Mania - Revision history

Codjwill at 04:22, 13 March 2026

2026-03-13T04:22:36Z

← Older revision		Revision as of 04:22, 13 March 2026
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	==Background<ref>American Psychiatric Association. Diagnostic and statistical manual of mental disorders. American Psychiatric Association Publishing; 2022 Mar 18.</ref>==		==Background<ref name="DSM">American Psychiatric Association. Diagnostic and statistical manual of mental disorders. American Psychiatric Association Publishing; 2022 Mar 18.</ref>==
	*See [[Bipolar disorder]]		*See [[Bipolar disorder]]
	*Manic episode defines Bipolar I disorder		*Manic episode defines Bipolar I disorder
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	*90% of those with a manic episode will have an additional mood episode within 5 years		*90% of those with a manic episode will have an additional mood episode within 5 years

	==Clinical Features==		==Clinical Features<ref name="DSM" />==
	===Manic Episode===		===Manic Episode===
	*Distinct period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently goal directed activity or energy lasting at least 7 days and including 3 of the following (4 if mood is only irritable):		*Distinct period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently goal directed activity or energy lasting at least 7 days and including 3 of the following (4 if mood is only irritable):
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	*Psychotherapy		*Psychotherapy
	**Supportive, family, group		**Supportive, family, group
	*Pharmacotherapy		*Pharmacotherapy<ref>Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8e. New York, NY, USA: McGraw Hill Education; 2016.</ref>
	**[[Lithium]]		**[[Lithium]]
	***Long term use reduces suicide risk		***Long term use reduces suicide risk

Codjwill: /* Evaluation */

2026-03-13T04:11:51Z

Evaluation

← Older revision		Revision as of 04:11, 13 March 2026
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	==Evaluation==		==Evaluation==
	[[General psychiatric approach]]		[[General psychiatric approach]]
	*Interview and physical for diagnostic criteria as above ~~and risk factors~~		*Interview and physical for diagnostic criteria as above
	*Collateral if available		*Collateral if available
	*Assess for alternate medical causes based on situation		*Assess for alternate medical causes based on situation

Codjwill at 04:10, 13 March 2026

2026-03-13T04:10:40Z

← Older revision		Revision as of 04:10, 13 March 2026
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	===Workup===		===Workup===
	====ACEP Clinical Policies: Psychiatric Patient====		====ACEP Clinical Policies: Psychiatric Patient<ref>Brown MD, Byyny R, Diercks DB, Gemme SR, Gerardo CJ, Godwin SA, Hahn SA, Hatten BW, Haukoos JS, Ingalsbe GS, Kaji A. Clinical policy: critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department. Annals of emergency medicine. 2017 Apr 1;69(4):480-98.</ref>====
	*Do not routinely order laboratory testing on patients with acute psychiatric symptoms. Use medical history, previous psychiatric diagnoses, and physician examination to guide testing. (Level C Recommendation)		*Do not routinely order laboratory testing on patients with acute psychiatric symptoms. Use medical history, previous psychiatric diagnoses, and physician examination to guide testing. (Level C Recommendation)
	*Tailor medical workup based on individual clinical scenario		*Tailor medical workup based on individual clinical scenario

Codjwill: Created page with "==BackgroundAmerican Psychiatric Association. Diagnostic and statistical manual of mental disorders. American Psychiatric Association Publishing; 2022 Mar 18.== See Bipolar disorder Manic episode defines Bipolar I disorder Do not need major depressive episode for Bipolar I diagnosis Hypomania is a feature of Bipolar II and cyclothymic disorders Psychiatric emergency - impaired judgement can make them dangerous to themselves and/or others 90% of th..."

2026-03-13T04:06:27Z

Created page with "==Background<ref>American Psychiatric Association. Diagnostic and statistical manual of mental disorders. American Psychiatric Association Publishing; 2022 Mar 18.</ref>== *See Bipolar disorder *Manic episode defines Bipolar I disorder **Do not need major depressive episode for Bipolar I diagnosis **Hypomania is a feature of Bipolar II and cyclothymic disorders *Psychiatric emergency - impaired judgement can make them dangerous to themselves and/or others *90% of th..."

