Mania is a mental health disorder that involves one or more manic episodes, also known as a manic phase, which lasts for at least one week and is characterized by a shift in behavior that has a significant impact on daily functioning.
Mania is distinguished from increased vigor and dysfunction brought on by substance abuse, illnesses, or other factors. Additionally, psychotic characteristics, such as delusions or hallucinations, are frequently present in mania.
Many patients have delusional ideas. For example, they believe that they are highly skilled professionals, government officials, spies, or other high-level agents (even when they have no such background).
Also, manic patients could have auditory or visual hallucinations, which only appear during manic episodes. Some of the most typical delusions are paranoid delusions, in which patients imagine that they are being stalked, targeted, or surveilled.
Signs and Symptoms of Mania
Mania creates observable problems in the workplace, school, and social gatherings in addition to relationship issues. A psychotic break (psychosis) brought on by mania may also necessitate hospitalization. The defining characteristics of mania include:
- increased talkativeness
- rapid speech
- a decreased need for sleep
- racing thoughts, distractibility
- increase in goal-directed activity
- psychomotor agitation
Some other hallmarks of mania are:
- an elevated or expansive mood
- mood lability
- impulsivity
- irritability
- grandiosity.
Cause of Mania
Mania and, more broadly, bipolar I disorder have an unknown cause. However, there is solid proof based on recent studies that a combination of genetic, psychological, and societal elements is the root of the problem.
Numerous investigations involving families have revealed a clear hereditary component. When one of the siblings is positive for the illness, a study of monozygotic twins found that up to 80% of the twins are concordant with the disorder.
Since there isn’t a perfect concordance between monozygotic twins, this is another proof of environmental impacts. Numerous studies have demonstrated the involvement of various allele frequencies in schizophrenia and bipolar I illness.
Mania or hypomania may be brought on by:
- high-stress levels
- alterations in sleep habits or sleep deprivation
- using drugs or alcoholic beverages recreationally
- Seasonal variations: For instance, certain persons are more susceptible to hypomania and mania in the spring.
- a life change that has a big impact, like moving or getting divorced,
- childbirth (see our article on postpartum psychosis for additional information) (see our page on postpartum psychosis for more information)
Common Triggers of Mania
- Heated Argument with the people surrounding the patient. Conflict in any kind of connection, whether it’s with the patient’s spouse, a coworker, a relative, or a friend, may make the patient feel stressed out. Negative social interactions were another thing that made them think about taking their own lives.
- Marriage Breakdowns. If the patient is experiencing a depressive or manic episode following or during a breakup, the patient may want to think about obtaining a durable power of attorney that enables someone else to handle important choices, such as financial ones.
- Substance Intoxication. Drug intoxication from cocaine and amphetamines can result in or increase manic symptoms, whereas cocaine or alcohol use’s side effects are linked to worsening depression symptoms.
- Certain medications like antidepressants, and corticosteroids. Treatment for bipolar disorder can precipitate manic episodes by escalating unstable emotions and actions. Antidepressants have been known to cause patients to go into a manic phase, according to many psychiatrists, and some are reluctant to prescribe them to those who have bipolar disorder.
- Clock genes. About 20% of bipolar illness patients report mood swings in response to changes in the weather. In particular, individuals experience seasonal depression more frequently in the early winter and mania or hypomania in the spring or summer.
- Pregnancy is accompanied by disturbed sleeping patterns. The weeks and months following giving birth are particularly risky for mood episodes in people with bipolar disorder.
- Job Loss. It can seem liberating to those who weren’t happy with their job. Others may experience significant stress due to the associated financial and emotional pressures.
- Bereavement. The most traumatic life event that anyone will experience is the death of a loved one. When many people successfully manage their manic episodes while they are grieving, it may have severe repercussions for others, who may develop funeral mania.
Risk Factors to Mania
The following are risk factors for the development of mania:
- Family with the disorder. The patient has a higher risk of acquiring mania if a family member suffers from bipolar disorder. Though not certain, this is. Even though there is a family history of mania, some individuals may not acquire the disease.
- Excessive stress. Events from a negative or stressful life were linked to subsequent mood crises. Bipolar disorder episodes of mania or depression may be more frequently brought on earlier in their course by stressful life experiences.
