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Manic Episode (Mania)

According to the DSM-IV-TR, in a Manic Episode (aka Mania) a person experiences an abnormally elevated, expansive or irritable mood. 

An elevated mood is where a person feels euphoric or "high."  Expansive moods are characterized by intense joy and enthusiasm and a feeling that anything is possible.  These moods can have an infectious quality whereby others may feel enlivened or giddy while being with the person in the manic state. 

When irritable, manic individuals tend to be very impatient, argumentative and quick to lose their temper. 

All three of these mood states can occur together or switch from one to another quite rapidly. 

It is the abnormal intensity of these moods that makes Manic Episodes different than regular happiness, joy or irritability. 

Besides these mood changes, a Manic Episode must include a number of other symptoms that define it.   Firstly, Manic Episodes, by definition, must last for at least 7 days in a row (or less if the person needs to be hospitalized because of their manic state).   Also, the person must experience at least 3 of the following symptoms during this period (or 4 if their mood is predominantly irritable):

  1. Inflated self-esteem or grandiosity:  The person's self-confidence and opinion of him or herself becomes grossly exaggerated and inflated, certainly compared with their usual personality, and sometimes to the point of reaching delusional proportions.  Examples range from a person suddenly feeling that they are smarter, more talented or more productive than usual, to thinking that they are suddenly an expert in a field in which they have little experience, to believing that they have received a special mission from God.  
  2. Decreased need for sleep:  The person will be sleeping much less than their usual amount, sometimes going for days without any sleep at all, and yet despite this they feel full of energy and without the need to regain any sleep. Sometimes people in this state may feel tired, but they will also describe feeling driven by some internal source of energy that makes it impossible for them to relax or slow down.
  3. Flight of ideas or the subjective feeling that one's thoughts are racing:   The person may feel that their thoughts are racing, that they have so many thoughts in their mind that it is hard to keep track of all of them, that their thoughts are jumping to all different places, or that these thoughts are occurring at a rate faster than can be spoken.  In conversation, the person may switch rapidly from one topic to another to the point where it becomes difficult to understand what they are saying.  In severe cases, the person's thoughts and speech will become completely disorganized and incoherent.
  4. More talkative than usual or pressure to keep talking:   The person speaks much more quickly or more loudly than usual, they keep talking for much longer than usual or than what is appropriate, and it often becomes difficult or even impossible to interrupt them.
  5. Distractibility:  The person's attention becomes too easily drawn to unimportant or irrelevant distractions, and he or she seems unable to focus on the topic at hand.  The person may be switching abruptly from one activity to another without completing any one task.  This can become so severe that the person's behaviors become completely disorganized. 
  6. Increased goal-directed activity or agitation:   The person suddenly becomes much more active than usual. They may get involved in certain activities, projects or plans that seem excessive, such as suddenly embarking on grand business ventures, deciding to repaint all the rooms in their home, or drastically increasing the amount of work that they perform at their job.  Alternatively, the person may become involved in various different activities simultaneously, though again the effect is that they seem to be motivated by a drive and determination that is far beyond their norm.  Sometimes in the course of these activities the person may feel overconfident and take certain risks that are out of character for them, such as embarking on unsound business ventures. 
    • This increased interest and involvement also affects how the person behaves socially. A person in a manic state may become much more sociable than they are normally and can lose their inhibitions, sometimes to the point of becoming intrusive or making bold advances to people.  Often, they will experience a surge in their sexual drive.  For these reasons they may suddenly become the center attention, may participate in many more social activities than they do normally, and also become more sexually active.  It is common that in this state the person will seem more fun and charismatic than normally and they will thus have an easier time attracting other people and having more social interactions.
    • A person in a manic state may also become restless or agitated and physically hyperactive. They may start to excercise or play sports much more than usual in order to release all of their physical energy.

  7. Excessive involvement in pleasurable activities that have a high potential for painful consequences:   The person loses their normal inhibitions and delves into activities that are pleasurable and exciting but that come with high risks, such as spending excessive amounts of money, engaging in more risky sexual behaviors that may include infidelity or indiscriminate sexual encounters with strangers, using excessive amounts of alcohol or drugs, gambling, or driving recklessly.

Psychosis and Catatonia in Manic Episodes

Psychosis can sometimes occur as part of a Manic Episode. This is referred to as a Manic Episode with Psychotic Features, and is a severe form of an episode.

When these psychotic features have themes that fit with the emotional tones of a Manic Episode, they are labelled as being mood-congruent. An example of this would be grandiose delusions. On the other hand, when the psychotic features do not seem to be related to the emotional tones of the Manic Episode, they are called mood-incongruent.

Catatonia is another severe reaction that can happen in very rare cases as part of a Manic Episode.

Loss of Insight in Manic Episodes

Although not included in the official DSM-IV-TR criteria for a Manic Episode, it is quite common for a person in a manic state to lose an awareness or an appreciation for the extent to which their behaviors have become excessive and abnormal.  This is referred to as a loss of insight.  This can make it very difficult for them to moderate their behaviors. This also makes it difficult to offer treatment to a person in a manic state, for they may not see the need for any help and may actively resist any attempts to bring them to medical attention, especially if they find their manic state to be pleasurable.  

Disability is a key features of Manic Episodes

Nevertheless, persons who are experiencing a Manic Episode will require urgent medical attention because, in addition to impairing their ability to function normally at work, in social settings or in relationships, their condition can also cause them to lose their inhibitions and to act ways that can also put them or others at risk of serious harm, including major financial losses if they end up spending all their money recklessly.

Diagnostic Exclusions

Of note, if manic symptoms are caused by a particular drug or medication, or are due to a general medical condition, then a diagnosis of Mania is not made, though this person will still require medical attention. This is true even if the Mania was caused by an antidepressant, though clinically such cases are usually treated like regular Manic Episodes [ref].

 

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