Editing Mania (section)

== Signs and symptoms ==
A ''manic episode'' is defined in the [[American Psychiatric Association]]'s [[DSM-5|diagnostic manual]] (DSM) as a "distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration, if hospitalization is necessary),"<ref>{{cite web |date=September 2016 |website=PsychiatryOnline |publisher=American Psychiatric Association Publishing |url=http://psychiatryonline.org/pb-assets/dsm/update/DSM5Update2016.pdf |title=DSM-5 Update: Supplement to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition |access-date=2017-04-19 |archive-date=2020-08-03 |archive-url=https://web.archive.org/web/20200803065243/https://psychiatryonline.org/pb-assets/dsm/update/DSM5Update2016.pdf |url-status=live }}</ref> where the mood is not caused by drugs/medication or a non-mental medical illness (e.g., [[hyperthyroidism]]), and: (a) is causing obvious difficulties at work or in social relationships and activities, or (b) requires admission to hospital to protect the person or others, or (c) the person has [[psychosis]].<ref name="DSMIV">{{cite web |title=Manic Episode |url=https://www.behavenet.com/manic-episode |access-date=4 July 2024 |website=behavenet.com}}{{cbignore|bot=medic}}</ref>

To be classified as a manic episode, while the disturbed mood and an increase in goal-directed activity or energy is present, at least three (or four, if only irritability is present) of the following must have been consistently present:
 
# Inflated self-esteem or [[grandiosity]]. 
# Decreased need for sleep (e.g., feels rested after 3 hours of sleep). 
# [[Thought disorder|More talkative than usual]], or acts pressured to keep talking.
# [[Flight of Ideas|Flights of ideas]] or subjective experience that [[Racing thoughts|thoughts are racing]]. 
# Increase in goal-directed activity, or [[Psychomotor agitation|psychomotor acceleration]]. 
# Distractibility (too easily drawn to unimportant or irrelevant external [[Stimulus (psychology)|stimuli]]). 
# Excessive involvement in activities with a high likelihood of painful consequences. (e.g., extravagant shopping, improbable commercial schemes, [[hypersexuality]]).<ref name=DSMIV />

Though the activities one participates in while in a manic state are not ''always'' negative, those with the potential to have negative outcomes are more common.

If the person is concurrently depressed, they are said to be having a [[mixed episode]].<ref name=DSMIV />

The [[World Health Organization]]'s [[International Classification of Diseases]] (ICD) defines ''a manic episode'' as one where mood is higher than the person's situation warrants and may vary from relaxed high spirits to barely controllable exuberance, is accompanied by hyperactivity, a compulsion to speak, a reduced sleep requirement, difficulty sustaining attention, and/or often increased distractibility. Frequently, confidence and self-esteem are excessively enlarged, and grand, extravagant ideas are expressed. Behavior that is out-of-character and risky, foolish or inappropriate may result from a loss of normal social restraint.<ref name=ICD>{{cite web|url=http://apps.who.int/classifications/icd10/browse/2010/en#/F30|title=Manic episode|access-date=18 November 2016|archive-date=2 November 2014|archive-url=https://web.archive.org/web/20141102133725/http://apps.who.int/classifications/icd10/browse/2010/en#/F30|url-status=live}}</ref>

Some people also have physical symptoms, such as [[Perspiration|sweating]], pacing, and [[weight loss]]. In full-blown mania, often the manic person will feel as though their goal(s) are of paramount importance, that there are no consequences, or that negative consequences would be minimal, and that they need not exercise restraint in the pursuit of what they are after.<ref>[[DSM-IV]]</ref> [[Hypomania]] is different, as it may cause little or no impairment in function. The hypomanic person's connection with the external world, and its standards of interaction, remain intact, although intensity of moods is heightened. But those with prolonged unresolved hypomania do run the risk of developing full mania, and may do so without even realizing they have.<ref>AJ Giannini. ''Biological Foundations of Clinical Psychiatry'', NY Medical Examination Publishing Company, 1986.</ref>

One of the signature symptoms of mania (and to a lesser extent, [[hypomania]]) is what many have described as [[racing thoughts]]. These are usually instances in which the manic person is excessively distracted by objectively unimportant stimuli.<ref>Lakshmi N. Ytham, Vivek Kusumakar, Stanley P. Kutchar. (2002). ''Bipolar Disorder: A Clinician's Guide to Biological Treatments'', page 3.</ref> This experience creates an absent-mindedness where the manic individual's thoughts totally preoccupy them, making them unable to keep track of time, or be aware of anything besides the flow of thoughts. Racing thoughts also interfere with the ability to fall asleep.

