of abnormally and persitently elevated,expansive,or irritable mood.
*Inflated self-esteem or grandiosity.
*Decreased need for sleep.
*More talkative that usual or pressure to keep talking.
*Flight of ideas or subjective experience that thoughts are racing.
*Distractibility,i.e.attention too easily drawn to unimportant or irralevant external stimuli.
*Increase in goal-directed activity(either socially,at work or school,or sexually)or psychomotor agitation.
*Excessive incolvement in pleasurable activites which have a high potential for painful consequences.
Mood distubace sufficiently severe to cause marked impariment in occupational functioning in usual social activities or relationships with others.

CAUSES
Mania can be due to biological psychological causes. There is increased Dopaminergic activity in brain. Mania also runs in families.If one parent has got mania them there is 25% chance of children having mania.If both parents suffer from mania there is 75% chance of children having this illness.If one of the monozygotic twins has this illness,in two out of three the other twin also gets the illness. According to Heinz Kohuta person who gives himself excessive importance(Narcissit)passes through periods of elation and depression hence suffers from mania.
Mania is a recurrings illness.Most of the pts experience both depression and mania alternatively.Initially mania is associated with precipitating events.This is not so as disese progresses.An untreated mania episode lasts upto 3 months,therfore,it is unwise to discontue drugs before that time.

PROGNOSIS
Mania has prognosis than depression.pts with mixed symptoms have worse fate.15% pts do well in long term.45% pts. have more than one episode.

TREATMENT
The first and most critical decision doctor has to take is whether to hospitalies the patinet.Risk of suicide or homicide,reduced ability to care for self,rapidly progressing symptoms and lack of social support sysmtem,are the then reasons for pt. tobe hospitaliesed. There are certain drugs that treat mood disorder(thymoleptics).A doctor has to treat a pt by drugs and psychotherpy.The drug of choice for treatment of mania is Lithium.The Lithium dose has to be about 800 to 1200 mg/d in the acute illness.Pt gets improvment. in 8 to 10 days,however it should be continued atleast for one month.If pt does nto improve withlithium he can be given L-tryptopan and carbamezapine. Drugs should be continued for 4 to 6 month.On the basis of past history a pt may be put on maintanance does of lithium which is about 400 to 800 mg/day.lithium reduces number,severity and length of mania episode.Liithium maintance is discontinued after pt is symptom free for a significant period.Pt is also given anti psychotic drusgs like Haloperidol and Chlorpromazine to cool down.Pt is given ECT(Shock Treatment)along with drugs.
(Author is Consultant Psychiatrist at Raahat Hospital, Aurangabad.)