Can mania be seen through the tongue or hair?

The typical symptoms of mania are high mood, avoidance of thinking and increased activity.

(1) High mood: I feel relaxed and happy, I feel good about myself, I feel that everything around me is beautiful, I feel that my life is rich and colorful, and I am extremely happy and happy. I have been in high spirits all day. His happy mood is vivid and vivid, which is consistent with his inner experience and has certain appeal, and often causes people around him to sing. Emotion can be unstable and irritable, and people often treat others' interference and opposition with hostility or fury, but irritability often lasts for a short time.

(2) Thinking escape: the association process is obviously accelerated, people become smart consciously, the brain reacts quickly, and the thinking content is rich. Concepts come into being one after another, and sometimes it feels that language can't keep up with the speed of thinking. It is characterized by quoting classics, talking with Kan Kan, and talking endlessly, giving people a superficial feeling. Both active and passive attention are enhanced, but it is not lasting, which shows that in thinking activities, due to the influence of changes in the surrounding environment, the topic has changed suddenly. Therefore, concepts are constantly emerging, imagination is rich, and some sound and meaning associations appear.

In the context of high emotions, I feel good about myself, feel strong and healthy, exaggerate my ideas, be pretentious and domineering, and think that I am outstanding in talent, ability, status and wealth. When exaggerated ideas are serious, they can develop into exaggerated delusions, which are mostly absurd, and sometimes there are relationships and delusions that suffer on the basis of exaggeration, but they are all short-lived.

(3) Increased activities: full of energy, obviously increased activities and unbearable, busy all day, doing things from beginning to end. Like to watch the excitement, communicate more, and be warm and generous to people. Nostalgic and aggressive, witty and joking, sometimes generous in spending money, paying attention to dressing up, frivolous and close to the opposite sex. Sometimes rude and reckless, appetite and sexual desire increase. Sleep less, but energetic and not tired.

(4) Other symptoms: rosy complexion, bright eyes, increased heart rate, slightly dilated pupils and constipation. When the attack is extremely serious, it is in a state of severe excitement, which is characterized by aimless and directionless activity disorder, often accompanied by aggressive behavior, and symptoms such as disturbance of consciousness, hallucinations and incoherent thinking can also appear, which is clinically called delirium mania.

Treatment of mania

(1) Injection drug therapy

(1) rapid treatment with haloperidol, 5mg haloperidol, intramuscular injection every half hour until the patient falls asleep, with the maximum daily dose not exceeding 50mg.

② chlorpromazine, chlorpromazine 50 ~ 100 mg, dissolved in 50% glucose 100ml, was injected intravenously slowly until the patient fell asleep.

③ intramuscular injection of clonazepam, clonazepam 1 ~ 2 mg, 3 ~ 4 times a day. This method can also make patients calm down as soon as possible, which is safer and more effective.

(2) Oral drugs

① Lithium carbonate should generally be used under the monitoring of blood lithium concentration, otherwise lithium poisoning is prone to occur. Generally, the dosage should not exceed 3.0g, preferably between 2.0 and 2.5g/day. The blood lithium concentration should be controlled at 0.8 ~ 1.5mmol/L, and the curative effect is about 80%. Pay attention to the appearance of poisoning symptoms and adverse reactions. In case of poisoning, the drug should be stopped immediately to accelerate the excretion of lithium.

② Clozapine, starting from 25mg, was taken orally three times a day and gradually increased to 450 ~ 600mg/ day. Its curative effect is rapid and reliable, but it is easy to cause leukopenia, so we should insist on blood test once a week.

③ Clonazepam has a strong effect of controlling psychomotor excitement, and its anti-mania effect is obviously superior to other nerve blockers with little side effects. Widely used, the oral dose is 2 ~ 6 mg each time, three times a day.

(4) Phenytoin sodium has certain antimanic effect, and its effective dose is 0. 1.2 ~ 0.2, taken orally three times a day.

