Bipolar — Mania Phase
The manic client feels invincible, hasn't slept in four days, and just gave away their savings — but they'll insist nothing is wrong. Recognizing mania means looking past the euphoria.
Core Concept
A manic episode requires at least 7 consecutive days (or any duration if hospitalization is needed) of abnormally elevated, expansive, or irritable mood plus increased goal-directed energy, with at least 3 of these features (4 if mood is only irritable): decreased need for sleep (feels rested after 2–3 hours), pressured speech, flight of ideas, distractibility, grandiosity, psychomotor agitation or increased goal-directed activity, and excessive involvement in risky behaviors (spending sprees, sexual indiscretion). Mania differs from hypomania by severity: mania causes marked functional impairment or may include psychotic features such as grandiose delusions. The client typically lacks insight — they feel better than ever (or, if irritable, may feel others are the problem) and resist treatment. Priority nursing concerns during acute mania are safety (impulsive behavior, aggression, exhaustion), nutrition and hydration (too distracted to eat or drink adequately), and sleep deprivation. The environment should be low-stimulation: dim lights, reduced noise, limited group interactions. Offer high-calorie finger foods and fluids the client can consume while moving. Set firm, consistent limits on unsafe behavior without being punitive.
Watch Out For
Don't confuse mania (≥7 days, severe impairment, possible psychosis) with hypomania (≥4 days, noticeable change but no psychosis and no hospitalization). Students often mistake the euphoric, talkative client as 'doing well' — elevated mood in mania is pathological, not recovery. Flight of ideas (loosely connected topics) differs from loose associations (no logical connection), which suggests a psychotic disorder.
Clinical Pearl
DIG FAST — Distractibility, Indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep deficit, Talkativeness. If the client checks most of these boxes, think mania.
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