![]() ![]() In general, a manic patient should be treated with both a medication that alleviates the acute mania as well as concomitant medication for maintenance stabilization to prevent future mood episodes. Rapid cycling bipolar disorder patients have been found to be more resistant to pharmacotherapy. Switching from mania to hypomania or vice-versa would not qualify because they are not opposite polarity. These episodes must be separated by periods of partial or full remission of at least 2 months or be separated by a switch to an episode of opposite polarities, such as mania or hypomania to major depressive episodes. These mood episodes may be manic, hypomanic, or depressive but must meet their full diagnostic and duration criteria. Rapid cycling in bipolar disorder is defined as having at least 4 or more mood episodes in a 12-month period. The problem is mainly noticed by others, including family members, friends, and even strangers or police. A component of the manic phase is that generally, the individuals themselves do not realize what is happening (poor insight). These patients are highly unlikely to respond to outsiders’ views on their psychosis as well as their mania. They may believe this to be done by government agencies, gangs, or others. Some of the most common delusions are delusions of paranoia, in which patients believe that people are stalking, targeting, or surveilling them. These individuals may also experience auditory or visual hallucinations, which only present when they are in the manic phases. Many patients endorse grandiose delusions, believing they are high-level operatives such as spies, government officials, members of secret agencies, or that they are knowledgeable professionals (even when they have no such background). Mania also commonly presents with psychotic features, which include delusions or hallucinations. Although the patient may have poor insight and may not recognize they are behaving out of the norm, it becomes apparent to family or friends that this behavior may be due to mental illness. They may also become highly aggressive, agitated, or irritable. Many patients engage in property damage or even harm themselves or others through verbal or physical assaults. Patients amid a manic phase commonly engage in goal-directed activities that may result in harmful consequences, such as spending excessive money, starting businesses unprepared, traveling, or promiscuity. ![]() ![]() Many families bring their loved ones to the emergency room due to the excessive behavioral changes they have noticed over a brief period. A single manic phase is sufficient to make the diagnosis of bipolar I disorder, although most cases of bipolar I also involve hypomanic and depressed episodes. Mania is a "natural" state which is the characteristic of bipolar I disorder. Mania must be distinguished from heightened energy and altered functioning that arises from substance use, medical conditions, or other causes. If the individual experiencing these symptoms requires hospitalization, then this period automatically qualifies as true mania and not hypomania, even if the symptoms are present for less than one week. Some other hallmarks of mania are an elevated or expansive mood, mood lability, impulsivity, irritability, and grandiosity. The defining characteristics of mania are increased talkativeness, rapid speech, decreased need for sleep, racing thoughts, distractibility, increase in goal-directed activity, and psychomotor agitation. Mania is different from hypomania because hypomania does not cause a major deficit in social or occupational functioning, and it is a period of at least 4 days rather than 1 week. Mania, or a manic phase, is a period of 1 week or more in which a person experiences a change in behavior that drastically affects their functioning. ![]()
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