Diagnosis, treatment and prevention of mania and hipomania within the bipolar disorder

Abstract

At least 5% (Moreno, 2004 e Angst et al., 2003) of the general population have presented mania or hypomania. Irritability and depressive symptoms during brief hyperactivity episodes and the heterogeneity of symptoms complicate the diagnosis. Neurological, metabolic, endocrine, inflammatory diseases, besides drugs intoxication and abstinence can cause a manic syndrome. Sometimes hypomania or mania are misdiagnosed as normality, major depression, schizophrenia, personality, anxiety and impulse control disorders. Lithium is the first treatment choice for episodes of mania. Valproic acid, carbamazepine and atypical antipsychotics are frequently used as well. Electroconvulsive therapy should be used in severe, psychotic or gestational mania. For the prophylaxy of manic episodes, lithium is the medication with most controlled studies. More studies are needed to investigate the prophylactic efficacy of valproate, olanzapine and other medications. The treatment and prophylaxis of hypomania remains understudied, and usually follows the guidelines used for mania.