Mania
Mania
Mania is a mood disturbance marked by an abnormal degree of elation or irritability along with a number of other symptoms including restlessness, inflated self-confidence, a marked decrease in the need for sleep, rapid and loud speech that is difficult to interrupt, racing thoughts, high distractibility, and a marked increase in certain goal-directed activities. Over time, manic episodes are usually preceded or followed by periods of major depression, and diagnostically mania is seen as a component of bipolar, or manic-depressive, disorder. In bipolar disorders individuals experience alternating manic and depressive symptoms. Mania is not currently considered a separate psychiatric disorder.
Symptoms
The primary symptom of a manic episode is a marked disturbance of mood in which the individual is extremely elated or irritable for at least one week. The individual’s mood may be unusually cheerful or good, and while this may not seem unusual to those who do not know the individual, to those who do, it is usually seen as excessive and strange. The person’s mood may also be one of extreme irritability, especially when his or her desires and goals are interfered with. It also quite common for the person to switch rapidly between irritability and elation. In addition to the mood disturbance the individual will usually show three or four of the following symptoms:
The need for less sleep is almost always seen, so that the individual may rise hours earlier than normal yet still be full of energy. Indeed, the person may not sleep for days but feel no fatigue. Another common symptom is overly high self-confidence. The individual may attempt complex and difficult tasks for which he or she has no experience or knowledge, such as sailing around the world or climbing Mount Everest. The person may also have grandiose delusions (false beliefs that do not seem possible) about himself or herself. Loud and rapid speech that is difficult to interrupt is also a common symptom. Speech will often show a pressured quality as if the person is compelled to speak, so that an individual may talk a lot, sometimes for hours without stopping. Extremely rapid or racing thoughts are often present, and may be manifest in very rapid speech in which the individual switches topics very rapidly; in extreme cases speech may become so disorganized that it is incomprehensible. A person having a manic episode will often plan and participate in an excessive amount of goal-directed behaviors, such as sexual, professional, political, or religious activities. The individual may, for example, volunteer in numerous school or work-related committees without regard to whether they can fulfill these obligations. Often a person having a manic episode does not believe there is anything wrong, and resists treatment.
Taken together, these symptoms often lead to reckless behaviors the individual would not normally engage in that are likely to have negative consequences. For instance, the individual may make unnecessary purchases that he or she cannot afford, or make unwise investments. In order for a diagnosis of manic episode to be made, an individual’s interpersonal, professional, or school functioning must be noticeably impaired or hospitalization must be required because of these symptoms.
Course
Manic episodes can last from a few weeks to two to three months in length, and they are often preceded by stressful life events. While the average age for a first manic episode is in the early twenties, some occur in the teenage years. Those who have their first episode in their teens often have a history of behavior problems. Sometimes mania is not seen until after age 50.
Over 90% of individuals who have one manic episode will have additional episodes. And approximately 60-70% of manic episodes occur just before or after periods of major depression. While this may paint a rather bleak picture, it should be noted that some experts hold that while up to 40% of those with bipolar disorder will experience repeating cycles, they rarely experience long-term physical or mental impairment. And most people with bipolar disorder have periods with almost no symptoms in which they essentially function normally.
Causality
Most researchers believe bipolar disorders have a biological basis. This is supported by findings that close relatives of those with bipolar disorder are significantly more likely to develop affective disorders than are relatives of people with no history of psychiatric illness. Theories of underlying biological mechanisms have centered on concentrations of various neurotransmitters in the nerve connections of the brain. Because neurotransmitter interactions are subtle, complex, and difficult to observe, the strongest supportive and discerning evidence for the roles of specific neurotransmitters comes from the differential efficacy of various drug treatments. The fact that patients diagnosed with bipolar disorder respond differently to various drugs indicates there may be more than one type of bipolar disorder with different biological bases.
Treatment
Lithium carbonate is the predominant drug treatment for manic episodes. Carbamazepine has been used to successfully treat those who cannot tolerate or do not respond to lithium. Various antipsychotic and antidepressant medications have also proven useful. Electroconvulsive shock therapy has also shown some effectiveness, and may be indicated for patients who cannot take lithium or antipsychotics, though its use remains controversial.
