Wir vermuten bei diesem Patienten daher einen kausalen Zusammenhang zwischen der Hyponatriämie und den manisch-psychotischen Symptomen. In der Literatur wird eine Dysfunktion von spannungsgesteuerten Ionenkanälen, namentlich von Natrium- und Kalzium-Kanälen, mit der Pathogenese der bipolaren Störung in Verbindung gebracht. Risperidon wurde nach drei Tagen wieder abgesetzt, und der Patient konnte nach 13 Tagen remittiert und ohne weitere medikamentöse Behandlung entlassen werden. Nach Normalisierung der Natriumkonzentration durch Infundierung von Kochsalzlösung klangen die Symptome innerhalb weniger Tage ab. Risperidon wurde als Antipsychotikum verabreicht. Das Drogenscreening war ebenfalls negativ. Die somatische Abklärung wies bis auf eine deutliche Hyponatriämie keine Auffälligkeiten auf. Die Anamnese war negativ für psychiatrische oder relevante somatische Erkrankungen, abgesehen von einer kurzen drogeninduzierten psychotischen Episode einige Jahre zuvor. Laut Fremdanamnese durch die Angehörigen sei der Patient bis wenige Tage vor der stationären Aufnahme unauffällig und gesund gewesen. Hier stellen wir den Fall eines jungen, kaukasischen Mannes vor, der mit manisch-psychotischer Symptomatik (beschleunigter, inkohärenter Gedankenduktus, wahnhafte religiöse und Größenideen sowie Affektlabilität) vorstellig wurde. In der Literatur sind mehrere Fallberichte von PatientInnen mit Hyponatriämie-assoziierten psychotischen Symptomen beschrieben worden. Hyponatremia was most likely induced by excessive water intake during a period of fasting in the context of a wellness practice. We therefore assume a causal relationship between hyponatremia and manic-psychotic symptoms in our patient. He was discharged by day 13 without further pharmacological treatment.ĭysfunction of voltage-gated ion channels, particularly sodium and calcium channels, has been implicated in the pathogenesis of bipolar disorder. After normalization of sodium levels using intravenous saline, the patient remitted within a few days and risperidone was discontinued on day 3. Antipsychotic treatment with risperidone was initiated. Tests for narcotics, in particular, were also negative. Somatic workup showed moderate hyponatremia, but no other abnormalities. He had no significant medical or psychiatric history, except a short drug-induced psychotic episode a few years earlier. The patient was described by his relatives as being healthy until a few days before admission.
We present the case of a young Caucasian male presenting with rapid, incoherent speech, religious and megalomanic delusions, and emotional lability.
Manic episode symptoms full#
Substantial rates of dysphoria, lability, anxiety and irritability were noted in the "pure" manic patients, as well as in those who meet the full DSM criteria for Bipolar Disorder, mixed, suggesting, that perhaps a less restrictive definition of mixed states would be more appropriate.In the literature, several cases of an association between hyponatremia and psychotic symptoms have been reported. The data underscore that mania is not a purely euphoric state.
In the current report we use the DSM-III-R definition of Bipolar Disorder, mixed, which may be too rigid. The comparison of mixed and manic episodes requires the appropriate definition of mixed states. Suicidality was present in a non-trivial 7% of the entire cohort, including some subjects who did not meet the criteria for mixed mania. Contrary to popular belief, paranoia did not differ significantly between the two groups. In contrast, grandiosity, euphoric mood, and pressured speech were significantly more often observed in the pure manic group. Dysphoric mood, mood lability, anxiety, guilt, suicidality, and irritability were the only symptoms significantly more common in the mixed group. Although euphoric mood was present in a large portion of the cohort, irritability, dysphoric mood and mood lability were also prominent in the entire cohort.
The most frequently noted signs and symptoms in mania are motor activation, accelerated thought process, pressured speech and decreased sleep. The frequencies of these signs and symptoms were computed for both diagnostic subtypes and compared using chi2 statistics and conditional probability parameters. Three hundred sixteen inpatients meeting DSM-III-R criteria for Bipolar Disorder, manic or mixed, were evaluated by rating 20 signs and symptoms.
Although awareness of dysphoric features during mania continues to grow, standard mania rating instruments do not adequately assess mixed states and there is a striking disparity between the dysphoric signs and symptoms emphasized in research studies and the commonly employed DSM criteria. Debate continues about the diagnosis of mixed mania and the restrictiveness of the DSM-III-R and DSM-IV criteria for Bipolar Disorder, mixed.
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