Identifying and treating manic behavior

Manic behavior impacts millions of Americans every year. Matthew Runyan, MD, section chief, PPG Psychiatry Hospital Section, walks us through the signs of mania, potential causes and the help available to families experiencing the effects of this condition.

What does the term “mania” mean?

Mania is a term dating back to the 1400s. Originally, it seems to have meant madness, insanity, frenzy or passion. These days, we define mania as mental illness marked by periods of great excitement or euphoria, overactivity, sometimes with delusions or psychosis. Mania is a psychiatric emergency and can have some very significant and serious consequences. Think of it as your brain running too “hot”. Now compare that with a computer or other technology. If that piece of equipment runs too hot or too fast for a long time, things break. Same thing with mania. If it isn’t stopped, it can lead to long term consequences, not to mention many social, legal and other issues.

What are the signs and symptoms?

Typically, mania presents around age 25, but more evidence is showing earlier onset having a worse prognosis, and some cases can be delayed with onset as late as the 50s.

The two core criteria for mania are “a distinct period of abnormally and persistently elevated, expansive, or irritable mood” and “abnormally and persistently increased goal-directed activity or energy.” Basically, for at least a day or two, up to several times a week or more, someone has an abnormally elevated mood and is amazingly active and driven.

We love mnemonics in medicine. It helps us remember stuff. Here is a good one for mania:

D - Distractibility and easy frustration

I - Irresponsibility and erratic, uninhibited behavior

G - Grandiosity - increased sense of importance

F - Flight of ideas

A - Activity increase, weight loss, increase in libido

S - Sleep is decreased

T - Talkative

Examples of manic behavior might include:

  • An 18-year-old female with 3 days of no sleep, excessive cleaning, talking nonstop and now hearing voices.
  • A 35-year-old male who is suddenly maxing out credit cards, telling family members he is going to be the next President, and exercising for 4 hours a day without seeming tired.
  • A 55-year-old female who relapsed on methamphetamine who is unable to stay on topic, not sleeping and paranoid.

Does mania indicate another mental health condition?

Typically, mania is very predictive of a condition called bipolar disorder. Briefly put, bipolar has an upper pole (mania) and a lower pole (depression). Think of a normal range of emotions and expand them to the point so far outside of a person's norm that they are nearly unrecognizable.

What causes mania?

Genetics are a huge indictor of bipolar disorder and, therefore, mania. A first degree relative with bipolar disorder is the single highest risk factor.

Drug use, especially uppers, like cocaine, methamphetamine and other stimulants, can cause mania, so these drugs should be avoided in anyone with a family history of mania or a previous history of mania.

Additionally, some medical conditions, like hyperthyroidism, hypermagnesium, Addison’s Disease, brain tumors and medications such as steroids (not the weightlifting type, the kind your doctor gives you) can all induce mania. As can antidepressants, if someone has a genetic risk for mania and is given enough antidepressants, they can go into a full manic episode.

Stress is the other big risk factor. The more stress someone is under, while having the above risk factors, the more likely they are to have an episode. So finding ways to minimize stress and handle it appropriately can be very effective in preventing manic episodes.

What can a loved one do if a family member/friend is showing signs of manic behavior?

The first thing is to talk with them. Ask how they are feeling. See if they recognize these changes in behaviors. If they do, ask how you can help them. Many people who have been manic before know when they are getting manic or are manic and may know ways to help address the situation through medications, sleep patterns, breathing exercises, etc. They may know they need to get to their doctor or hospital. Help them do so.

If they do not recognize these changes and they have a doctor, therapist or psychiatrist, try and get in contact with them. However, this is not always possible. If they are displaying truly worrisome behaviors, like hallucinations or suicidal or homicidal thoughts, or if they seem unable to care for themselves or seem to be losing complete control of their actions, call 911. Ask for the police, specifically the Crisis Intervention Team (CIT) officers, who are trained in working with patients with mental health issues, to get them help instead of arrested. If you can get them to a hospital do so, but if you have any concerns for safety please use emergency services.

When should you seek intervention and where?

Mania is an emergency. It can cause long term psychiatric issues as well as a variety of legal, financial and social situations that can be extremely distressing. As such, you should seek to intervene as early as possible to prevent longer episodes. Sometimes, if caught early enough, people experiencing mania can be kept out of the hospital. However, most episodes of mania require hospitalization in a psychiatric hospital for safety and stabilization. Any emergency room can initiate a hospitalization. Here in Fort Wayne, I recommend the Parkview Hospital Randallia Emergency Department as most of Parkview’s emergency behavioral services are located there. Once you get them to the ER, we can take things from there.

What are common treatment options?

If it is one of the drug or medical causes, mania should resolve if you remove the drug or treat the underlying condition. If it is due to bipolar disorder, it is very similar and has very good results with treatment.

Medications are typically needed to stop manic episodes. These can Include mood stabilizers like lithium, depakote, and lamotrigine, or antipsychotics like risperidone, aripiprazole and olanzapine. Antidepressants are not used in treating acute mania, as they typically worsen the condition. The psychiatrist selects medication based on the patient’s condition, history, and other medical and social situations.

Therapy can definitely be helpful, and actually the best treatment for mania is a combination of medication and therapy. This might include Bipolar specific Cognitive Behavioral Therapy, Interpersonal Therapy with Social Rhythm Therapy and Family Focused Therapy (if family is willing and engaged in treatment).

Sleep hygiene is also extremely important. Ensuring someone with a history of mania stays on a healthy sleep cycle and recognizes when they are not getting adequate sleep can be very effective in preventing future manic episodes.

Stress reduction is also critical in reducing manic episodes. Pile enough stress on someone with the risk factors and sometimes even someone who is on medication can have a manic episode.

Resources

Parkview Access Center
(260) 373-4500

This is a great place to star. They will help triage to the best place to get help.

911

When in doubt, call 911 to get immediate assistance and potential transport to a hospital for evaluation.

National Alliance on Mental Illness
(260) 447-8990

This is an organization set up for education and advocacy for patients and families with mental health issues. They can help with the numerous questions and concerns that family and friends may have during and after a manic episode. They are non-profit, so most of their resources are free or very affordable.

There are numerous support groups and therapists in Northeastern Indiana that provide a variety of services and support options as well.

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