For treating some types of depression, psychotherapy has been found to be effective, although its efficacy in treating manic states however is still unclear, as there have been few studies assessing this. This may be due to the general difficulty of treating someone in a manic state. In general, however, it seems that after a manic episode most people may benefit from supportive psychotherapy as they often experience a lowering of their confidence and self esteem.
Current research
Over the years, psychiatrists and psychologists have questioned whether mania is experienced without depressive episodes and thus whether it is a disorder distinct from bipolar disorder. Some recent research looking at this indicates that it the concept of mania
KEY TERMS
Antipsychotic drugs —Also called neuroleptics, these drugs seem to block the uptake of dopamine in the brain. They help to reduce psychotic symptoms across a number of mental illnesses.
Bipolar disorder —A psychiatric disorder in which individuals experience alternating states of mania and depression, it is often referred to as manic-depressive disorder.
Delusions —Fixed, false beliefs that are resistant to reason or factual disproof.
Electroconvulsive therapy (ECT) —Administration of a low-dose electric current to the head in conjunction with muscle relaxants to produce convulsions. A treatment method whose underlying action is still not fully understood, it has proven effective in relieving symptoms of some severe psychiatric disorders for which no other treatment has been effective, for example, severe depression.
Neuroimaging techniques —High technology methods that enable visualization of the brain without surgery such as computed tomography (CT), and magnetic resonance imaging (MRI).
Neurotransmitters —Biochemical substances that transmit nerve impulses between nerve cells.
Psychotherapy —A broad term that usually refers to interpersonal verbal treatment of disease or disorder that addresses psychological and social factors.
as a distinct disorder merits further investigation. Currently, however, the Diagnostic and Statistical Manual of Mental Disorders, Text Revision 4th edition (DSM-IV-TR), the official psychiatric classification system in the United States, has no separate diagnostic disorder called mania or manic disorder. Neuroimaging techniques allowing visualization of the functioning brain have enabled further distinctions between psychiatric disorders based on underlying differences in brain structure, and hold promise for research in bipolar disorder and mania.
See also Bipolar disorder.
Resources
BOOKS
Andreason, N.C., and D.W. Black. Introductory Textbook of Psychiatry. Washington, DC: American Psychiatric Press, Inc. 1991.
Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4th ed., text revision. Washington, DC: American Psychiatric Association, 2000.
Jefferson, James W., and John H. Greist. Lithium and Manic Depression: A Guide. Madison, WI: Madison Institute of Medicine, 1999.
Kaplan, H.I., and B.J. Sadock. Comprehensive Textbook of Psychiatry. 6th ed. Baltimore: Williams and Wilkins, 1995.
PERIODICALS
Hyman, S.E. “The Genetics of Mental Illness: Implications for Practice.” Bulletin of the World Health Organization 78 (April 2000): 455-463.
OTHER
Medicine Net. “Bipolar Disorder (Mania)” <http://www.medicinenet.com/bipolar_disorder/article.htm> (accessed December 2, 2006).
Merck Manuals, Online Medical Library. “Manic-Depressive Disorder” <http://www.merck.com/mmhe/sec07/ch101/ch101d.html> (accessed December 3, 2006).
Marie Doorey
Mania
Mania
Mania is a mood disturbance marked by an abnormal degree of elation or irritability along with a number of other symptoms including restlessness, inflated self confidence, a marked decrease in the need for sleep , rapid and loud speech that is difficult to interrupt, racing thoughts, high distractibility, and a marked increase in certain goal-directed activities. Over time , manic episodes are usually preceded or followed by periods of major depression , and diagnostically mania is seen as a component of bipolar, or manic-depressive, disorder. In bipolar disorders individuals experience alternating manic and depressive symptoms. Mania then is not currently considered a separate psychiatric disorder.
