Mania

Overview

In mania the life-time risk of unbalanced episode is about 0.81%. Additionally, This disorder tends to occur in episodes lasting usually 3-4 months, followed by complete clinical recovery.

The future episodes can be unbalanced, depressive or mixed.

A unbalanced episode is typically characterized by the following features (which should last for at least one week and cause disruption in occupational and social activities).

Epidemiology

Causes of Mania

The exact cause of mania is unknown, but a combination of genetic, biological, and environmental factors likely contributes to its development.

• Genetics: Family history of bipolar disorder significantly increases the risk of developing mania.
• Neurobiology: Imbalances in neurotransmitters like dopamine, norepinephrine, and serotonin are implicated in mania.
• Brain structure and function: Abnormalities in certain brain regions and circuits may contribute to manic episodes.
• Environmental factors: Stressful life events, sleep disturbances, and substance use can trigger mania in susceptible individuals. [3]

Types

● Hypomania:

This term refers to a state in which wild symptoms are present and noticeable, but they do not cause a serious degree of functional impairment.

● Mild mania:

Physical activity and speech are increased, mood is labile, mainly euphoric but at times irritable, ideas are expansive, and the patient often spends more than he can afford. By definition, there is significant social impairment in this and the other patterns of mania.

● Moderate mania:

In brief, there is marked over-activity with pressure also disorganization of speech, the euphoric mood is increasingly interrupted by periods of irritability, hostility, and depression, and grandiose also other preoccupations may become delusional.

● Severe mania:

There is frenzied overactivity, thinking is incoherent and delusions become increasingly bizarre, and hallucinations are experienced. Very rarely, however, the patient becomes immobile and mute instead of overactive and talkative (in other words, wild stupor).

Risk Factors of Mania

• Genetic Predisposition: Having a family history of bipolar disorder or other mood disorders significantly increases the risk of developing mania.

• Biological Factors: Imbalances in neurotransmitters (e.g., dopamine, norepinephrine, serotonin), hormonal fluctuations, and disruptions in the circadian rhythm are associated with mania.

• Environmental Triggers: Stressful life events, major changes, sleep deprivation, substance abuse, and certain medications can trigger manic episodes in susceptible individuals.

• Psychological Factors: Certain personality traits, such as impulsivity, high achievement orientation, and sensitivity to reward, may increase vulnerability to mania.

• Medical Conditions: Certain medical conditions, like hyperthyroidism and neurological disorders, can contribute to mania. [4]

Pathogenesis of Mania

• Neurotransmitter Dysregulation: Imbalances in neurotransmitters, particularly dopamine, norepinephrine, and serotonin, play a crucial role in the development of mania. Elevated levels of dopamine and norepinephrine are associated with increased energy, impulsivity, and grandiosity, while dysregulation of serotonin can affect mood stability.

• Brain Circuitry Abnormalities: Mania is associated with dysfunction in specific brain circuits, including the prefrontal cortex (involved in decision-making and impulse control), the limbic system (involved in emotions and reward processing), and the basal ganglia (involved in motor control and habit formation).

• Neuroinflammation: Recent research suggests that neuroinflammation may contribute to the development and progression of mania. Elevated levels of inflammatory markers have been found in individuals experiencing manic episodes.

• Circadian Rhythm Disruptions: Disruptions in the circadian rhythm, the body’s internal clock that regulates sleep-wake cycles and other biological processes, are often observed in individuals with mania. Irregular sleep patterns and altered light exposure can trigger or exacerbate manic symptoms.

• Genetic and Environmental Factors: Genetic predisposition and environmental factors, such as stressful life events, substance abuse, and certain medications, can interact to trigger or worsen mania in susceptible individuals. [5]

Pathophysiology

1. Neurotransmitter Imbalance: Mania is associated with dysregulation of several neurotransmitters, primarily dopamine, norepinephrine, and serotonin. Increased dopamine activity is linked to heightened energy, impulsivity, and reward-seeking behavior. Elevated norepinephrine levels contribute to increased arousal and goal-directed activity. Serotonin dysregulation can affect mood stability and impulse control.

2. Brain Structure and Function: Neuroimaging studies have revealed structural and functional abnormalities in specific brain regions of individuals with mania. These include alterations in the prefrontal cortex (responsible for decision-making and impulse control), the amygdala (involved in emotional processing), and the hippocampus (crucial for memory and learning).

3. Circadian Rhythm Disruptions: Disruptions in the circadian rhythm, the body’s internal clock regulating sleep-wake cycles, are commonly observed in mania. These disruptions can lead to irregular sleep patterns, altered hormone levels, and changes in gene expression, contributing to manic symptoms.

