MANIC-DEPRESSIVE REACTION (THERAPY AND PROGNOSIS)

Thefirst aim in the treatment of manic reactions is to control hyperactivity, and this can often be accomplished through theuse of tranquilizing drugs, particularly chlorpromazine. Mild cases can sometimes be treated in day or night hospitals and some patients can even live at home, although it is important for the family to recognize that the condition is a genuine disorder and to watch the patient lest he invest his money unwisely or engage in sexual improprieties. Electroshock treatment or prolonged narcosis are used in refractory cases. These forms of treatment do not always shorten the duration of the episodes or prevent recurrence, but they do reduce the intensity of the symptoms to a point where the patient becomes accessible to psychotherapy, and where his energies can be directed into constructive channels. In addition, lithium has recently been administered to acutely manic patients, and results have been promising.Patients who suffer from prolonged delirious mania may become so debilitated that they develop severe infectious diseases. In such cases treatment is primarily directed at the infection, but the delirium itself can often be controlled by ice packs, continuous baths or packs, and tranquilizing drugs. These treatments are most effective when they are accompanied by such psychological measures as reassurance, a quiet and unstimulating environment, and the presence of the patient’s family. Disorientation for time, place, and person clears up before the hallucinations disappear, and ordinarily the patient returns to normal a short time after the fever subsides. There is no damage to the brain except in rare cases where the illness has been both severe and prolonged.Mild depressions are sometimes treated on an outpatient basis with anti- depressants, such as imipramine (Tofranil) or with one of the MAO inhibitors. The patient should not be cared for at home, however, if there is any danger of suicide. If these drugs prove insufficiently effective, electroshock therapy is administered.In severe cases antidepressants and electroshock are often combined, and chlorpromazine is usually added in agitated depressions. Hospitalization is always required in severe depressions, not only to assure adequate nursing and frequent nourishment, but to relieve the patient of burdens and to guard against suicide.When the patient’s symptoms subside, he is given reassurance, emotional support, and psychotherapy directed at relief of guilt feelings and an understanding of the forces that precipitated the depression. Neither the depressed nor the manic patient is amenable to a deeper analytic approach. Social therapy is particularly valuable in helping patients reorganize their lives and return to usefulness.Despite the fact that only one in four patients remains completely free from a recurrence of attacks, the general prognosis in manic-depressive reactions is favorable. The great majority of patients recover within a year without special treatment and active therapy increases the recovery rate to well over 90 per cent. Response to treatment may be slower or less complete where aggravating factors are present, such as schizoid trends, old age, or unfavorable life situations—but the presence of manic-depressive reactions in the family has been found to have little or no effect on the prognosis. See energizer, TRANQUILIZER, ELECTROSHOCK THERAPY, NARCOTHERAPY.