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What is mania?

Mania is an elevated “high state” that is a phase of bipolar disorder but may also occur in other situations, such as following a head injury or metabolic disturbance.

It is a mood state that is in complete contrast to the depressive phase (or “lows”) of bipolar disorder and characterized by hyperactivity and a reduced need for sleep. Heightened mood states that are not as severe as classic mania may be called hypomania or “mania-light”.

What causes mania?

The most common cause of mania is type I bipolar disorder, and hypomania is characteristic of type II bipolar disorder; however, both mania and hypomania can be a feature of substance abuse or neurologic, toxic, or metabolic disturbances.

What are the symptoms of mania?

Symptoms of mania can vary but may include:

  • A reduced need for sleep with little apparent fatigue
  • A sudden burst of creative insight or fractured or nonsensical thoughts
  • A sudden increase in goal-oriented activities (such as a project) to the exclusion of other activities
  • Clang associations (words that sound similar are grouped even if they don’t make any sense)
  • Constant, rapid, pressured talking (ie, a "motor mouth") which is difficult or even impossible to interrupt
  • Delusions
  • Hallucinations
  • Hypersexuality and sexually provocative behaviors
  • Impaired judgment or impulsive, risky, hurtful, or even dangerous behavior
  • Inappropriate humor
  • Incoherent speech (often described as rambling and persistent)
  • Paranoia
  • Persistent and often purposeless movement
  • Reckless and extravagant spending
  • Restlessness and an inability to remain still.

The difference between mania and hypomania is that in mania these symptoms cause substantial impairment in occupational, social, or interpersonal functioning, but in hypomania, the symptoms are not as severe and do not last as long.

Also, the diagnosis depends on how long any delusions or hallucinations are present for and the existence of any other mental health conditions, such as a psychotic or anxiety disorder.

How is mania diagnosed?

If you are experiencing symptoms of mania, or if you are concerned about the behavior of a friend or loved one, talk to your doctor or a mental health professional in your area.

The diagnosis of mania relies on the presence of an abnormally and persistently elevated or irritable mood and at least three of the following associated symptoms (or four if the mood is only irritable and not elevated):

  • An increase in activities or psychomotor agitation
  • Decreased need for sleep
  • Easily distracted
  • Excessive involvement in pleasurable activities despite the risk of negative consequences
  • Flight of ideas or a subjective feeling that thoughts are racing
  • Inflated self-esteem or grandiosity
  • More talkative than usual or pressure to keep talking.

How is mania treated?

If left untreated, mania can affect a person’s ability to function daily. Treatments may include:

  • Correction of the underlying disturbance if possible
  • Lithium
  • Valproate
  • Mood stabilizers
  • Atypical antipsychotics (these are preferred over typical antipsychotics).