Mania
Mania is characterized by excessive physical activity and feelings of extreme elation that are grossly out of proportion to any positive event. Hypomania is a less severe form of mania.
Mania most commonly occurs as a part of manic-depressive illness (bipolar disorder (see Section 7, Chapter 101)). The few people who appear to experience only mania (unipolar disorder) may actually have mild or brief episodes of depression. Mania and hypomania are less common than depression, and they are also less easily recognized. Whereas extreme and protracted sadness may prompt a visit to a doctor, elation much less commonly does, because people with mania are unaware that anything is wrong with their mental state or behavior. A doctor must rule out an underlying physical disorder in a person who is experiencing mania for the first time without a previous episode of depression.
 See the sidebar Physical Disorders That Can Cause Mania.
Symptoms and Diagnosis
Manic symptoms typically develop rapidly over a few days. In the early (milder) stages of mania, the person feels better than normal, exuberant, and energetic.
A person who is manic may be irritable, cantankerous, or hostile. He typically believes he is quite well. A lack of insight into his condition, along with a huge capacity for activity, can make the person impatient, intrusive, meddlesome, and aggressively irritable when crossed. Mental activity speeds up (a condition called flight of ideas). The person is easily distracted and constantly shifts from one theme or endeavor to another. The person may have false convictions of personal wealth, power, inventiveness, and genius and may temporarily become delusional or assume a grandiose identity, sometimes believing that he is God.
The person may believe he is being assisted or persecuted by others or have hallucinations, hearing and seeing things that are not there. The need for sleep decreases. A manic person is inexhaustibly, excessively, and impulsively involved in various activities (such as risky business endeavors, gambling, or perilous sexual behavior) without recognizing the inherent social dangers. In extreme cases, mental and physical activity is so frenzied that any clear link between mood and behavior is lost in a kind of senseless agitation (delirious mania). Immediate treatment is then required, because the person may die of sheer physical exhaustion. In less severe mania, hospitalization may be needed during periods of overactivity to protect the person and his family from ruinous financial or sexual behavior.
Mania is diagnosed by its symptoms. However, because people with mania are notorious for denying that there is anything wrong with them, doctors usually have to obtain information from family members.
Treatment
Untreated episodes of mania end more abruptly than those of depression and are typically shorter, lasting from a few weeks to several months. Because mania is a medical and social emergency, a doctor makes all attempts to treat the person in a hospital.
The drug lithium can reduce the symptoms of mania (see Section 7, Chapter 101). Because lithium takes 4 to 10 days to work, a drug that works rapidly, such as haloperidol, is often given at the same time to control excited thought and activity. However, haloperidol can cause muscle stiffness and unusual movements. Therefore, haloperidol is given in small doses, in combination with a benzodiazepine, such as lorazepam or clonazepam, which enhances the antimanic effects of haloperidol while reducing its unpleasant side effects. Haloperidol usually is stopped after about a week.
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