Among personality disorders, a special place is occupied by a condition that experts call mild mania. Hypomania is manifested by excessive cheerfulness and energy. Against the background of high spirits, a person feels a surge of physical and mental strength, but at the same time he is overly irritable and even angry.
This disorder differs from mania in the absence of psychotic symptoms such as delusions and hallucinations. Hypomanic states can occur for various reasons, but most often hypomania is explained by the peculiarities of bipolar disorder.
Possible causes of Madelung's deformity
- Madelung's deformity (Madelung's disease) is a developmental disorder of the distal end of the forearm and wrist joint, affecting the palmar part of the epiphyses of the ulna and radius. It manifests itself as a radial deviation of the hand, and a bayonet-shaped deformity is formed due to the protruding distal part of the ulna.
- Most often affects teenage girls
- Associated with Turner syndrome
- Bilateral damage in 50% of cases.
Henry and Thornburn classification:
1. Post-traumatic
- after repeated microtrauma
- after a single injury with impaired consolidation of the palmar epiphysis of the radius and ulna.
2. Dysplastic
- Combined with bone dysplasias, such as osteochondromatosis, Ollier's disease, achondroplasia, mucopolysaccharidosis.
3. Chromosomal abnormalities (X-linked mutation, Turner syndrome).
4. Idiopathic.
What are the dangers of hypomania?
A large number of people do not pay due attention to hypomania and excessive activity. It seems to them that this ability to find time for work, and for communication, and for
entertainment is a character trait bestowed upon man from above. Indeed, there is nothing wrong with a person experiencing happiness at a certain point in his life, but this should not harm his health: physical and mental.
Bipolar disorder, the phase of which is hypomania, requires mandatory treatment, since manic hyperactivity will invariably lead to exhaustion of the body, the development of apathy and depression, and a decrease in the quality of life.
The dangers of hypomania are as follows:
- Lack of sleep causes fatigue to accumulate in the body. The patient loses the ability to focus and concentrate, and his memory deteriorates. If you refuse sleep and proper rest for a long time, “fog” appears in your head and constant drowsiness occurs.
- Overeating, consuming large quantities of fatty and fried foods lead to a person storing excess fat and becoming obese, as well as developing vitamin deficiency. Against the background of these diseases, there is a decrease in the body’s defenses and an exacerbation of existing chronic diseases.
- Frivolity and wastefulness invariably lead to financial problems and other difficulties in life. The patient is prevented from correcting the situation by the onset of apathy; he cannot pull himself together and do something to solve the problems that have arisen.
- A few days of excessive activity are followed by periods of depression that can last several months. The longer the attack of hypomania, the more difficult it is for a person to cope with a decadent mood subsequently.
A person in a hypomanic state is unable to adequately perceive the reality around him; he gradually loses the ability to control his own life, constantly comes into conflict with others and spoils relationships with them.
Hypomania often develops in creative people. There are cases when writers, composers or artists experienced inspiration for several months, allowing them to create real masterpieces. But the period of creative growth was certainly replaced by a breakdown and depression.
Some of them tried to regain lost inspiration with the help of alcohol or drugs, but this only worsened the situation. This is another danger of hypomania. A person strives by any means to regain the energy he has lost, and this can lead to unpredictable consequences.
Which method of diagnosing Madelung's deformity to choose: MRI, CT, X-ray
Selection method
- X-ray examination in two projections.
What will an x-ray of the wrist show with Madelung deformity?
Features of the affected joints of the distal articular surface of the radius:
- Increased inclination of the articular surface of the radius towards the ulna: a wide angle between the distal articular surface and the perpendicular line to the long axis of the radius, measured in a direct projection (normal values: 21-23°);
- Palm tilt: The increase in the angle between the distal articular surface of the radius and a line perpendicular to the long axis of the radius, measured in the lateral view (normal values are 10-15°).
- Curvature of the distal radius in the dorsal and radial direction.