- Substance abuse. Substance abuse might become a temptation to make poor or risky choices.
- Gender. Men experience their first manic episode more frequently than women, who appear to be more prone to experience a depressive episode.
Complications of Mania
A manic episode might have negative consequences. Untreated mania can result in more serious problems that might negatively affect the sufferer’s life, such as:
- misuse of alcohol and drugs
- connections suffer harm
- inadequate performance at work or school
- legal or financial difficulties
Bipolar disorder patients have an increased risk of getting the following conditions:
Diagnosis of Mania
A physician may do a range of tests to identify mania, rule out any other disorders, and look for any underlying reasons. Testing might include:
- History taking and physical examination. When obtaining a patient’s history, it is important to get information regarding the key mania-related symptoms, such as recent changes in sleep, activity, hunger, and irritability. To help physicians remember to inquire about distractibility, irresponsibility or irritability, grandiosity, flight of ideas, increased activity, decreased sleep, and excessive talkativeness, they often employ the mnemonic “DIG FAST.” The entire set of DSM-5 criteria must be used in the assessment. According to the DSM-5, a manic episode is identified if the patient has a sudden, euphoric or angry mood shift that lasts for at least one week, or for any length of time if the patient needs to be hospitalized.
- Complete blood count (CBC). To rule out anemia as a contributing factor to depression in individuals with bipolar disorder or manic-depressive disease, a complete blood count (CBC) with differential is employed (MDI).
- Comprehensive metabolic panel (CMP). Hospitalization, changes in a patient’s mental state while they are in the hospital, screening tests before beginning new psychotropic medications, monitoring for negative effects of psychotropic medications, and routine health checks for patients with chronic illnesses for whom the psychiatrist serves as their primary care provider are all indications for the metabolic panel in psychiatry. The CMP is favored over the BMP for these indications—as well as for general psychiatric practice—due to the inclusion of both proteins and liver function tests.
- Thyroid panel. Most patients who have hyperthyroidism or thyrotoxicosis experience symptoms like anxiety, melancholy, mood swings, and insomnia. Patients with late-onset mania may occasionally be found to have hyperthyroidism, which must be treated to make a full recovery.
- Drug screen. For patients who are elderly or extremely young (>60 or 13 years old), brain imaging in the form of a CT or MRI would be crucial in identifying any organic causes of manic symptoms.
Treatment for Mania
Treatment for mania may include:
- Mood stabilizers. Manic or hypomanic episodes are often controlled by mood-stabilizing medication for the patient.
- Anticonvulsants. Several anticonvulsants are known to treat or prevent mood episodes as mood stabilizers.
- Psychotherapy. Initial and continuous therapy can help stop symptoms from returning. Psychotherapy can assist children and teenagers with routine management, coping skill development, learning disabilities, social issues, and family communication and bonding. Additionally, if necessary, it can aid in the treatment of drug usage issues, which are frequent in adolescents and teenagers with mania.
- Cognitive Behavioral Therapy. The focus is on identifying unfavorable, unhealthy thoughts and behaviors and replacing them with positive, healthy ones. The patient also picks up helpful coping mechanisms for stressful circumstances.
- Electroconvulsive Therapy. Electroconvulsive therapy (ECT) is an uncommon alternative for patients with bipolar disorder who are experiencing life-threatening mania or whose condition does not improve with existing therapies. To impact certain chemicals and neurons in the brain, ECT uses regulated electrical currents to send a short seizure through the brain.
Nursing Diagnosis for Mania
Nursing Care Plan for Mania 1
Risk for self-directed violence
Nursing Diagnosis: Risk for self-directed violence related to anhedonia, helplessness, hopelessness, and social isolation secondary to mania as evidenced by previous attempts of violence, and suicidal plans.
Desired Outcomes:
- The patient will ask for assistance if they feel the need to harm themselves.
- The patient will display behavioral signs of untreated depression.
- The patient will name at least two or three persons they can turn to for support and emotional direction when they are feeling self-destructive before being released.