New page

==Background<ref>American Psychiatric Association. Diagnostic and statistical manual of mental disorders. American Psychiatric Association Publishing; 2022 Mar 18.</ref>==
*See [[Bipolar disorder]]
*Manic episode defines Bipolar I disorder
**Do not need major depressive episode for Bipolar I diagnosis
**Hypomania is a feature of Bipolar II and cyclothymic disorders
*Psychiatric emergency - impaired judgement can make them dangerous to themselves and/or others
*90% of those with a manic episode will have an additional mood episode within 5 years

==Clinical Features==
===Manic Episode===
*Distinct period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently goal directed activity or energy lasting at least 7 days and including 3 of the following (4 if mood is only irritable):
**Distractibility
**Inflated self-esteem or grandiosity
**Increased goal directed activity (can be social, work, or sexual in nature) or psychomotor agitation
**Decreased need for sleep
**Flight of ideas or racing thoughts
**More talkative than usual or pressured speech (rapid and uninterruptible)
**Excessive involvement in pleasurable activities that have high risk of negative consequences
*Symptoms must not be attributable to a substance or medical conditions
*Symptoms must cause clinically significant distress or social/occupational impairment
===Hypomanic Episode===
**Features as above except:
***Lasts at least 4 days
***No marked impairment in social/occupational function
***Does not need hospitalization
***No psychotic features

==Differential Diagnosis==
===Psychiatric===
*Mania (Bipolar I)
**With or without psychosis
*[[Schizophrenia]] spectrum of disorders
**[[Schizoaffective disorder]], bipolar type
*ADHD
*[[Borderline personality disorder]]
===Medical===
*[[Delirium]]
*[[Hyperthyroidism]]
*[[Wilson disease]]
*Infectious
**[[HIV]]
**[[Encephalitis]]
**[[Neurosyphilis]]
*Medication/Substance induced
**Cocaine/Amphetamines/Other [[Sympathomimetics]]
**[[Corticosteroids]]
**[[Dopamine]]/Levodopa
**Antidepressants
*Alcohol/benzodiazepine withdrawal
*Neurologic disorders
**Temporal lobe [[epilepsy]]
**Frontotemporal [[dementia]]
**Neoplasms

==Evaluation==
[[General psychiatric approach]]
*Interview and physical for diagnostic criteria as above and risk factors
*Collateral if available
*Assess for alternate medical causes based on situation
*Psychiatric consultation

===Workup===
====ACEP Clinical Policies: Psychiatric Patient====
*Do not routinely order laboratory testing on patients with acute psychiatric symptoms. Use medical history, previous psychiatric diagnoses, and physician examination to guide testing. (Level C Recommendation)
*Tailor medical workup based on individual clinical scenario
**Pregnancy test in reproductive age female
**TSH often reasonable if new mania
**Consider toxicologic workup if unclear med/substance history
**Consider Head CT if altered and no psychiatric history
**Consider LP if high concern for infectious CNS cause
**Consider lab evaluation for causes of delirium

===Diagnosis===
*Clinical - see clinical features
*Exclude organic causes as best as possible

==ED Management==
*'''Psychiatric evaluation''' - typically with admission
*Medications for agitation as needed - consider atypical antipsychotics

==General Management==
*Psychotherapy
**Supportive, family, group
*Pharmacotherapy
**[[Lithium]]
***Long term use reduces suicide risk
***[[Lithium toxicity]] can be fatal
**Mood stabilizers
***[[Carbamazepine]]
***[[Valproic acid]]
**Atypical [[antipsychotics]]
***Often as adjunct to mood stabilizer, less common monotherapy
*ECT

==Disposition==
*Mania usually necessitates admission
*Medical admit if underlying cause identified
*Hypomania may be able to be discharged with outpatient support

==See Also==
*[[Bipolar disorder]]
*[[Acute psychosis]]
*[[Delirium]]
*[[General psychiatric approach]]

==External Links==
https://www.acep.org/patient-care/clinical-policies/Psychiatric-Patient

==References==
<references/>