Manic Episode

Manic episode is typically an elevated or irritable mood, which can range from intense energy, pacing thoughts to other intense or exaggerated behaviors.

What Is A Manic Episode?

Manic episode or mania in general terms is a psychological state of mind that involves euphoria and high energy levels, which can last for a period of one week or more in which a person experiences a change in their normal behaviors that drastically affects their day to day functioning.

Mania can be typically characterized by that person’s talkativeness, rapid speech, insomnia, disturbing thoughts, distraction towards their work, increased goal driven anxiety and psychomotor commotions. According to a recent 2021 research paper [mfn] Dailey MW, Saadabadi A. Mania. [Updated 2021 Aug 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493168/ [/mfn] , some significant characteristics of a manic episode include elevated talkativeness, erratic mood change, impulsiveness, irritability,and pretentiousness. Mania is different from heightened tension and altered functioning that arises from substance abuse, different medical conditions or any other causes.

Mania is a psychological state of mind which is a characteristic of bipolar I disorder [mfn] Jain A, Mitra P. Bipolar Affective Disorder. [Updated 2021 May 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558998/ [/mfn]. A single manic phase is enough to conclude that it is a bipolar I disorder. Although many cases of bipolar I disorder are also associated with hypomania and depressed episodes.
Mania is commonly associated with psychotic features which includes delusions or hallucinations. The sufferer might also experience auditory or visual hallucinations, which only comes out when they are present in the manic state. When the sufferer is in a state of paranoia a common hallucination is that the sufferer starts to believe that people are surveilling them, they might believe that this is done by government officials or agencies, criminal gangs or other persons with whom the sufferer might have a rift.

Read More About Delusional Disorder Here

Types Of Manic Episodes

Some of the common types of manic episodes, which are generally found in a maximum number of cases are – Hypomania, Mixed state, Bipolar mania.

1. Hypomania

Hypomania [mfn] Camacho, M., Almeida, S., Moura, A. R., Fernandes, A. B., Ribeiro, G., da Silva, J. A., Barahona-Corrêa, J. B., & Oliveira-Maia, A. J. (2018). Hypomania Symptoms Across Psychiatric Disorders: Screening Use of the Hypomania Check-List 32 at Admission to an Outpatient Psychiatry Clinic. Frontiers in psychiatry, 9, 527. https://doi.org/10.3389/fpsyt.2018.00527 [/mfn] literally means “ less than mania”, which is a mild state of mania that has little to no effect to impair body functioning or decrease the quality of life, on the contrary it might increase productivity or creativity. The sufferer might develop a habit of late night sleeping or sleep deprivation [mfn] Lewis, K. S., Gordon-Smith, K., Forty, L., Di Florio, A., Craddock, N., Jones, L., & Jones, I. (2017). Sleep loss as a trigger of mood episodes in bipolar disorder: individual differences based on diagnostic subtype and gender. The British journal of psychiatry : the journal of mental science, 211(3), 169–174. https://doi.org/10.1192/bjp.bp.117.202259 [/mfn]. The sufferer might develop a goal driven behavior or metabolism.

Though the sufferer might develop an elevated mood or have high energy levels, it could result in the benefit of the sufferer, but in hypomania if the eminent mood is irritability to little things in their day to day life as opposed to euphoric, it would be a rather unpleasant experience.

In case of exaggerated hypomania, the sufferer can display excessive faith in something, pretentiousness and bad decision making with often no regard to the consequences.

Read More About Hypomania Here

2. Mixed State

When the sufferer is in a mixed state, even though it meets the general criteria for hypomania or manic experience, the sufferer simultaneously experiences three or more concurrent symptoms. When the sufferer is in a prominent manic condition it automatically places the patient at a higher risk of committing a suicide.

