Are Manic Episodes Found in Other Mental Health Disorders?
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Q:  Are there any mental health disorders other than Bipolar Disorder that can cause severe manic episodes? My spouse experiences significantly more manic episodes than depressions (although he has had depressions as well-- but not nearly as many..)

Dear LC --
Mania is fairly distinctive.  Even when it occurs following a head injury, or a reaction to a medication like a steroid, it is still regarded as "mania" and treated accordingly.  So having classic manic symptoms like euphoria and grandiosity and decreased need for sleep and increased activity and big plans and impulsive, poor judgment -- no, there is really nothing else to call this other than a "manic episode".

Can these occur due to some other mental health disorder?  Almost by definition, no. If a person was psychotic, for example, and also demonstrated the above manic symptoms, the diagnosis would be bipolar disorder with psychosis.  If a person demonstrated symptoms of depression, and also symptoms like those above, the diagnosis would be bipolar disorder, mixed state.  If a person had obsessive compulsive disorder, and also displayed the symptoms above, the diagnosis would be bipolar disorder, with "comorbid" obsessive compulsive disorder.  In other words, bipolar disorder trumps other diagnoses if manic symptoms are clearly present.

(All the trouble comes when manic symptoms are not clearly present.  Then the confusion about bipolar diagnosis is really rampant.  What do you do as someone who has obsessive compulsive disorder, and depression?  Or psychosis and depression?  Or even just highly recurrent depression that doesn't seem to behave like "unipolar" Major Depressive Disorder -- when do you have to think about "bipolar?  Controversy abounds here.)

Is it possible to have manic symptoms without ever having depression at all?  This definitely happens.  I have seen estimates of the literature ranging from 2% to 10% of all patients with bipolar disorder.  In other words, it is not common, but it is well recognized.  What would the diagnosis be?  "Bipolar disorder", again, because mania is not associated with any other diagnosis.  There is no controversy about this.

(You might see that this raises the question, at least in my view, as to whether it is possible to have "bipolar disorder" and never have manic episodes, only depressive episodes.  It would be the mirror image of the manic-only version.  Since the manic-only version is not controversial (no one seems to choke on the idea that "bipolar disorder" can manifest itself with only one of the two "poles"), why should it be so difficult to think of a version of "bipolar disorder" which only manifests itself through depressive episodes? I assure you, there is a great deal of choking about that way of thinking.)

Finally, you could ask your question slightly differently: are there any disorders of any kind, including medical disorders, other than bipolar disorder, that can cause severe manic episodes? In this case, the "trumping" effect of the bipolar diagnosis is not so obvious.  An alternative diagnostic code could be used, namely "mood disorder due to a general medical condition".  In other words, the symptoms would be recognized as "mania", but the emphasis in the diagnosis would be on the medical condition as the basis thereof, not "bipolar disorder" per se. To invoke this diagnosis, the manic symptoms should be very clearly related to a medical condition, such as head injury, a new medication, a stroke, or something like that.  Quite a few medical conditions have been associated with seeming to cause the emergence of mania.  Thus when a person has manic symptoms for the first time after age 45 or so, he usually occasions a hunt for some medical basis. Such a person might get a brain imaging study, like an MRI; and perhaps an electroencephalograph (EEG); and probably a battery of blood tests -- were such testing is not routine when a young person shows up with manic symptoms, because we have learned over time that the "yields" on such tests is too low to justify their expense.  Rather, they are reserved for late onset bipolar symptoms.

 I hope that in that ramble I have addressed your question.

Dr. Phelps

February, 2009

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