Manic-Depressive Disorder

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					                    Manic-Depressive Disorder

What is manic-depressive disorder?

It is a mental disorder characterized by elated mood or depressed mood states
with related symptoms. It is also called mood disorder. The main feature is
cyclic swing of elated or depressed mood. It has periods of remission or
recurrence. When the patient is in remitted state, he will function normally.
Its prognosis is quite good. A minority of patients may run a chronic course.



What are the causes of manic-depressive disorder?

1)    genetic factor :
      Twins and first degree relatives of patients have higher chance of
      getting this disorder.
2)    neurotransmitter disturbance in the brain :
      Studies showed abnormalities of some neurotransmitters, like
      dopamine, serotonin.
3)    Periodic pattern :
      There is seasonal trend. Manic episodes usually occur in summer and
      depressive episodes usually occur in winter.



How do you know that you have the disorder?

1)    Manic state :
      (a)   Elated mood: happy mood, optimistic attitude, sustained elation,
            irritability, easily getting angry upon trivial matters, aggression
            to people or properties.
      (b)   Flight of ideas : racing thoughts, talkativeness, husky voice due
            to speaking a lot, inflated self-esteem, boastfulness
      (c)   Increased will power : over-friendliness, full of ideas, increased
            social activities, inability to finish business, distractibility,
            over-expansiveness, over-buying things, increased cosmetic
            concern of female patients, casual sex attitude, increased libido,
            reduced need for sleep yet remaining energetic all the time.
2)   Depressed state :
     (a)   Depressed mood : low mood, negative cognitions, hopelessness,
           reduced energy, reduced interest, loss of feelings to relatives,
           hopelessness about present and future life, social withdrawal
           from friends or relatives
     (b)   Retarded thinking : slow thinking speed, poverty of thoughts,
           sluggish response, soft voice, hypochondriacal attitude,
           suspicion of oneself having contracted incurable illness
     (c)   Decreased will power : passive lifestyle, reduced activity,
           sluggish response, idling in bed, social withdrawal, self-neglect
           at severe stage including refusal to eat and drink, activity of
           living dependent on others, suicidal idea or attempt present at
           the severest stage of depressive illness.



What are the treatments for manic-depressive disorder?

1)   Medication :
     (a)  Mood stabilizers:
          Lithium therapy reduces the frequency of relapse. Doctors will
          regularly check the blood lithium level. In case of presence of
          nausea, vomiting, diarrhea, confusion, muscle weakness, gross
          tremor, muscle twitching, unsteady gait, irrelevant speech while
          taking lithium, patient should consult doctor at once.
     (b)  Anti-depressants.
     (c)  Anti-psychotics.


2)   Electroconvulsive therapy: mainly used for severely depressed
     patients.


3)   Other rehabilitative therapy :
     (a)   Self-care training : personal hygiene, money management,
           cooking skill, knowledge of community support network,
           domestic safety, domestic hygiene
     (b)   Mental health education : knowledge of various mental
           disorders and psychiatric medication
(c)   Counseling and training on home-living and social skills
(d)   Psychological treatment : stress management workshop, skills in
      managing worries, skills in managing delusions and
      hallucinations
(e)   Vocational rehabilitative training : training on vocational skills
      and work attitude
(f)   Special accommodation arrangement : half-way house,
      compassionate re-housing, long-stay care home
(g)   Financial assistance: case medical officer refers patients to social
      workers for financial assistance.

				
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