Manic State (a state of psychiatric excitation, a symptom)

MANIC STATE, a state of psychiatric excitation, a symptom complex opposite to depression (see). In its full scope, a manic state is observed only in the corresponding phase of manic-depressive psychosis (see). Here it is characterized by a triad of symptoms: 1) motor (and speech) excitation, 2) facilitation of the course of associations, resulting on the one hand in a rush of thoughts and on the other in sharp distractibility, and 3) elevated (cheerful, euphoric, sometimes angry) mood. Similar states develop not only in manic-depressive patients, but also in many other diseases: progressive paralysis, cerebral arteriosclerosis, schizophrenia, epilepsy, etc. The clinical symptomatology of the state in each disease is entirely specific and peculiar. The pictures observed in the expansive form of progressive paralysis may at times seem very similar to what we see in manic-depressive psychosis; however, essentially they differ sharply from true manic states by an insufficient depth of affect (emotional lability), low productivity (the absence of an actual rush of thoughts), and the presence of more or less significantly expressed elements of progressive dementia; to a somewhat lesser extent, the same applies to cerebral arteriosclerosis. Pictures of psychiatric excitation tinged with manic features, arising in circularly proceeding schizophrenias, betray their origin by the absence of brightness and vividness of affect (emotional dullness), paleness and monotony of the picture, frequent transition of distractibility into responsiveness (associations by sound rather than by content), and the presence of other schizophrenic symptoms (absurdity, mannerisms, impulsive actions, stereotypies, etc.). Epileptic manias differ sharply by the obscurity (twilight state) of consciousness, the presence of elements of psychiatric automatism, the monotony of the content of productions (tendency toward perseverations), and a predominantly malicious, angry affect. Regarding the "chronic" manic states characteristic of some psychopaths, see Hypomania. The forensic-psychiatric significance of manic states is determined by the fact that excitation, the rush of thoughts, and an increased drive for activity occur in patients in parallel with a disturbance of constancy and stability in behavior and a weakening of moral and other inhibitions. Being unable to sufficiently comprehensively evaluate the consequences of their actions, patients make purchases beyond their means, squander money that does not belong to them, give obligations that they are unable to fulfill, and so on. Increased eroticism often leads them to offenses against morality, while excitability and lack of restraint lead to conflicts and actions that violate public order. A manic state, by depriving the patient of the ability to correctly evaluate the consequences of their actions, thereby excludes the imputation of guilt for offenses committed in this state. Literature: see literature to the article Manic-Depressive Psychosis.