Editing Bipolar disorder (section)

=== Manic episodes ===
[[File:A woman diagnosed as suffering from hilarious mania. Colour Wellcome L0026687.jpg|thumb|left|An 1892 color lithograph depicting a woman diagnosed with ''hilarious mania'']]

Also known as a manic episode, mania is a distinct period of at least one week of elevated or irritable mood, which can range from euphoria to [[delirium]]. The core symptom of mania involves an [[Psychomotor agitation|increase in energy of psychomotor activity]]. Mania can also present with increased self-esteem or [[grandiosity]], [[racing thoughts]], [[Pressure of speech|pressured speech]] that is difficult to interrupt, decreased need for sleep, disinhibited social behavior,<ref name=akiskalsadock/> increased [[goal-oriented]] activities and impaired judgement, which can lead to exhibition of behaviors characterized as impulsive or high-risk, such as [[hypersexuality]] or [[Compulsive buying disorder|excessive spending]].<ref name="Barnett2009" /><ref name="Tarr2011">{{cite journal|vauthors=Tarr GP, Glue P, Herbison P|date=November 2011|title=Comparative efficacy and acceptability of mood stabilizer and second generation antipsychotic monotherapy for acute mania—a systematic review and meta-analysis|journal=J Affect Disord|volume=134|issue=1–3|pages=14–19|doi=10.1016/j.jad.2010.11.009|pmid=21145595}}</ref><ref name="Beentjes2012">{{cite journal|vauthors=Beentjes TA, Goossens PJ, Poslawsky IE|date=October 2012|title=Caregiver burden in bipolar hypomania and mania: a systematic review|journal=Perspect Psychiatr Care|volume=48|issue=4|pages=187–197|doi=10.1111/j.1744-6163.2012.00328.x|pmid=23005586|doi-access=free}}</ref> To fit the definition of a manic episode, these behaviors must impair the individual's ability to socialize or work.<ref name="Barnett2009" /><ref name="Beentjes2012" /> If untreated, a manic episode usually lasts three to six months.<ref>{{cite journal | author = Titmarsh S | title = Characteristics and duration of mania: implications for continuation treatment | journal = Progress in Neurology and Psychiatry | date = May–June 2013 | volume = 17 | issue = 3 | pages = 26–27 | doi = 10.1002/pnp.283 | s2cid = 144883133 | doi-access = free }}</ref>

In severe manic episodes, a person can experience [[psychosis|psychotic]] symptoms, where thought content is affected along with mood.<ref name="Beentjes2012" /> They may feel unstoppable, [[Persecutory delusion|persecuted]], or as if they have a special relationship with God, a great mission to accomplish, or other grandiose or delusional ideas.<ref name="Knowles2011">{{cite journal |vauthors=Knowles R, McCarthy-Jones S, Rowse G | title = Grandiose delusions: a review and theoretical integration of cognitive and affective perspectives | journal = Clin Psychol Rev | volume = 31 | issue = 4 | pages = 684–696 | date = June 2011 | pmid = 21482326 | doi = 10.1016/j.cpr.2011.02.009 }}</ref><ref>{{cite journal | vauthors = Baethge C, Baldessarini RJ, Freudenthal K, Streeruwitz A, Bauer M, Bschor T | title = Hallucinations in bipolar disorder: characteristics and comparison to unipolar depression and schizophrenia | journal = Bipolar Disorders | volume = 7 | issue = 2 | pages = 136–145 | date = April 2005 | pmid = 15762854 | doi = 10.1111/j.1399-5618.2004.00175.x }}</ref> This may lead to violent behavior and, sometimes, hospitalization in an inpatient [[psychiatric hospital]].<ref name="Tarr2011" /><ref name="Beentjes2012" /> The severity of manic symptoms can be measured by rating scales such as the [[Young Mania Rating Scale]], though questions remain about the reliability of these scales.<ref>{{cite journal | author = Furukawa TA | title = Assessment of mood: Guides for clinicians | journal = Journal of Psychosomatic Research | volume = 68 | issue = 6 | pages = 581–589 | year = 2010 | pmid = 20488276 | doi = 10.1016/j.jpsychores.2009.05.003 }}</ref>

The onset of a manic or depressive episode is often foreshadowed by [[Sleep disorder|sleep disturbance]].<ref name="McKenna2012">{{cite journal |vauthors=McKenna BS, Eyler LT | title = Overlapping prefrontal systems involved in cognitive and emotional processing in euthymic bipolar disorder and following sleep deprivation: a review of functional neuroimaging studies | journal = Clin Psychol Rev | volume = 32 | issue = 7 | pages = 650–663 | date = November 2012 | pmid = 22926687 | pmc = 3922056 | doi = 10.1016/j.cpr.2012.07.003 }}</ref> Manic individuals often have a history of [[substance use disorder]] developed over years as a form of "self-medication".<ref name="Post2013">{{cite journal|vauthors=Post RM, Kalivas P|date=March 2013|title=Bipolar disorder and substance misuse: pathological and therapeutic implications of their comorbidity and cross-sensitisation|journal=Br J Psychiatry|volume=202|issue=3|pages=172–176|doi=10.1192/bjp.bp.112.116855|pmc=4340700|pmid=23457180}}</ref>