Mania

Mania is the mood of an abnormally elevated arousal energy level, or ""a state of heightened overall activation with enhanced affective expression together with lability of affect."" Although it is often thought of as a ""mirror image"" to depression, the heightened mood can be either euphoric or irritable and, indeed, as the mania progresses, irritability becomes more prominent and can eventuate in violence. Although bipolar disorder is by far the most common cause of mania, it is a key component of other psychiatric conditions (e.g., schizoaffective disorder, bipolar type; cyclothymia) and may occur secondary to neurologic or general medical conditions, or as a result of substance abuse.The nosology of the various stages of a manic episode has changed over the decades. The word derives from the Greek μανία (mania), ""madness, frenzy"" and the verb μαίνομαι (mainomai), ""to be mad, to rage, to be furious"". In current DSM-5 nomenclature, hypomanic episodes are separated from the more severe full manic ones, which, in turn, are characterized as either mild, moderate, or severe (with or without psychotic features). However, the “staging” of a manic episode – hypomania, or stage I; acute mania, or stage II; and delirious mania, or stage III – remains very useful from a descriptive and differential diagnostic point of view, in particular allowing for a more thorough consideration of the more pronounced manic states, wherein the fundamental signs become increasingly obscured by other symptoms, such as delusions.The cardinal symptoms of mania are the following: heightened mood (either euphoric or irritable); flight of ideas and pressure of speech; and increased energy, decreased need for sleep; and hyperactivity. These cardinal symptoms are often accompanied by the likes of distractibility, disinhibited behaviour, and poor judgement, and, as the mania progresses, become less and less apparent, often obscured by symptoms of psychosis and an overall picture of disorganized and fragmented behaviour.Mania may be caused by drug intoxication (notably stimulants, such as cocaine and methamphetamine), medication side effects (notably SSRIs), and malignancy (the worsening of a condition), to name but a few. Mania, however, is most commonly associated with bipolar disorder, a serious mental illness in which episodes of mania may alternate unpredictably with episodes of depression or periods of euthymia. Gelder, Mayou, and Geddes (2005) suggest that it is vital that mania be predicted in the early stages because otherwise the patient becomes reluctant to comply with the treatment. Those who never experience depression also experience cyclical changes in mood. These cycles are often affected by changes in sleep cycle (too much or too little), diurnal rhythms, and environmental stressors.Mania varies in intensity, from mild mania (hypomania) to delirious mania, marked by such symptoms as a dreamlike clouding of consciousness, florid psychotic disorganization, and incoherent speech. Standardized tools such as Altman Self-Rating Mania Scale and Young Mania Rating Scale can be used to measure severity of manic episodes. Because mania and hypomania have also been associated with creativity and artistic talent, it is not always the case that the clearly manic bipolar person needs or wants medical help; such persons often either retain sufficient self-control to function normally or are unaware that they have ""gone manic"" severely enough to be committed or to commit themselves. Manic persons often can be mistaken for being on drugs or other mind-altering substances.