What we’ve said about Mania

“There's so many times where I'll ask important screener questions, they all screen no, and then when I do a narrative, I hear things that are clear-cut mania”

“I like to start with just asking about the most extreme version. I want to say, in your whole life, can you ever remember having a time where where you were totally awake, zero sleep at all for 48 hours, two days in a row at least”

“Ask about energy and activity level, but don't ask yes or no. Say, what was your energy and activity like during that time? What were you doing”

“When you talk about energy, I find that a lot of people often interpret having energy as feeling good. You have to really drill down on that one. People who have agitated depression, who are very anxious or irritable, they may say, oh, I didn't have energy”

“being more sexual even alone people will not count their hypersexuality when alone they think that's only social Spending a lot of money. Make sure you get an idea of their baseline spending”

“Think of a manic patient, a manic patient telling you two hours worth of history in one hour because of how quickly they're talking. If you don't interrupt them is not going to help you get closer to either a diagnosis or a treatment plan”

“many people in manic hypomanic episodes or mixed states will lack memory once they are out of that episode of what was going on at that time. Very common”

“He wasn't your typical picture of mania where you have this pressured speech, you have this flight of ideas, almost the opposite. He was essentially not talking that much and incredibly quick to violence”

“it's about four to six percent of people with bipolar disorder never have depression. interesting there's a pure mania subtype uh pure mania hypomania that is possible and i have encountered that”

“A mania is basically a state of denial. of all the sad things that depressive people are acutely aware of. It's not accidental that they're absolutely opposite. That doesn't mean they're not the same phenomenon”

“PTSD is like the great imitator for psychiatry. And you do see patients all the time that it's so confusing because what you're seeing in front of you feels like a mania or hypomania”

“Psychosis itself can look or sound like mania when it's mostly agitation and insomnia without the manic features. This can get confusing with the schizoaffective spectrum”

“You can't forget the prescription medications that are being taken by patients that don't consider drugs, even if they are prescribed or are not prescribed to them. Obviously, the biggest ones are stimulants, but we also have to consider the possibility of antidepressant induced mania”

“Don't forget also random herbs and supplements. A lot of these are unregulated and have some stimulant properties. And then finally, steroids, prednisone, or any other more esoteric or unique medications, prescription medications that can cause mania”

“ridiculously rare to see true mania or hypomania happening as the result of cannabis use. Psychosis, yes, and agitation from psychosis, yes, but just plain mania and hypomania, quite unlikely”

“Be very careful when you lower lithium though. Among the mood stabilizers, abrupt lowering of lithium or stopping the lithium may be more likely to even induce mania rather than simply unmask it”

“A full-on light box at 18 inches is Can induce a manic episode. It's just, it's an antidepressant. So light is a powerful tool”

“I usually do a combination treatment. I think of three main things. So the mood stabilizer, I want to solve that and I want to start it. Whatever one we can get on. But I also know that that one's going to take some time to work”

“It's lithium. Okay. And... It's latuda, and then it's gabapentin. And why? Because I find latuda to be effective quickly and at low doses. Lithium is most effective long-term”

“The truth is, it's a really great medication, especially in bipolar. It just was never tested in acute mania”

“I think of it as it's going to be off-label, but it still has a good evidence base as an effective medication for bipolar mania. And we would use it all the time inpatient, especially the LAI, and I saw it work really well”

“I do think they are basically a mood stabilizer. They function to reduce the excitability of the brain. It's just that they're a full shutdown medication, and it's not good for those reasons. But when you see catatonia, you should probably be using it”

“Even though Keppra is well known for causing irritability in some patients and worsening anger outbursts, apparently it may have some anti-manic effect. At least there's some evidence for it in some patients”

“there are two randomized trials of darkness for the treatment of inpatient mania that did show efficacy and then this most recent one that did not, efficacy relative to placebo”

“people who were exposed to more than three candles worth of light at one meter, like three yards, three feet, more than that, like you could just barely read by it. More than that light overnight is associated with more frequent manic episodes”

“There was a randomized trial on an inpatient unit in Norway where half the people, people who are admitted with a manic episode, who signed a consent for this, half of them were randomized to get the amber lenses and half of them got a gray control lens that really didn't do anything from a circadian point of view”