Mania

What is Mania?

Mania is a state where someone undergoes significant changes in behavior for a week or more, impacting how they live their everyday lives. This is not the same as hypomania, which also causes changes but to a less severe degree, and typically lasts for about four days. Key signs of mania include talking more, speaking quickly, requiring less sleep, having fast-paced thoughts, becoming easily distracted, and being involved in many activities or becoming highly restless. Other distinctive features include changes in mood, impulse control issues, becoming annoyed more easily, and inflated self-importance.

If a person experiencing these symptoms needs to be hospitalized, it is considered be a mania episode rather than hypomania, even if the duration is less than a week. Mania should be differentiated from an energy surge or other functioning changes caused by drug use, physical illnesses, or other reasons. Mania is a natural state that is often seen with bipolar I disorder. A single episode of mania is enough to diagnose someone with bipolar I disorder, although people with this illness usually also experience hypomania and depressive episodes.

Often, family members bring their loved ones to the hospital after noticing major behavioral changes over a short time. During a manic episode, patients frequently participate in activities that could lead to harmful outcomes, such as spending too much money, starting businesses without proper preparation, traveling suddenly, or displaying inappropriate sexual behavior. Some patients may damage property, or hurt themselves or others with their words or actions. They might also become excessively aggressive or irritated. The patient may not realize their behavior is abnormal, but friends or family members usually can tell that it might be due to a mental illness.

Mania can also often include psychotic features, such as delusions or hallucinations. Some patients start believing that they are spy agents, government officers, or capable professionals (even when they aren’t). They might also start seeing or hearing things that aren’t real, but these hallucinations are only present during manic phases. They might also become paranoids, thinking that someone is stalking them or making them a target. These patients usually won’t accept others’ perspectives on their mental state. Most of the time, the individuals themselves don’t recognize what is happening, it’s usually noticed more by the people around them, including family members, friends, and even strangers or law enforcement officers.

Rapid cycling in bipolar disorder is when someone has at least four mood episodes in a year. These episodes might be manic, hypomanic, or depressive, but they must fulfil their full diagnostic and duration criteria. These episodes need to be separated by at least two months of partial or full recovery, or by a shift to an episode of the opposite polarity, such as from mania or hypomania to a major depressive episode. Switching from mania to hypomania or vice versa does not count as they aren’t opposite polarities. Patients with rapid cycling bipolar disorder are usually more resistant to medication treatment.

What Causes Mania?

The exact causes behind mania and bipolar I disorder, a type of mental health condition, remain unknown. Researchers, however, believe it’s likely due to a mix of three factors; genetics (your family health history), psychological (your brain’s health), and social (your environment).

Medical research involving families shows clear signs of a genetic link. For example, in a study of identical (monozygotic) twins, where one twin has bipolar I disorder, the other one also has the disorder about 80% of the time. However, it’s crucial to point out that it’s not 100%. This suggests there are other influences at play like environmental factors, which goes beyond just genes.

Studies have also found that certain gene variants have been noted in both people with bipolar I disorder and those with schizophrenia (another mental health disorder), hinting a possible genetic connection.

Additionally, there’s strong anecdotal evidence – meaning stories from real people, rather than scientific studies – that stressful life situations and environmental factors can play a significant role in the onset and frequency of manic episodes, which are periods of extraordinarily high energy, restlessness, or irritability.

Risk Factors and Frequency for Mania

Bipolar I Disorder, typically diagnosed by episodes of mania, affects about 4% of people in their lifetime. Both men and women are equally likely to have this disorder. However, women tend to have multiple mood episodes in a year – a condition known as ‘rapid cycling’. The average age when people start showing signs of bipolar disorder is around 25. Men usually start experiencing symptoms earlier than women and are more likely to show initial signs of a manic episode. On the other hand, women typically have their first brush with a depressive episode. It’s also worth noting that almost two-thirds of people with bipolar disorder have at least one family member who has either been diagnosed with the disorder or with depression.

• Bipolar I Disorder, recognized by manic episodes, affects about 4% of people in their lifetime.
• It affects men and women equally, but women may experience multiple mood episodes in a year, known as ‘rapid cycling’.
• The disorder usually begins around the age of 25.
• Men are likely to start showing symptoms earlier than women, often with a manic episode.
• Conversely, women’s first encounter is typically a depressive episode.
• About two-thirds of those with bipolar disorder have a close relative diagnosed with the disorder or depression.

Signs and Symptoms of Mania

If a patient is suspected of having mania, doctors will ask about specific signs. These can include recent changes in sleep, energy levels, eating habits, and mood swings such as becoming easily annoyed. Medical professionals use a easy-to-remember tool known as “DIG FAST” to recall important symptoms. This includes:

• Distractibility
• Irresponsibility or Irritability
• Grandiosity
• Flight of ideas (rapidly changing thoughts)
• Increased activity
• Decreased sleep
• Excessive talkativeness

Diagnosing a manic episode depends on certain criteria laid out in the DSM-5. A manic episode could be identified if the patient experiences a sudden shift in mood, towards extreme happiness or anger, that lasts at least a week. Or, it could be any length of time if the symptoms are so severe that the patient needs to be hospitalized.