Symptoms
The primary symptom of a manic episode is a marked disturbance of mood in which the individual is extremely elated or irritable for at least one week unless hospitalization is necessary. The individual's mood may be unusually cheerful or good, and while this may not seem unusual to those who do not know the individual, to those who do, it is usually seen as excessive and strange. The person's mood may also be one of extreme irritability, especially when his or her desires and goals are interfered with. It also quite common for the person to switch rapidly between irritability and elation. In addition to the mood disturbance the individual will usually show three or four of the following symptoms.
In a manic episode the need for less sleep is almost always seen, so that the individual may rise hours earlier than normal yet still be full of energy . Indeed, the person may not sleep for days but feel no fatigue. Another common symptom is overly high self-confidence. The individual may attempt complex and difficult tasks for which he or she has no experience or knowledge, such as sailing around the world or climbing Mount Everest. The person may also have grandiose delusions (false beliefs that do not seem possible) about himself or herself. Rapid and loud speech that is difficult to interrupt is also a common symptom. Speech will often show a pressured quality as if the person is compelled to speak, so that an individual may talk a lot, sometimes for hours without stopping. Extremely rapid or racing thoughts are often present in a manic episode. This may be seen in very rapid speech in which the individual switches topics very rapidly, and in extreme cases speech may become so disorganized that it is incomprehensible. A person having a manic episode will often plan and participate in an excessive amount of goal-directed behaviors, such as sexual, professional, political, or religious activities. The individual may, for example, volunteer in numerous school or work related committees without regard to whether they can fulfill these obligations. Often a person having a manic episode does not believe there is anything wrong, and resists treatment. Taken together, these symptoms often lead to reckless behaviors the individual would not normally engage in that are likely to have negative consequences. For instance, the individual may make unnecessary purchases that he or she cannot afford, or make unwise investments. In order for a diagnosis of manic episode to be made, an individual's interpersonal, professional, or school functioning must be noticeably impaired or hospitalization must be required because of these symptoms.
Course
Manic episodes can last from a few weeks to two to three months in length, and they are often preceded by stressful life events. While the average age for a first manic episode is in the early twenties, some occur in the teenage years. Those who have their first episode in their teens often have a history of behavior problems. Sometimes mania is not seen until after age 50.
Over 90% of individuals who have one manic episode will have additional episodes. And approximately 60-70% of manic episodes occur just before or after periods of major depression. While this may paint a rather bleak picture, it should be noted that some experts hold that while up to 40% of those with bipolar disorder will experience repeating cycles, they rarely experience long-term physical or mental impairment. And most people with bipolar disorder have periods with almost no symptoms in which they essentially function normally.
Causality
Most researchers believe bipolar disorders have a biological basis. And this stance is supported by findings that close relatives of those with bipolar disorder are significantly more likely to develop affective disorders than are relatives of people with no history of psychiatric illness. Theories of the underlying biological mechanisms have centered on concentrations of various neurotransmitters in the nerve connections of the brain . Because neurotransmitter interactions are subtle, complex, and obviously hard to observe, the strongest supportive and discerning evidence for the roles of specific neurotransmitters comes from the differential efficacy of various drug treatments. The fact that patients diagnosed with bipolar disorder respond differently to various drugs indicates there may be more than one type of bipolar disorder with different biological bases.
Treatment
Lithium carbonate is the predominant drug treatment for manic episodes. Carbamazepine has been used to successfully treat those who cannot tolerate or do not respond to lithium. Various antipsychotic and antidepressant medications have also proven useful. Electroconvulsive shock therapy has shown some effectiveness in the treatment of mania and it may be indicated for patients who cannot take lithium or antipsychotics, though its use remains controversial. For treating some types of depression, psychotherapy has been found to be effective, its efficacy in treating manic states however is still unclear, as there have been few studies assessing this. This may be due to the general difficulty of treating someone in a manic state. In general, however, it seems that after a manic episode most people may benefit from supportive psychotherapy as they often experience a lowering of their confidence and self esteem.
