Elsevier

The Lancet

Volume 349, Issue 9059, 19 April 1997, Pages 1157-1160
The Lancet

Seminar
Mania

https://doi.org/10.1016/S0140-6736(96)07253-4Get rights and content

Section snippets

The spectrum of mania

Manic symptoms cover a spectrum of severity from cyclothymia to severe delusional mania. Cyclothymia, which usually starts in adolescence or early adulthood, describes fluctuations of mood between mild elation and depression. Although mild elation of this type may be associated with enhanced personal and social functioning, cyclothymia can also lead to considerable social or interpersonal difficulties because of its unpredictability. A proportion of cyclothymic individuals go on to develop

Clinical description and diagnosis

An episode of mania may begin abruptly, over the space of a few hours or days, or gradually, over some weeks. The subjective experience of mania in its minor forms usually includes heightened feelings of well-being with increased alertness and drive, inflated self-esteem, and expansive sociability. In addition to a general elevation of mood, instability or lability is typical. Irritability may easily be evoked, and other mood states such as anxiety or sadness, fleetingly but intensely

Epidemiology

The lifetime prevalence of mania (bipolar affective disorder) is approximately 1%. Onset is most common in late adolescence or early adulthood although new cases are seen in all decades. First occurrence in childhood or early adolescence is increasingly being recognised, when it is sometimes accompanied by hyperactivity disorders.3 A minority, about 10%, of people with major depression will subsequently develop mania, most within 5 years of onset. Prevalence rates do not differ between men and

Aetiology

Mania shows greater heritability than any of the other major disorders in psychiatry. Concordance rates for monozygotic twins are about 70% and the risk for mood disorders among first degree relatives is about 20%,5 depression being more frequently reported than mania. Earlier reports of genetic linkage have not been replicated in wider populations, although large-scale studies are underway. Disturbances in monoamine neurotransmitter function have been studied much less extensively in mania

Course and outcome

Most manic episodes remit with treatment within a few months. However, the majority of patients will go on to have recurrences. Variability in outcome is considerable. While the length of episode does not show any consistent variation over time, some follow a pattern where the duration between the first few episodes seems to shorten progressively. Thereafter, it may level out and, later, may begin to lengthen again. In general, more depression and less mania is associated with advancing age.

Management and treatment

Mild mania may be managed at out-patient clinics but it is important to realise that progression to more severe mania can occur quite rapidly and unexpectedly. Out-patient management should include frequent clinical monitoring and a careful evaluation of the patient's support network. It is important to extend support to family members and to monitor their coping abilities. The possible consequences for both patient and family of disinhibited or socially embarrassing behaviour may dictate a

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