Mania is an alteration in mood characterized by abnormally elevated, expansive, or irritable affect, accompanied by increased psychomotor activity, euphoria, flight of ideas, and pressured speech. It most commonly occurs in the manic phase of bipolar disorder but may also appear in other psychiatric or medical conditions.

Pathophysiology

Normal physiology:

• Mood, energy, and thought processes are regulated by balanced neurotransmitter systems (dopamine, norepinephrine, serotonin) and intact prefrontal-limbic circuits.

Abnormal physiology (mania):

• Dysregulation of dopaminergic and noradrenergic neurotransmission leads to:

  • Increased psychomotor activity and goal-directed behavior

  • Heightened mood (euphoria or irritability)

  • Rapid, fragmented, or tangential thought processes (flight of ideas)

  • Pressured, loud, or rapid speech

• Genetic predisposition, environmental stressors, and neurochemical imbalance contribute to onset.

Associated findings: May include decreased need for sleep, distractibility, impulsivity, grandiosity, and poor judgment.

Examination Technique

• Patient observation: Note affect, speech rate, psychomotor activity, and social behavior.

• History taking: Assess onset, duration, triggers, sleep patterns, and functional impairment.

• Mental status examination: Evaluate thought content (grandiosity), thought process (flight of ideas), judgment, insight, and attention span.

• Documentation: Record severity, duration, associated behaviors, and impact on daily functioning.

Clinical Features

Differential Diagnosis

Special populations

Adolescents:

• Mania may present with irritability, risk-taking, or academic decline, sometimes misdiagnosed as behavioral problems.

Elderly:

• Less common; may be triggered by medications, metabolic disorders, or neurologic disease.

Limitations

• Mania is clinically diagnosed, lacking a definitive laboratory test.

• Comorbid substance use or medical illness can confound assessment.

• Requires careful evaluation to distinguish from hypomania, mixed episodes, or personality disorders.

Patient counseling

• Explain that mania is a medical condition requiring psychiatric evaluation and treatment.

• Discuss medication adherence, sleep hygiene, and monitoring for risky behaviors.

• Educate family or caregivers to recognize early warning signs and seek prompt care.

• Encourage follow-up with mental health professionals to prevent relapse or complications.

Conclusion

Mania is a distinct mood disorder state marked by elevated or irritable mood, hyperactivity, pressured speech, and impaired judgment, most commonly occurring in bipolar disorder. Early recognition and treatment facilitate symptom control, functional recovery, and prevention of complications.

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: APA; 2013.

2. Goodwin FK, Jamison KR. Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression. 2nd ed. New York: Oxford University Press; 2007.

3. Geddes JR, Miklowitz DJ. Treatment of bipolar disorder. Lancet. 2013;381:1672–1682.

4. Hirschfeld RMA. Clinical features and diagnosis of bipolar disorder. J Clin Psychiatry. 2001;62 Suppl 15:5–9.