Current research
Currently, the Diagnostic and Statistical Manual of Mental Disorders, Text Revision, 4th edition (DSM-IVTR) has no separate diagnostic disorder called mania or manic disorder. The DSM-IV-TR is the official psychiatric classification system for medical and legal uses in the United States. Over the years, psychiatrists and psychologists have questioned whether mania is experienced without depressive episodes and thus whether it is a disorder distinct from bipolar disorder. Some recent research looking at this indicates that it the concept of mania as a distinct disorder merits further investigation. Neuroimaging techniques allowing visualization of the functioning brain have enabled further distinctions between psychiatric disorders based on underlying differences in brain structure, and hold promise for research in bipolar disorder and mania.
See also Manic depression.
Resources
books
Andreason, N.C., and D.W. Black. Introductory Textbook ofPsychiatry. Washington, DC: American Psychiatric Press, Inc. 1991.
Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994.
Diagnostic and Statistical Manual of Mental Disorders: DSM IV-TR. 4th ed., text revision. Washington, DC: American Psychiatric Association, 2000.
Jefferson, James W., and John H. Greist. Lithium and ManicDepression: A Guide. Madison, WI: Madison Institute of Medicine, 1999.
Kaplan, H.I., and B.J. Sadock. Comprehensive Textbook of Psychiatry. 6th ed. Baltimore: Williams and Wilkins, 1995.
periodicals
Hyman, S.E. "The Genetics of Mental Illness: Implications for Practice." Bulletin of the World Health Organization 78 (April 2000): 455-463.
Marie Doorey
KEY TERMS
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .- Antipsychotic drugs
—These drugs, also called neuroleptics, seem to block the uptake of dopamine in the brain. They help to reduce psychotic symptoms across a number of mental illnesses.
- Bipolar disorder
—A psychiatric disorder in which individuals experience alternating states of mania and depression, it is often referred to as manic-depressive disorder.
- Delusions
—Fixed, false beliefs that are resistant to reason or factual disproof.
- Electroconvulsive therapy (ECT)
—Administration of a low dose electric current to the head in conjunction with muscle relaxants to produce convulsions. A treatment method whose underlying action is still not fully understood, it has proven effective in relieving symptoms of some severe psychiatric disorders for which no other treatment has been effective, for example, severe depression.
- Neuroimaging techniques
—High technology methods that enable visualization of the brain without surgery such as computed tomography (CT), and magnetic resonance imaging (MRI).
- Neurotransmitters
—Biochemical substances that transmit nerve impulses between nerve cells.
- Psychotherapy
—A broad term that usually refers to interpersonal verbal treatment of disease or disorder that addresses psychological and social factors.
Mania
Mania
Definition
Mania is an abnormally elated mental state, typically characterized by feelings of euphoria, lack of inhibitions, racing thoughts, diminished need for sleep, talkativeness, risk taking, and irritability. In extreme cases, mania can induce hallucinations and other psychotic symptoms.
Description
Mania typically occurs as a symptom of bipolar disorder (a mood disorder characterized by both manic and depressive episodes). Individuals experiencing a manic episode often have feelings of self-importance, elation, talkativeness, sociability, and a desire to embark on goal-oriented activities, coupled with the less desirable characteristics of irritability, impatience, impulsiveness, hyperactivity, and a decreased need for sleep. (Note: Hypomania is a term applied to a condition resembling mania. It is characterized by persistent or elevated expansive mood, hyperactivity, inflated self esteem, etc., but of less intensity than mania.) Severe mania may have psychotic features.
Causes and symptoms
Mania can be induced by the use or abuse of stimulant drugs such as cocaine and amphetamines. It is also the predominant feature of bipolar disorder, or manic depression, an affective mental illness that causes radical emotional changes and mood swings.
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV ), the diagnostic standard for mental health professionals in the U.S., describes a manic episode as an abnormally elevated mood lasting at least one week that is distinguished by at least three of the following symptoms: inflated self-esteem, decreased need for sleep, talkativeness, racing thoughts, distractibility, increase in goal-directed activity, or excessive involvement in pleasurable activities that have a high potential for painful consequences. If the mood of the patient is irritable and not elevated, four of these symptoms are required.
