What is mania (bipolar disorder)?

From the Guidelines

Mania is a mental health condition characterized by abnormally elevated mood, energy, and activity levels that significantly impact daily functioning, typically involving symptoms such as decreased need for sleep, racing thoughts, rapid speech, increased goal-directed activities, grandiose beliefs, poor judgment, and impulsive behavior, as described in the practice parameter for the assessment and treatment of children and adolescents with bipolar disorder 1.

Key Characteristics of Mania

• Marked euphoria, grandiosity, and irritability, with associated racing thoughts, increased psychomotor activity, and mood lability 1
• Paranoia, confusion, and/or florid psychosis may also be present 1
• Marked sleep disturbance is a hallmark sign 1
• Significant depressive symptoms may precede, occur conjointly (mixed episodes), or follow those of mania within the same episode 1

Diagnosis and Assessment

• The DSM-IV-TR Criteria, including the duration criteria, should be followed when making a diagnosis of mania or hypomania in children and adolescents 1
• Manic-like symptoms of irritability and emotional reactivity may be found in a number of conditions, including disruptive behavior disorders, posttraumatic stress disorder, and pervasive developmental disorders 1
• A thorough workup can rule out other confounding illnesses and identify comorbid disorders that need to be addressed as part of a comprehensive treatment plan 1

Treatment

• Traditional mood stabilizers (e.g., lithium, valproate) and/or atypical antipsychotic medications are the primary treatment, with other psychotropic agents and psychotherapies generally used as adjunctive therapy or to address comorbid conditions and problems 1
• Treatment typically involves mood stabilizers like lithium (600-1200mg daily), valproate (750-1500mg daily), or carbamazepine (400-1200mg daily), sometimes combined with atypical antipsychotics such as olanzapine (5-20mg daily) or risperidone (2-6mg daily) 1

Importance of Early Recognition and Treatment

• Early recognition and consistent treatment are essential to prevent complications like financial problems, relationship difficulties, or dangerous behaviors that can occur during manic episodes 1
• Acute mania often requires hospitalization to ensure safety and medication compliance 1

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. Mania is characterized by symptoms such as:

• Pressure of speech
• Motor hyperactivity
• Reduced need for sleep
• Flight of ideas
• Grandiosity
• Elation
• Poor judgment
• Aggressiveness
• Possibly hostility 2

From the Research

Definition of Mania

• Mania is characterized by an abnormally and persistently elevated or irritable mood 3
• It is a cardinal symptom of manic syndromes, which can have many neurologic, toxic, and metabolic causes 3
• Mania can be distinguished from primary idiopathic mania (bipolar disorder) based on factors such as age of onset and underlying causes 3

Types of Mania

• Dysphoric mania: a subtype of mania characterized by depressive symptoms associated with mania 4
• Organic mania: a type of mania caused by underlying neurologic, toxic, or metabolic disorders 3
• Acute mania: a sudden onset of manic symptoms, which can be treated with adjunctive pharmacologic therapy 5

Symptoms of Mania

• Elevated or irritable mood 3
• Depressive symptoms, such as those measured by the Hamilton Rating Scale for Depression (HRSD) 4, 6
• Suicidality, as measured by the HRSD suicide item 4
• Manic symptoms, such as those measured by the Young Mania Rating Scale (YMRS) 4, 6

Treatment of Mania

• Olanzapine, in combination with lithium or valproate, has been shown to be effective in treating depressive symptoms associated with mania 4
• Adjunctive treatment with olanzapine, risperidone, quetiapine, or haloperidol has been shown to be effective in treating acute mania 5
• Lithium and valproate are commonly used in maintenance treatment of bipolar I disorder, either in monotherapy or in combination with atypical antipsychotics 7