Saturday, May 14, 2022

What Happens In The Brain During A Manic Episode

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How Long Do Manic Episodes Last

What Happens During a Manic Episode? (Mental Health Guru)

Untreated, an episode of mania can last anywhere from a few days to several months. Most commonly, symptoms continue for a few weeks to a few months. Depression may follow shortly after, or not appear for weeks or months. Many people with bipolar I disorder experience long periods without symptoms in between episodes.

Signs And Symptoms Of Mania

Many people wonder, What does mania feel like? There are multiple signs of mania that are experienced during a manic episode. These mania symptoms include:

  • Increased energy
  • Extreme talkativeness

The signs of bipolar mania include these manic episode symptoms over a prolonged period, normally for at least one week.

Does Medication Always Prevent Mania

Dr. Ghaemi:

In my view, a big problem is that bipolar patients are on the wrong medications. They often will get mood stabilizers and anti-psychotics these days, but they also are getting anti-depressants. And there is increasing evidence that anti-depressants counteract the benefits of the other drugs. They basically break through the mood stabilizers, and they destabilize patients, and they get manic anyway. One big reason patients continue to experience mania even though they are on medications is that they are on drugs that cause mania, like anti-depressants, and they therefore are getting more manic episodes than they would have naturally had without those drugs.

Another cause is that they often dont get the mood stabilizers, which prevent mania. They instead will get anti-psychotics, which, although they work short term, may not actually have as much long-term prevention benefit.

So its sort of like if you were to have coronary artery disease and you get on appropriate cardiac medications, you might still have a heart attack. You cant make it go away completely in terms of the risks, but you certainly do decrease the risks with the appropriate medications.

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Whats The Difference Between Mania And Adhd

Mania occurs in episodes, whereas ADHD is a chronic condition.

Some common mania symptoms in children include:

  • Heightened activity levels
  • Easily distractible
  • Problems with falling or staying asleep

If your child is showing signs of mania or depression, talk to their pediatrician or your family doctor as soon as possible. Moods and behaviors often return to baseline after manic episodes.

Signaling Networks: The Cellular Cogwheels Underlying Long

Introductory Psychology: Depression

More recently, research into the pathophysiology and treatment of mooddisorders has moved from a focus on neurotransmitters and cell surface receptorsto intracellular signaling cascades.

Multicomponent, cellular signaling pathways interact at various levels,thereby forming complex signaling networks which allow the cell to receive,process, and respond to information . These networks facilitate the integrationof signals across multiple time scales, the generation of distinct outputsdepending on input strength and duration, and regulate intricate feed-forwardand feedback loops . Given their widespread and crucial role in the integrationand fine-tuning of physiologic processes, it is not surprising that abnormalitiesin signaling pathways have now been identified in a variety of human diseases. Furthermore, signaling pathways representmajor targets for a number of hormones, including glucocorticoids, thyroidhormones, and gonadal steroids . These biochemical effects may play arole in mediating certain clinical manifestations of altered hormonal levelsin mood disorder subjects .

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What Triggers Bipolar Episodes

Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:Having a first-degree relative, such as a parent or sibling, with bipolar disorder.Periods of high stress, such as the death of a loved one or other traumatic event.Drug or alcohol abuse.Feb 16, 2021

Can Bipolar Show Up On A Brain Scan

Differences may be physical or show diminished or increased activity in the brain. Currently, doctors do not use brain images to diagnose bipolar disorder. However, as research advances, more evidence may help doctors use MRI scans or other imaging technology to accurately diagnose bipolar disorder.

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Understanding Manic Episodes Of Bipolar Disorder

The way bipolar disorder symptoms manifest, the duration of symptoms, and the overall effect on a person may vary greatly from person to person. The manic symptoms of bipolar disorder may be especially difficult for some people to understand as people may react differently during these episodes. For example, when manic episodes occur, one person may experience mania or hypomania episodes with feelings of frustration or irritability while another may exhibit a decreased need for sleep, accelerated thinking, or hyperactivity.