Manic states are always relative to the normal state of intensity of the affected individual; thus, already irritable patients may find themselves losing their tempers even more quickly, and an academically gifted person may, during the hypomanic stage, adopt seemingly "genius" characteristics and an ability to perform and articulate at a level far beyond that which they would be capable of during [[Euthymia (medicine)|euthymia]]. A very simple indicator of a manic state would be if a thus far clinically depressed patient suddenly becomes inordinately energetic, enthusiastic, cheerful, aggressive, or "over-happy". Other, often less obvious, elements of mania include delusions (generally of either [[Grandiose delusions|grandeur]] or [[Persecutory delusion|persecution]], according to whether the predominant mood is euphoric or irritable), hypersensitivity, [[hypervigilance]], hypersexuality, hyper-religiosity, hyperactivity and impulsivity, a compulsion to over explain (typically accompanied by pressure of speech), grandiose schemes and ideas, and a decreased need for sleep (for example, feeling rested after only 3 or 4 hours of sleep). In the case of the latter, the eyes of such patients may both look and seem abnormally "wide open", rarely blinking, and may contribute to some clinicians' erroneous belief that these patients are under the influence of a stimulant drug, when the patient, in fact, is either not on any mind-altering substances or is actually on a depressant drug. Individuals may also engage in out-of-character behavior during the episode, such as questionable business transactions, wasteful expenditures of money (e.g., spending sprees), risky sexual activity, abuse of recreational substances, excessive gambling, reckless behavior (such as extreme speeding or other daredevil activity), abnormal social interaction (e.g., over-familiarity and conversing with strangers), or highly vocal arguments. These behaviours may increase stress in personal relationships, lead to problems at work, and increase the risk of altercations with law enforcement. There is a high risk of impulsively taking part in activities potentially harmful to the self and others.<ref name="pmid23489397">{{cite journal |vauthors=Fletcher K, Parker G, Paterson A, Synnott H | title = High-risk behaviour in hypomanic states | journal = J Affect Disord | volume = 150 | issue = 1 | pages = 50–6 | year = 2013 | pmid = 23489397 | doi = 10.1016/j.jad.2013.02.018 }}</ref><ref name="pmid23352318">{{cite journal |vauthors=Pawlak J, Dmitrzak-Węglarz M, Skibińska M, Szczepankiewicz A, Leszczyńska-Rodziewicz A, Rajewska-Rager A, Maciukiewicz M, Czerski P, Hauser J | title = Suicide attempts and psychological risk factors in patients with bipolar and unipolar affective disorder | journal = Gen Hosp Psychiatry | volume = 35 | issue = 3 | pages = 309–13 | year = 2013 | pmid = 23352318 | doi = 10.1016/j.genhosppsych.2012.11.010 }}</ref>

The experience of mania is often quite unpleasant and sometimes frightening, for the person involved and for those close to them, and it may lead to impulsive behaviour that may later be regretted. It can also often be complicated by the individual's lack of judgment and insight regarding periods of exacerbation of characteristic states. Manic patients may frequently deny anything is wrong with them.<ref name=":1">{{Citation |last1=Dailey |first1=Mark W. |title=Mania |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK493168/ |work=StatPearls |access-date=2023-12-29 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29630220 |last2=Saadabadi |first2=Abdolreza |archive-date=2024-01-11 |archive-url=https://web.archive.org/web/20240111090418/https://ncbi.nlm.nih.gov/books/NBK493168/ |url-status=live }}</ref> Because mania frequently encourages high energy and decreased perception of need or ability to sleep, within a few days of a manic cycle, sleep-deprived [[psychosis]] may appear, further complicating the ability to think clearly. 

Mania may also, as earlier mentioned, be divided into three "stages". Stage I corresponds with hypomania and may feature typical hypomanic characteristics, such as [[Sociality|gregariousness]] and [[euphoria]]. In stages II and III mania, however, the patient may be extraordinarily irritable, [[psychotic]] or even [[delirium|delirious]]. These latter two stages are referred to as acute and delirious (or Bell's), respectively.