Mania most often occurs in Bipolar I Disorder, as its most elevated mood stage. Thus, mania is not diagnosed if the patient is affected by substances, or a medical condition. To be characterized as mania, the patient's mood must be very elevated mood for at least a week, with irritability or an unusually expansive state.
Inflated Sense of Self
According to the Diagnostic and Statistical Manual of Mental Disorders, in mania, the patient may experience an abnormally high sense of himself and his value. Often he expresses himself in grandiose images, behaviors or gestures. He may do something like buying up all the flowers in a flower shop, without regard for his actual monetary limits. He may do dangerous things, such as jumping off a building several stories up, because he believes he can fly.
Sleep Pattern
Often a manic patient will stay up for days at a time, seeming to need no sleep, or she may feel completely rested after only a couple of hours of sleep. During this wakeful time, she may obsessively work on a project, or clean or do anything at a feverish pace, even though she may abandon one activity and switch to another.
Speech
When someone is manic, his speech rate becomes rapid. The rapidity produces an effect noted by clinicians as "pressured speech," according to "Synopsis of Psychiatry." Manic patients also talk more than usual and are difficult to interrupt.
Thought Pattern
When a patient experiences mania, she may rapidly shift from one subject to another. She may experience "racing" thoughts.
Attention
Typically a manic patient is highly distractible. Others may notice he loses attention by focusing on irrelevant things around him. He cannot focus exclusively on one thing for very long.
Activity Level
When someone is manic she may increase very goal-directed activity, no matter how unimportant. She may also seem agitated physically.
Focus on Pleasure
In a patient experiencing mania, the psychic controls that govern ordinary behavior do not work. He may tend to overdo risky behavior, including sexual behavior, without regard to consequences.
Psychosis
Some manic patients become psychotic at the height of the mania. Often they experience grandiose delusions that they are all-powerful, invulnerable, or even God. The delusions in mania may be somewhat connected to the person's life. For example, an actual severely Bipolar I manic patient was "Jesus," solving all of his company's problems, even though he was not in a powerful company position. When he cycled to severe depression, the delusion was still about the company, but he believed they were going to kill him, and was terrified. When he arrived back at his ordinary baseline condition, he remembered both sets of delusions.
References
- "Synopsis of Psychiatry, 9th ed."; Benjamin J. Sadock, Virginia A. Sadock; 2003.
- "Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision"; American Psychiatric Association; 2000