⑤ Sodium valproate has a good anti-mania effect, the dosage is 0.2 ~ 0.6, taken orally, three times a day.

⑥ Carbamazepine has positive anti-mania effect, especially suitable for people who can't tolerate lithium salt.

(3) Electroshock Therapy

It is one of the effective methods to treat mania, which is safe, effective and rapid. Every other day 1 time, 8 ~ 12 times is a course of treatment. Generally, symptoms can be controlled after 3 to 5 times.

(4) Maintenance treatment

Although manic symptoms are easy to control, they are also easy to recur, so it takes a certain period of maintenance treatment. For the first time, after manic recovery, lithium therapy should be maintained for at least another 6 months. For people who have hair every year, lithium salt should be used for a long time. At this time, slow-release agents can be used.

(5) Anti-recurrence therapy

Mania has the characteristics of recurrent attacks and often needs anti-recurrence treatment.

① After a period of cure, the first manic patients can gradually stop taking drugs, and there is no need for anti-relapse treatment. However, if you find recurrent symptoms such as reduced sleep, more talking and more activities, you should immediately resume treatment.

② For patients with recurrent mania, the anti-recurrence treatment after cure should be based on the recurrence law.

A once a year, depending on the season, you can take the medicine before the season changes. If the attack is irregular within one year, you should insist on taking medicine all the year round.

B those who have relapsed for more than two years can start taking medicine at some time in the year of recurrence.

C Anti-relapse treatment is a thorny problem for people who have no certain regularity of attack, but it is not necessary to treat them, but to observe them. If there are signs of recurrence, they should take medicine quickly.

D the anti-relapse drug has been recognized as lithium carbonate, the dose is 0.5 ~ 0.75, and it is taken orally twice a day. In addition, small and medium doses of antipsychotic drugs are often used as anti-relapse drugs for mania, such as chlorpromazine 200~300mg per night 1 time, clozapine 100 ~ 150mg per night 1 time, which have obvious curative effects. It is reported that.

Anti-mania drugs are drugs with good therapeutic and preventive effects on mania, which are highly specific and often ineffective for schizophrenia. Lithium salt and some antiepileptic drugs, such as carbamazepine and sodium valproate, were first used in clinic and achieved positive results in the treatment of mania. It is reported that other psychotropic drugs, such as clonazepam, have antimanic effects. Because of the uncertain curative effect and the lack of strict experimental research and academic debate, it will not be introduced again. Now mainly introduce lithium salt, carbamazepine and sodium valproate.

(1) lithium salt

① Pharmacological action: Mainly related to lithium ion.

A sleep and electrophysiology: it can prolong the slow-wave sleep time, prolong the REM latency and shorten the REM sleep period.

B cardiovascular system: it often causes nonspecific changes of ECG and flattening or inversion of T wave.

C endocrine and metabolism: it can inhibit the production, release and utilization of thyroxine.

D Urinary system: At the therapeutic dose of lithium, the glomerular filtration function is mostly within the normal range, but the renal tubular reabsorption function is often affected. The clinical manifestations are polyuria and polydipsia, and a few cases have diabetes insipidus.

② Mechanism of action: The anti-mania mechanism of lithium has not been clarified, and the research mainly focuses on electrolytes, cAMP and central neurotransmitters.

Electrolyte: the balance of lithium and sodium inside and outside the cell membrane plays an important role in the permeability of the membrane and the excitability of the cell. Lithium enters cells through ion channels, replacing sodium in cells and reducing the excitability of cells.

B- cyclic adenosine monophosphate (cAMP): The therapeutic dose of lithium affects many enzyme systems, such as Na+-K-ATPase, but adenylate cyclase is the most studied.

Neurotransmitter C: Norepinephrine (ne) found that lithium can promote the reuptake of ne by presynaptic membrane, increase the storage of NE by neurons, enhance the activity of MAD, promote the degradation of NE by neurons and inhibit the release of NE, so the decrease of NE in synapses is beneficial to correct the hyperactivity of catecholamine in mania.

