Mania

Psychologists

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The experience of mania is often quite unpleasant and sometimes disturbing, if not frightening, for the person involved and may lead to impulsive behavior that may later be regretted.

Understanding Mania

Mania is a medical condition characterized by severely elevated mood People who experience a manic state often describe themselves as feeling high and superior. Generally, mania also provokes racing thoughts and creative ideas. However, it also pushes sufferers into agitation and poor decisions. Mania is most usually associated with bipolar disorder, where episodes of mania may alternate with episodes of depression. Not all mania can be classified as bipolar disorder, as mania may result from other diseases or causes. However, bipolar disorder is the classic manic disease.

Manic patients are frequently grandiose, irritable, belligerent, and frequently deny anything is wrong with them. Because mania frequently encourages high energy and decreased perception of need or ability to sleep, within a few days of a manic cycle, sleep-deprived psychosis may appear, further complicating the ability to think clearly. Racing thoughts and misperceptions lead to frustration and decreased ability to communicate with others.

Other manic symptoms include irritability, hyper-sexuality, hyper-religiosity, hyperactivity, talkativeness, and grandiose ideas and plans. In manic and less severe hypomanic cases, the afflicted person may engage in out of character behavior such as questionable business transactions, wasteful expenditures of money, risky sexual activity or highly vocal arguments uncharacteristic of previous behaviors. These behaviors increase stress in personal relationships, problems at work and increases the risk of altercations with law enforcement as well as being at high risk of impulsively taking part in activities potentially harmful to self and others.

Additional possible symptoms of mania include elation, extreme optimism, rapid unstoppable flow of speech, racing thoughts/flights of ideas, agitation, poor judgment, recklessness, inordinate capacity for activity, tendency to be easily distracted, inability to concentrate, exuberant and flamboyant or colorful dress, authoritative manner, and tendency to believe they are in their best mental state.

More severe symptoms include hallucinations (hearing, seeing, or otherwise sensing the presence of stimuli that are not there) and delusions (false personal beliefs that are not subject to reason or contradictory evidence and are not explained by a person's cultural concepts). Feelings of paranoia, during which the patient believes he or she is being persecuted or monitored by the government or a hostile force, may be present. Intense and unusual religious beliefs may also be present, such as a patient's strong insistence that they have a God-given role to play in the world, a great and historic mission to accomplish, or even that they possess supernatural powers.

Understanding Hypomania

Hypomania is a less severe form of mania, without progression to psychosis (hallucinations and delusions). Many of the symptoms of mania are present, but to a lesser degree than in overt mania.  People with hypomania are generally perceived as being energetic, euphoric, overflowing with new ideas, and sometimes highly confident and charismatic, and unlike full-blown mania, they are sufficiently capable of coherent thought and action to participate in everyday activities.

Mixed state

In the context of bipolar disorder, a mixed state is a condition during which symptoms of mania (or hypomania) and clinical depression occur simultaneously (for example, agitation, anxiety, fatigue, guilt, impulsiveness, insomnia, disturbances in appetite, irritability, morbid and/or suicidal ideation, panic, paranoia, psychosis, pressured speech, indecisiveness and rage).  Mixed states can be the most dangerous period of mood disorders, during which panic attacks, substance abuse, and suicide attempts increase greatly.

Cycling

Rapid cycling, defined as having four or more episodes per year, is found in a significant fraction of patients with bipolar disorder.  Ultradian or 'Ultra-Ultra-Rapid' cycling, in which mood cycling can also occur daily or even hourly, is less common.

Causes of Mania and Bi-Polar Disorder

According to the US government's National Institute of Mental Health (NIMH), there is no single cause for bipolar disorder, rather, many factors act together to produce the illness. Since bipolar disorder tends to run in families, researchers have been searching for specific genes passed down through generations that may increase a person's chance of developing the illness.

It is well established that bipolar disorder is a genetically influenced condition which can respond very well to medication.  Psychological factors also play a strong role in both the psychopathology of the disorder and the psychotherapeutic factors aimed at alleviating core symptoms, recognizing episode triggers, reducing negative expressed emotion in relationships, recognizing prodromal symptoms before full-blown recurrence, and practicing the factors that lead to maintenance of remission.

