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Mania

Mania

Definition

Mania is an abnormally elated mental state, typically characterized by feelings of euphoria, lack of inhibitions, racing thoughts, diminished need for sleep, talkativeness, risk taking, and irritability. In extreme cases, mania can induce hallucinations and other psychotic symptoms.

Description

Mania typically occurs as a symptom of bipolar disorder (a mood disorder characterized by both manic and depressive episodes). Individuals experiencing a manic episode often have feelings of self-importance, elation, talkativeness, sociability, and a desire to embark on goal-oriented activities, coupled with the less desirable characteristics of irritability, impatience, impulsiveness, hyperactivity, and a decreased need for sleep. (Note: Hypomania is a term applied to a condition resembling mania. It is characterized by persistent or elevated expansive mood, hyperactivity, inflated self esteem, etc., but of less intensity than mania.) Severe mania may have psychotic features.

Causes and symptoms

Mania can be induced by the use or abuse of stimulant drugs such as cocaine and amphetamines. It is also the predominant feature of bipolar disorder, or manic depression, an affective mental illness that causes radical emotional changes and mood swings.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV ), the diagnostic standard for mental health professionals in the U.S., describes a manic episode as an abnormally elevated mood lasting at least one week that is distinguished by at least three of the following symptoms: inflated self-esteem, decreased need for sleep, talkativeness, racing thoughts, distractibility, increase in goal-directed activity, or excessive involvement in pleasurable activities that have a high potential for painful consequences. If the mood of the patient is irritable and not elevated, four of these symptoms are required.

Diagnosis

Mania is usually diagnosed and treated by a psychiatrist and/or a psychologist in an outpatient setting. However, most severely manic patients require hospitalization. In addition to an interview, several clinical inventories or scales may be used to assess the patient's mental status and determine the presence and severity of mania. An assessment commonly includes the Young Mania Rating Scale (YMRS). The Mini-Mental State Examination (MMSE) may also be given to screen out other illnesses such as dementia.

Treatment

Mania is primarily treated with drugs. The following mood-stabilizing agents are commonly prescribed to regulate manic episodes:

  • Lithium (Cibalith-S, Eskalith, Lithane) is one of the oldest and most frequently prescribed drugs available for the treatment of mania. Because the drug takes four to seven days to reach a therapeutic level in the bloodstream, it is sometimes prescribed in conjunction with neuroleptics (antipsychotic drugs ) and/or benzodiazepines (tranquilizers) to provide more immediate relief of mania.
  • Carbamazepine (Tegretol, Atretol) is an anticonvulsant drug usually prescribed in conjunction with other mood-stabilizing agents. The drug is often used to treat bipolar patients who have not responded well to lithium therapy. As of early 1998, carbamazepine was not approved for the treatment of mania by the FDA.
  • Valproate (divalproex sodium, or Depakote; valproic acid, or Depakene) is an anticonvulsant drug prescribed alone or in combination with carbamazepine and/or lithium. For patients experiencing "mixed mania," or mania with features of depression, valproate is preferred over lithium.

Clozapine (Clozaril) is an atypical antipsychotic medication used to control manic episodes in patients who have not responded to typical mood-stabilizing agents. The drug has also been a useful preventative treatment in some bipolar patients. Other new anticonvulsants (lamotrigine, gubapentin) are being investigated for treatment of mania and bipolar disorder.

Prognosis

Patients experiencing mania as a result of bipolar disorder will require long-term care to prevent recurrence; bipolar disorder is a chronic condition that requires lifelong observation and treatment after diagnosis. Data show that almost 90% of patients who experience one manic episode will go on to have another.

Prevention

Mania as a result of bipolar disorder can only be prevented through ongoing pharmacologic treatment. Patient education in the form of therapy or self-help groups is crucial for training patients to recognize signs of mania and to take an active part in their treatment program. Psychotherapy is an important adjunctive treatment for patients with bipolar disorder.

Resources

ORGANIZATIONS

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. (888) 357-7924. http://www.psych.org.