③ Clinical application

A preparation before treatment: a detailed examination of the body, nervous system, routine hematuria, heart and EEG. The clearance rate of T3, T4, TSH, creatinine or lithium should be checked in the elderly or people suspected of having thyroid or kidney disease. The possible side effects and early poisoning symptoms of lithium should be introduced to patients' families, and patients should be encouraged to drink more water.

B curative effect prediction: at present, the curative effect prediction is mainly based on clinic, that is, from the typical manic depression, bipolar course or bipolar family history and the previous lithium treatment effect.

C inhibitor and dosage: lithium carbonate is the most commonly used. Generally, the treatment dose of mania in acute phase is 600 ~ 2000mg/ day, and the maintenance dose is 500 ~ 1000mg/ day, which can be taken orally for 2 ~ 3 times.

D. Serum lithium concentration: Because the therapeutic dose of lithium salt is close to the toxic dose, it is necessary to monitor the serum lithium concentration, which not only helps to adjust the therapeutic dose and maintain the dose, but also provides the doctor with an objective basis for whether the patient takes the medicine according to the doctor's advice, and timely discovers that it gradually becomes renal insufficiency and acute poisoning. The minimum blood lithium concentration for acute treatment is 0.6 ~ 1.2 mmol/L, and the blood lithium concentration for maintenance treatment is 0.4 ~ 0.8 mmol/L. 1.4 nmol/L should be regarded as the upper limit of effective concentration, beyond which it is easy to be poisoned. However, the blood lithium concentration is not directly proportional to the clinical manifestations, so the dose adjustment should not rely solely on laboratory data, but mainly on clinical observation.

④ Adverse reactions

Gastrointestinal symptoms: epigastric discomfort, nausea, vomiting, diarrhea, anorexia.

B Nervous system: fatigue, weakness, lethargy, memory and understanding decline in a few cases, tremor and unconsciousness in a few cases.

C cardiovascular system: T wave is low.

D hematopoietic system: leukocytosis may occur.

E metabolism and endocrine: weight can be increased, with occasional edema of face, lower limbs and anterior tibia.

Urinary system: polyuria and upset symptoms.

⑤ Lithium poisoning: The typical clinical sign of lithium poisoning is acute organic brain syndrome, which shows different degrees of consciousness disorder, accompanied by nervous system symptoms such as dysarthria, ataxia, hyperreflexia, pyramidal tract sign, and even coma and death. The treatment method is to stop using lithium preparation to accelerate lithium excretion. Intravenous drip of normal saline, theophylline, mannitol and sodium bicarbonate is beneficial to lithium excretion, and hemodialysis is feasible in severe cases.

(2) Carbamazepine

① Mechanism of action: It acts on diencephalon and limbic area. The limbic system of diencephalon is the localization area of many mental diseases, and it is the basis for CBZ to treat affective mental disorders.

② Clinical application: it is effective for all kinds of mania, and its curative effect is not inferior to that of lithium salt, especially for accelerating circulation, and it is also effective for those who are ineffective in lithium salt treatment, so it can be used as the first choice for this type of emotional disorder.

Because the clinical efficacy and adverse reactions are dose-related and vary greatly from individual to individual, individualized medication should be used. 600 ~ 1200mg daily, taken orally for 2 ~ 3 times, with the maximum dose not exceeding 1600mg/ day, and gradually increasing from a small dose. The maximum therapeutic dose should be maintained for 2 ~ 3 weeks. Before treatment, you should carefully check your body, and check your blood, urine routine, liver function and EEG once a week. Pay attention to the occurrence of adverse reactions. Stop taking the medicine in time when there are serious side effects.

③ Adverse reactions

A nervous system: dizziness, lethargy, ataxia, blurred vision, diplopia, tinnitus and peripheral neuritis.

B Digestive system: nausea, vomiting, abdominal pain, constipation, abnormal liver function, gastritis, dry mouth, etc.