When manic symptoms of bipolar disorder emerge, its not uncommon for one to experience feelings of creativity, heightened energy, or euphoria. Some people may feel they are destined for greatness or are invincible.

While the overall feeling of increased energy and euphoria may feel good at first, manic episodes can cause a spiral in emotions. For instance, during this phase, some people engage in dangerous or inappropriate behavior. They may become sexually promiscuous, gamble, or go on spending sprees. Some people are easily angered, may start fights or lash out at others, or blame those who criticize their behavior.

Some common symptoms of manic episodes include:

  • Sleeping less, but feeling extremely energetic
  • Racing thoughts that jump from one subject to another quickly
  • Talking rapidly
  • Difficulty concentrating, easily distracted

Can You Have Mild Mania Without Depression

My Experience with Mania (Bipolar Disorder)

Dr. Ghaemi:

Now, the better question would be, what if there is no depression? Can people just have mild mania? And the answer to that is at one level it appears that God or nature or Darwin or whoever evolved our brains or created our brains did it in such a way that it doesnt seem that episodic, mild mania can happen by itself. It has not really been described that people can have intermittent hypomania and nothing else, no depression. It can happen, but its probably rare. Just having manic episodes without depressive episodes is reported in maybe 5 to 10 percent of bipolar patients, and we dont really know if just having hypomanic episodes can happen.

Now, that being said, there is something else, and that is that there are many people that dont have episodic hypomania, but they do have kind of a chronic hypomania. Its part of their personality that they have high energy, a decreased need for sleep, high levels of activity, increased libido and so on. And the phrase thats being used for them in recent years is hyperthymic personality. People may have heard of dysthymia, which is chronic low-level depression. Thats parts of the DSM-IV diagnostic system. But hyperthymia has not been part of that system. Sometimes people use the word cyclothymia for when patients go back and forth between low-level hypomanic symptoms and low-level depression symptoms.

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Bipolar Disorder And Neurochemistry

The brain uses a number of chemicals as messengers to communicate with other parts of the brain and nervous system. These chemical messengers, known as neurotransmitters, are essential to all of the brain’s functions. Since they are messengers, they typically come from one place and go to another to deliver their messages. Where one neuron or nerve cell ends, another one begins.

In between two linked neurons is a tiny space or gap called a synapse. In a simple scenario, one cell sends a neurotransmitter message across this gap and the next cell receives the signal by catching the messenger chemical as it floats across the gap. The receiving neuron’s capture of the neurotransmitter chemicals alerts it that a message has been sent, and this neuron in turn sends a new message off to additional neurons that it is connected to, and so on down the line.

Neurons cannot communicate with each other except by means of this synaptic chemical message. The brain would cease to function in an instant if chemical messengers were somehow removed. By providing a way for allowing neurons to communicate with one another, neurotransmitters literally allow the brain to function. There are millions and millions of individual synapses, or gaps, in the brain. The neurotransmitter traffic and activity happening inside those gaps is constant and complicated.

Imaging Studies Of Mania

Data from neurocognitive studies indicate widespread impairments in executive, attentional, and emotional function during the manic phase of bipolar disorder. Functional imaging studies that scanned manic patients at, rest, have indicated changes in blood flow and metabolism, particularly in the orbitofrontal cortex.,- The disadvantage of these resting state studies is that it is not, possible to control for thought content during scanning, and increased activity may relate to aspects of the manic state like flights of ideas. Consequently, recent work has scanned patients while they perform a neuropsychological task, in order to investigate task-related neural activity. For example, Rubinsztein et al scanned a small number of manic patients with positron emission tomography while they performed a variant, of the Cambridge Gamble Task in the scanner . Blocks of a decision-making task were contrasted against blocks of a control task that was matched for visual and motor demands, but, without the requirement, for risk assessment, and decision-making. Compared with demographicallymatched healthy controls, the manic cases showed a dysregulation of medial and ventral prefrontal circuitry during risky decision-making.

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Early Identification And Intervention Improve Outcomes

Treatment interventions that improve PFC modulation might improve outcome

Can we find the molecular basis of BPD1 to enable therapeutic intervention and improve the lives of people with BPD1, asked Professor Strakowski.