Depression [mfn] Swann, A. C., Steinberg, J. L., Lijffijt, M., & Moeller, G. F. (2009). Continuum of depressive and manic mixed states in patients with bipolar disorder: quantitative measurement and clinical features. World psychiatry : official journal of the World Psychiatric Association (WPA), 8(3), 166–172. https://doi.org/10.1002/j.2051-5545.2009.tb00245.x [/mfn] though is a huge risk factor for the sufferer but if it is coupled with increase in energy levels or hyper-tension, the sufferer is more likely to act in a violent manner on suicidal thrust. Some prominent features of a sufferer being in a mixed state [mfn] Malhi, G. S., Fritz, K., Elangovan, P., & Irwin, L. (2019). Mixed States: Modelling and Management. CNS drugs, 33(4), 301–313. https://doi.org/10.1007/s40263-019-00609-3 [/mfn] are episodes of despair, doubt, anguish, rage, homicidal ideation, splitting, racial thoughts, sensory overload or splitting.

3. Bipolar Mania

If a sufferer has one manic episode without any substance abuse or any medical condition, the condition is often diagnosed as bipolar I disorder. Bipolar I disorder is often termed as manic depressive disorder or bipolar mania [mfn] Jain A, Mitra P. Bipolar Affective Disorder. [Updated 2021 May 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558998/ [/mfn]. A manic episode is often associated with abnormally elevated or irritable mood, accompanied by high energy levels and abnormal behavior that disrupts the daily functions in a sufferer’s life.

Many people diagnosed with bipolar I disorder also suffer from depression. Often switching between mania and depression , this is where the term manic depression [mfn] Hilty, D. M., Leamon, M. H., Lim, R. F., Kelly, R. H., & Hales, R. E. (2006). A review of bipolar disorder in adults. Psychiatry (Edgmont (Pa. : Township[/mfn], 3(9), 43–55. [/mfn] comes from. In between episodes of manic and depression, many people suffering from bipolar I disorder can live their normal lives.

Some common symptoms of associated disorders which a sufferer exhibits can be jumping from one idea to the next, rapid uninterruptible loud speech, increased energy along with hyperactivity, decreased need for speech, expanded self image, hypersexuality[mfn] Kopeykina, I., Kim, H. J., Khatun, T., Boland, J., Haeri, S., Cohen, L. J., & Galynker, I. I. (2016). Hypersexuality and couple relationships in bipolar disorder: A review. Journal of affective disorders, 195, 1–14. https://doi.org/10.1016/j.jad.2016.01.035 [/mfn], hypertension [mfn] Goldstein, B. I., Fagiolini, A., Houck, P., & Kupfer, D. J. (2009). Cardiovascular disease and hypertension among adults with bipolar I disorder in the United States. Bipolar disorders, 11(6), 657–662. https://doi.org/10.1111/j.1399-5618.2009.00735.x [/mfn] etc.

