Related Subjects:
|Psychiatric Emergencies
|Depression
|Mania
|Schizophrenia
|Suicide
|Acute Psychosis
|Delusions
|General Anxiety Disorder
|Obsessive-Compulsive disorder
|Wernicke Korsakoff Syndrome
|Medically Unexplained symptoms
|Postpartum/Postnatal Depression
|Postpartum / Postnatal Psychosis
|Eating disorders in Children
🧠 About
- Hypomania = a milder, less severe form of mania, without marked social/occupational impairment or psychosis.
- Mania = more severe, often with psychotic features, dangerous impulsivity, and loss of function.
🔎 Clinical Features
- Persistently elated or irritable mood.
- Disinhibition → impulsive spending, substance misuse, risky behaviours.
- Hypersexuality and socially inappropriate behaviour.
- Motor overactivity, pressured speech, “flight of ideas.”
- Reduced need for sleep without fatigue.
- Grandiose ideas or delusions (common in mania, not typical in hypomania).
- Poor insight, loss of contact with reality (manic state).
🚨 Management of Acute Episode
- Risk assessment is essential (suicide, violence, finances, sexual risk).
- Hospital admission often required; may involve detention under the Mental Health Act 1983.
- Rapid tranquilisation: Haloperidol, Chlorpromazine, or Olanzapine. Benzodiazepines (Lorazepam) may be added for acute agitation.
- Always check for medical triggers (thyroid disease, steroids, substance misuse).
📅 Chronic / Maintenance Management
- Lithium → gold standard mood stabiliser for prophylaxis.
- Monitor U&E, TFTs, calcium, and serum lithium every 3–6 months.
- Maintain levels 0.6–1.0 mmol/L (higher end for mania prevention).
- Valproate → effective but contraindicated in women of childbearing potential due to teratogenicity.
- Carbamazepine → alternative, esp. with rapid cycling or mixed states.
- Lamotrigine → more effective in bipolar depression than mania.
⚡ Management of Acute Mania
- First-line antipsychotics: Olanzapine, Haloperidol, or Risperidone.
- Mood stabilisers: Sodium Valproate, Lithium (slower onset).
- Combination therapy may be needed for severe or resistant cases.
🛡️ Mania Prophylaxis
- Lithium Carbonate (best evidence, suicide risk reduction).
- Sodium Valproate (if lithium unsuitable, avoid in women of childbearing age).
- Carbamazepine for some patients.
- Other agents (Lamotrigine, Gabapentin, Topiramate) → limited evidence, under investigation.
- ECT may be used for severe, treatment-resistant mania.
Cases - Mania
- Case 1 - Classic acute mania 🔥: A 26-year-old man presents with 1 week of decreased need for sleep, pressured speech, flight of ideas, and grandiose plans to “start a global company overnight.” He is distractible and spending large amounts of money online. Diagnosis: manic episode (bipolar I disorder). Managed with hospital admission, antipsychotics (e.g. olanzapine), and mood stabiliser initiation.
- Case 2 - Mania with psychosis 🧠: A 34-year-old woman presents with elevated mood, irritability, and increased energy. She reports hearing voices telling her she is chosen to be “queen of the world.” Exam: disinhibited behaviour and persecutory delusions. Diagnosis: mania with psychotic features. Managed with antipsychotics, mood stabilisers, and inpatient psychiatric care.
- Case 3 - Secondary mania ⚕️: A 58-year-old man with no psychiatric history develops new hyperactivity, pressured speech, and irritability after starting high-dose prednisolone for temporal arteritis. Diagnosis: steroid-induced mania. Managed by reducing steroids if possible and using antipsychotics for behavioural control.
Teaching Point 🩺: Mania is defined as ≥1 week of abnormally elevated or irritable mood with increased energy, reduced sleep, pressured speech, and impaired functioning. Always distinguish primary bipolar mania from secondary causes (drugs, steroids, neurological disease).