Imaging and other measures can be used to identify those patients at high risk of BPD1, and treatment interventions that improve PFC modulation might be able to impact the course of the illness, Professor Strakowski said. Decreases in brain activation have been observed in patients being treated for BPD1, providing evidence for potential neuroanatomic treatment response markers in first-episode BPD1.2

The natural course of the illness is shortening intervals between episodes of BPD1 over time. Lateral ventriculomegaly is greater in BPD1 patients, who have had repeated manic episodes and is associated with the number of previous manic episodes.5 This is probably part of the progressive course, said Professor Strakowski. A similar finding has been found in the cerebellum, but further work is needed to clarify the changes.

The biggest predictor of treatment response is prior treatment response, concluded Professor Strakowski. Most importantly, patients who adhere to early treatment and who avoid recreational drugs and alcohol have much better outcomes, and most can lead normal lives with good management.

No Euphoria: Distinguishing Bipolar Mania From Hypomania

Ch16 ppt

Dr. Ghaemi:

If I were to give you a sense of the frequency of mania, probably about one-third of all classic, full manic episodes involve euphoria or feeling extremely happy. In the other two-thirds, the mood is usually irritable or angry. So its not only the case that mania is not simply euphoria. Its not even usually euphoria.

We use the word hypomania to describe a milder version of mania, and the big distinction between the two terms, mania and hypomania, is really about a patients functioning. If the patient is unable to function at work or has a lot of conflict at home with spouse and family, then thats a manic episode. However, if the patient has those manic symptoms of high energy and activity but they are not leading to problems with functioning often, in fact, patients function better, especially at work then we call it hypomania.

Another distinction between the two conditions is that manic episodes tend to last a longer period of time. We could say that they should last a minimum of a week. However, they usually last a few weeks to a few months. And hypomanic periods last a shorter amount of time. The minimum is four days, and they typically last a few weeks.

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What Happens In The Manic Phase Of Bipolar Disorder

Medically Reviewed By: Aaron Dutil

Are you or someone you know affected by mood swings that seem extreme or out of the ordinary? Do those changes in mood affect your ability to stay focused or complete tasks? While occasional changes in mood are normal, when those changes occur often, or without obvious reason, they may be a reason for concern. For some, these could be signs of a mental health disorder known as bipolar disorder. Because not everyone who has bipolar disorder has been properly diagnosed or is receiving treatment, it is important to understand the symptoms and know when to seek help.

Risk Factors For Developing Bipolar Disorder

The exact cause of bipolar disorder remains unknown among mental health professionals. Scientists believe that there is a genetic component that may cause the disorder to run in some families. However, while people are genetically predisposed to be at risk of developing bipolar disorder, not everyone who has a family member with the disorder will experience it. Environmental factors such as gender, stress, and alcohol or substance abuse are also thought to be contributing factors to the development of bipolar disorder.

Family Tendencies

If you have a first-degree relative with bipolar disorder, such as a parent or sibling, you may be at higher risk for developing the disorder. For many people, the first symptoms tend to There is not appear during teenage years or early adulthood. Although bipolar disorder can be diagnosed at any age, the typical age of onset is 25.


While men and women are equally affected by bipolar disorder, there are some symptoms that are more specific to each gender. For example, women are more likely to experience rapid cycling mood episodes. Additionally, they are more likely to experience mixed and depressive episodes compared to men with the disorder. Men, on the other hand, may exhibit bipolar disorder symptoms such as anger, hostility, or aggression.


Alcohol or Substance Abuse

Although alcohol and other substances do not cause bipolar disorder, their use can hasten the onset of symptoms and make the associated mood episodes worse.

