Mania, or a manic phase, is a period of 1 week or more in which a person experiences a change in behavior that drastically affects their functioning. Mania is different from hypomania because hypomania does not cause a major deficit in social or occupational functioning, and it is a period of at least 4 days rather than 1 week. The defining characteristics of mania are increased talkativeness, rapid speech, decreased need for sleep, racing thoughts, distractibility, increase in goal-directed activity, and psychomotor agitation. Some other hallmarks of mania are an elevated or expansive mood, mood lability, impulsivity, irritability, and grandiosity. If the individual experiencing these symptoms requires hospitalization, then this period automatically qualifies as true mania and not hypomania, even if the symptoms are present for less than one week.
Mania must be distinguished from heightened energy and altered functioning that arises from substance use, medical conditions, or other causes. Mania is a "natural" state which is the characteristic of bipolar I disorder. A single manic phase is sufficient to make the diagnosis of bipolar I disorder, although most cases of bipolar I also involve hypomanic and depressed episodes.
Many families bring their loved ones to the emergency room due to the excessive behavioral changes they have noticed over a brief period. Patients amid a manic phase commonly engage in goal-directed activities that may result in harmful consequences, such as spending excessive money, starting businesses unprepared, traveling, or promiscuity. Many patients engage in property damage or even harm themselves or others through verbal or physical assaults. They may also become highly aggressive, agitated, or irritable. Although the patient may have poor insight and may not recognize they are behaving out of the norm, it becomes apparent to family or friends that this behavior may be due to mental illness.
Mania also commonly presents with psychotic features, which include delusions or hallucinations. Many patients endorse grandiose delusions, believing they are high-level operatives such as spies, government officials, members of secret agencies, or that they are knowledgeable professionals (even when they have no such background). These individuals may also experience auditory or visual hallucinations, which only present when they are in the manic phases. Some of the most common delusions are delusions of paranoia, in which patients believe that people are stalking, targeting, or surveilling them. They may believe this to be done by government agencies, gangs, or others. These patients are highly unlikely to respond to outsiders’ views on their psychosis as well as their mania. A component of the manic phase is that generally, the individuals themselves do not realize what is happening (poor insight). The problem is mainly noticed by others, including family members, friends, and even strangers or police.
Rapid cycling in bipolar disorder is defined as having at least 4 or more mood episodes in a 12-month period. These mood episodes may be manic, hypomanic, or depressive but must meet their full diagnostic and duration criteria. These episodes must be separated by periods of partial or full remission of at least 2 months or be separated by a switch to an episode of opposite polarities, such as mania or hypomania to major depressive episodes. Switching from mania to hypomania or vice-versa would not qualify because they are not opposite polarity. Rapid cycling bipolar disorder patients have been found to be more resistant to pharmacotherapy.
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