Manic Episode

Bipolar Affective Disorder

Bipolar Affective Disorder

A manic episode is characteristic of bipolar disorder or manic-depressive disorder, also referred to as bipolar affective disorder or manic depression. The manic episode is defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood. In bipolar disorder, the mania may alternate with depression, although it is typical that the two phases are separated by periods of “normal” moods. A person with bipolar disorder may experience mixed episodes in which features of both mania and depression are present at the same time.

The cause(s) of bipolar affective disorder are not known. Risk factors include genetics (it tends to run in families, and most bipolar patients have at least one close relative who also has the disorder), poor diet, and illegal drug use (although it’s easy to confuse cause and effect).

Diagnosing bipolar disorder can be difficult even for experienced mental health professionals. Bipolar disorder is distinguished from simple depression in that the affected person experiences states of manic episode and depression. Bipolar is also inconsistent in its presentation. Some people feel depressed more often than not, and experience little mania, whereas others experience predominantly manic episode symptoms. The younger the age of onset (bipolar disorder starts in childhood or early adulthood in most patients), the more likely the first few episodes are to be depression. Since a bipolar diagnosis requires a manic episode (or hypomanic episode), many patients are initially diagnosed with, and treated for, major depression.

A manic episode is the signature characteristic of bipolar disorder. Mania is a distinct period of an elevated mood, or even euphoria. Mania is typically presented as an increase in energy and a decreased need for sleep. In a manic episode, a person can sometimes go days without sleeping. Typically, attention span is abnormally low (as in ADHD), but in some cases, manic episode can be accompanied by hyperfocus and periods of extremely high creativity and productivity. Judgment may be impaired, and sufferers may go on spending sprees or engage in other abnormal behavior. Manic episodes sometimes lead to substance abuse, particularly alcohol or other depressants, cocaine or other stimulants, or sleeping pills. Behavior may become aggressive, intolerant, belligerent, or abusive. Sex drive may increase. At more extreme phases of bipolar I, a person in a manic state can begin to experience psychosis, or a break with reality, where thinking is affected along with mood.

A formal diagnosis of manic episode, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM), requires observation of a state of elevated or irritable mood, as well as other symptoms, for at least one week (less if hospitalization is required). However, in some individuals, depression and mania may rapidly alternate, which is known as rapid cycling.

Severity of manic symptoms can be measured by rating scales such as self-reported Altman Self-Rating Mania Scale and clinician-based Young Mania Rating Scale.