How can I understand hypomania
Mania is a mental disorder in which the world of emotions, the experience of feeling and the expression of feelings are disturbed (affective disorder). Affected people live in phases in an intense but unfounded feeling of elation, accompanied by an excessively good mood and an increased self-esteem that is well above the normal average. Mania usually occurs in phases, and doctors refer to the symptomatic period as a manic episode. In the periods between two episodes, sufferers show no signs of mania.
During a manic episode, those affected are particularly productive, energetic and euphoric. Many things are started and quickly broken off again, deals are made, contracts are concluded. It is impossible for those affected to sit still for a period of time and do nothing. They often considerably overestimate their own strength, their own attractiveness and also their own financial resources and can inadvertently cause great damage to themselves or to those around them.
After a manic episode, people are often overwhelmed by feelings of guilt and shame and try to undo what they did during the mania.
It is very difficult for outsiders to deal with a mania. Those affected often show unrestrained, uninhibited disinhibition, are quickly irritated and do and say many things that normally fundamentally contradict their moral ideas.
The causes of mania are not fully understood. It is probably favored by several factors. It is assumed that with a certain hereditary disposition (disposition), various triggering events such as lasting changes in the life of those affected can trigger manic phases. However, mania can occur suddenly even without triggering factors.
Around every hundredth German suffers from an affective disorder, but pure manias only make up around five percent of them. It is generally assumed that the number of unreported cases in mania is high - not all manias are diagnosed. On the one hand, this is due to the fact that many of those affected only show mild symptoms that do not seriously affect everyday and professional life. On the other hand, many people feel ashamed to see a doctor with symptoms of a mental illness.
Manias in childhood and adolescence are rare. Most people affected have the first manic episode by the age of 25.
Other forms of mania
A weakened form of mania, in which the mood swings are still well above the normal state, is called hypomania. The risk of developing mania from hypomania is low.
Hypomania does not always require treatment. If those affected and their immediate environment are not fundamentally affected by the symptoms of hypomania, then no therapy is necessary.
Conditions resembling hypomania are also often reported by people who are sleep deprived, such as people on night or shift work.
The mania can also be combined with the symptoms of schizophrenia (schizoaffective psychosis).
The most important symptom of mania is an exaggerated and unusually intense but mostly unfounded feeling of elation that occurs suddenly and can last for several days. The following symptoms are associated with this feeling of elation:
- strong internal excitement
- excessive activity
- strong restlessness
- increased efficiency and creativity
- immeasurably increased self-confidence
- Loss of reality
- significantly reduced need for sleep
- Lack of distance in dealing with other people
- decreased consideration
- decreased perception of danger
- lack of sensitivity to the needs and feelings of others
- sometimes neglect of food intake and personal hygiene
It is often difficult for outsiders to keep up with the thoughts and actions of those affected. Their inner restlessness carries over to their actions and conversations with others. It is difficult to have a normal conversation with a manic. Manics jump with their thoughts from one topic to another and never stick to one thing for long. In addition, symptoms such as a strong urge to speak (logoreal) and slurred, unclear speech occur in mania. Manicists may speak so quickly that listeners are unable to understand anything at all.
It is also typical of mania that countless things are started at once, but nothing is completed. With great enthusiasm, those affected can tackle a new task from one second to the next and forget about it again within a few minutes. Sitting still for long periods of time or doing nothing for a few minutes is almost impossible for them.
Disinhibition can occur in mania in different areas of daily life. Almost all manic patients become distant and begin to address strangers indiscriminately, distribute gifts to strangers or invite an entire pub for a drink.
In the case of mania, there is also often disinhibition in the sexual area and increased sexual desire (libido). Sexual disinhibition takes place not only with regard to one's own partner, but also with regard to total strangers. Affected people often overestimate their own attractiveness during an episode.
Furthermore, mania can lead to an excessive buying frenzy; Transactions are carried out on a large scale or contracts are concluded, often far exceeding one's own financial resources.
In addition to these common symptoms, some people with mania also experience somewhat less common delusions. Most often it comes to the so-called megalomania. The transition between megalomania and excessive self-esteem is fluid. Manias with psychotic symptoms also develop delusions that can be defended as reality for several weeks - even in phases in which the mania has subsided. In very rare cases, hallucinations or waking dreams occur.
Rapid change of mood
It is crucial during a manic phase that the feeling of elation can turn into irritation within seconds, for example if something does not work as the affected person imagined it or if they experience contradiction from friends or acquaintances.
In some cases of mania, the loss of reality can become so pronounced that people develop suicidal ideation. Inpatient treatment in a psychiatric hospital is particularly necessary at such a stage. However, it is also dangerous that in the acute phase, as a result of the complete overestimation of themselves, many sufferers develop the feeling that they can fly. Due to the reduced ability to correctly recognize dangers, those affected can also endanger themselves and others, for example in traffic.
Behavior after a manic phase
As long as a manic phase persists, those affected are not susceptible to the information that they are in a pathological phase. If this is addressed by friends or family, patients react with irritation and incomprehension. Often, violent differences of opinion and insults to close or complete strangers are the result. Only when the phase of exhilaration has subsided will those affected realize what they have done and how they have acted. Above all, disinhibition often leads to actions that are in stark contradiction to the usual principles of those concerned. The phases after the feeling of elation are so often marked by serious self-reproaches and a deep feeling of guilt.
After a mania, people tend to try to undo what they did during the manic phase and to apologize to people who were involved.