National Alliance for the Mentally Ill (NAMI). Colonial Place Three, 2107 Wilson Blvd., Ste. 300, Arlington, VA 22201-3042. (800) 950-6264. http://www.nami.org.

National Depressive and Manic-Depressive Association (NDMDA). 730 N. Franklin St., Suite 501, Chicago, IL 60610. (800) 826-3632. http://www.ndmda.org.

National Institute of Mental Health. Mental Health Public Inquiries, 5600 Fishers Lane, Room 15C-05, Rockville, MD 20857. (888) 826-9438. http://www.nimh.nih.gov.

KEY TERMS

Hypomania A less severe form of elevated mood state that is a characteristic of bipolar type II disorder.

Mixed mania A mental state in which symptoms of both depression and mania occur simultaneously.

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"Mania." Gale Encyclopedia of Medicine, 3rd ed.. . Encyclopedia.com. 20 Oct. 2017 <http://www.encyclopedia.com>.

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Mania

MANIA

Mania is a state of psychomotor excitation. Its onset most often comes through inversion of a melancholic mood, either spontaneously or owing to treatment for depression.

The manic mood is euphoric, changeable, and accompanied by emotional hyperesthesia. The subject exhibits pathological optimism with an overestimation of the self and unrealistic plans that sometimes lead to delusions along megalomaniacal lines (grandeur, omnipotence, messianism). The expansiveness of mania is associated with agitation, expressed in hyperactivity and hypermimia. It is also accompanied by tachypsychia ("rushing thoughts"), an acceleration of the thought processes externally manifested in logorrhea, graphorrhea, hypermnesia, and distractibility. Hypersyntony, a immediate and increased receptivity to stimuli from the outside world and a loss of the ability to discriminate between important facts and details, gives the impression that the subject is closely emotionally attuned with his or her surroundings. Reduction in the duration of sleep, sometimes to the point of total insomnia, is a constant clinical sign.

In "Mourning and Melancholia" (1916-17g [1915]), based on his impressions as an analyst, Sigmund Freud observed that melancholic and manic patients were "wrestling with the same 'complex"' (p. 254)a complex to which the melancholic ego succumbs and over which the manic ego triumphs. From nonpathological states of jubilation, triumph, and joy, he extrapolated the economic precondition of mania: It corresponded to a fresh availability of the psychic energy expended in the unconscious work of melancholia, which in mania again becomes "available for numerous applications and possibilities of discharge" (p. 254). At the point where melancholia turns into mania, the subject's ego is liberated from the object of its suffering; it surmounts its loss and triumphs over the object, and consequently the psychic energy that has been counter-cathected and bound to mental pain is suddenly available. In mourning there is no liberation of this type, for detachment from the object is more gradual, although Karl Abraham (1924/1927) viewed the increase in libidinous desires in some bereaved persons as comparable to mania.

From a topographical viewpoint, Freud showed in "Group Psychology and Analysis of the Ego" (1921c), that whereas a severe ego ideal crushes the melancholic's ego with its rigorous control, during mania it is suddenly absorbed or merged into the ego. The ego and the ego ideal of the manic subject become one, thus freeing the subject from all hindrances and all criticism, procuring for the subject a feeling of triumph and boundless satisfaction.

For Abraham, "the manic patient has thrown off the yoke of his super-ego, which now no longer takes up a critical attitude towards the ego, but has become merged in it" (1924/1927, p. 471). Abraham compared mania to a cannibalistic orgy. The manic subject, he argued, manifests an "increase in . . . oral desires" (p. 472) a veritable object-bulimia. This accelerated incorporation of the object is immediately followed by an "equally pleasurable act of ejecting [introjected objects] almost as soon as they have been received" (p. 472). The subject's "psychosexual metabolism" (p. 472) thus appears to be significantly accelerated.

Alban Jeanneau

See also: Acute psychoses; Manic defenses; Melancholia; Megalomania; Mourning and Melancholia ; Reparation; Secondary revision; Self-representation; Suicide.