Diagnosis of Mania and Bi-Polar Disorder

The DSM-IV-TR details four categories of bipolar disorder, Bipolar I, Bipolar II, Cyclothymia, and Bipolar Disorder NOS (Not Otherwise Specified).  There are many problems with symptom accuracy, relevance, and reliability in making a diagnosis of bipolar disorder using the DSM-IV-TR. These problems all too often lead to misdiagnosis.  If misdiagnosed with depression, patients are usually prescribed antidepressants, and the person with bipolar depression can become agitated, angry, hostile, suicidal, and even homicidal (these are all symptoms of hypomania, mania, and mixed states).

Treatment of Mania and Bi-Polar Disorder

Currently, mania and bipolar disorder cannot be cured, but psychiatrists and psychologists believe that it can be managed. Before beginning treatment for mania, careful differential diagnosis must be performed to rule out non-psychiatric causes.

Acute mania in bipolar disorder is typically treated with mood stabilizers and/or antipsychotic medication. When the symptoms of mania have gone, long-term treatment then focuses on prophylactic treatment to try to stabilize the patient's mood, typically through a combination of pharmacotherapy and psychotherapy.

The emphasis of treatment is on effective management of the long-term course of the illness, which usually involves treatment of emergent symptoms. Treatment methods include pharmacological and psychotherapeutic techniques.  The goals of long-term optimal treatment are to help the individual achieve the highest level of functioning while avoiding relapse.

Bipolar disorder is a severely disabling medical condition. In fact, it is the 6th leading cause of disability in the world, according to the World Health Organization. However, with appropriate treatment, many individuals with bipolar disorder can live full and satisfying lives. Persons with bipolar disorder are likely to have periods of normal or near normal functioning between episodes.

Ultimately one's prognosis depends on many factors including the right medicines and the right dose of each, an informed patient, a good working relationship with a competent medical doctor, a competent, supportive, and warm therapist, and a balanced lifestyle including a regulated stress level, regular exercise and regular sleep and wake times.

There are obviously other factors that lead to a good prognosis, as well, such as being very aware of small changes in one's energy, mood, sleep and eating behaviors, as well as having a plan in conjunction with one's doctor for how to manage subtle changes that might indicate the beginning of a mood swing.

Wikipedia: Bipolar Disorder in Children

The following 4 paragraphs briefly presents information on mania and manic-depressive illness in children.  This material has been adapted from Wikipedia.

Children with bipolar disorder tend to have rapid-cycling or mixed-cycling. Rapid cycling occurs when the cycles between depression and mania occur quickly, sometimes within the same day or the same hour. When the symptoms of both mania and depression occur simultaneously, mixed cycling occurs.

Often other psychiatric disorders are diagnosed in bipolar children. These other diagnoses may be concurrent problems, or they may be misdiagnosed as bipolar disorder. Depression, ADD, ADHD, OCD, schizophrenia, and Tourette syndrome are common comorbid conditions. Misdiagnosis can lead to incorrect medication. Incorrect medications can trigger mania and/or suicidal ideation and attempts.

During severe episodes of mania and mixed states, a child may suffer from symptoms of psychosis. These episodes can be negative (such as thinking their poster on the wall is staring at them angrily) or positive (such as telling people that a rock band is coming to his or her birthday party).

There are many medications which can help calm the symptoms of bipolarity, including in children and adolescents. However, finding the right medicine or combination of medicines is not easy. An exact scientific means of choosing medication for bipolar treatment does not exist. With children this problem is made worse by the fact that as children grow, their weight, metabolism, hormones, brain structure, etc. changes. These changes often require adjustments in the medication(s), significantly more often than adults.

Additional Information

For more information about mania, bi-polar disorder, and other mental health problems, please click on the linked websites listed below.

 About Pediatric Bipolar Disorder
 Behavenet: Criteria for Manic Episode
 Child and Adolescent Bipolar Foundation

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