- Shortening of the radius, change in length: the ulna is longer than the radius.
- Incongruence of articular surfaces - incongruence of the distal radioulnar joint is possible.
- Premature closure of the growth plate in the ulnar part of the distal radius.
- Focal osteopenia in the ulnar part of the distal radius.
- Triangular (teardrop-shaped) deformity of the distal epiphysis of the radius and V-shaped configuration of the proximal wrist.
- Exostoses in the ulnar part of the distal radius.
- Relative dorsal subluxation of the ulna compared to the radius and carpal bones or volar subluxation of the carpal bones.
a, b X-ray examination of the forearm with Madelung deformity : a) Shortening of the radius and Y-shaped configuration of the carpal bones. b ) X-ray examination after treatment. Bone callus after spreading the radius.
What will a CT scan of the wrist bones show with Madelung deformity?
- If necessary, a CT scan is performed to obtain a three-dimensional image of Madelung's deformity.
To make a diagnosis, cytological examination of punctate is necessary.
Microscopically lipoma
It is built like regular adipose tissue and differs from it in the size of the lobules and fat cells. The latter are either very small or reach gigantic sizes. In some cases, between the lobules and individual fat cells there is a proliferation of connective tissue, sometimes significant, and a fibrolipoma is formed. If there are a large number of vessels in it, the tumor is called angiolipoma.
For Dercum's disease
the histological picture is often similar to that described above, however, in some cases an angiolipoma structure or granulomatous structure with the presence of giant cells of foreign bodies is observed.
For benign symmetrical lipomatosis
the nodes have the structure of a regular lipoma. In the systemic form of multiple lipomatosis, in addition to mature fat cells, undifferentiated mesenchymal cells are found, as well as intermediate cells containing varying amounts of lipids in their cytoplasm. In well-differentiated areas, mature fat cells are visible, usually located in the mucoid stroma; in less differentiated areas there are lipoblasts of varying degrees of maturity containing lipids, as well as areas consisting of fibroblastic elements.
For familial lipomatosis
Histologically, mature adipose tissue is revealed, separated by connective tissue layers.
Histologically with angiolipoma
the ratio of adipose tissue, vascular and stromal elements can vary widely. From the shell, loose fibrous septa penetrate into the tumor, overgrown with vessels, the walls of which do not contain elastic and muscular elements. The intervascular space is filled with a substance with the histochemical properties of glycosaminoglycans. The cellular component, in addition to fat cells, is represented by vascular endothelial cells, erythrocytes, fibrocytes, lymphocytes and, rarely, polymorphonuclear leukocytes. Signs of inflammation or necrosis are usually not observed. Angiolipomas are characterized by minimal mitotic activity, slow growth, differentiation of elements, and lack of germination into surrounding tissues.
Anhymyolipoma
consists of adipose tissue, proliferating blood vessels and smooth muscle fibers that form a node in the subcutaneous tissue or deep parts of the reticular layer of the dermis. Data from IHC studies in cutaneous angiomyolipomas are contradictory: in some cases, tumors express HMB-45, in others the staining is negative.
Fibrous component in fibrolipoma
can be represented either by extensive fibrous fields or narrow layers between accumulations of fat cells. The fibrous part resembles a soft fibroma with a small number of cellular forms - fibroblasts, histiocytes, located in the loose intercellular substance. Less commonly, the fibrous component is represented by coarse fibrous connective tissue. Along the fibers there are spindle-shaped and stellate cells that contain neither glycogen nor fat, how they differ from the cells of embryonic adipose tissue. The fatty component included in these neoplasms is represented by mature fat cells. The latter have different sizes and shapes, some are flattened, some are signet-shaped. Small or large fat vacuoles are detected in the cytoplasm. The number of vessels in both the fibrous and fatty parts of the tumor is usually small. Along the course of the vessels, focal lymphoid infiltrates are detected.