4. Genetic Predisposition: Mania has a strong genetic component, with heritability estimates ranging from 60% to 85%. Studies have identified several candidate genes associated with increased susceptibility to bipolar disorder, but the exact genetic mechanisms are still under investigation.

5. Environmental Factors: While genetic factors play a significant role, environmental triggers can also contribute to the onset and course of mania. Stressful life events, substance abuse, sleep deprivation, and certain medications can precipitate or exacerbate manic episodes in vulnerable individuals. [3]

Clinical Features

As per DSM-5:

1. Elevated Mood: Individuals experiencing mania may exhibit an overly joyful, optimistic, or euphoric mood. They may feel excessively happy, enthusiastic, or confident.

2. Expansive Mood: This refers to an exaggerated sense of self-importance, grandiosity, or inflated self-esteem. Individuals may believe they have special abilities, talents, or powers.

3. Irritable Mood: Some individuals may experience mania primarily as irritability, anger, or agitation. They may be easily frustrated, quick to anger, or have a low tolerance for frustration.

4. Increased Activity or Energy: Mania is often accompanied by increased goal-directed activity or energy. Individuals may engage in excessive activities, talk rapidly and excessively, have racing thoughts, and exhibit decreased need for sleep.

5. Other Associated Symptoms: Additional symptoms commonly associated with mania include:

   • Decreased need for sleep
   • Increased talkativeness
   • Racing thoughts or flight of ideas
   • Distractibility
   • Increased goal-directed activity
   • Excessive involvement in pleasurable activities that have a high potential for painful consequences [6]

Sign & Symptoms

Clinical Examination 

Components of the Clinical Examination:

1. Psychiatric Interview:

   • A thorough interview is conducted to assess the patient’s current mood, energy level, thought processes, sleep patterns, and any recent changes in behavior.
   • The clinician will inquire about the presence of manic symptoms, such as elevated or irritable mood, increased activity, decreased need for sleep, racing thoughts, grandiosity, impulsivity, and risky behaviors.
   • The patient’s medical history, family history of mental illness, and any current medications or substance use are also explored.

2. Mental Status Examination (MSE):

   • The MSE is a structured assessment of the patient’s current mental state, including their appearance, behavior, mood, affect, speech, thought process, thought content, perception, cognition, and insight.
   • In mania, the MSE may reveal an elevated or irritable mood, pressured speech, flight of ideas, grandiose delusions, and impaired judgment.

3. Physical Examination:

   • A physical examination is performed to rule out any medical conditions that could mimic or contribute to manic symptoms, such as hyperthyroidism, neurological disorders, or substance intoxication.

4. Laboratory Tests:

   • Blood tests may be ordered to assess thyroid function, electrolyte levels, and to screen for drug use.
   • Neuroimaging studies (e.g., MRI, PET) may be considered if there are concerns about underlying brain abnormalities.

5. Collateral Information:

   • Gathering information from family members, friends, or other healthcare providers can provide valuable insights into the patient’s behavior and functioning. [4]

Diagnosis:

DSM-IV diagnostic criteria for mania i.e.:

A.  A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).

B.  During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree i.e.:

• Inflated self-esteem or grandiosity
• Decreased need for sleep (e.g. feels rested after only 3 hours of sleep)
• More talkative than usual or pressure to keep talking
• Flight of either ideas or subjective experience that thoughts are racing
• Distractibility (i.e. attention too easily drawn to unimportant or irrelevant external stimuli)
• Increase in goal-directed activity (either socially, at work or school, or sexually) or out of control motor  agitation.

C. The symptoms do not meet criteria for a Mixed Episode.

D. A mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

E. The symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication, or other treatment) or a general medical condition (e.g. hyperthyroidism).

Differential diagnosis of unbalanced disorders

• Schizophrenia
• Dementia
• Endocrine disorders such as Hypothyroid
• Abuse of stimulant drugs

Complications of Mania

• Financial Problems:

  • Impulsive spending, reckless investments, and poor financial decisions during manic episodes can lead to significant debt and financial ruin.

• Legal Problems:

  • Increased risk-taking behavior, impaired judgment, and impulsivity can result in legal issues, such as arrests for disorderly conduct, substance abuse, or traffic violations.

• Relationship Problems:

  • The unpredictable mood swings, irritability, and grandiose behavior associated with mania can strain relationships with family, friends, and romantic partners.