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Abnormalities Of Calcium Signaling

Calcium ions play a critical role in regulating the synthesis and releaseof neurotransmitters, neuronal excitability, and long-term neuroplastic events,and it is thus not surprising that a number of studies have investigated intracellularCa2+ in peripheral cells in BD . These studies have consistently revealedelevations in both resting and stimulated intracellular Ca2+ levelsin platelets, lymphocytes and neutrophils of patients with BD. The regulationof free intracellular Ca2+ is a complex, multi-faceted process,and the abnormalities observed in BD could arise from abnormalities at a varietyof levels . Ongoing studies shouldserve to delineate the specific regulatory sites at which the impairment occursin BD.

How Do You Sleep When Your Manic

bipolar episode caught on tape | manic night

Sleep hygiene tips

  • Create a schedule. Establish a regular time to go to sleep at night and to wake up in the morning. …
  • Optimize your bedroom. Sleep hygiene also involves making the bedroom as comfortable as possible. …
  • Limit other activities. …
  • Adjust your diet and exercise. …
  • Take time to relax.
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    Bipolar Disorder And Endocrinology

    Neurotransmitters are not the only important chemical messengers in the body. The body also uses hormones as chemical messengers. Produced in the endocrine system, hormones circulate from one organ to another through the bloodstream. Receiving organs in the body interpret hormonal signals and respond to their messages.

    The endocrine and nervous systems are linked by the hypothalamus. This is a centrally located ‘switching station’ within the brain. The hypothalamus is an exceptionally complex brain region. It controls many different body functions such as blood pressure, appetite, immune responses, body temperature, maternal behavior, and body rhythms dealing with circadian and seasonal rhythms. This coordination of circadian and seasonal body rhythms is particularly important when discussing bipolar disorder. .

    Another component of the endocrine system which is known to cause mood fluctuations when not being regulated correctly is the reproductive system. As reproductive hormones are known to affect mood, most prominently in women, the source of this effect is thought to be the ovaries which secrete estrogen and testosterone. Although the role sex hormones play in mood conditions are well documented , exactly how these hormones affect mood is unclear. There is little information available currently regarding their possible role in causing or maintaining bipolar symptoms.

    Increased Talkativeness Or Fast Speech

    While some people naturally speak more frequently or more quickly than others, people with mania only do this during a manic episode. It is a noticeable difference from their regular speech behavior, but others may be able to detect the change more readily. Speaking more loudly than usual is another mania symptom.

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    Brain Perfusion And Cognitive Performance At Follow

    • Emotional network perfusion: Processing Speed Test with decreased perfusion in the bilateral dACC, the left TP, and correlate positively with the OFC perfusion asymmetry, the Verbal Fluency Test with the increased perfusion in the bilateral ACC, Delay Verbal Learning Test correlate negatively with the TP perfusion asymmetry.
    • Working memory network: Processing Speed Test with decreased perfusion in the bilateral DLPFC and the left FPC Verbal Fluency Test correlate positively with the DLPFC perfusion asymmetry.
    • Language network: Processing Speed Test with perfusion decreased in the right MTG and the right STG.

    Another study described similar results of increased perfusion at temporal, frontal and limbic areas in resting state associated with poor executive functions in patients with BD .

    Similarly, other authors have found increased perfusion at limbic network-related areas in euthymic BD type II patients. This has been associated with decreased processing speed when compared to healthy subjects, who had greater activation in parietal areas . Another study, using PET scans, euthymic BD patients have shown hypometabolism in prefrontal areas related to verbal fluency test, with no temporal changes .

    The Warning Signs Of A Manic Episode

    Quick description : bipolar

    If you’ve already been diagnosed with bipolar disorder, know your own warning signs of mania, says Dr. Duckworth. For example, you may start:

    • Driving faster than usual
    • Having agitated mannerisms
    • Singing a certain song or using certain phrases

    “One thing we’ve learned is that people have predictable episodes of mania. If you can recognize patterns and allow people in your life to give you feedback without activating your own defensiveness, then you can participate in collaborative problem-solving,” says Dr. Duckworth.

    Also, realize that early manic episodes can be “seductive,” says Dr. Duckworth. “Some people prefer it because they feel that they’re more open, funnier, and interesting. The experience can be reinforcing in the beginning,” he says. However, mania can also lead to extreme agitation or irritability, which ultimately won’t feel good.

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