1- maniac Access:
* Excitation state of mental and motor functions
* Insomnia is the earliest symptom
* Presentation: slovenly, extravagant, hypermimie, mannerism, playfulness, grimaces, anger, disgust, passion; wishes of perfect symmetry.
* Contact is hypersyntone familiar
* Cognitive Impairment: hypoprosexie (dispersion of attention); tachypsychia and verbal diarrhea (passage of one subject to another); verbal delirium with megalomaniac note.
* Excitement Psychomotor: sterile agitation and inappropriate; dispersion
* Somatic Disorders: rebellious total sleeplessness; anorexia; hypersexuality; alcoholism; transgression of moral principles
* Sometimes hallucinatory delirium
2- melancholy Access:
* Start brutal: a few hours or days; spontaneous evolution in 3 to 6 months
* Depressed mood: pessimistic; anhedonia; self-dévalorisaion; moral pain;
* Idea delirious incurability, guilt, self-blame, ruin, persecution
* Affective blunting; instability affects (irritability, impulsivity)
* Psychomotor Slowing (bradypsychia): ideation slow; poor speech; aboulie; catalepsy
* Somatic Syndrome: early morning insomnia; anorexia; decreased libido; somatic complaints
3- Common Symptoms:
– Bipolar I disorder: One or more manic or mixed episodes associated with major depressive disorder
– Bipolar II Disorder: combination of at least one major depressive episode and a hypomanic episode.
– Four Temperaments: hyperthymic, depressive, cyclothymic and irritable (bipolar patient outside the free access and related).
4- Treatment:
* Before the melancholy -> antidepressant Anafranil kind: + graded doses sedative neuroleptics (Nozinan)
* Before the manic: neuroleptic like Haldol or Nozinan
* Between the access: mood stabilizers (lithium or carbamazepine)
