| This diagnosis describes those who have recurrent manic episodes, characterized by an elevated (euphoric) mood and self-image. The individual is consumed with ideas and exhibits excessive energy. Behavior is dramatic, expansive, and usually overactive, with racing thoughts and an inflated sense of confidence and self-esteem. Behavior may also be impulsive, intruding on other people's lives, or alienating to friends, family, and co-workers. Because of an inflated sense of self-worth (grandiosity), there is often lack of insight into how harmful the mania is to relationships. Mood can be unstable and irritable. If opposed, the individual may even become hostile.
Mania occurs because of an imbalance in brain chemicals called neurotransmitters. Manic episodes usually have a rapid onset, building suddenly over a few days. The episodes last a few weeks to several months. They often are preceded by difficulty sleeping. Impaired sense of reality (psychotic features) can occur during mania. The individual may see visions, hear voices, or fixate upon untrue beliefs (delusions). The psychosis is usually consistent with the individual's sense of extraordinary well being. Grandiose delusions are common, such as the individual believing he is a genius or of noble birth.Risk: Although usually beginning in the early twenties, the onset of mania ranges from adolescence to over age 50. The manic episodes usually appear after some psychologically stressful event. |
Source: Medical Disability Advisor
| History: Individuals experiencing a manic episode have a persistently elevated, euphoric, or irritable mood for at least 1 week. During the episode, the individual will exhibit at least three of the following symptoms: inflated opinion of self (grandiosity), belief that the individual possesses great or unusual powers, difficulty sleeping (insomnia) or requiring drastically less sleep than usual, excessive talkativeness, racing thoughts, distractibility, increased goal-directed activity, and indulging excessively in pleasurable activities that can have undesirable consequences (such as buying sprees, gambling, or sexual binges). The manic episode leads to a disruption in relationships and/or impairment of work performance. If psychosis is present (hallucinations, delusions), the individual may be a danger to himself or others. Physical exam: Manic disorder is diagnosed primarily through observation of the individual's orientation, dress, mannerisms, behavior, and speech, as well as through an evaluation of the individual's past mental health, medical, and drug history. Physical examination should rule out the possibility that recurrent mania is caused by a medical disorder (such as hyperthyroidism), use of certain types of antidepressants (such as monoamine oxidase inhibitors), or substance abuse (cocaine, amphetamines, or steroids). Recurrent manic disorder is not diagnosed if the mania results from another psychological condition. Tests: Tests do not conclusively establish a diagnosis of recurrent manic disorder but may be used to eliminate medical disorders as the source of the mania. A brain magnetic resonance imaging (MRI) or computed tomography (CT) scan can rule out mania caused by epilepsy or brain tumors (neoplasm). Blood tests to establish the level of thyroid stimulating hormone (TSH) can identify hyperthyroidism. The Minnesota Multiphasic Personality Inventory - 2 (MMPI-2), a self-reported psychiatric test, may also be used to help identify recurrent manic disorder. |
Source: Medical Disability Advisor
| Mild mania leaves the individual with heightened feelings of well-being, alertness, and impulsiveness. Individuals with mild symptoms are often successfully treated as outpatients. Moderate to severe mania is a medical emergency. When the individual experiences psychosis, almost continual supervision is necessary to prevent harm to self or others. Under these conditions, hospitalization to stabilize medication and maintain the individual's safety is the most effective form of treatment.
Mania is treated with mood stabilizing and antipsychotic drugs. Lithium or divalproex sodium is usually the mood stabilizer of choice. It affects the balance of chemicals in the brain and is very effective in moderating racing thoughts and inappropriate behaviors associated with mania. When taken regularly, lithium helps prevent mania from recurring.
Because lithium does not produce a noticeable effect for 4 to 14 days, faster-acting antipsychotic drugs are often given at the same time. In some individuals, antidepressant medication heightens the manic state. If a manic individual is taking an antidepressant and is unresponsive to treatment, the antidepressant is often discontinued to assure that it is not interfering with the treatment regimen.
Electroconvulsive therapy (ECT) was used to treat mania fifty years ago. Although it is rarely used now because of the availability of fast-acting antipsychotic drugs, ECT may be an appropriate treatment for women in their first trimester of pregnancy when drug therapy could harm the developing fetus.