Read More About Bipolar Disorder Here

Causes Of A Manic Episode

Some causes of manic episodes can be stated as:-

1. After child birth – There is tremendous hormonal change coupled with cognitive impairments and grossly disorganized behavior that represents a total change of functioning from previous one. If the symptoms are left unnoticed it can jeopardize the safety of the offspring and the mother and can have devastating consequences.
2. Brain injury – Due to an accident on the road or some mishap can cause a person to suffer from bipolar I disorder.
3. Brain tumors – They are more common in youngsters and older people even though brain tumors [mfn] Madhusoodanan, S., Ting, M. B., Farah, T., & Ugur, U. (2015). Psychiatric aspects of brain tumors: A review. World journal of psychiatry, 5(3), 273–285. https://doi.org/10.5498/wjp.v5.i3.273 [/mfn] can happen to anybody at any point of their lives, but mania is a very uncommon result of brain tumor, though the sufferer may persist or resist with the treatment.
4. Dementia – A sufferer diagnosed with dementia has an increased risk of mania as dementia [mfn] Diniz, B. S., Teixeira, A. L., Cao, F., Gildengers, A., Soares, J. C., Butters, M. A., & Reynolds, C. F., 3rd (2017). History of Bipolar Disorder and the Risk of Dementia: A Systematic Review and Meta-Analysis. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 25(4), 357–362. https://doi.org/10.1016/j.jagp.2016.11.014 [/mfn] itself declines the cognitive function due to damage or disease in the brain beyond what might be expected from normal aging.
5. Encephalitis – A number of studies suggest that encephalitis [mfn] Myers, K., & Dunner, D. L. (1984). Acute viral encephalitis complicating a first manic episode. The Journal of family practice, 18(3), 403–407. [/mfn] can also bring around a manic episode as due to the hyperinflammation of the brain, it can cause hypertension as well as irritability which can have devastating consequences if left unnoticed.
6. Lupus – It is a systematic chronic inflammatory condition caused by an autoimmune disease which may be manic lupus erythematosus [mfn] Spiegel, D. R., Holtz, L., & Chopra, K. (2010). A Case of Mania in a Patient with Systemic Lupus Erythematosus: Can Its Inflammatory Pathogenesis be Applied to Primary Mood Disorders?. Psychiatry (Edgmont (Pa. : Township), 7(4), 31–36. [/mfn]. It is a disease related to connective tissue where the immune system attacks the body cells and tissues and causes inflammation and tissue damage, this can bring around a manic episode.
7. Medicinal side effects – Drugs induced mania [mfn] Peet, M., & Peters, S. (1995). Drug-induced mania. Drug safety, 12(2), 146–153. https://doi.org/10.2165/00002018-199512020-00007 [/mfn] can occur by chance particularly in patients who have a history of mood disorder. Drugs which can cause a manic episode include levodopa, corticosteroids and anabolic- androgenic steroids. Other drugs may also induce mania but scientific evidence is very less. Management includes discontinuation or reduction of dosages of the concerned drugs.
8. Intoxicating drugs or alcohol abuse – On the influence of any intoxicating drugs [mfn] Frank, E., Boland, E., Novick, D. M., Bizzarri, J. V., & Rucci, P. (2007). Association between illicit drug and alcohol use and first manic episode. Pharmacology, biochemistry, and behavior, 86(2), 395–400. https://doi.org/10.1016/j.pbb.2006.11.009 [/mfn] for ex. Cocaine, morphine, heroine,etc. Or alcohol use on the onset or during the course of the abuse the resultant outcome is bipolar I disorder. Many experience their first manic episodes immediately after discontinuing or not getting the substance which they are addicted to.
9. Sleep deprivation – Sleep loss may trigger manic episodes but individual differences could be seen such as some sufferer might get Insomnia [mfn] Roth T. (2007). Insomnia: definition, prevalence, etiology, and consequences. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 3(5 Suppl), S7–S10. [/mfn] (the inability to fall asleep) which can cause a manic episode due to fatigue, some sufferer might get hypersomnia [mfn] Bollu, P. C., Manjamalai, S., Thakkar, M., & Sahota, P. (2018). Hypersomnia. Missouri medicine, 115(1), 85–91. [/mfn] (over-sleeping) which as per study is more common than insomnia, some sufferer might have a decreased need for sleep, a sleep disorder characterized by a circadian rhythm that causes insomnia and daytime sleepiness. Irregular sleep wake patterns due to excess activity during the night can also induce a sufferer’s brain to hallucinate and trigger manic episodes.
10. Childhood trauma – Studies [mfn] Quidé, Y., Tozzi, L., Corcoran, M., Cannon, D. M., & Dauvermann, M. R. (2020). The Impact of Childhood Trauma on Developing Bipolar Disorder: Current Understanding and Ensuring Continued Progress. Neuropsychiatric disease and treatment, 16, 3095–3115. https://doi.org/10.2147/NDT.S285540 [/mfn] suggest that childhood trauma is one of the major factors for developing bipolar I disorder. It can lead to alteration of feelings, tolerance towards petty mistakes of others will decrease, the sufferer cannot control his or her urges etc.

Numerous Scientific studies have found that several genes belonging to several biological pathways such as hypothalamic-pitutary-adrenal (HPA) axis, serotonergic transmission, neuroplasticity, immunity, calcium signaling and circadian rhythms to interact with childhood trauma to decrease the age of the onset of the bipolar I disorder or else their is a higher percentage of chances that the sufferer might commit suicide.