• Occupational Problems:

  • Difficulties concentrating, impulsive decision-making, and erratic behavior can lead to poor job performance, job loss, and difficulties maintaining employment.

• Substance Abuse:

  • Individuals with mania may turn to alcohol or drugs to self-medicate or enhance the euphoric feelings associated with mania, leading to substance abuse and dependence.

• Suicidal Behavior:

  • While mania is characterized by elevated mood, there is also an increased risk of suicidal thoughts and behaviors, especially during mixed episodes or when transitioning between mood states.

• Physical Health Problems:

  • Neglecting self-care, engaging in risky sexual behaviors, and poor sleep hygiene during manic episodes can lead to physical health problems, such as sexually transmitted infections, injuries, and cardiovascular issues.

• Hospitalization:

  • In severe cases, mania may require hospitalization to stabilize the individual, manage risky behaviors, and prevent harm to themselves or others. [4]

Investigations for Mania

1. Physical Examination and History:

   • A thorough physical examination and detailed medical history are crucial to identify any underlying medical conditions that may be causing or exacerbating manic symptoms.

2. Blood Tests:

   • Complete Blood Count (CBC): To check for infections or anemia.
   • Thyroid Function Tests: To rule out hyperthyroidism, which can mimic mania.
   • Electrolyte Levels: To assess for imbalances that can affect mood and behavior.
   • Liver Function Tests: To evaluate liver health, as some medications used to treat mania can affect liver function.
   • Kidney Function Tests: To assess kidney function, as some medications used to treat mania can affect kidney function.
   • Toxicology Screen: To rule out substance abuse, which can trigger or mimic mania.

3. Neuroimaging:

   • Magnetic Resonance Imaging (MRI): To rule out structural brain abnormalities that may contribute to mood disorders.
   • Computed Tomography (CT) Scan: Less commonly used than MRI, but may be helpful in certain cases.

4. Electroencephalogram (EEG):

   • Rarely used in the routine evaluation of mania, but may be helpful in cases where seizures or other neurological conditions are suspected. [4]

Treatment

General aspects of the treatment of mania:

Milder wild episodes may treat as an outpatient, but more severe disorders with associated loss of judgement will almost always need initial treatment as an inpatient. When the disorder is more severe, compulsory admission is likely to need.

Almost all patients with a wild episode will need drug treatment (Anti-psychotic drugs). The clinical status should monitor frequently.

Progress is judge not only by the mental state and general behavior, but also by the pattern of sleep and by the regaining of any weight lost during the illness. As progress continues, anti-psychotic drug treatment is reduce gradually.

It is important, however, not to discontinue the drug too soon, otherwise relapse may occur. During treatment a careful watch should be kept for the appearance of depressive symptoms because transient but profound depressive mood change and depressive ideas are common among unbalanced patients.

In either case, suicidal ideas may appear. A sustained change to a depressive syndrome may require treatment, including with antidepressant drugs which should use cautiously to avoid precipitation of a unbalanced relapse.

Specific treatments for mania:

Anti-psychotic drugs i.e.:

Anti-psychotic drugs have an established place in the treatment of mania. An atypical anti-psychotic, such as olanzapine, quetiapine, or risperidone, is therefore usually the first-choice treatment.

Antipsychotics should generally not be used to control behavior because the doses required for this effect are high and adverse effects are therefore more likely.

A benzodiazepine such as lorazepam or diazepam should be used instead.

Lithium i.e.:

Lithium is effective in mania, but less so than anti-psychotic drugs, and it can be difficult to use safely in severely disturbed patients.

It is therefore used mainly in patients with milder unbalanced episodes, especially when it is intended to continue the treatment in the long term to prevent relapse.

It is also used in combination with anti-psychotics—caution is required when used in combination with haloperidol because extra-pyramidal effects occur commonly.

Anti-epileptic drugs i.e.:

Valproate is effective in acute mania. It is slightly less effective than anti-psychotics, but causes fewer adverse effects.

Thus, it may be particularly useful in patients who are not currently taking a long-term mood stabilizer, and who have a mild wild illness without psychotic features.

An advantage of valproate over lithium in the acute phase is that a high loading dose can be given, which leads to a more rapid response and shorter hospital stays.

Carbamazepine is another anti-epileptic drug that can be used in mania.

Electroconvulsive therapy i.e.:

Clinical experience indicates that ECT has a powerful therapeutic effect in mania.

Nevertheless, ECT is not a first-line treatment; its use is mainly in the uncommon cases when anti-psychotic drugs are ineffective and the patient is so seriously disturbed that to spend time trying further medication or awaiting natural recovery is not justified.

