Irritability, risky behavior are signs of clinical mania


August 30, 1994|By Dr. Simeon Margolis | Dr. Simeon Margolis,Special to The Sun

Q: My husband is a businessman in his early 40s. He has always been conservative in managing our finances and in his business dealings. Several weeks ago he made some unusually speculative investments and wrote a check to his college for much more money than we can afford. He gets angry when questioned about these matters and has been far more irritable than in the past. Do you have any suggestions about what could be wrong?

A: Without meaning to discourage any grateful graduate from donating generously to his or her college or university, let me suggest that your husband may be suffering from a bout of clinical mania, which can last a few days or up to several months. During mania, people have a heightened mood, need less sleep, increase their physical activity, may talk more than usual or feel the need to keep talking, and exhibit an overblown self-esteem, self-confidence and grandiosity. They are easily distracted and may be more irritable than usual. They often fail to recognize that anything is wrong and tend to resist advice or attempts at medical treatment. During such periods, individuals must be protected from high-risk, self-destructive activities such making terrible investments or other foolish business decisions, giving their money away, buying sprees, reckless driving and sexual indiscretions.

In some people, the disorder is characterized by recurrent bouts mania alone. In others, who have manic-depression or bipolar illness, manic episodes alternate with periods of depression. The term bipolar refers to the swings back and fourth between these opposite moods. The majority of people have multiple epi

sodes, which are followed by a remission period free from any symptoms, then interrupted by a bout opposite in nature from the previous one.

Manic-depression most often begins before the age of 30, but about 25 percent of patients experience their first symptoms between the ages of 40 and 50. Although the illness can start with either a depressive or manic bout, about two-thirds start with a manic episode, and attacks of mania tend to predominate in such individuals. Women have bipolar disorders slightly more often than men. Men tend to have more manic episodes while depression is more common in women.

Various forms of psychotherapy and an array of drugs have been used to treat bipolar illness. Lithium is usually the first choice to treat acute manic episodes and to prevent recurrences of mania and depression in those with bipolar illness. One recent study showed, however, that about 40 percent of patients either failed to respond or were unable to tolerate lithium treatment. A number of other drugs can be tried in such individuals.

It is important to monitor your husband's behavior and have a qualified physician evaluate him if his condition continues.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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