Diagnosis
Mania is usually diagnosed and treated by a psychiatrist and/or a psychologist in an outpatient setting. However, most severely manic patients require hospitalization. In addition to an interview, several clinical inventories or scales may be used to assess the patient's mental status and determine the presence and severity of mania. An assessment commonly includes the Young Mania Rating Scale (YMRS). The Mini-Mental State Examination (MMSE) may also be given to screen out other illnesses such as dementia.
Treatment
Mania is primarily treated with drugs. The following mood-stabilizing agents are commonly prescribed to regulate manic episodes:
- Lithium (Cibalith-S, Eskalith, Lithane) is one of the oldest and most frequently prescribed drugs available for the treatment of mania. Because the drug takes four to seven days to reach a therapeutic level in the bloodstream, it is sometimes prescribed in conjunction with neuroleptics (antipsychotic drugs ) and/or benzodiazepines (tranquilizers) to provide more immediate relief of mania.
- Carbamazepine (Tegretol, Atretol) is an anticonvulsant drug usually prescribed in conjunction with other mood-stabilizing agents. The drug is often used to treat bipolar patients who have not responded well to lithium therapy. As of early 1998, carbamazepine was not approved for the treatment of mania by the FDA.
- Valproate (divalproex sodium, or Depakote; valproic acid, or Depakene) is an anticonvulsant drug prescribed alone or in combination with carbamazepine and/or lithium. For patients experiencing "mixed mania," or mania with features of depression, valproate is preferred over lithium.
Clozapine (Clozaril) is an atypical antipsychotic medication used to control manic episodes in patients who have not responded to typical mood-stabilizing agents. The drug has also been a useful preventative treatment in some bipolar patients. Other new anticonvulsants (lamotrigine, gubapentin) are being investigated for treatment of mania and bipolar disorder.
Prognosis
Patients experiencing mania as a result of bipolar disorder will require long-term care to prevent recurrence; bipolar disorder is a chronic condition that requires lifelong observation and treatment after diagnosis. Data show that almost 90% of patients who experience one manic episode will go on to have another.
Prevention
Mania as a result of bipolar disorder can only be prevented through ongoing pharmacologic treatment. Patient education in the form of therapy or self-help groups is crucial for training patients to recognize signs of mania and to take an active part in their treatment program. Psychotherapy is an important adjunctive treatment for patients with bipolar disorder.
Resources
ORGANIZATIONS
American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. (888) 357-7924. 〈http://www.psych.org〉.
National Alliance for the Mentally Ill (NAMI). Colonial Place Three, 2107 Wilson Blvd., Ste. 300, Arlington, VA 22201-3042. (800) 950-6264. 〈http://www.nami.org〉.
National Depressive and Manic-Depressive Association (NDMDA). 730 N. Franklin St., Suite 501, Chicago, IL 60610. (800) 826-3632. 〈http://www.ndmda.org〉.
National Institute of Mental Health. Mental Health Public Inquiries, 5600 Fishers Lane, Room 15C-05, Rockville, MD 20857. (888) 826-9438. 〈http://www.nimh.nih.gov〉.
KEY TERMS
Hypomania— A less severe form of elevated mood state that is a characteristic of bipolar type II disorder.
Mixed mania— A mental state in which symptoms of both depression and mania occur simultaneously.
Mania
MANIA
Mania is a state of psychomotor excitation. Its onset most often comes through inversion of a melancholic mood, either spontaneously or owing to treatment for depression.
The manic mood is euphoric, changeable, and accompanied by emotional hyperesthesia. The subject exhibits pathological optimism with an overestimation of the self and unrealistic plans that sometimes lead to delusions along megalomaniacal lines (grandeur, omnipotence, messianism). The expansiveness of mania is associated with agitation, expressed in hyperactivity and hypermimia. It is also accompanied by tachypsychia ("rushing thoughts"), an acceleration of the thought processes externally manifested in logorrhea, graphorrhea, hypermnesia, and distractibility. Hypersyntony, a immediate and increased receptivity to stimuli from the outside world and a loss of the ability to discriminate between important facts and details, gives the impression that the subject is closely emotionally attuned with his or her surroundings. Reduction in the duration of sleep, sometimes to the point of total insomnia, is a constant clinical sign.