C hematopoietic system: leukopenia, thrombocytopenia, aplastic anemia, etc.

D Cardiovascular system: congestive heart failure, hypertension, hypotension, edema, thrombophlebitis, arrhythmia and atrioventricular block.

E urogenital system: frequent urination, urinary retention, renal failure, diabetes, impotence, etc.

F others: rash, exfoliative dermatitis, hyperhidrosis, fever, hypothyroidism, etc.

(3) Sodium valproate

① Mechanism of action: It is not clear at present, which may be related to the increase of GABA content in brain.

② Adverse reactions: common gastrointestinal symptoms, such as anorexia, nausea, vomiting and indigestion. Transient transaminase elevation, mild tremor, alopecia, fatal liver necrosis and acute pancreatitis occurred in some cases.

③ Clinical application: It is used to treat affective disorder with rapid circulation, and its curative effect is equivalent to CBZ, and it is also suitable for treating acute mania and senile mania.

The therapeutic dose is 800 ~ 1800mg/ day, taken orally for 2 ~ 3 times. Pay attention to check liver function before and during treatment.

When manic patients are in high spirits, their self-evaluation is too high, showing arrogance, arrogance, pretentiousness, arrogance and arrogance. You can have exaggerated ideas and think that you are the greatest, most capable and richest person in the world. You can even exaggerate or fantasize, but the content is not absurd. Sometimes, it refers to delusions, delusions of victimization, and so on. It may happen, mostly secondary to high emotions, and generally does not last long. The escape of thinking shows that the process of association is obviously accelerated, conscious thinking is very agile, the content of thinking is rich and changeable, and the concepts in the mind follow one after another. Sometimes I feel that my tongue is racing against my thoughts, and my words can't keep up with the speed of my thoughts. Often manifested as talking more and more, talking nonstop, jumping nonstop, even if the mouth is dry and the voice is hoarse, I still have to talk nonstop. However, the content of the speech is superficial, messy and unrealistic, which often gives people a sense of nonsense. The increase in activities is manifested in energetic, wide-ranging interests, quick and agile movements, obvious increase in activities, and unbearable busy all day, but doing anything is often anticlimactic, endless and accomplished nothing. Physical symptoms because patients feel good about themselves and are full of energy, there are few complaints of physical discomfort, which are often manifested as rosy cheeks and eyes. Physical examination can find that the pupil is slightly dilated, the heart rate is accelerated, and there are symptoms of sympathetic hyperactivity such as constipation. Other symptoms during manic episode, patients' active and passive attention is enhanced, but it can't last long and is easily attracted by the surrounding things. Depression attack

Clinically, depressive episodes are mainly manifested as depression, slow thinking, decreased will activity and physical symptoms. Emotional depression is mainly manifested as significant and lasting depression, depression and pessimism. People with mental retardation have slow thinking association, slow reaction and blocked thinking. Patients with decreased will activity show significant and lasting inhibition of will activity. Clinical manifestations are slow behavior, passive life, laziness, unwillingness to do things and contact with people around. Physical symptoms are very common, mainly including sleep disorder, loss of appetite, weight loss, loss of libido, constipation, pain in any part of the body, impotence, amenorrhea, fatigue and so on. Other depressive episodes can also lead to personality disintegration, reality disintegration and obsessive-compulsive symptoms. Mixed seizure mixed seizure refers to the simultaneous occurrence of manic symptoms and depressive symptoms in one seizure, which is rare in clinic. It usually happens when mania and depression quickly reverse. Ring Mood Disorder Ring Mood Disorder refers to the repeated occurrence of high and low emotions, but to a lesser extent, both of which do not meet the diagnostic criteria for manic or depressive episodes. During the period of hypomania, he is cheerful and positive, and will make some promises in social life; But when it turns into depression, it is no longer optimistic and confident, but becomes a painful "loser". The interval between normal moods can last for several months, and its main feature is persistent emotional instability. Dysthymia refers to a mild depression, persistent depression and never mania.