"dysphoric mania"

[PikminOC]

---

Members do not see this ad.

This is not going to be a dark knight thread, but the alleged perp allegedy texted an alleged classmate stating he had "dysphoric mania".

My question is, what is dysphoric mania? Is it bipolar disorder 1, most recent episode mixed? Is it agitated depression? What is it exactly and can it last for 4 months with a person functioning at such a high level?? Doesn't mania burn out in several months and certainly isn't usually so single minded and organized??

😕

 

[nitemagi]

This is not going to be a dark knight thread, but the alleged perp allegedy texted an alleged classmate stating he had "dysphoric mania".

My question is, what is dysphoric mania? Is it bipolar disorder 1, most recent episode mixed? Is it agitated depression? What is it exactly and can it last for 4 months with a person functioning at such a high level?? Doesn't mania burn out in several months and certainly isn't usually so single minded and organized??

😕

Why are you listed as an attending?

 

[zenman]

Why are you listed as an attending?

Don't worry as his mania will burn out soon.

 

[PikminOC]

Why are you listed as an attending?

The reason I like SDN over sermo is I felt the SERMO docs were judgemental jerks. Actually I have never had a comment like this on SDN, until now.

I am an attending, I was just trying to figure out how his mania could be so focused and sustained for so long. My manic patients lose interest and get disorganized or focused on a million topics at once. Maybe there is some language barrier, but I usually don't refer to "dysphoric mania" on a regular basis and it was odd to me the dark knight guy mentioned this specifically (allegedly).😱

 

[nitemagi]

The reason I like SDN over sermo is I felt the SERMO docs were judgemental jerks. Actually I have never had a comment like this on SDN, until now.

I am an attending, I was just trying to figure out how his mania could be so focused and sustained for so long. My manic patients lose interest and get disorganized or focused on a million topics at once. Maybe there is some language barrier, but I usually don't refer to "dysphoric mania" on a regular basis and it was odd to me the dark knight guy mentioned this specifically (allegedly).😱

Wasn't intending to be judgmental, and I can completely understand questioning a specific definition. Your multiple questions seemed focused on investigating what mania looks like and how it plays out, as well as common aspects of it, which to me seemed inconsistent with an attending (natural course of mania IMO should be learned during residency). Which I then presume you learned, and were inquiring whether "dysphoric mania" is its own entity that differs from traditional mania. Kinda like how excited delirium is its own entity. So, sorry.

 

[nitemagi]

Some working definitions:

http://www.ncbi.nlm.nih.gov/pubmed/16176439
http://www.ncbi.nlm.nih.gov/pubmed/9435757
http://www.ncbi.nlm.nih.gov/pubmed/7852662
http://www.ncbi.nlm.nih.gov/pubmed/8354772

(yes, mixed in nature).

 

[PikminOC]

I think it is not a language barrier, but a difference in semantics.

http://www.ncbi.nlm.nih.gov/pubmed/15051107

I use the term agitated depression instead of dysphoric mania.

I have not seen such a concerted sustained level of concentration with a great deal of deliberation in these patients as in the dark knight case allegedly. I have seen them get agitated to the point where they impulsively hurt themselves or others. This is not something I could find in a lit search so I thought I would find out about other psychiatrist's opinions.

 

[vistaril]

I think it is not a language barrier, but a difference in semantics.

http://www.ncbi.nlm.nih.gov/pubmed/15051107

I use the term agitated depression instead of dysphoric mania.

QUOTE]

this is all fairly meaningless and artificial constructs anyways, but in general when one uses the term "mania" in any way one has to actually meet dsm criteria(if one cares about such things) for mania. With "agitated depression", there is obviously no such requirement.

 

[F0nzie]

Figuring out if someone has had a maniac episode in the past, IMO, is one of the more frustrating aspects of the psychiatric evaluation. It's no where near as revealing as SIGECAPS, or AVH. So many confounding variables are involved ie. level of insight, defenses, resistance to name a few. Perhaps there was a strong element of psychosis or extreme sleep deprivation during the episode that resulted in memory impairment. On the other hand, when you're working on an inpatient unit there is no question when you see a manic episode 🙂 The objective examination is where the money is.

 

[OldPsychDoc]

Figuring out if someone has had a maniac episode in the past, IMO, is one of the more frustrating aspects of the psychiatric evaluation. It's no where near as revealing as SIGECAPS, or AVH. So many confounding variables are involved ie. level of insight, defenses, resistance to name a few. Perhaps there was a strong element of psychosis or extreme sleep deprivation during the episode that resulted in memory impairment. On the other hand, when you're working on an inpatient unit there is no question when you see a manic episode 🙂 The objective examination is where the money is.

...or Meth. 🙄

 

[surftheiop]

Figuring out if someone has had a maniac episode in the past, IMO, is one of the more frustrating aspects of the psychiatric evaluation. It's no where near as revealing as SIGECAPS, or AVH. So many confounding variables are involved ie. level of insight, defenses, resistance to name a few. Perhaps there was a strong element of psychosis or extreme sleep deprivation during the episode that resulted in memory impairment. On the other hand, when you're working on an inpatient unit there is no question when you see a manic episode 🙂 The objective examination is where the money is.

Friend was interviewing a patient the other day and some financial stressors came up, patient then admitted to recently spending his life savings of 10k on drugs/booze at a strip club 😱

After some fact checking they figured out this actually didn't happen, which makes them terrified to find out what actually happened to the 10k if lying about spending it on booze/drugs at a strip club was a preferable excuse

(I dont know what the fact checking entailed, but conjured up something like from House in my imagination)

 

[kugel]

Friend was interviewing a patient the other day and some financial stressors came up, patient then admitted to recently spending his life savings of 10k on drugs/booze at a strip club 😱

After some fact checking they figured out this actually didn't happen, which makes them terrified to find out what actually happened to the 10k if lying about spending it on booze/drugs at a strip club was a preferable excuse

(I dont know what the fact checking entailed, but conjured up something like from House in my imagination)

Yes, as part of proper medical practice, a group of us Medicine fellows went to the pts apt to rumage through his belongings and closets but we found no proximate cause. We did however find evidence of behavior consistent with possible cholinergic poisoning (AC was set at 62 and there were dozens of almost empty glasses of water scattered around the apt) so we presumed he was getting exposed through from somewhere else. So we broke into all the adjoining apts and found one with very sparse furnishings, no TV, but very fast internet connection, printer, and high grade shredder. The bedroom had heavy lock, so we used the bolt cutters we always bring and busted in only to find a full chemistry lab set up to make phosgene gas bombs. We reported all this to Dr House. He said we cannot report any of this to law enforcement, because this would require a HIPAA violation. Since the pt got better in the hospital, the case manager said we have to discharge him.

Wow! I need to switch to decaf.

 

[Suedehead]

nobody knows what bipolar disorder is anymore.

great article on the topic. http://thoughtbroadcast.com/2012/08/05/my-own-bipolar-kerfuffle/

 

[PikminOC]

nobody knows what bipolar disorder is anymore.

great article on the topic. http://thoughtbroadcast.com/2012/08/05/my-own-bipolar-kerfuffle/

Thanks! Good article with relevant comments. I'm glad I'm not the only one with questions. 👍

 

[Ceke2002]

...

 

[PikminOC]

I was directed to pubmed so that is what I used. It may help you too. I still don't know.