The Affective Disorders With Focus On Manic Depressive Psychosis (MDP): Clinical Manifestation And Etiology
Manic Depressive Psychosis
Manic Depressive Psychosis
The main affective disorder is manic depressive psychosis (MDP). The affect varies between the two poles of depression and elation. If the affect remains depressed or sad, the resulting illness is called MDP depression. Similarly, when the affect remains happy or elated, the resulting illness is called MDP-mania. Thus mania and depression are the two phases of MDP. Manic depressive psychosis is called “cyclic’ when depression and mania alternate with symptom-free intervals and is called “circular” when one phase of depression directly leads to mania or vice versa. In addition to the primary disturbance or affect, the other features of the illness include absence of personality deterioration; complete recovery from the symptoms after an episode, and symptom-free intervals between episodes. The illness is prone to recurrence.
Many etiological factors have been proposed. A dominant inheritance is postulated and about 10% of relatives of MDP patients show personality disorders such as cycloid temperament (rapid change of moods without any cause) and morphological abnormalities such as pyknic body build. Manic depressive psychosis is more common among the jewish race and it is more prevalent among females (M:F = 2:1). Physical illnesses like arteriosclerosis, head injury, neuro-syphilis and hypothyroidism may lead on to depression. Drugs such as reserpine may give rise to a high incidence of depression. Biochemical basis of psychiatric illness has been explored by several workers and some biochemical abnormalities have been detected in the brain in MDP. These include relative deficiency of dopamine and other amines such as serotonin and alternation in residual sodium. The residual sodium is found to be increased by fifty folds in depression and by two hundred folds in mania.
An MDP Manic patient
Symptomatology: Elation is the primary affective disturbance in mania. Generally, the manic patient appears well-dressed, often in colourful clothing and he is cheerful. He is entertaining and often highly interfering. He forms the focus of attention by his talk and jocularity. In the case of hypomania, the mood is euphoria- a generalized feeling of increased well-being. In case of manic excitement, the mood is one of excitement.
Speech: The patient is over talkative. The talk is often coherent, but may not be relevant. As the rate of talk is high, too many ideas may be crowded into the mind, giving rise to pressure of talk. Often, the ideas fly from topic to topic giving rise to “flight of ideas”. The talk may contain persecutory or grandiose delusions.
Disorders of perception such as hallucinations are rare in mania but illusions may be present during manic excitement. The manic patient shows overactivity. He may get up very early in the morning and engage himself in various kinds of unwanted activites which are all left incomplete. He unnecessarily interferes in the affairs of other people. In states of excitement, he may turn violent, aggressive, destruction and uncontrollable. Generally, the sexual urge is increased. Manic subjects are extravagant and may get involved in drug addiction and intoxication. The intelligence is well preserved. The power of retention (memory) shows apparent impairment since the attention is fleeting. Manic subjects lack insight and judgement.
Diagnosis: The diagnosis is based on the clinical features which include elation increased psychomotor activity, pressure of talk, flight of ideas and grandiose delusions. In the differential diagnosis, schizophrenia, GPI, phenobarbitone poisoning, alcoholic excitement and delirium have to be considered.
Course: The illness has a self-limiting course and the patient may recover with treatment but recurrence of mania or depression is common.
Treatment: The main drugs used in the treatment of mania are the tranquilisers. Electroconvulsive therapy (ECT) has also a role in selected cases.
Drugs can also be used. Examples are phenothiazine derivatives such as chlorpromazine hydrochloride (300 to 900 mg daily in three divided doses given orally. Or injection: 50 to 100 mg intramuscularly). Thioridazine hydrochloride (300 to 900 mg daily in three divided doses given orally). Haloperidol (5 to 15 mg given orally thrice daily); Lithium salts (Carbonate or sulphate: 750 to 1500 mg daily in three divided doses so as to maintain a serum level of 0.8 to 1.2 meq/liter) and Hypnotics such as nitrazepam are useful in the early phase to overcome insomnia. ECT is found useful in cases of manic excitement.
© 2014 Funom Theophilus Makama