Prevention

The prevention of mania can be divided into two categories: preventing the onset of mania in individuals at risk and preventing relapse in those who have already experienced a manic episode.

Prevention Strategies :

1. Early Identification and Intervention:

   • Recognizing early warning signs of mania, such as changes in sleep patterns, increased energy, and irritability, can allow for timely intervention and potentially prevent a full-blown manic episode.
   • Individuals with a family history of bipolar disorder or those who have experienced a previous manic episode should be particularly vigilant about monitoring their mood and seeking help if they notice any concerning changes.

2. Mood Stabilizing Medications:

   • Mood stabilizers, such as lithium, valproate, and carbamazepine, have been shown to be effective in preventing both the onset and recurrence of manic episodes.
   • These medications are often prescribed as long-term maintenance therapy for individuals with bipolar disorder.

3. Psychotherapy:

   • Cognitive-behavioral therapy (CBT) and other forms of psychotherapy can help individuals identify and manage triggers for mania, develop coping skills for stress and emotional regulation, and establish healthy sleep and lifestyle habits.

4. Lifestyle Changes:

   • Maintaining regular sleep patterns, avoiding substance abuse, managing stress effectively, and adhering to a healthy diet and exercise routine can all contribute to mood stability and reduce the risk of manic episodes.

5. Support Groups and Psychoeducation:

   • Participating in support groups and psychoeducation programs can provide individuals with information about bipolar disorder, coping strategies, and social support, all of which can be helpful in preventing relapse. [7]

Homeopathic Treatment of Mania

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis. 

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines. 

Homeopathic Medicines for Mania: 

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath)

Medicines:

Lillium Tigrinum

• Lillium Tigrinum is of great help in treating increased energy levels in Bipolar Disorder where the main symptom is extreme restlessness and difficulty in sitting still at one place.
• Another feature to look out for while choosing Lillium Tigrinum is when a patient shows great hurriedness without any ambition or aim.
• The patient requiring this medicine usually has a heart or uterine disease associated with the mental symptoms.

Cannabis Indica

• Cannabis Indica is another helpful remedy for treating increased energy levels in Bipolar Disorder.
• One noticeable symptom for which this medicine is of great help is when the patient has bouts of uncontrollable laughter on listening to every little word spoken, which may not even be funny, and excessive talkativeness.
• The patient requiring Cannabis Indica is full of thoughts crowding the brain at one time, making the patient forgetful of words while talking.

Belladonna

• Belladonna works very well for those patients of Bipolar Disorder who show marked violent behavior and violence occurs in fits that come and go suddenly and the patient even bites and strikes the person near him or her.
• Another symptom of violence where Belladonna is beneficial as a cure is when the patient spits on people and the face turns red.

Ignatia Amara

• In general, Ignatia Amara is one of the best remedies for treating sadness experienced by a patient in the depressive phase of Bipolar Disorder.
• Moreover, The patients requiring this medicine usually have a history of long-held grief like the death of a family member or close friend or in cases where the disease has originated after disappointed love affections or from suppressed emotions.
• Ignatia Amara is a very helpful remedy for patients who sit silently also weep or brood over the past.

Sepia 

• Sepia is also beneficial for treating sadness during the depression stage of Bipolar Disorder.
• The main symptoms for using this medicine are constant weeping, indifferent behavior towards people and even family members who were once much respected and loved, and lack of interest in doing any mental or physical work.

Aurum Metallicum

• Aurum Metallicum is an excellent medicine for treating those cases of depression in Bipolar Disorder where suicidal thoughts predominate and the patient feels hopeless and worthless and has persistent suicidal thoughts.

Natrum Sulphuricum

• Natrum Sulphuricum is another remedy of great help for a patient in whom suicidal thoughts are marked and they has to apply much self-control to stop themselves from actually died by suicide.
• Another symptom that calls for the use of medicine Natrum Sulphuricum is gloominess.
• When the patient of Bipolar Disorder feels sad even when listening to lively music and has an aversion to talk or be spoken to, Natrum Sulphuricum is very beneficial.

Diet & Regimen for Mania:

• Regular Meal Times: Maintaining a consistent eating schedule can help stabilize blood sugar levels and mood swings. Skipping meals or eating erratically can trigger mood changes.

• Nutrient-Dense Foods: Focus on a balanced diet rich in fruits, vegetables, whole grains, and lean protein sources. These foods provide essential nutrients that support brain health and overall well-being.

