Brief overview
- Course and prognosis: Exaggerated elation during the manic phase is often followed by feelings of guilt. After a manic episode, the likelihood of relapse is high
- Symptoms: Exaggerated self-esteem, excessive activity, inner restlessness, overestimation of self, volatility, etc., sometimes delusions
- Causes and risk factors: Disturbed neurotransmitter metabolism in the brain, genetic factors, external influences such as separation, death, or relocation.
- Treatment: medication as well as behavioral and psychotherapy
- Prevention: relapse prophylaxis through treatment with medication as well as behavioral and psychotherapy.
What is mania?
Mania usually occurs in phases; physicians refer to the symptomatic period as a manic episode. In the phases between two episodes, affected persons show no signs of mania.
Manias in childhood and adolescence are rare. In most sufferers, the first manic episode occurs by the age of 25.
Mania sometimes occurs in combination with the symptoms of schizophrenia. Physicians then speak of a schizoaffective psychosis.
Hypomania
A weakened form of mania in which mood swings are still significantly above normal is called hypomania. Hypomania does not always require treatment. If those affected and their immediate environment are not fundamentally affected by the symptoms of hypomania, no therapy is necessary.
What is the course of a manic phase?
After a manic episode, sufferers are often overwhelmed by feelings of guilt and shame and try to undo things they did during the mania.
What are the symptoms of mania?
The most significant symptom of mania is an exaggerated and unusually intense, but usually unfounded, feeling of elation. This occurs suddenly and lasts for several days. This high feeling is mainly accompanied by the following symptoms:
- Strong inner excitement
- Excessive activity
- Great restlessness
- Increased performance and creativity
- Excessive self-confidence
- Loss of reality
- Significantly decreased need for sleep
- Disinhibition
- Lack of consideration
- Decreased perception of danger
- Decreased sensitivity to the needs and feelings of others
- Sometimes neglect of food intake and personal hygiene
Jumpiness
In addition, mania is accompanied by symptoms such as a strong urge to talk (logorrhea) and blurred, slurred speech. Sometimes manics speak so fast that it is impossible for listeners to understand them.
It is also typical of mania that countless things are started at once, but nothing is completed. Affected persons start a new task with great enthusiasm from one second to the next – and forget it again after a few minutes.
Disinhibition
Sexual disinhibition and increased sexual desire (libido) are also frequently present in mania. Sexual disinhibition occurs not only in relation to one’s own partner, but also in relation to complete strangers. Affected persons often overestimate their own attractiveness during an episode.
Delusions
In manias with psychotic symptoms, delusions also present themselves, which are defended as reality for several weeks – even in phases in which the mania has subsided. In very rare cases, hallucinations or waking dreams occur.
Suicidal thoughts
What causes mania?
The exact causes of mania are not fully understood. At present, the cause of mania is thought to be primarily a disorder of the neurotransmitters in the brain. These so-called neurotransmitters are responsible for the transmission of nerve impulses. In most cases of mania, there is an imbalance of these transmitters. The neurotransmitters dopamine and norepinephrine are present in higher concentrations than in a healthy person.
In many cases, a manic episode is preceded by changes or significant events in the lives of the affected individuals or close relatives. These are, for example, events such as:
- Job change
- Unemployment
- The end of a relationship
- Bereavement
- Relocation
However, it is also possible for mania to develop without a triggering event.
How is mania diagnosed?
Although mania is a manifest and serious illness, it is not diagnosed with physical examinations. A diagnosis of mania is made through discussions with a primary care physician or a psychiatrist, as well as through in-depth interviews with the affected person and his or her relatives. It is helpful in making the diagnosis if people suspected of having mania keep a feelings diary or mood calendar.
How is mania treated?
Drug treatment
To alleviate the acute symptoms of mania and prevent new manic episodes, drugs such as lithium preparations, antiepileptic drugs or atypical neuroleptics are administered. They influence transmitter activity in the brain and alleviate symptoms. Sedatives are also used in the acute phase of mania. They dampen the restlessness and increased agitation of those affected.
Psychotherapy
Psychotherapy or behavioral therapy accompanies drug treatment in the case of mania. This teaches patients to recognize early warning signs of a manic episode, to avoid stimulating stimuli during a mania, and to deal properly with an acute phase of the illness.
How can mania be prevented?
It is not possible to prevent the development of mania. Nevertheless, relapses and repeated manic episodes can be prevented or reduced in intensity by means of well-adjusted drug therapy and ongoing psychotherapy and behavioral therapy.
