A manic episode is a mood state characterized by period of at least one week where an elevated, expansive, or unusually irritable mood exists. A person experiencing a manic episode is usually engaged in significant goal-directed activity beyond their normal activities. People describe a manic mood as feeling very euphoric, “on top of the world,” and being able to do or accomplish anything. The feeling is like extreme optimism — but on steroids.
Sometimes the manic mood is more irritable than it is elevated, especially if the person’s wishes are curtailed or denied altogether.
Often a person in the midst of mania will engage in multiple projects at the same time, with little premeditation or thought going into them, and finishing none of them. They may work on these projects at all hours of the day, with little regard for sleep or rest.
A person’s change in mood is typically associated with manic symptoms that should be observable by others (e.g., friends or relatives of the individual) and must be uncharacteristic of the individual’s usual state or behavior. In other words, they’re acting in a way that isn’t typical of themselves, and other people recognize it.
The manic feelings the person experiences should be severe enough to cause difficulty or impairment in their ability to function at work, with friends or family, at school, or other important areas in their life. Symptoms also cannot be the result of substance use or abuse (e.g., alcohol, drugs, medications) or caused by a general medical condition.
Specific Symptoms of a Manic Episode
In order for a manic episode to be diagnosed, three (3) or more of the following symptoms must be present:
- Inflated self-esteem or grandiosity
- Decreased need for sleep (e.g., one feels rested after only 3 hours of sleep)
- More talkative than usual or pressure to keep talking
- Flight of ideas or subjective experience that thoughts are racing
- Attention is easily drawn to unimportant or irrelevant items
- Increase in goal-directed activity (either socially, at work or school; or sexually) or psychomotor agitation
- Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
Inflated self-esteem is typically present, ranging from uncritical self-confidence to marked grandiosity, and may reach delusional proportions. Individuals may give advice on matters about which they have no special knowledge (e.g., how to run the United Nations). Despite lack of any particular experience or talent, the individual may embark on writing a novel or composing a symphony or seek publicity for some impractical invention. Grandiose delusions are common (e.g., having a special relationship to God or to some public figure from the political, religious, or entertainment world).
Almost invariably, there is a decreased need for sleep. The person usually awakens several hours earlier than usual, feeling full of energy. When the sleep disturbance is severe, the person may go for days without sleep and yet not feel tired.
Manic speech is typically pressured, loud, rapid, and difficult to interrupt. Individuals may talk nonstop, sometimes for hours on end, and without regard for others’ wishes to communicate. Speech is sometimes characterized by joking, punning, and amusing irrelevancies. The individual may become theatrical, with dramatic mannerisms and singing. Sounds rather than meaningful conceptual relationships may govern word choice (i.e., clanging).
If the person’s mood is more irritable than expansive, speech may be marked by complaints, hostile comments, or angry tirades.
The individual’s thoughts may race, often at a rate faster than can be articulated. Some individuals with manic episodes report that this experience resembles watching two or three television programs simultaneously.
Frequently there is flight of ideas evidenced by a nearly continuous flow of accelerated speech, with abrupt changes from one topic to another. For example, while talking about a potential business deal to sell computers, a salesperson may shift to discussing in minute detail the history of the computer chip, the industrial revolution, or applied mathematics.
When flight of ideas is severe, speech may become disorganized and incoherent.
A person in a manic episode may easily lose attention. Distractibility is evidenced by an inability to screen out irrelevant external stimuli (e.g., the interviewer’s tie, background noises or conversations, or furnishings in the room). There may be a reduced ability to differentiate between thoughts that are germane to the topic and thoughts that are only slightly relevant or clearly irrelevant.
The increase in goal-directed activity often involves excessive planning of, and excessive participation in, multiple activities (e.g., sexual, occupational, political, religious). Increased sexual drive, fantasies, and behavior are often present.
The person may simultaneously take on multiple new business ventures without regard for the apparent risks or the need to complete each venture satisfactorily. Almost invariably, there is increased sociability (e.g., renewing old acquaintances or calling friends or even strangers at all hours of the day or night), without regard to the intrusive, domineering, and demanding nature of these interactions. Individuals may also display psychomotor agitation or restlessness by pacing or by holding multiple conversations simultaneously (e.g., by telephone and in person at the same time). Some individuals write a torrent of letters on many different topics to friends, public figures, or the media.
Expansiveness, unwarranted optimism, grandiosity, and poor judgment often lead to an imprudent involvement in pleasurable activities such as buying sprees, reckless driving, foolish business investments, and sexual behavior unusual for the person, even though these activities are likely to have painful consequences. The individual may purchase many unneeded items (e.g., 20 pairs of shoes, expensive antiques) without the money to pay for them. Unusual sexual behavior may include infidelity or indiscriminate sexual encounters with strangers.
People who experience a manic episode are often diagnosed with a type of bipolar disorder.
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