Mania and Psychosis - Causes and Treatments

[Petros Agapetos]

This thread is about about the following:
- what causes mania and psychosis?
- how can one induce mania and psychosis?
- how can one treat mania and psychosis?


Mania, or manic syndrome is a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together with lability of affect." Although mania is often conceived as a "mirror image" to depression, the heightened mood can be either euphoric or irritable; Hypomania is a milder form of mania. Mania often develops from Hypomania to full-blown mania gradually; until it builds up enough momentum; then the swing in elevation increases non-gradually, in leaps and bounds. Mania can be intensely affective, bright, elated , euphoric , as well as irritable. Under mania people perform better academically; better executive functions; though people might also get disorganized in both thought and behaviour; rapid thoughts and pressured speech; intense emotional state.

[Petros Agapetos]

What is mania?: Mania, also known as manic syndrome, is a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together with lability of affect."

What causes mania?
- D2 dopamine receptor overactivity is associated with mania.
- Sleep deprivation
- Stimulants (Cocaine, Methamphetamine)
- Heavy marijuana usage (can cause mania; is associated with schizophrenia and schizoaffective disorder, bipolar subtype)
- Dopamine agonists: medicines for Parkinson's disease can trigger mania and psychosis due to excessive dopaminergic activity in the brain. particularly D2 type dopamine receptor: Bromocriptine, Pramipexole, Ropinirole, etc.
- Anabolic Steroids and Androgens

To be classed as a manic episode, while the disturbed mood and an increase in goal directed activity or energy is present at least three (or four if only irritability is present) of the following must have been consistently present:

Inflated self-esteem or grandiosity.
Decreased need for sleep (e.g., feels rested after 3 hours of sleep).
More talkative than usual or pressure to keep talking.
Flights of ideas or subjective experience that thoughts are racing.
Increase in goal directed activity, or psychomotor acceleration.
Distractibility (too easily drawn to unimportant or irrelevant external stimuli).
Excessive involvement in activities with a high likelihood of painful consequences.
(e.g., extravagant shopping, improbable commercial schemes, hypersexuality).

[Petros Agapetos]

Mania is a syndrome with multiple causes.

Although the vast majority of cases occur in the context of bipolar disorder, it is a key component of other psychiatric disorders (such as schizoaffective disorder, bipolar type) and may also occur secondary to various general medical conditions, such as multiple sclerosis; certain medications may perpetuate a manic state, for example prednisone; or substances of abuse, such as caffeine, cocaine or anabolic steroids.

Mental disorders such as schizoaffective disorder and bipolar disorder are treated with mood stabilizers (anticonvulsants), lithium, and antipsychotics/neuroleptics (dopamine blocking agents).

[Petros Agapetos]

Hypomania is a less severe form of mania:

In the current DSM-5, hypomanic episodes are separated from the more severe full manic episodes, which, in turn, are characterized as either mild, moderate, or severe, with specifiers in regard to certain symptomatic features (e.g. catatonia, psychosis).

Mania is divided into three stages: hypomania, or stage I; acute mania, or stage II; and delirious mania (delirium), or stage III. This "staging" of a manic episode is very useful from a descriptive and differential diagnostic point of view.

Mania varies in intensity, from mild mania (hypomania) to delirious mania, marked by such symptoms as disorientation, florid psychosis, incoherence, and catatonia. Standardized tools such as Altman Self-Rating Mania Scale and Young Mania Rating Scale can be used to measure severity of manic episodes. Because mania and hypomania have also long been associated with creativity and artistic talent, it is not always the case that the clearly manic bipolar person needs or wants medical help; such persons often either retain sufficient self-control to function normally or are unaware that they have "gone manic" severely enough to be committed or to commit themselves. Manic persons often can be mistaken for being under the influence of drugs.