- The patient must show compliance with any drug or treatment plan within the next two weeks.
| Nursing Interventions for Mania | Rationale |
| Determine the necessary level of suicide prevention measures. If the risk is high, is hospitalization necessary? Will the patient be safe to return home with monitoring from a family member or friend if there is a low risk? Does the patient, for instance: Recognize prior suicide attempts.any substance abusehas no friends or peers.a suicide plan of any kind. | A high-risk patient will need ongoing supervision and a secure setting. The most prevalent psychiatric illnesses connected to suicide are by far mood disorders (e.g., depression and bipolar manic-depression). At least 25-50% of manic individuals have made at least one attempt at suicide. |
| Verify whether the necessary supply of drugs is readily available. | The typical duration of a suicidal patient’s medicine supply should be three to five days. |
| Encourage them to express their emotions (rage, grief, guilt) and think of alternative solutions to deal with their frustration and anger. | Patients can pick up new coping mechanisms for dealing with intense emotions and feel more in control of their lives. |
| Make arrangements for crisis therapy with the family. Establish self-help group links. | To reduce their sentiments of worthlessness, worthlessness, and loneliness, patients require a network of services. The best method to support a loved one with mania. is to encourage and support treatment in addition to providing emotional support. |
| Follow the unit protocols if the patient is hospitalized. | Suicidal patients may seek help from institutions as they offer interventions such as pharmacologic, therapy, and counseling. |
Nursing Care Plan for Mania 2
Risk for Self-Directed Violence
Nursing Diagnosis: Risk for self-directed violence related to severe personality disorder/ depression/ psychosis, substance abuse secondary mania as evidenced by suicidal behavior
Desired Outcomes:
- The patient will ask for assistance if they feel the need to harm themselves.
- The patient will display behavioral signs of untreated depression.
- The patient will be content with their social situation and life goals being met.
- The patient will name at least two or three persons they can turn to for support and emotional direction when they are feeling self-destructive before being released.
- The patient will not hurt themselves or others.
- The patient will list the groups and resources with which they are in contact within a month
- The patient will express a desire to live.
| Nursing Interventions for Mania | Rationale |
| Establish the appropriate level of suicide prevention efforts. Does the patient need to be hospitalized if the risk is high? If there is a low risk, will the patient be secure enough to return home with supervision from a relative or friend? Does the patient, for example: recognize previous efforts at suicide.any overuse of drugshas no classmates or friends.a plot for suicide of any type. | A high-risk patient will require continual oversight and a safe environment. |
| Verify whether the necessary supply of drugs is readily available. | A suicidal patient’s medication supply should typically last three to five days. |
| Encourage them to communicate their feelings (such as hate, grief, or guilt) and consider creative ways to deal with their frustration and rage. | Patients can learn new coping skills for handling strong emotions and gain a sense of control over their life. |
| Set up a session of crisis counseling with the family. Link up with self-help groups. | Patients need a network of services to lessen their feelings of unworthiness, worthlessness, and loneliness. |
| If the patient is a hospital patient, adhere to the unit protocols. | Suicidal patients may seek help from institutions (i.e., hospitals and clinics, or communities) as they offer interventions such as pharmacologic, therapy, and counseling. |
Nursing Care Plan for Mania 3
Nursing Diagnosis: Disturbed Thought Processes related to biological/medical factors, biochemical imbalances, persistent feelings of extreme guilt, fear or anxiety, and prolonged grief reaction secondary to mania as evidenced by Decreased problem-solving abilities, hypervigilance, impaired ability to grasp ideas or orders thoughts, impaired attention span/easily distracted, impaired insight.
Desired Outcomes:
- The patient will analyze the information and make the right choices.
- The patient will remember details from the past and a distance accurately.
- The patient will display well-organized thinking.
- The patient will identify two treatment-related objectives with the help of nursing assistance within one to two days.
- The patient will address with the nurse two illogical thoughts about themselves and others by the end of the first day.