• Omega-3 Fatty Acids: Studies suggest that omega-3 fatty acids, found in fatty fish (salmon, tuna), flaxseeds, and walnuts, may have mood-stabilizing effects.

• Limit Caffeine and Alcohol: Caffeine and alcohol can disrupt sleep patterns and worsen mood swings. It’s best to avoid or limit these substances.

• Hydration: Staying hydrated is essential for overall health and can help regulate mood. Aim to drink plenty of water throughout the day.

• Sleep Hygiene: Establishing a regular sleep schedule and practicing good sleep hygiene (e.g., avoiding screens before bed, creating a relaxing bedtime routine) is crucial for mood stability.

• Stress Management: Stress can trigger manic episodes. Incorporate stress-management techniques like exercise, mindfulness, and relaxation techniques into your daily routine.

• Medication Adherence: If prescribed medication for bipolar disorder, it’s important to take it as directed. Skipping doses or stopping medication abruptly can worsen symptoms. [8]

The Do’s & Don’ts

Do’s of Mania:

• Seek professional help immediately: If you or someone you know is experiencing symptoms of mania, it’s crucial to consult a mental health professional as soon as possible. Early intervention can prevent complications and improve outcomes.

• Stick to a routine: Maintaining a regular schedule for sleep, meals, and activities can help stabilize mood swings and prevent manic episodes from escalating.

• Prioritize sleep: Adequate sleep is essential for mood regulation. Aim for 7-8 hours of sleep per night and establish a relaxing bedtime routine.

• Limit stimulation: Avoid excessive noise, bright lights, and stimulating activities, as these can exacerbate mania symptoms.

• Practice relaxation techniques: Deep breathing exercises, mindfulness meditation, and yoga can help reduce stress and promote relaxation.

• Maintain social connections: Staying connected with supportive friends and family can provide emotional support and help you stay grounded.

• Communicate openly: Talk to your loved ones about how you’re feeling and what you need. Don’t be afraid to ask for help.

• Focus on self-care: Engage in activities that you enjoy and that promote relaxation and well-being, such as reading, listening to music, or spending time in nature.

Don’ts of Mania:

• Don’t isolate yourself: Withdrawing from social interactions can worsen mania symptoms. Make an effort to stay connected with others, even if it’s just for a short period.

• Don’t make major decisions: Impulsivity is a common symptom of mania. Avoid making any major life decisions, such as quitting your job or making large purchases, until your mood stabilizes.

• Don’t engage in risky behaviors: Mania can lead to impulsive and reckless behavior, such as excessive spending, substance abuse, and unsafe sexual activity. Avoid these behaviors to protect yourself and others.

• Don’t stop taking medication: If you’re taking medication for bipolar disorder, don’t stop taking it without consulting your doctor. Abruptly stopping medication can trigger a manic episode or worsen symptoms.

• Don’t ignore warning signs: Be aware of early warning signs of mania, such as changes in sleep patterns, increased energy, and irritability. If you notice these signs, seek help from a mental health professional.

Terminology

1. Mania: A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy.

2. Hypomania: A milder form of mania, with similar symptoms but less severe and not causing significant impairment in functioning.

3. Bipolar Disorder: A mood disorder characterized by recurrent episodes of mania or hypomania, often alternating with episodes of depression.

4. Euphoria: An intense feeling of well-being, elation, or happiness.

5. Grandiosity: An inflated sense of self-importance, power, or knowledge.

6. Pressured Speech: Rapid, excessive, and sometimes incoherent speech.

7. Flight of Ideas: A rapid flow of thoughts that jump from one topic to another.

8. Impulsivity: Acting without thinking, often leading to risky or inappropriate behaviors.

9. Decreased Need for Sleep: A reduced desire or need for sleep, often accompanied by increased energy.

10. Psychomotor Agitation: Excessive physical activity or restlessness.

11. Mixed Episode: A period in which both manical and depressive symptoms occur simultaneously.

12. Bi-polar I Disorder: Characterized by at least one manic episode, with or without major depressive episodes.

13. Bi-polar II Disorder: Characterized by at least one hypomanic episode and at least one major depressive episode, but no manic episodes.

14. Rapid Cycling: A pattern of frequent mood swings, with four or more distinct episodes of mania, hypomania, or depression within a 12-month period.

