Treatment of Manic States

Here is an expert article on the treatment of manic states, based on the information provided in the URL:

Treatment of Manic States

The manic phase is characterized by excitement, turbulent ideas, and pathological increase in motivation. Patients overestimate themselves, work without breaks, suffer from impaired thinking, and behave irresponsibly (financially, sexually, etc.).

Lithium Therapy

Lithium, the lightest metal, plays a crucial role in the body, along with other alkali metals like sodium and potassium. Lithium ions are evenly distributed in the extracellular and intracellular spaces, forming a weak concentration gradient across the cell membrane, but cannot be transported through it via the Na-K-ATPase membrane pump. Once inside the cell, Li ions participate in signal transmission: they reduce the hydrolysis of inositol phosphate, which in turn decreases the sensitivity of nerve cells to neurotransmitters. Additionally, the metabolism of biogenic amines is also altered in the presence of Li ions. However, these mechanisms do not fully explain the action of this „simple“ medication in mania. Furthermore, the underlying somatic pathology of mania is also unknown. It is assumed that, as with depression, Li ions do not exert a psychotropic effect, but rather induce typical side effects.

Indications for Lithium Therapy

1. Emergency treatment of the manic phase – the effect occurs within a few days.
2. Long-term treatment (6-12 months to achieve full efficacy) for the prevention of mania, as well as depressive phases in the case of bipolar disorder.
3. Additional treatment for severe, treatment-resistant depressions.

Treating acute manic states with lithium is very difficult, as the therapeutic range of this medication is very narrow, and monitoring of patients is often challenging. The concentration of Li ions in the blood in the morning should be 0.8-1.2 mM (requires monitoring). To prevent relapses, a concentration of 0.6-0.8 mM should be maintained. When it increases to 1.2-1.5 mM, side effects appear. The first symptom of toxic effect is fine tremor, followed by decreased ability to concentrate, fatigue, impaired kidney function (polyuria, diabetes insipidus), diarrhea, electrolyte imbalance with edema and/or hypothyroidism. Severe intoxications can lead to convulsions and coma. Fluctuations in Li concentration in the blood during the day are common, depending on salt intake or fluid loss (diarrhea, diuretics). The renal excretion of Li also changes accordingly. Thus, this therapy requires constant medical supervision and active participation of the patient and their relatives in the treatment process.