Anticonvulsants are frequently prescribed to treat acute mania. However, as of 2004, this use has not been approved for long-term treatment of bipolar disorder by the Food and Drug Administration, though it is frequently used ‘off-label' for this purpose. |
Source: Medical Disability Advisor
| Many individuals with mild forms of mania do not view it as a disability. They enjoy the way they feel and may be extremely successful because of their high energy level, enthusiasm, and sociability. Without treatment, manic episodes can be expected to recur, the interval between them often becoming shorter and shorter. Eventually the associated psychosis erodes social support and effective functioning.
Antipsychotic drugs are an effective form of immediate treatment of mania, but research suggests that their benefits do not extend beyond the short term. Lithium is effective in reducing manic symptoms. Proper treatment vastly improves the individual's level of functioning. Many individuals require long-term, even lifelong, maintenance treatment in order to significantly decrease the likelihood of recurrent manic episodes. Not realizing the harm that mania can cause, however, some individuals refuse to take antimania medication or to continue treatment, because they may feel euphoric, more powerful, and effective when manic. |
Source: Medical Disability Advisor
| Most of the complications resulting from recurrent manic disorder come about because of the individual's impaired judgment and inability to evaluate situations realistically. Suicide or accidental injury are the most serious complications. Other complications of manic episodes may include ruined personal relationships and finances as a result of behaviors such as promiscuity and gambling, disrupted employment or other work-related problems, failure to attend to proper nutrition and self-care, and physical exhaustion. In extreme cases, mental and physical activity is so frenzied that mood and behavior merge into a senseless agitation called delirious mania. Immediate treatment is vital because the individual may die of sheer physical exhaustion. |
Source: Medical Disability Advisor
| Schedule may need to incorporate flex-time, a part-time position, or job sharing, and break time according to individual needs rather than a fixed schedule. Other accommodations may include creating a flexible schedule for medical appointments, and allowing workers to phone professionals during the workday and meet with employer, supervisor, or job coach to explore other alternatives. The individual's work may need to be more closely supervised due to a lack of judgment or insight when a manic episode is developing. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has diagnosis of recurrent manic disorder been confirmed?
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Does the individual's behavior meet the diagnostic criteria?
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Although they share characteristic symptoms, does individual experience manic or hypomanic episodes?
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Have other conditions with similar symptoms been ruled out?
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Is individual unaware of or denying that anything is wrong with his or her mental state or behavior?
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Has physician obtained a reliable report from a family member or associate who has ample opportunity to observe individual?
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Have all underlying physical diseases been ruled out that may be causing the mania?
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Has individual's past mental health history been obtained?
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Has individual's medication history (use of antidepressants, amphetamines, steroids) been established?
Regarding treatment:
- How often are the mania episodes recurring? How long do they last?
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Would individual benefit from hospitalization to stabilize medication and maintain the individual's safety?
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Should treatment thereafter be inpatient or outpatient?
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Is individual taking appropriate medication?
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Is individual complying with the medication regimen?
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If unwilling to take the medication, is it because individual enjoys how a manic episode feels?
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Is someone else available who could administer or monitor the medication regime?
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Does individual continue to exhibit overactive or highly physical behavior?
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Is individual also taking an antidepressant?
Regarding prognosis:
- Do manic episodes appear associated with psychosocial stressors?
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How does individual deal with current stresses? How were major stresses dealt with in the past?
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If healthy and adaptive methods were used in the past, are they currently being used?
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What is happening outside of work that may be contributing to or worsening the problems experienced at work?
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Since control of manic episodes may require long-term maintenance treatment, is individual willing and reliable in medication regime?
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Is someone else available to help monitor and ensure individual remains on medication as prescribed?
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Does individual have a personal accepting support system in place? What are his or her social supports? Family? Friends? Church or other community affiliations?
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Are these resources being utilized?
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Source: Medical Disability Advisor
| Anderson, Alan C., and Christopher M. Filley. "Behavioral Presentations of Medical and Neurologic Disorders." Psychiatric Secrets. Ed. James L. Jacobson. 2nd ed. Philadelphia: Hanley & Belfus, Inc., 2001.Bloomingdale, Kerry L. "Electroconvulsive Therapy." Psychiatric Secrets. Ed. James L. Jacobson. 2nd ed. Philadelphia: Hanley & Belfus, Inc., 2001. Zarate, C. A., and M. Tohen. "Use of a Typical Antipsychotic After Manic Episode." Psychopharmacology Update 15 (2004): 5. |
Source: Medical Disability Advisor
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