Treatment methods
- Depends on the patient’s age, severity of the deformity, clinical symptoms and radiological signs.
Vicker's physiolysis when detecting deformation before the growth of the bone skeleton stops:
- Ulnar straightening with partial resection of the affected epiphyses
- Only part of the epiphysis is preserved
- Stimulation of compensatory growth.
Osteotomy of the radius:
- with late detection of deformity
- usually corrective osteotomy of the radius to restore adequate articular surface of the distal radioulnar joint
- If the ulna is too long, osteotomy to shorten the ulna is also the treatment of choice.
- Alternative method: radius stretching using the Ilizarov apparatus.
Resection of the distal head of the ulna to restore rotation.
Arthrodesis of the wrist - for the treatment of severe secondary degenerative changes.
Symptoms of the disorder
The main symptoms of hypomania include excessive talkativeness, social activity, obsession with one's professional activities and obvious inadequacy of statements and judgments. However, there are two types of this disorder, each of which has specific symptoms and causes of development.
Pure hypomania occurs with pronounced symptoms and is usually accompanied by increased aggressiveness:
- In professional activities, an obsession with a certain project or idea often arises, while the person always seems that those around him are trying to hinder or harm him. Hypomania does not allow a person to concentrate; he is often distracted by extraneous noises or conversations of people nearby. As a result, the patient becomes irritated and angrily expresses his dissatisfaction.
- Against the background of attacks of impatience with other people, patients with hypomania develop a need for constant communication. If harsh words offend someone, then the person will be the first to start a conversation, demonstrate exaggerated gaiety, give advice, make fun of colleagues or friends, encourage everyone to have a party, etc. The patient's behavior often seems too familiar to others.
- Hypomania is characterized by a lack of sleep. The patient is too passionate about a certain idea, he strives to do everything at once, so he often works at night. The productivity of such work is usually not high; a person does several things at the same time, without bringing any of them to completion.
- The patient's self-esteem is prohibitively high, he does not listen to the advice of others, and reacts negatively to constructive criticism. Most of his actions are frivolous, and his judgments are rather superficial.
The latent form of the disorder manifests itself in a similar way, with the only difference being that the person is less aggressive. The patient is also passionate about work, he practically does not sleep, feels the need to communicate, but less often enters into conflicts with others. A person with this form of disorder is almost always in a good mood and experiences unjustified optimism. People say about such individuals: “I put on rose-colored glasses.” A person does not pay attention to negative forecasts, difficulties do not cause fear, he takes on the most difficult tasks. However, the work he started will never be completed.
Other manifestations of both types of hypomania include:
- greatly increased appetite, in some cases a person begins to suffer from outright gluttony;
- a sharp increase in sexual attraction to the opposite sex;
- craving for various forbidden pleasures and alcohol;
- a tendency to make unnecessary purchases develops, a person becomes wasteful, and shopping addiction arises.
People suffering from hypomania say that they have too much internal energy and urgently need to put it somewhere. Many of them note that they experience impatience and internal trembling; tremors in the hands and twitching of the eyelids often occur.
Characteristic manifestations of the disease
Madelung syndrome is expressed in a tumor that grows infiltratively (penetrating into adjacent joints and tissues). This resembles a malignant formation, but the examination confirms its benign nature.
The patient's salivary glands almost immediately enlarge, but doctors cannot make a diagnosis based on a visual examination alone - this can be caused by various reasons, including the patient's excessive obesity. But during a manual examination of these areas, tumors are felt, soft and painless, not stationary. Moreover, the affected salivary glands continue to function normally, producing a standard volume of saliva.
Lipomatosis has the following symptoms:
- visual change in appearance;
- feeling of tension in the neck;
- painful sensations due to compression of various organs;
- the appearance of headaches;
- disorders of blood circulation, breathing, and swallowing;
- weakness in the arms;
- occasionally - the appearance of convulsions and epileptic seizures.