Bibliography

Abraham, Karl. (1927). Notes on the psycho-analytical investigation and treatment of manic-depressive insanity and allied conditions. In Selected Papers of Karl Abraham, M.D. (pp. 137-156). London: Hogarth and the Institute of Psycho-analysis. (Original work published 1911)

. (1927). A short study of the development of the libido, viewed in the light of mental disorders, In Selected papers of Karl Abraham, M.D. (pp. 418-201). London: Hogarth and the Institute of Psycho-analysis. (Original work published 1924)

Freud, Sigmund. (1916-17g [1915]). Mourning and melancholia, SE, 14: 237-258.

. (1921c), Group psychology and the analysis of the ego. SE, 18: 65-143.

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Mania

Mania

A description of the condition opposite depression in manic-depressive psychosis, or bipolar disorder. It is characterized by a mood of elation without apparent reason.

Most episodes of maniaelation without reasonable cause or justificationare followed in short order by depression ; together they represent the opposites described as bipolar disorder . Manic episodes are characterized by intense feelings of energy and enthusiasm, uncharacteristic self-confidence, continuous talking, and little need for sleep . People experiencing a manic period tend to make grandiose plans and maintain inflated beliefs about their own personal abilities. While manic people appear to be joyful and celebratory, their mood corresponds little to conditions they are experiencing in reality. Expressions of hostility and irritability also are common during manic episodes.

Further Reading

Duke, Patty. Call Me Anna. New York: Bantam, 1987.

Jamison, Kay. Touched with Fire: Manic-Depressive Illness and the Artistic Temperament. New York: Free Press, 1993

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mania

mania highly excited form of madness XIV; great enthusiasm, craze XVII. — late L. mania — Gr. maníā, rel. to maínesthai be mad, f. IE. *mn- *men- see MIND -IA1. As a terminal el. it was used in later Gr., e.g. in gunaikomaníā mad passion for women, hippomaníā passionate love of horses, on the model of which a number of comps. were formed in mod. medical L., e.g. nymphomania; later imitations of these are kleptomania, megalomania. The sbs. in -mania have corr. adj. forms in -maniac (one) affected with the particular mania.
So maniac, maniacal XVII. — late L. maniacus — late Gr. maniakós.

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mania

mania (may-niă) n. a state of mind characterized by excessive cheerfulness and increased activity. The mood is euphoric and changes rapidly to irritability. Thought and speech are rapid to the point of incoherence and the connections between ideas may be impossible to follow. Treatment is usually with drugs such as lithium or phenothiazines. See also bipolar affective disorder.
manic (man-ik) adj.

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mania

ma·ni·a / ˈmānēə/ • n. mental illness marked by periods of great excitement, euphoria, delusions, and overactivity. ∎  an excessive enthusiasm or desire; an obsession: he had a mania for automobiles.

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mania

mania Mental illness marked by feelings of intense elation and excitement. Speech is rapid and physical activity frenetic. In extreme cases, violent behaviour accompanies mania.

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mania

maniaCampania, Catania, pannier •apnoea •Oceania, Tanya, Titania •biennia, denier, quadrennia, quinquennia, septennia, triennia •Albania, balletomania, bibliomania, crania, dipsomania, egomania, erotomania, kleptomania, Lithuania, Lusitania, mania, Mauritania, megalomania, miscellanea, monomania, nymphomania, Pennsylvania, Pomerania, pyromania, Rainier, Romania, Ruritania, Tasmania, Transylvania, Urania •Armenia, bergenia, gardenia, neurasthenia, proscenia, schizophrenia, senior, SloveniaAbyssinia, Bithynia, curvilinear, Gdynia, gloxinia, interlinear, Lavinia, linear, rectilinear, Sardinia, triclinia, Virginia, zinnia •insignia • Sonia • insomnia • Bosnia •California, cornea •Amazonia, ammonia, Antonia, Babylonia, begonia, bonier, Catalonia, catatonia, Cephalonia, Estonia, Ionia, Laconia, Livonia, Macedonia, mahonia, Patagonia, pneumonia, Rondônia, sinfonia, Snowdonia, valonia, zirconia •junior, petunia •hernia, journeyer

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