Testing for Mania

When someone shows signs of mania, a thorough check-up is necessary to rule out other possible conditions. Some of the standard lab tests that may be conducted include a complete blood count (CBC), a complete metabolic panel (CMP), a thyroid panel, and a urine drug test. These tests are essential in evaluating a patient experiencing mania.

In addition, doctors may use brain imaging techniques like a CT scan or MRI to identify any physical causes of manic symptoms. This is especially important in patients who are elderly (over 60) or very young (under 13).

Treatment Options for Mania

People who experience manic episodes generally need medicines to both soothe the acute manic symptoms and to maintain emotional stability to prevent future mood swings. This is the usual treatment approach for mania, a symptom of bipolar I disorder.

Traditionally, medications like lithium, valproic acid, and carbamazepine were used to treat mania. These are known as mood stabilizers and anticonvulsants, which have been effective in helping balance mood fluctuations. Nowadays, the category of mood stabilizers does not only include lithium and antiepileptics but also some newer class of drugs known as atypical antipsychotics.

A study analyzing various medications used in treating acute mania found that atypical antipsychotics were more effective in quickly managing manic symptoms than mood stabilizers. However, this doesn’t necessarily mean they are better for the long-term management of bipolar disorder. Some of these effective atypical antipsychotics are risperidone, olanzapine, and haloperidol. Medications like lithium, quetiapine, and aripiprazole were also found to be effective, but not at the same level as the atypical antipsychotics.

Other medications such as valproic acid, carbamazepine, and ziprasidone, while more effective than a placebo, weren’t as effective as their counterparts mentioned earlier. Meanwhile, gabapentin, lamotrigine, and topiramate didn’t show any significant difference in effectiveness compared to a placebo when used to treat mania.

While less used, clozapine and electroconvulsive therapy (a procedure where electric currents are passed through the brain to trigger a brief seizure) have shown benefits for treatment-resistant mania. In addition to these treatments, education about the condition and supportive therapy can be very beneficial in managing bipolar disorder for the ongoing benefit of patients and their families or caregivers.

What else can Mania be?

When a patient shows signs of mania, a doctor needs to consider many different possibilities, because several other health and mental disorders can have similar symptoms. For example, if someone has been consuming too much caffeine or using stimulant drugs like cocaine, amphetamines, PCP, or nicotine, they might appear manic. Even certain hallucinogen drugs can produce similar symptoms.

Excessive use of steroids and human growth hormones can also mimic mania. They may make a person appear anxious, irritated, or aggressive. Mental health conditions like schizophrenia, severe anxiety, obsessive-compulsive disorder, and major depression with psychotic features can look like the manic phase of bipolar disorder. Mood disorders that involve a mix of emotions, especially if they involve psychosis, should be considered as a possibility.

Personality disorders, such as histrionic and borderline personality, can also have similar symptoms. These might include mood swings, difficulties with regulating anger, unusual or dramatic clothing choices, and bizarre behaviors.

Lastly, certain physical conditions can mimic mania too. These include hyperthyroidism (an overly active thyroid), hypertensive urgency (very high blood pressure), high levels of hormones like cortisol and aldosterone, brain tumors, major deficits in cognitive functions, acromegaly (an excess of growth hormone in adults), and delirium (a state of confusion).

• Stimulant intoxication (through caffeine, cocaine, amphetamines, PCP, nicotine)
• Hallucinogen use
• Excessive steroid and human growth hormone use
• Mental illnesses such as schizophrenia, severe anxiety, obsessive-compulsive disorder, major depressive disorder with psychotic features
• Mixed mood disorder
• Personality disorders like histrionic and borderline personality
• Physiological conditions such as hyperthyroidism, hypertensive urgency, hypercortisolemia, hyperaldosteronism, brain masses or tumors, major neurocognitive disorders, acromegaly, and delirium

What to expect with Mania

If someone experiencing a manic episode follows their recommended treatment plan, which includes taking prescribed medications and attending therapy, they often have a good chance of improvement. However, there are some things that could make their recovery more challenging. These include a history of abuse, experiencing psychotic symptoms, having a lower socioeconomic status, dealing with other illnesses at the same time, or having their first episode at a young age.

Possible Complications When Diagnosed with Mania

The consequences of a manic episode can be very serious. People going through these episodes can behave in inappropriate ways that might damage their professional and personal reputation. Other, more severe problems can occur as well, such as causing physical harm to themselves or to others.

• Damage to professional and personal reputation
• Physical harm to self
• Physical harm to others

Preventing Mania

It’s crucial for people to understand that mania, a state of abnormally elevated arousal, often fluctuates, occurring in episodes. They should also be aware of how to notice the first symptoms, which might indicate that an episode is about to happen. This understanding can help them better manage their condition and seek timely help.