From the Guidelines
Signs of mania include elated, expansive, or irritable mood, inflated self-esteem, grandiosity, decreased need for sleep, more talkative than usual, pressured speech, racing thoughts, and excessive participation in multiple activities. When assessing for mania, look for someone who seems unusually energetic or euphoric, talks rapidly and jumps between topics, expresses unrealistic beliefs about their abilities or importance, and shows poor judgment in spending, sexual activity, or business ventures 1. They may function on little sleep without feeling tired, be easily distracted, and engage in multiple activities simultaneously. Physical signs include psychomotor agitation, rapid speech, and decreased attention span. Some key points to consider when assessing for mania include:
- Decreased need for sleep
- More talkative than usual, pressured speech
- Racing thoughts
- Abrupt topic changes when talking
- Distractible
- Excessive participation in multiple activities
- Agitated or restless
- Hypersexual, spends foolishly, uninhibited remarks These symptoms result from dysregulation in neurotransmitter systems, particularly dopamine and norepinephrine, as noted in the assessment and treatment of children and adolescents with suicidal behavior 1. Early recognition is crucial as untreated mania can lead to serious consequences including psychosis, self-harm, and damaged relationships.
From the FDA Drug Label
Typical symptoms of mania include pressure of speech, motor hyperactivity, reduced need for sleep, flight of ideas, grandiosity, elation, poor judgment, aggressiveness, and possibly hostility. The signs that can be assessed for mania are:
- Pressure of speech
- Motor hyperactivity
- Reduced need for sleep
- Flight of ideas
- Grandiosity
- Elation
- Poor judgment
- Aggressiveness
- Hostility 2
From the Research
Signs of Mania
The signs of mania can be assessed through various symptoms, including:
- Abnormally and persistently elevated, expansive, or irritable mood 3
- Abnormally and persistently increased activity or energy, which is now considered a core symptom of manic and hypomanic episodes 3
- Target symptoms such as faster onset of action, or wider spectrum of symptoms 4
- Manic episodes should be managed on a personalized basis considering the clinical course and patient criteria 5
Assessment of Mania
To assess mania, the following criteria can be used:
- DSM-5 criterion of increased activity or energy as a primary criterion for the diagnosis of bipolar mania 3
- Manic State Rating Scale (MSRS) to measure the changes in manic symptoms 6
- Clinical Global Impression-Severity of illness scale (CGI-S) to rate overall illness severity 6
Treatment of Mania
The treatment of mania can involve various medications, including:
- Lithium, which is considered the prototype drug for mood stabilizers 4, 7, 6
- Olanzapine, which has been shown to be effective in the treatment of acute manic and mixed episodes 4, 7, 5, 6
- Other mood stabilizers such as divalproex, carbamazepine, and lamotrigine 7, 5
- Antipsychotics such as chlorpromazine, haloperidol, risperidone, quetiapine, ziprasidone, aripiprazole, inhaled loxapine, asenapine, and cariprazine 5