Mania

Definition

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.

Description

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.

Diagnosis

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.

Treatment

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.

Prognosis

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.

Prevention

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.

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press, Inc., 1994.

Maxmen, Jerrold S., and Nicholas G. Ward. "Mood Disorders." In Essential Psychopathology and Its Treatment. 2nd ed. New York: W. W. Norton, 1995.

Whybrow, Peter C. A Mood Apart. New York: HarperCollins, 1997.

PERIODICALS

Biederman, Joseph A. "Is There a Childhood Form of Bipolar Disorder?" Harvard Mental Health Letter 13 (Mar. 1997): 8.

Daly, Ian. "Seminar: Mania." The Lancet 349 (1997): 1157-60.

ORGANIZATIONS

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>.

OTHER

Bowden, Charles L. "Choosing the Appropriate Therapy for Bipolar Disorder." Medscape Today 2, no. 8 (1997) <http://www.medscape.com>.

Sachs, Gary. "Adolescent Mania: Underdiagnosed and Under-treated." Medscape Today May 1997 <http://www.medscape.com>.

Paula Anne Ford-Martin

KEY TERMS

Hypomania—A less severe form of elevated mood state that is a characteristic of bipolar type II disorder.

Mixed mania—A mental state in which symptoms of both depression and mania occur simultaneously.