[Petros Agapetos]

Symptoms: False beliefs, seeing or hearing things that others do not see or hear, incoherent speech

Causes: Mental illness (schizophrenia, bipolar disorder), sleep deprivation, some medical conditions, certain medications, drugs (including alcohol and cannabis)

Treatment Antipsychotics, counselling, social support
Prognosis Depends on cause
Frequency 3% of people at some point in time (US)

Psychosis is an abnormal condition of the mind that results in difficulties determining what is real and what is not. Symptoms may include false beliefs (delusions) and seeing or hearing things that others do not see or hear (hallucinations). Other symptoms may include incoherent speech and behavior that is inappropriate for the situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities.

Psychosis has many different causes. These include mental illness, such as schizophrenia or bipolar disorder, sleep deprivation, some medical conditions, certain medications, and drugs such as alcohol or cannabis. One type, known as postpartum psychosis, can occur after childbirth. The neurotransmitter dopamine is believed to play a role. Acute psychosis is considered primary if it results from a psychiatric condition and secondary if it is caused by a medical condition.[8] The diagnosis of a mental illness requires excluding other potential causes.[9] Testing may be done to check for central nervous system diseases, toxins, or other health problems as a cause.

Treatment may include antipsychotic medication, counselling, and social support. Early treatment appears to improve outcomes. Medications appear to have a moderate effect. Outcomes depend on the underlying cause. In the United States about 3% of people develop psychosis at some point in their lives.

[Petros Agapetos]

The dopamine theory of psychosis is borne out of an understanding how antipsychotic drugs work on the brain. Since antipsychotics are dopamine blockers; it is hypothesized that psychosis is caused by too much dopamine in the brain. It is not borne out of a genuine understanding of what is actually wrong with people suffering from psychosis. Antipsychotics work better than placebo at curbing psychotic symptoms over the short term (6 weeks); however their long term use is not recommended. due to intolerable side effects such as brain shrinkage, cognitive impairment, sexual dysfunction, low testosterone , emotionally empty and dull, blunting of affect, etc. Antipsychotics should only be used for treating symptoms not for maintenance or prevention. Antipsychotics were celebrated as "chemical lobotomizers". they cause a temporary severing of frontal lobes , without removal of tissue , but chemically induced. They are mental straight-jackets

[Tie red]

Biological insights from 108 schizophrenia-associated genetic loci.
https://www.ncbi.nlm.nih.gov/pubmed/25056061

Nice study with replicable results since then, much of those genes are also found in bipolar disorders.

Each of the variants appear to change very subtly brain function and/or structure.
Some of these genetic variants on CACNA1C, NCAN, Ep300, ZNF804A, DRD2 etc... are well studied in the litterature with visible effects thanks to MRI.

While a high polygenic risk score seem to decrease slightly cognitive performance and increase lifetime risk, interestingly it appears that a subset of these risk variants are also over represented in bright people.
https://www.nature.com/articles/s41467-018-05510-z

Polygenic score for schizophrenia and plenty of other traits are available at impute.me
https://www.impute.me/AllDiseases/

[Petros Agapetos]

Three categories of treatments exist for mania:

1. Lithium
2. Anticonvulsant/Mood Stabilizer (ex. Divalproex)
3. Antipsychotics: dopamine receptor blockers or Abilify (partial agonist).

[Yinwang888]

Petros, in your list of drugs you should also mention valproate. It's a fairly commonly prescribed drug for that state, and in many countries it's even right after lithium in the treatment cascade. But it's a GABA inhibitor so I don't think it's covered by your current three groups - ok, maybe group 2 "mood stabilizer". But aren't they all.

For Tie Red, I thought maybe you'd be interested in this short essay I recently wrote on Reddit. I'm new to these forums so many apologies if cross posting is considered uncool. Still, it's an appropriate comment on polygenic risk scoring and I think it mirrors your thoughts well:
https://www.reddit.com/r/genetics/co...mplex_genetic/

[Kazimiera]

I've been stable for 6 years now (and counting) but I miss the hypomania.

I just don't like having to pay for all the stuff I've bought.