Mania

Mania (from the ancient Greek μανία maníā, German 'Raserei, Wut, Wahnsinn') is an affective disorder that usually occurs in episodes. Drive, mood and activity are far above normal in a mania.

In its development and maintenance, mania is probably multifactorial. Genetic factors and psychosocial stress are suspected as causes. On the neurochemical level, disturbances in serotonin, catecholamine and GABA metabolism are discussed.

During mania, sleep is reduced. Over-exertion of areas of the brain occurs, which then, if not treated, can trigger psychotic symptoms. A weakened form of mania, but still well above the normal fluctuations of mood, is called hypomania.

Symptoms and characteristics

Very roughly simplified, mania can be described as the "opposite of depression". The symptoms appear in virtually all areas of life and affect almost all mental functions:

Drive

The drive and mood are far above normal - sometimes raised to the extreme - at the limit. There is strong excitement and inner drive, restless activity and restlessness. Even if those affected are still aware of the overstimulation, they spend themselves completely, although they are aware that this can have harmful consequences.

Mood

There is an intense, but unfounded uplifted and cheerful mood, but sometimes also irritability or ill-tempered restlessness.

Social behaviour

In mania, sociability and talkativeness are greatly increased. Patients often show completely maladjusted, aloof behavior; for example, strangers are simply approached and engaged in conversations that are far beyond social conventions. Affected individuals show a lack of sensitivity to the needs and feelings of their immediate peers and tend to behave in an uninhibited and uncritical manner.

Others can not stop the person from these behaviors, a manic can hardly or not at all be braked or taught. Violent disputes with loud and severe insults towards close people are then usually the result.

All of these actions can be completely out of character, which can be extremely distressing for relatives or friends. Often this leads to the breaking of close, long-standing - and for the affected person very important - ties, which further significantly worsens the overall condition of the affected person.

Sexuality

The libido is increased; those affected can become completely disinhibited, losing control over themselves. Sexually suggestive behavior and frequent and indiscriminate sexual contact with strangers are also common. Often there is also the conviction that one can have voluntary sexual contacts with any desired person, if only this were desired.

Cognitive symptoms

The affected person constantly has new ideas running through his head; this ranges from a prolixity of thoughts to a flight of ideas. Prolixity means that when talking about a subject, the person concerned repeatedly goes astray from the original train of thought, to which he finds his way back only with difficulty. In the case of flight of ideas, the thoughts follow one another at breakneck speed, the person concerned gets from the "hundredth to the thousandth", the associations may be loosened. The thoughts remain in themselves logically consecutive, but it is hardly possible for the person concerned to answer a further question, because he does not find his way back to the goal of his narrative or keeps digressing. This also manifests itself in logorrhoea, a strong urge to talk; in extreme cases, the words overlap so much that it is hardly or no longer possible for the listener to understand anything.

Perception of reality

The self-confidence can be increased to an excessive degree; loss of reality and delusions of grandeur (megalomania) are possible. Other delusions, which are sometimes defended and developed as "reality" over several weeks to months, also occur (however, like hallucinations, only in so-called manias with psychotic symptoms - mania can also be present without delusions). Hallucinations are possible, attenuated, an intensified, intense perception of colors and impressions is typical, also waking dreams, which can strongly reduce the attention.

Sleep and hygiene

Excessive preoccupation with pleasant things is typical; fanatically and excessively one sub-area is exercised, while other, often more important things, are completely neglected. There is a greatly diminished need of sleep, often grinding of teeth, smacking and talking in sleep. Sometimes the neglect of food intake and personal hygiene can also be observed.

money management

Often, people spend more and faster than usual. In restaurants local rounds are spent, money and valuables are given away to strangers. Sometimes, during a mania, sufferers even engage in mass transactions due to their ideas of grandeur, which can have very unpleasant consequences for the sufferers and their relatives, such as high indebtedness.

Lack of understanding

Mania sufferers typically have no insight into problems during the manic phase; they "feel dazzled". Relatives or experts in the disorder, on the other hand, are able to recognize them. When the phase has subsided, sufferers are sometimes left in a shambles and feel ashamed of their behaviour. Due to the overestimation of self, self-endangering behaviour, even suicide, may occur; more rarely, there is a danger to others, which can be further increased by the increased strength, endurance and resistance (for example, to some tranquilizers) of acute manics.

Types

The overall picture of mania differs from case to case, often also from episode to episode in a single patient. A distinction can be made between classic mania (with a foregrounded increase in drive and elevated mood) and irritable mania (with an angry, irritable mood). With extreme acceleration of thought and speech, confused mania is possible, an appearance that can closely resemble a state of confusion such as occurs in brain-organic mental disorders. Depending on its severity, mania can be very stressful for the person affected and their relatives and can have serious social consequences. In addition to pure mania, a mixed phase (mixed state) can also occur: in addition to manic symptoms, depressive symptoms also occur. In this state, suicidal tendencies play a major role, because the "power" that arises from the mania can provide the impetus to actually put into practice a suicidal desire or suicidal decision caused by the depression. For this reason, mixed states are considered by far the most dangerous episodes of bipolar disorder, and these patients need to be cared for/supervised as closely as possible to prevent this.