Questions to Diagnose Mania
To diagnose mania, clinicians should ask specific questions about distinct, spontaneous periods of mood changes associated with sleep disturbances and psychomotor activation. 1
Core Diagnostic Questions
Mood Changes
- Have you experienced periods of unusually elevated, expansive, or irritable mood that represent a marked departure from your normal self?
- How long did these mood changes last? (Looking for episodes lasting at least 7 days or requiring hospitalization)
- Did others notice these changes in your mood or behavior?
Sleep Patterns
- During these periods, did you feel a decreased need for sleep without feeling tired?
- Were you able to stay awake for days with little or no sleep yet still feel energetic?
Activity and Energy
- During these periods, did you experience increased energy or activity levels?
- Did you feel more talkative than usual or feel pressure to keep talking?
- Did you have racing thoughts or feel your mind was going unusually fast?
Judgment and Behavior
- Did you engage in activities that had potential for painful consequences (excessive spending, sexual indiscretions, foolish business investments)?
- Did you feel more self-confident than usual or have grandiose beliefs about your abilities or importance?
- Were you more easily distracted than usual during these periods?
Additional Assessment Areas
Functional Impact
- How did these symptoms affect your work, relationships, or daily functioning?
- Did these symptoms cause significant distress or impairment in your life?
- Were you hospitalized during any of these episodes?
Psychotic Features
- Did you experience hallucinations or delusions during these periods?
- Did you believe you had special powers or a special relationship with important figures?
Cycling Patterns
- How frequently do these episodes occur?
- Do you experience rapid shifts between elevated mood and depression?
- How long do your episodes typically last?
Important Considerations
Manic symptoms must represent a significant departure from baseline functioning and be evident in different areas of the patient's life, not isolated to one setting 1
Distinguish true mania from other conditions with similar presentations:
- Disruptive behavior disorders
- Posttraumatic stress disorder
- Pervasive developmental disorders
- Substance-induced mood disorders
For children and adolescents, carefully assess whether symptoms represent true mania versus other conditions, as diagnostic validity in very young children has not been firmly established 1
Use standardized assessment tools as supplements to clinical interviewing:
- Young Mania Rating Scale (YMRS) 2
- Mood Disorder Questionnaire (MDQ)
Diagnostic Pitfalls to Avoid
- Failing to distinguish between true grandiosity versus age-appropriate fantasy or negotiation strategies
- Misinterpreting irritability as mania when it may be due to other conditions
- Not recognizing that psychosis in adolescents may be the first presentation of mania 1
- Overlooking mixed features where depressive symptoms co-occur with manic symptoms 3
- Failing to assess for comorbid conditions like ADHD, substance abuse, or anxiety disorders 1
Remember that mania is characterized by an elevated mood or euphoria, overactivity with decreased need for sleep, and increased optimism that often becomes so severe that judgment is impaired 4. The diagnostic assessment must incorporate both current and past history regarding symptomatic presentation, treatment response, psychosocial stressors, and family psychiatric history 1.