Observations on Mania

Manic states are regarded as an expression of the disease entity manic-depressive psychosis. The characteristic manifestations are psychomotor overactivity, elation of mood, distractibility and delusions with an omnipotent and omniscient content. The psychomotor overactivity is to be observed in the rapid speech, the pressure of talk, the continuous movement and the distractibility. As far as the mood state is concerned, the patient is not continually elated for there are occasions when there is depression with a lowering of self-esteem and self-criticism. When frustrated in his intentions the patient may become aggressive in word and action.

The symptoms which appear in mania are not peculiar to manic-depression alone. All or several of the clinical manifestations are to be encountered in other mental illnesses—in schizophrenia and in organic mental states. Schizophrenic illnesses are sometimes initiated by a manic attack and they may occur in the course of the illness. There are also psychotic states which present a combination of manic and schizophrenic symptoms. They have been designated schizo-affective states.

While manic attacks may occur on one or more occasions throughout a patient's life without any preceding mental illness, it is quite common for them to follow an attack of depression. In turn, a depressive attack may appear on the subsidence of the mania. Patients are found who seem to be constantly in a manic condition and they are regarded as suffering from chronic mania. While these patients are not as overactive as the recent case, they nevertheless show all the typical features. Such patients have sometimes suffered an earlier illness in which there were persecutory delusions and other schizophrenic-like symptoms.

All manic states reveal an exaggerated sense of self-esteem, heightened self-confidence and well-being. The patient feels possessed of limitless physical and mental powers and at times he appears physically inexhaustible. He may