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Such a patient may file numerous lawsuits or seek redress from government agencies (querulous paranoia). A patient who becomes resentful and angry may lash out violently against the alleged offender. Somatic delusions Somatic delusions center on an imagined physical defect or deformity. The patient may perceive a foul odor coming from his skin, mouth, rectum, or other body part. Other delusions involve skin-crawling insects, internal parasites, or physical illness. Gathering accurate information from a delusional patient may prove difficult.
There is some support for the theory that bipolar disorder is linked to an X chromosome disorder. For example, the incidence of bipolar disorder among relatives of affected patients is higher than in the general population. The pathophysiologic mechanisms involving mood swings is unknown for bipolar disorder. Membrane changes in sodium- and potassium-activated adenosine triphosphatase involve disordered intracellular signals. Lithium is thought to help in this respect. Complications The impulsive behavior characteristic of manic episodes may have far-reaching emotional and social consequences, such as bankruptcy, child abuse, and divorce.
U ADVANCED PRACTICE Differentiating bipolar disorder A physical examination and laboratory tests such as endocrine function studies rule out medical causes of mood disturbances such as schizophrenia, mixed mania, and agitated depression. In addition, stimulants and sympathomimetic compounds taken by the patient can cause manic symptoms. Secondary mania, which closely resembles the mania of bipolar disorders, can be caused by hyperthyroidism, acquired immunodeficiency syndrome, neurologic disorders such as Huntington's chorea, or cerebrovascular accidents.