In "Mourning and Melancholia" (1916-17g [1915]), based on his impressions as an analyst, Sigmund Freud observed that melancholic and manic patients were "wrestling with the same 'complex"' (p. 254)—a complex to which the melancholic ego succumbs and over which the manic ego triumphs. From nonpathological states of jubilation, triumph, and joy, he extrapolated the economic precondition of mania: It corresponded to a fresh availability of the psychic energy expended in the unconscious work of melancholia, which in mania again becomes "available for numerous applications and possibilities of discharge" (p. 254). At the point where melancholia turns into mania, the subject's ego is liberated from the object of its suffering; it surmounts its loss and triumphs over the object, and consequently the psychic energy that has been counter-cathected and bound to mental pain is suddenly available. In mourning there is no liberation of this type, for detachment from the object is more gradual, although Karl Abraham (1924/1927) viewed the increase in libidinous desires in some bereaved persons as comparable to mania.
From a topographical viewpoint, Freud showed in "Group Psychology and Analysis of the Ego" (1921c), that whereas a severe ego ideal crushes the melancholic's ego with its rigorous control, during mania it is suddenly absorbed or merged into the ego. The ego and the ego ideal of the manic subject become one, thus freeing the subject from all hindrances and all criticism, procuring for the subject a feeling of triumph and boundless satisfaction.
For Abraham, "the manic patient has thrown off the yoke of his super-ego, which now no longer takes up a critical attitude towards the ego, but has become merged in it" (1924/1927, p. 471). Abraham compared mania to a cannibalistic orgy. The manic subject, he argued, manifests an "increase in . . . oral desires" (p. 472) a veritable object-bulimia. This accelerated incorporation of the object is immediately followed by an "equally pleasurable act of ejecting [introjected objects] almost as soon as they have been received" (p. 472). The subject's "psychosexual metabolism" (p. 472) thus appears to be significantly accelerated.
Alban Jeanneau
See also: Acute psychoses; Manic defenses; Melancholia; Megalomania; Mourning and Melancholia ; Reparation; Secondary revision; Self-representation; Suicide.
Bibliography
Abraham, Karl. (1927). Notes on the psycho-analytical investigation and treatment of manic-depressive insanity and allied conditions. In Selected Papers of Karl Abraham, M.D. (pp. 137-156). London: Hogarth and the Institute of Psycho-analysis. (Original work published 1911)
——. (1927). A short study of the development of the libido, viewed in the light of mental disorders, In Selectedpapers of Karl Abraham, M.D. (pp. 418-201). London: Hogarth and the Institute of Psycho-analysis. (Original work published 1924)
Freud, Sigmund. (1916-17g [1915]). Mourning and melancholia, SE, 14: 237-258.
——. (1921c), Group psychology and the analysis of the ego. SE, 18: 65-143.
Mania
Mania
A description of the condition opposite depression in manic-depressive psychosis, or bipolar disorder. It is characterized by a mood of elation without apparent reason.
Most episodes of mania—elation without reasonable cause or justification—are followed in short order by depression ; together they represent the opposites described as bipolar disorder . Manic episodes are characterized by intense feelings of energy and enthusiasm, uncharacteristic self-confidence, continuous talking, and little need for sleep . People experiencing a manic period tend to make grandiose plans and maintain inflated beliefs about their own personal abilities. While manic people appear to be joyful and celebratory, their mood corresponds little to conditions they are experiencing in reality. Expressions of hostility and irritability also are common during manic episodes.
Further Reading
Duke, Patty. Call Me Anna. New York: Bantam, 1987.
Jamison, Kay. Touched with Fire: Manic-Depressive Illness and the Artistic Temperament. New York: Free Press, 1993
mania
So maniac, maniacal XVII. — late L. maniacus — late Gr. maniakós.
mania
ma·ni·a / ˈmānēə/ • n. mental illness marked by periods of great excitement, euphoria, delusions, and overactivity. ∎ an excessive enthusiasm or desire; an obsession: he had a mania for automobiles.
mania
—manic (man-ik) adj.