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MANIAC-DEPRESSIVE
ILLNESS
This is a disorder
characterized by a state of either elation or
depression or of intermediate mixed states.
It occurs in about three people in
every 1000 of the population. Heredity is a
factor, and it is more common in women than in
men. It tends to happen to people of fairly high
intelligence, and suffers usually tend to be of
stocky build, usually with fresh colouring and
thick hair, and are vigorously active. Episodes
seem to occur more often in late spring or early
summer, and usually near both equinoxes (March
and September).
It usually appears in
extroverted personalities and often starts
without obvious cause, although
indications are that there is a disturbance in
the body chemistry. Severe infections have been
known to precede attacks and so may a marked
emotional
sock.
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Manic individuals are
frequently infectiously gay, witty and, at
times, painfully sarcastic to those about them.
They have tremendous flights of ideas,
often very good ones, but usually too many at
one time. Elation and over-activity can vary
from mild to intense agitation and total
restlessness which can be fatal if untreated.
Often they don't realize that anything is wrong
with them (lack of insight) and their judgment
is also frequently impaired.
The milder degrees of the
manic state are known as hypomania, where
abundant energy is present, and intolerance and
lack of control are common. The more
intense state is mania. Insight is totally lost
and judgment is grossly disturbed. Sufferers are
highly elated, and full of boundless energy.
They have wild flights of grandiose ideas,
increased appetites, and never stop talking.
This state can merge into delirious mania in
which the victim becomes exhausted and very
often
voiceless.
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The depressive phase of the
manic-depressive may be mild, acute or stuporose
(helpless). In the mild phase, the skin
looks dull, the face worn and old. Depression is
marked, and interest in self and surroundings is
lost. Apathy and hopelessness are the order of
the day. In the acute phase, there is a greater
slowing down, with a marked feeling of
isolation. Absolute
hopelessness is present and the sufferer often
believes, quite falsely, that she or he has
committed grievous crimes and seeks punishment.
The manic-depressive often believes his
bowels are stopped up; it is difficult to
converse with need for survival, and good
nursing care is essential. Sufferers tend not to
move and are unaware of their environment.
Unfortunately some
manic-depressives alternate from mania to
depression without intervals of being
normal. Others may be 'set' at one
extreme or other; for example a sufferer may
vary between manic and normal, rarely if ever
becoming depressed. However, on the credit side,
many manic individuals carry out masses of
valuable activities, good ideas are put into
effect and their infectious zest enlivens and
enthuses others. Like many other depressive
states, much can now be done to alleviate both
phases. It should be remembered that many people
have mood swings which have nothing to do with
manic-depressive illness.
If the condition is mild,
understanding and acceptance by the individual
and those closest to him is more important than
anything else. It must be realized that
the different moods only last a short time and,
if mood tends to be extreme in either direction,
moderate sedation may be required.
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At the other end of the
spectrum, if over-activity is excessive or even
life endangering, or if depression is profound,
treatment in hospital with rest and sleep is
essential. Haloperidol or
chlorpromazine by mouth or by injection are
usually very effective in reducing over
activity. One of the many anti-depressants can
be used to combat the depressive phase.
Long-term management with lithium carbonate has
transformed the control of this illness, but its
level in the blood must be carefully controlled
as the body's level of tolerance is narrow. This
will be checked carefully, especially at the
beginning of treatment, but the patient soon
becomes quick to recognize if the level is
getting too high. Treatment must continue
indefinitely.
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