15. Mood Stabilizer: A medication used to treat bipolar disorder by preventing or reducing the severity of mood swings.

Potential Homeopathic Remedies for Mania:

While scientific evidence supporting the effectiveness of homeopathy for mania is limited, some homeopathic remedies are suggested for specific symptom patterns:

• Belladonna: For intense mania with restlessness, agitation, and delusions.
• Hyoscyamus: For manical excitement with silliness, inappropriate laughter, and sexual overactivity.
• Stramonium: For manical delirium with fear, hallucinations, and violence.
• Veratrum Album: For mania with delusions of grandeur, religious themes, and excessive talkativeness.

References

1. Psychiatry, Fourth Edition – Oxford Medical Publications -SRG-by John Geddes, Jonathan Price, Rebecca McKnight
2. Kessing, L. V., Vradi, E., Vázquez, G. H., Angst, J., Azorin, J. M., Bowden, C. L., … & Young, A. H. (2015). Predominant mania course in Indian patients with bi-polar I disorder. Asian journal of psychiatry, 18, 34-39.
3. Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Wolters Kluwer.
4. Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (2021). Benjamin J. Sadock, Virginia A. Sadock, Pedro Ruiz (12th edition) Wolters Kluwer.
5. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (2014), Stephen M. Stahl, (5th edition), Cambridge University Press
6. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) 5th edition, by American Psychiatric Association
7. Mania-Depressive Illness: Bi-polar Disorders and Recurrent Depression (1990). Frederick K. Goodwin and Kay Redfield Jamison (2nd edition). Oxford University Press.
8. The Bi-polar Disorder Survival Guide: What You and Your Family Need to Know (2018) by David J. Miklowitz (3rd edition) The Guilford Press.

Also Search As

There are several ways people can search for homeopathic articles on mania:

1. Online Databases:

   • The National Center for Homeopathy (NCH): The NCH website has a searchable database of articles and research on homeopathy, including some on mania.
   • Homeopathy Plus: This online platform offers a large collection of homeopathic books, journals, and articles. You can use the search function to find relevant information on mania.
   • PubMed: While not specifically for homeopathy, PubMed includes some studies and case reports on homeopathic treatment for mania.

2. Homeopathic Journals:

   • The American Journal of Homeopathic Medicine: This peer-reviewed journal publishes original research articles, case reports, and reviews on various aspects of homeopathy.
   • Homeopathy: This international journal focuses on research and clinical practice in homeopathy.
   • The Indian Journal of Research in Homeopathy: This journal publishes research articles and case reports on homeopathy from an Indian perspective.

3. Homeopathic Libraries:

   • The National Library of Medicine: This extensive library collection includes books and journals on homeopathy, which may contain relevant articles on mania.
   • Homeopathic College Libraries: Many homeopathic colleges and schools have libraries with resources on homeopathic research and practice.

4. Online Search Engines:

   • Google Scholar: Use keywords like "homeopathy mania," "homeopathic treatment mania," or specific remedy names to search for scholarly articles and research papers.
   • General Search Engines: A simple Google search with similar keywords can also lead you to articles, blog posts, and forums discussing homeopathy and mania.

5. Consulting Homeopathic Practitioners:

   • Homeopathic practitioners often have access to resources and information not readily available to the public. They can provide you with relevant articles or guide you towards reliable sources.

There are several ways to search for information about mania, depending on what type of information you are looking for:

1. Medical and Scientific Resources:

   • Medical Databases: PubMed, Google Scholar, and other academic search engines can help you find peer-reviewed research articles, clinical trials, and expert opinions on mania.
   • Mental Health Organizations: Reputable organizations like the National Institute of Mental Health (NIMH) and the American Psychiatric Association (APA) provide reliable information on the symptoms, causes, diagnosis, and treatment of mania.

2. General Information:

   • Search Engines: A simple Google search for "mania" will bring up a plethora of websites, articles, and blog posts on the topic. However, be sure to evaluate the credibility of the source before relying on the information.
   • Online Encyclopedias: Websites like Wikipedia can provide a general overview of mania, but they should not be used as the sole source of information.

3. Support Groups and Forums:

   • Online Support Groups: Platforms like Reddit and Facebook have communities where people with bipolar disorder and their loved ones can share experiences, offer support, and exchange information about mania.
   • Mental Health Forums: Many mental health websites host forums where you can ask questions, connect with others, and learn from personal experiences.

4. Books and Publications:

   • Medical Textbooks: Psychiatric textbooks like Kaplan & Sadock’s Synopsis of Psychiatry provide comprehensive information on mania, including its pathophysiology, diagnosis, and treatment.
   • Self-Help Books: Books written by people with bipolar disorder or mental health professionals can offer valuable insights and coping strategies for managing mania.