Manic-depressive illness, in which phases of exaggerated feeling of excitement alternate with phases of depression, is one of the most common forms of mania.
Symptoms of hypomania
In hypomania, the symptoms of mania are less pronounced. Classic signs are an above-average good mood, increased self-esteem, increased activity, an increased willingness to take risks and increased sociability. In contrast to mania, hypomania leads to pronounced states of exhaustion. Those affected often sleep excessively long. Appetite can also change. People with hypomania either eat much more or less than normal.
Mania: causes and risk factors
The exact causes of the mania are still not fully understood. At present, the cause of a mania is mainly suspected to be a disturbance of the messenger substances (transmitters) in the brain. The neurotransmitters in the brain are responsible for transmitting nerve impulses. In most cases of mania there is an imbalance in these transmitters; the transmitters dopamine and noradrenaline are present in higher concentrations than in a healthy person.
So far, researchers have been able to identify several genes that could be partly responsible for the development of a bipolar disorder such as mania. However, these genes are also changed in many healthy people, so that they cannot be the sole cause of a mania. Even if these genes are changed, other factors must also be added in order for mania to develop.
In many cases, a manic episode is preceded by changes or significant events in the lives of those affected or close relatives. These can be events like:
- Job change
- End of a relationship
But mania can also develop without a triggering event.
Mania: examinations and diagnosis
In the rarest of cases, the symptoms of mania are felt by those affected. Manic phases tend to be perceived as liberating and enriching. During a manic episode, there is usually no insight into the disease. In the symptom-free time, those affected are often plagued by feelings of guilt and shame, but most of them find it very difficult to recognize the disease as such.
Although mania is a manifest and serious condition, it cannot be diagnosed by physical exams or clinical tests. A diagnosis of mania can only be made through long-term discussions with a family doctor or a psychiatrist and through detailed questioning of the person affected and their relatives. Usually it is relatives who initiate these conversations. It can help with the diagnosis if people suspected of having mania keep a mood diary or mood calendar.
The symptoms of mania vary in severity in every person. If the symptoms are very pronounced, it is easier for the attending physician to make a diagnosis. It is especially difficult if the symptoms differ only slightly from the basic personality of the person affected.
On average, it takes about ten years for the correct diagnosis to be made; in difficult cases it can take up to 15 years.
The treatment of mania usually consists of two components, drug treatment and psychotherapy or behavioral therapy.
In order to alleviate the acute symptoms of mania and to prevent new manic episodes, drugs such as lithium preparations, anti-epileptics or atypical neuroleptics are administered. They affect the transmitter activity in the brain and relieve symptoms. Sedatives can also be administered in the acute phase of mania. They dampen the restlessness and increased restlessness of those affected and enable them, for example, to sleep again.
For long-term therapy of mania and, above all, to avoid a relapse (relapse), those affected should also be treated with lithium salts such as lithium carbonate during the symptom-free period.
In addition to drug treatment, psychotherapy or behavioral therapy should be carried out in the case of mania. Those affected can learn to recognize the first signs of a manic episode, to avoid stimulating stimuli during a mania and to deal properly with an acute phase of illness.
Above all, those affected should learn to maintain a normal daily routine and to carry out their normal activities in a structured manner - such as a normal sleep rhythm. In this way, the symptoms can be reduced during an acute episode and it becomes easier for those around you to deal with those affected. Scientists also suspect that consistent psychotherapy can prevent many manic episodes in the long term.
Mania can show symptoms so strong that it is no longer possible to deal with affected people. In extreme cases, forced admission to a psychiatric facility may be necessary. The prerequisite is an acute risk to yourself or others, which must be confirmed by a judge in accordance with the requirements of country-specific law. Compulsory induction primarily serves to ensure that strangers are not endangered and that the person concerned is shielded from stimulating stimuli from the environment.
The admission can be followed by compulsory treatment, but this too must be approved by a judge and, depending on the facility, monitored by a second doctor.
Whether or not hypomania needs treatment depends on how often individual hypomanic phases occur and how much the person affected is affected by them in their professional and everyday life. Isolated hypomanic phases that do not seriously impair social and professional life do not need to be treated. However, if those affected or their relatives suffer severely from the symptoms of a hypomanic episode and if the person concerned is aware of the disease, treatment can be carried out with the help of psychotherapy or psychotropic drugs.
Minors with mania
When treating mania in children and adolescents, it must be borne in mind that some of the drugs used in adults do not show the same effectiveness in these age groups.
Mania: disease course and prognosis
As with other diseases, the same applies to mania: the earlier the right therapy is started, the better the prognosis.
According to scientific studies, mania shortens life expectancy by one to two percent. From an effective point of view, however, the persons concerned lose a lot of life that they could otherwise use.
After a first episode of illness, the probability of a second episode is around 95 percent. However, a relapse can be prevented with a suitable drug therapy (relapse prophylaxis).
In Germany, it usually takes about ten years for a final diagnosis to be made. During this time, many patients experience serious problems that can affect their private and professional life and worsen a mania. Relatives and friends often turn away because they no longer know how to deal with the sick person. Partnerships often break up or those affected are dismissed from their jobs. In many cases, those affected overestimate their material resources during a manic episode and plunge themselves and their loved ones into serious debt.
So if you notice symptoms of mania in yourself or a loved one, you should definitely consult a doctor as soon as possible - with one that has been consistently treated mania you can lead a symptom-free life!
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