Mania is an abnormally elated mental state, typically characterized by feelings of euphoria, lack of inhibitions, racing thoughts, diminished need for sleep, talkativeness, risk taking, and irritability. In extreme cases, mania can induce hallucinations
and other psychotic symptoms.
Mania typically occurs as a symptom of bipolar disorder
(a mood disorder characterized by both manic and depressive episodes). Individuals experiencing a manic episode often have feelings of self-importance, elation, talkativeness, sociability, and a desire to embark on goal-oriented activities, coupled with the less desirable characteristics of irritability, impatience, impulsiveness, hyperactivity, and a decreased need for sleep. (Note: Hypomania is a term applied to a condition resembling mania. It is characterized by persistent or elevated expansive mood, hyperactivity, inflated self esteem, etc., but of less intensity than mania.) Severe mania may have psychotic features.
Causes and symptoms
Mania can be induced by the use or abuse
of stimulant drugs such as cocaine
and amphetamines. It is also the predominant feature of bipolar disorder, or manic depression, an affective mental illness that causes radical emotional changes and mood swings.
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the diagnostic standard for mental health professionals in the U.S., describes a manic episode as an abnormally elevated mood lasting at least one week that is distinguished by at least three of the following symptoms: inflated self-esteem, decreased need for sleep, talkativeness, racing thoughts, distractibility, increase in goal-directed activity, or excessive involvement in pleasurable activities that have a high potential for painful consequences. If the mood of the patient is irritable and not elevated, four of these symptoms are required.
Mania is usually diagnosed and treated by a psychiatrist and/or a psychologist in an outpatient setting. However, most severely manic patients require hospitalization. In addition to an interview, several clinical inventories or scales may be used to assess the patient's mental status and determine the presence and severity of mania. An assessment commonly includes the Young Mania Rating Scale (YMRS). The Mini-Mental State Examination (MMSE) may also be given to screen out other illnesses such as dementia
Mania is primarily treated with drugs. The following mood-stabilizing agents are commonly prescribed to regulate manic episodes:
- Lithium (Cibalith-S, Eskalith, Lithane) is one of the oldest and most frequently prescribed drugs available for the treatment of mania. Because the drug takes four to seven days to reach a therapeutic level in the bloodstream, it is sometimes prescribed in conjunction with neuroleptics (antipsychotic drugs) and/or benzodiazepines (tranquilizers) to provide more immediate relief of mania.
- Carbamazepine (Tegretol, Atretol) is an anticonvulsant drug usually prescribed in conjunction with other mood-stabilizing agents. The drug is often used to treat bipolar patients who have not responded well to lithium therapy. As of early 1998, carbamazepine was not approved for the treatment of mania by the FDA.
- Valproate (divalproex sodium, or Depakote; valproic acid, or Depakene) is an anticonvulsant drug prescribed alone or in combination with carbamazepine and/or lithium. For patients experiencing "mixed mania," or mania with features of depression, valproate is preferred over lithium.
Clozapine (Clozaril) is an atypical antipsychotic medication used to control manic episodes in patients who have not responded to typical mood-stabilizing agents. The drug has also been a useful preventative treatment in some bipolar patients. Other new anticonvulsants (lamotrigine, gubapentin) are being investigated for treatment of mania and bipolar disorder.
Patients experiencing mania as a result of bipolar disorder will require long-term care to prevent recurrence; bipolar disorder is a chronic condition that requires lifelong observation and treatment after diagnosis. Data show that almost 90% of patients who experience one manic episode will go on to have another.
Mania as a result of bipolar disorder can only be prevented through ongoing pharmacologic treatment. Patient education in the form of therapy or self-help groups is crucial for training patients to recognize signs of mania and to take an active part in their treatment program. Psychotherapy is an important adjunctive treatment for patients with bipolar disorder.
American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. (888) 357-7924. http://www.psych.org.
National Alliance for the Mentally Ill (NAMI). Colonial Place Three, 2107 Wilson Blvd., Ste. 300, Arlington, VA 22201-3042. (800) 950-6264. http://www.nami.org.
National Depressive and Manic-Depressive Association (NDMDA). 730 N. Franklin St., Suite 501, Chicago, IL 60610. (800) 826-3632. http://www.ndmda.org.
National Institute of Mental Health. Mental Health Public Inquiries, 5600 Fishers Lane, Room 15C-05, Rockville, MD 20857. (888) 826-9438. http://www.nimh.nih.gov.
— A less severe form of elevated mood state that is a characteristic of bipolar type II disorder.
— A mental state in which symptoms of both depression and mania occur simultaneously.
Patient discussion about mania
Q. could my child have manic depression? My 15 year old girl has been too upset about her weight but I see her at different times with too different moods. sometimes it looks like she's very depressed and sometimes she's happy but too happy- like unreal happiness. can it be bipolar? I'm really afraid
A. yea actually there's my sister who is closer to her age and they're pretty attached but my girl can get pissed on anyone right now- wouldnt want to burn this connection as well so I have to be carefull.
what would you suggest her to do?
Q. One of my friend`s son in the manic episode. I have seen people in manic episode to be happy. What could be the reason for their happiness. One of my friend`s son in the manic episode, is generally seen with high euphoria, but often he gets in to different episodes, where he seems to be happy but at the same time aggressive, which is a symptom of depression. Please clarify?
A. Yes Waylon, all bipolar in manic episode are happy for no reasons. All Bipolar with depressions are depressed continuously with aggression and agitation. These two episodes of bipolars are at different poles, but a bipolar with mixed episodes is also found among some. Your friend’s son may also be in the mixed episode where bipolars have mania and depression as well at the same time.
Q. what is this and how it differs during episodes of mania and depression? I have heard of psychotic symptoms, what is this and how it differs during episodes of mania and depression?
A. I believe that psychosis is more common among people who have Bipolar 1. Psychosis develops in manias as Johnson said above, the person believes themselves to be someone, something they are not. They can believe themselves to be rich or invincable. I knew a gentleman once that was arrested at a car dealership because he believed that he had all the money in the world and was insisting that the dealership give him a Dodge Viper and refused to leave the showroom. When the day before he had spent both his and his partners entire paychecks on a bike (leaving no money for bills etc...) Sometime during that day he left the bike lying arund on the street somewhere because he said he had plenty of money and would just go and get another one.More discussions about mania
In a depressive state psychosis can manifest in other ways such as believeing in all kinds of conspiracy theories, believing the world is ending... etc...
Essentially the difference between psychosis in mania and depression is that in mania the per