Charlie Sheen’s recent antics have certainly caused a media blitz. Is he bipolar; is he on crack, is he brain damaged from years of excessive partying, etc.? One thing is for sure, he has certainly educated the public as to the signs of a true manic episode. Law enforcement can review his videos for free online as an excellent training exercise into the symptoms and consequences of mania.
Mania can be a symptom of several disorders: bipolar disorder, drug intoxication (stimulants such as cocaine or methamphetamine), medication side effects (steroids), multiple sclerosis, stroke or malignancy. It is also a symptom of excited delirium, also referred to as acute exhaustive mania. The problem with mania is that most individuals in an episode fail to recognize that there is something wrong. They feel invincible, as Charlie put it, “I'm bi-winning. I win here, I win there.” They are oblivious to the damage they are creating for themselves or possibly for others. Eventually, they will crash.
Bipolar disorder (also called manic depression) is a mental illness that is characterized by severe mood swings; repeated episodes of depression; and at least one episode of mania. The National Alliance on Mental Illness (NAMI) estimates that 10 million Americans suffer from bipolar disorder. The United States has the highest lifetime rate of bipolar disorder at 4.4%. Bipolar disorder is the fifth leading cause of disability worldwide. The number of individuals with bipolar disorder who commit suicide is 60 times higher than that of the general population.
Additionally, the National Institute on Drug Abuse reported in 2009 that one million Americans age 12 and older had abused crack and 1.2 million had abused methamphetamine in the past year. Do the math. The chances that law enforcement will encounter an individual experiencing a manic episode are quite high. People in mania can and do become threatening, assaultive and violent.
Fifteen Symptoms of Mania
- Dramatic increase in energy; decreased need for sleep and food
- Racing thoughts; pressured/tangential speech; rapid-fire conversation
- Feelings of euphoria; invincibility
- Distractibility; irritability
- Impulsivity; poor judgment (questionable business transactions, wasteful expenditures of money)
- Intrusive, provocative, aggressive or even violent behavior
- Hypersexuality; reckless sexual behaviors
- Increased alcohol or drug abuse
- Elevated self-esteem
- Grandiose plans, ideas, beliefs (feeling like one has super powers or talents)
- Increased risk of altercations with law enforcement
- Increased social, familial problems; problems at work
- Denial of problems; refusal to seek medical treatment or comply with a medical regime
Bipolar Disorder Explained
Bipolar disorder, also referred to as manic depression, is a serious medical illness. It is classified as a mood disorder characterized by episodes of depression alternating with euphoric (manic) states. Untreated manic episodes can last for weeks or even months. Symptoms of depression include feelings of hopelessness; thoughts of suicide; changes in sleep/eating patterns; and loss of interest in activities that once were a source of pleasure. Bipolar symptoms can develop in childhood. The disorder affects men and woman equally. Bipolar disorder is frequently misdiagnosed as depression, schizophrenia, or ADHD, delaying appropriate treatment. Bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.
In order to qualify for the diagnosis of bipolar disorder, a person must experience at least one manic episode and symptoms of mania must last for at least a week. Classic bipolar disorder (Bipolar Disorder I) is marked by episodes of acute mania and psychosis. Delusions occur in 75% of all Bipolar I manic episodes. Bipolar Disorder II is characterized by episodes of milder depression and milder mania (called hypomania). A hypomanic episode does not include psychotic symptoms or signs that might indicate a person is dangerous to him/her or others.
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.