Acute Mania 101: Signs and Treatment

Sasha is in her twenties and is attending the A&E department. She has hurt her ankle and is waiting for an X-ray to check it’s not broken. But everything is not quite as straightforward as it might seem. Sasha is not the usual drunk attendee, who missed her footing.

For a start, Sasha has candidly explained that she received the injury by jumping from a first-floor building. She seems very talkative and is keen to get home because she’s working on a business plan. This, she claims, will make her a millionaire by this time next year.

Asked if she’s sleeping well, Sasha is indignant. She says she’s too busy to sleep. She is about to launch her business and has no time for sleeping. That’s all within the remit of possibilities. Just about! But Sasha is now hopping from cubicle to cubicle, flirting with patients. She’s also explaining her business and offering shares of her non-company to somewhat bewildered and sick patients.

Staff speaks to her accompanying friend who agrees, Sasha has been acting out of character, for a few days now.

While waiting for her X-ray, a psychiatrist speaks to an irritated Sasha who considers his involvement to be completely unnecessary. She thinks that the doctor is a fool and he will very much regret not to be on board concerning her brilliant business ideas. Asked to explain why she jumped out of a window, Sasha claims that it was just a bit of fun. It’s only because she landed badly that it’s become an issue.

It is explained to Sasha that she is going to be admitted to a psychiatric ward for assessment. She has a choice of going voluntarily or being committed against her will.

After the assessment, it is concluded that Sasha has acute mania.

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So what is acute mania?

Lots of medical conditions can be described as either acute or chronic. In medical terms, acute means a condition that has a sudden onset and is severe. Chronic conditions, conversely, develop slowly over time.

Mania can be defined as an extremely elevated mood, both physical and emotional. Therefore, we can say that acute mania is a sudden and severe onset of an elated mood. The mood can be irritable, aggressive, or psychotic. 

To dispel any ambiguity, it would be possible to have chronic bipolar disorder that resulted in acute mania.

Why does acute mania happen?

People associate mania as an element of an already present mental illness, in particular, bipolar disorder. However, mania can happen for several other reasons:

  • Seasonal influences
  • Genetic factors
  • Stressful events
  • Drug abuse including cocaine and amphetamines
  • Biochemical factors such as an imbalance in neurotransmitters
  • Organic conditions including Huntington’s disease, neurological tumors, thyroid conditions, and vitamin B12 deficiency

For individuals who experience manic episodes, the first episode often occurs in a person’s twenties. However, it can happen earlier in adolescence and it may happen later. It is extremely rare for a first episode to happen in a person’s fifties or later.

Difficulties treating mania on the ward

Acute mania is usually treated in an acute psychiatric ward. When a person is in hospital as a patient it ought to go without saying that they are expecting to be treated with dignity and compassion. But for all the best will in the world, that is not always the case owing to the nature of the illness.

In an acute psychiatric ward environment, doctors see patients for short appointments and discuss care plans with nurses based also on their comprehensive notes. Thus, it’s mostly nurses and health care workers that care for patients with acute mania.

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Reactions to acute mania

However, reactions to acute mania are not entirely within our control. We would hope to always behave in the most professional manner. But sometimes things slide when caring for patients with acute mania.

With patients in the full throws of mania that never get tired of repetitive, stressful, and annoying behavior it can mean that they become very irritating to be around. After a certain number of hours, it can be difficult for health care workers to suppress their irritation and annoyance.

Patients with acute mania can often behave in labile ways which in turn causes nurses to be embarrassed. Another reaction to dealing with acute mania is to be amused. Some of the behavior and tall stories exhibited by manic patients can be on face value, very funny. Thus, health care workers, including doctors, may find it impossible to suppress laughter or a wry smile. Once again, while forgivable, it’s not the ideal reaction and can be considered as trampling on a patient’s dignity. Especially when you’re essentially laughing at a person – not with them.

And finally, patients with mania can often be verbally abusive. Nurses may feel discomfort in dealing with the patient. It’s not an easy situation to deal with a patient when their behavior is so directly abusive.

Guidelines for responding to people experiencing mania

For nurses managing patients hospitalized with mania, some guidelines are helpful and correct ways to respond to patients. They include:

  • Set clear boundaries as to what is expected of patients on the ward
  • Support realistic ideas
  • Encourage the person to slow their thoughts. This can be achieved by asking questions that require brief answers
  • Support regular sleeping patterns
  • Provide family and friends with reassurance and information
  • Follow through with boundaries by repeating what is acceptable, expected, and allowed
  • If speech is confused then stop the conversation and sit quietly with the person instead
  • Always show respect for the person experiencing mania
  • Be aware of your thoughts and feelings when managing a patient with mania. It can be that support is required when dealing with patients with severe mania.  If this is the case, you can arrange for a debriefing with a colleague
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Treating Acute Mania

Treating acute mania requires careful observation to rule out organic conditions.

Typically mood-stabilizing drugs such as lithium, sodium valproate, and benzodiazepines. Strategies also include counseling, support, and education.

Depending on the causes, an acute phase of mania can last around 6-12 weeks. If the episode is severe, the patient may need to be hospitalized for 4 weeks or more.  Careful planning is needed to coordinate services before discharge. A patient may need to have regular contact with community mental health services to prevent a recurrence.

If the mania is associated with bipolar disorder, then manic episodes may be followed by depressive episodes, later on, so a referral to services is essential. The good news is adherence to medication or treatment of organic causes can prevent further episodes.