Read More About Insomnia Here

Treatment For Manic Episodes

Bipolar I disorder is a chronic illness which is detected only after thorough diagnosis and their are various ways to manage the symptoms –

1. Medication

Medication as directed by the psychiatrist can be a variety of mood stabilizer drugs.

Antipsychotic drugs suggested if depression or mania persists even after taking other medicine.

Antidepressant drugs are given to manage depression, antianxiety drugs to help with anxiety and improve sleep but are usually recommended for a shorter period.

As above stated bipolar I disorder is a chronic illness so there needs continued treatment even on a day when the sufferer feels better.

Skipping the treatment might result in relapsing, a minor mood change can lead to a full-blown manic episode or depression.

Read More About Antidepressants Here

2. Day Treatment Programs

Day treatment programs are needed as it provides the necessary counseling and support which is needed to get the disease under control.

If the patient suffers from substance abuse then he/she must receive substance abuse treatment with the help of family support and communication, it will help the sufferer stick to the treatment plan.

3. Psychoeducation

Psychoeducation [mfn] Joas, E., Bäckman, K., Karanti, A., Sparding, T., Colom, F., Pålsson, E., & Landén, M. (2020). Psychoeducation for bipolar disorder and risk of recurrence and hospitalization – a within-individual analysis using registry data. Psychological medicine, 50(6), 1043–1049. https://doi.org/10.1017/S0033291719001053 [/mfn] can help the suffer and their loved ones to understand bipolar disorder better, which will help to identify issues better and follow the treatment plan.

4. Cognitive Behavioral Therapy

A recent scientific study [mfn] Chiang, K. J., Tsai, J. C., Liu, D., Lin, C. H., Chiu, H. L., & Chou, K. R. (2017). Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. PloS one, 12(5), e0176849. https://doi.org/10.1371/journal.pone.0176849 [/mfn] suggests that Cognitive behavioral therapy can help in focusing on identifying unhealthy, negative beliefs and focus on positive and healthy beliefs, this will help to cope with negative thoughts and manage stress in the sufferer’s life .

Read More About Cognitive Behavioral Therapy (CBT) Here

Coping Strategies

1. Manic episodes can be managed if the sufferer realizes it and maintains a stable sleeping pattern.

2. The sufferer should set realistic, short-term targets which can be achieved on that particular day or week.

3. Abandoning the habit of recreational drugs or alcohol, if consumed, can easily make the sufferer deviate from the targets that he/she has set for him or herself.

4. The sufferer should open up to his/her family and friends and discuss it with them, to help the sufferer to have a support network, so that the sufferer can make good decisions.

5. Reducing stress at work or home will help the sufferer to manage manic episodes.

6. The sufferer should keep track of the mood changes every single day so that he/she can write a journal and write down the symptoms.

7. The sufferer should seek professional help if he/she finds the symptoms uncontrollable.

Read More About Alcoholism Here

Takeaway

In a Bipolar – I – Disorder affected person with an episode of mania, any differential treatment towards them can make irreversible changes to their condition.

Manic episodes are a hallmark of Bipolar – I – Disorder, a person is in such a psychological state having high mood and energy, pacing thoughts and erratic behavior.

People who have experienced manic episodes also experience illogical thinking marred with false beliefs or hallucinations, which places them as well as their loved ones lives in danger.

The caregiver must be patient with the sufferer, as love, care and support can help the person recover and contain those symptoms.

Manic Episodes At A Glance

1. Manic episode or mania in general terms is a psychological state of mind that involves euphoria and high energy levels.
2. Mania can be typically characterized by that person’s talkativeness, rapid speech, insomnia, disturbing thoughts, distraction towards their work, increased goal driven anxiety and psychomotor commotions.
3. Manic episodes can be managed if the sufferer realizes it and maintains a stable sleeping pattern.
4. Reducing stress at work or home will help the sufferer to manage manic episodes.