The term “mania” refers to a pathological mental state. It is considered the opposite of depression and most often occurs as part of bipolar disorder. This condition was formerly known as manic-depressive illness and is classified as a so-called endogenous psychosis.
Unipolar mania (without depression) is very rare, but when it does occur, it is associated with a high risk of relapse.
Even rarer are manic-like syndromes associated with
- high fever,
- drug intoxication,
- physical or organic brain disorders, or
- as a side effect of medication
.
Historically, the term “mania” dates back to Hippocrates in the 5th century B.C. Translated from Latin, “mania” means something like frenzy, obsession, or madness.
According to ICD-10, hypomania (= mild forms of mania) is characterized by
- a persistently slightly elevated mood,
- increased activity and drive,
- an enhanced sense of well-being,
- sociability,
- talkativeness, and
- a reduced need for sleep for a few days.
The range of individual variation is very wide. Therefore, to accurately classify mania, it is often necessary to consult the accounts of family members who know the affected person well.
Due to the subjective sense of well-being that often accompanies mania, those affected sometimes refuse treatment. Artists describe experiencing a surge in creativity while in a manic state. However, there is a risk of deterioration, which can sometimes lead to serious negative consequences.
Manic Phase Without Psychotic Symptoms
Clear-cut mania without psychotic symptoms is characterized by
- an elevated mood that is inappropriate for the situation,
- hyperactivity,
- a strong urge to talk,
- a reduced ability to listen,
- reduced need for sleep,
- loss of usual social inhibitions,
- easily distracted,
- overconfidence,
- expansiveness,
- delusions of grandeur,
- risky projects, and
- in some cases, high spending
lasting at least one week.
During a manic episode, those affected are extremely energetic and tend to overestimate their abilities © © yesdoubleyes | AdobeStock
Manic episode with psychotic symptoms
Manic episodes with psychotic symptoms are also characterized by
- gross overconfidence,
- delusions of grandeur of a delusional nature,
- racing thoughts,
- possibly delusions of persecution,
- aggressiveness/violence, and
- possibly delusional thoughts or hallucinations.
Consequences of a manic episode
In severe mania, those affected may have already
- irreparably damaged relationships or employment situations,
- squandered their savings,
- incurred significant debt, or
- seriously endangered themselves and others through risky behavior or while under the influence of alcohol or drugs.
In so-called mixed manic-depressive episodes, suicidal impulses may also occur briefly. When combined with a general reduction in inhibitions, these can quickly lead to suicidal acts.
The clinical picture of mania is particularly problematic when it is accompanied by a lack of insight into the illness. Those affected are often recognizable as ill even to a layperson, but they do not seek help or vehemently reject the help offered.
Only in cases of acute danger to themselves or others can those affected be admitted to a psychiatric facility for treatment against their will. Responsibility for making this determination lies with the public order offices, public health departments, and the police—though the organizational structure varies by district and state.
Committal for a period exceeding 24 hours requires judicial approval.
In most cases, manic episodes are treated with medication, such as mood stabilizers (lithium, valproate) or antipsychotics. In cases of mania, a low-stimulus environment and regular follow-up with a physician or specialist are recommended as supportive measures.
The relapse rate is very high in the months following a manic phase. Therefore, even after the acute phases of the illness have subsided, maintenance medication and relapse prevention are necessary. Tapering off the mood stabilizer should not begin until at least one year has passed, and sometimes much later.
A patient with mania should definitely seek outpatient specialist care. This care is provided by a private-practice psychiatrist or neurologist in their office or at psychiatric outpatient clinics (PIA). If this care is insufficient during acute phases of the illness, day hospital or inpatient psychiatric treatment may be considered.
During more stable phases,
- during more stable phases,
- a need for information, or
- work-related concerns,
medical rehabilitation at a specialized clinic may also be helpful.
In cases of legal incapacity due to a diagnosed manic episode, purchases can sometimes be returned or sales contracts rescinded.
A 48-year-old teacher was admitted to the hospital after becoming increasingly hyperactive in the preceding weeks in order—as she herself put it—to “make the world happy.”
An elevated mood had been evident for several days. Then the manic episode fully erupted during a weekend course, during which the patient barely slept. She slept only 1 to 2 hours per night, was on her feet all day, talked a lot, and was driven by the goal of making those around her happy. To this end, she made flower wreaths for all her neighbors, wanted to sing with children at the playground, and so on.
She refuses inpatient treatment because she feels extremely well and still has a lot to do. Her medical history includes several manic and severe depressive episodes. The patient initially refuses inpatient admission, but a close friend is able to persuade her to stay at the clinic. She is initially prescribed a highly effective antipsychotic (Zyprexa®), which is effective against acute mania.
After her condition stabilized after about four weeks, lithium was cautiously titrated for further phase prophylaxis. The patient had already had positive experiences with the medication. However, on the advice of a very religious new acquaintance who was opposed to medication, she had stopped taking it half a year before her hospitalization.
Therefore, the importance of taking lithium regularly—and possibly for many years—is discussed with her at length.
