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(also circular psychosis or cyclophrenia), a mental disease manifested by periodic disturbances of mood. The term “cyclothymia” is used in moderate cases.
Typically, manic-depressive psychosis proceeds in alternating phases—the manic, during which the patient experiences elation, and the depressive. Attacks usually alternate with intervals of complete health. The classic course of the disease is observed relatively rarely; more often, only one of the two phases is manifested.
In the manic phase patients are mobile, restless, and agitated. The facial expression is animated, and speech is accelerated. The timbre of the voice is often inappropriate to the circumstances. Patients are overactive and sleep little, without experiencing fatigue. They crave activity and plot innumerable schemes, which they try to carry out immediately but always fail to complete, being distracted and tending to underestimate real difficulties. In pronounced manic states the patient is uninhibited, living extravagantly and easily becoming sexually aroused. As a result of the extreme distractibility and agitation, thought becomes undirected and judgments become superficial. However, patients may also manifest subtle powers of observation. The patient is highly critical in relation to his own capabilities and achievements at work and in his daily life. As the agitation decreases and the moods level out, the patient’s judgments become more realistic.
The depressive state is characterized by excessive melancholy combined with motor inhibition and retarded thinking. Diminished mobility may, in severe cases, develop into torpor—the complete lack of response to normal stimuli. More often the inhibition is partial or less sharply pronounced, and the patient engages in repetitive actions. Manic-depressives in the depressive phase often experience guilt and a lack of faith in their own abilities, considering themselves worthless and capable only of bringing unhappiness to those people that are close to them. Such thinking is evidence of suicidal inclinations, and therefore the companions of the patient must be especially alert. In cases of deep depression, patients feel that their mind is a void, and their thinking becomes labored and constrained. Responses to even the most elementary questions are elicited only after much delay. Sleep is disturbed, and there is a loss of appetite.
Manic-depressive psychosis most often begins between the ages of 15 and 30, although it may not appear until age 40 or later. The duration of the attacks varies from several days to several months. In severe forms, attacks may last as long as a year. On the average, the depressive episodes are longer than the manic ones, especially in old age. Heredity is undoubtedly a pathogenic factor.
Treatment of aggravated states of the disease is conducted on an inpatient basis. Psycholeptic drugs (tranquilizers) and psychoanaleptic drugs (stimulants and antidepressants) are prescribed. Lithium carbonate gives some relief from the manic phase and helps prevent the depressive phase.
REFERENCESLukomskii, I. I. Maniakal’no-depressivnyi psikhoz, 2nd ed. Moscow, 1968.
Kraines, S. H. Mental Depressions and Their Treatment. New York, 1957.
I. I. LUKOMSKII