Mania and depression do not necessarily follow one after the other. Some individuals; experience a long symptom-free period before having another mood disturbance. Another classification of bipolar disorder is called rapid cycling. This refers to someone experiencing four or more episodes of mania or depression within one year.
Treatment for Mania
The treatment for mania is directly related to the underlying cause of the symptoms. If a person is experiencing mania due to bipolar disorder he/she requires psychiatric care and possible mental health inpatient treatment. Bipolar disorder is treated with mood stabilizing medications which include: lithium carbonate, Depakote, Tegretol, and Lamictal. Neuroleptic medications are also effective in treating both manic and mixed symptoms: Zyprexa, Risperdal, Seroquel, Geodon, and Abilify. Antidepressant medications may be prescribed for the depressive symptoms of bipolar disorder: Prozac, Zoloft, Paxil, Celexa, Lexapro, Effexor, Cymbalta, and Wellbutrin.
Psychotherapy is also essential. Unfortunately, medication compliance can be a major problem. Individuals experience mania lose their awareness of having an episode and stop taking medications. Additionally, some people enjoy the effects (happiness, energy, creativity) of unmedicated hypomania.
If the mania is caused by acute stimulant intoxication emergency medical attention is frequently needed. Treatment includes medical stabilization, drug rehabilitation, and psychiatric follow up. In some instances their treatment is initiated while they are incarcerated. If an individual is in exhaustive mania (excited delirium) activation of the EMS is mandated.
Tips for Law Enforcement Officers Dealing with Manic Subjects in Crisis
As in any psychiatric crisis make sure that you introduce yourself, remain calm, and be patient and reassuring. Maintain a safe and comfortable distance from the subject. Only one officer should communicate with the individual; giving clear and specific directions. Understand that a rational conversation will probably not occur. If others in the area are causing agitation have them removed.
Determine if the subject appears to be in mania and/or in medical distress. Evaluate the level of agitation and aggression; call for backup as appropriate. If you even suspect excited delirium call for a paramedic response. Make sure you assess the entire situation, reassess and reassess again. If possible, attempt to determine the probable cause for the episode/stressor; try to obtain information from others on scene who may know the subject. Arrange for the safe transportation of the subject to the nearest emergency department. If you believe the individual is an immediate threat to himself/herself, to others, or is gravely disabled, complete the required application for a 72 hour involuntary psychiatric evaluation to give to the emergency room staff.
I do give Charlie Sheen credit for giving the world an understandable image of mania. He continues to deny having bipolar disorder or being under the influence of stimulants, proclaiming he is “a total fricking rock star from Mars”. Mental health professionals, the public and the media are still speculating about the cause for his recent crash. Millions of fans follow him on Twitter. Maybe a few of these people will look in the mirror and seek appropriate treatment.
Charlie has had frequent interactions with law enforcement related to aggressive, threatening and assaultive behavior. Individuals in mania often do. Forget trying to diagnose an individual in acute mania on the scene. Assess the situation completely. Assure the safety of yourself, others and the subject. Then make a decision to do what you need to do to protect and serve.
Links & About The Author:
Pamela Kulbarsh, RN, BSW has been a psychiatric nurse for over 25 years. She has worked with law enforcement in crisis intervention for the past ten years. She has worked in patrol with officers and deputies as a member of San Diego's Psychiatric Emergency Response Team (PERT) and at the Pima County Detention Center in Tucson. Pam has been a frequent guest speaker related to psychiatric emergencies and has published articles in both law enforcement and nursing magazines.