- The patient will work with the nurse to reframe three unreasonable thoughts.
| Nursing Interventions for Mania | Rationale |
| Assess the patient’s previous level of cognitive function (from the patient, family, and past medical records). | A baseline set of data allows evaluation of the patient’s development. |
| Allow the patient ample time to reflect and formulate their responses. | Slow thinking makes it necessary to take some time to plan a response. |
| Give the patient more time than normal to complete routine daily tasks (ADLs) (e.g., eating, dressing). | Normal chores could take a long time; urging a patient to rush merely heightens the tension and impairs their capacity for clear thinking. |
| Encourage the patient to put off making crucial life decisions. | Optimal psychophysiological functioning is necessary for making wise significant life decisions. |
| Assist the patient in recognizing negative ideas and thinking. Teach the patient how to challenge or rephrase unfavorable thoughts. | Negative thoughts are part of a depressed person’s flawed mental processes and contribute to emotions of hopelessness. Participating in this process leads to a happier and more realistic outlook on life. |
Nursing Care Plan for Mania 4
Nursing Diagnosis: Chronic low self-esteem related to impaired cognitive self-appraisal, repeated past failure, unrealistic expectation of self secondary to mania as evidenced by a negative view of self and abilities, repeated expression of worthlessness, rejection of positive feedback, and self-negating verbalizations.
Desired Outcomes:
- The patient will maintain a daily workload and rate their level of self-hatred, remorse, and shame on a scale of 1 to 10.
- the patient will describe reduced levels of guilt, shame, and self-hatred (1 being the lowest, 10 being the highest) using a scale of 1 to 10,
- The patient will show that they can adjust their inflated expectations.
- The patient will list two areas they wish to improve as well as four favorable attributes in an honest and nonjudgmental manner.
| Nursing Interventions for Mania | Rationale |
| Determine the patient’s level of self-esteem. | Withdrawal from social interactions, a sense of inadequacy, disregard for personal appearance and grooming, and self-rejection are all symptoms of poor self-esteem and could all be signs of a negative thought pattern. |
| Allow the patient to partake in easy recreational activities before moving on to more difficult ones in a group setting. | the patient could initially feel overpowered When taking part in a group activity. |
| Teach the patient visualization skills that will enable them to replace their negative self-perceptions with more optimistic ones. | Assisting the patient in selecting more optimistic ideas and behaviors, to foster a better and more realistic self-image. |
| Encourage the patient to take part in a group therapy session where the other participants will experience similar circumstances or emotions. | Reducing loneliness and creating an environment where constructive criticism and a more honest assessment of oneself are possible. |
| Determine whether the patient requires assertiveness training tools to go for the things in life that he or she wants or needs. Set up instruction through literature, one-on-one therapy, community-based programs, etc. | People with low self-esteem frequently feel unworthy and struggle to identify their needs and wants. |
Nursing Care Plan for Mania 5
Nursing Diagnosis: Deficient Knowledge related to Unfamiliarity with the causes, signs, and symptoms, and management of depression secondary to mania as evidenced by verbalizing inaccurate information, inaccurate follow-through of instruction, inappropriate behaviors (e.g., agitated, apathetic, hysterical, hostile), questioning members of the healthcare team.
Desired Outcome:
- The patient and their significant other will accurately discuss at least two potential causes of depression, three to four symptoms of depression, and the usage of medication, psychotherapy, and electroconvulsive therapy as treatments.
| Nursing Interventions for Mania | Rationale |
| Examine the patient’s and their close companions’ understanding of depression and its causes. | Depression is a mood condition brought on by a combination of genetic predispositions, chronic stressful situations, and chemical imbalances in the brain. |
| Inform the patient and their close family about the main signs and symptoms of depression. | The following signs and symptoms of a major depressive episode are typically present: persistent sadness, loss of enjoyment in daily activities, decreased energy, feelings of guilt, hopelessness, or worthlessness, disturbed sleep, changes in appetite, difficulty thinking or making decisions, and frequent thoughts of suicide or suicidal attempts. |
| Let the patient and their loved ones know that there are drugs and psychotherapy available to address depression. | Antidepressants are frequently used as a kind of treatment for depression. While mild depression patients who have a situational reason are treated with psychotherapy (cognitive-behavioral therapy, interpersonal therapy) alone. Depression in severe, chronic cases can be treated with both medication and psychotherapy. |
| Discuss and educate the patient about the aims of electroconvulsive therapy (ECT). | Patients who have not responded to prior therapies are offered electroconvulsive therapy (ECT) (medications and psychotherapy). Throughout 3 to 6 weeks, there are roughly 6 to 12 sessions. Two electrodes will be positioned on the patient’s scalp by the physician, and an electric current will be transferred between them until a seizure manifests itself. Typically, it lasts for 30 to 60 seconds. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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