Clinical Features of Manic Episodes

A. The most common presentation is excessive euphoria, but some patients may present with irritability alone.

B. Patients may seek out constant enthusiastic interaction with others, frequently using poor judgment in those interactions.

C. Increased psychomotor activity can take the form of excessive planning and participation, which are ultimately nonproductive.

D. Reckless behavior with negative consequences is common (eg, shopping sprees, excessive spending, sexual promiscuity).

E. Inability to sleep can be severe and persist for days.

F. Lability of mood is common.

G. Grandiose delusions are common.

H. Speech is pressured, loud and intrusive, and it is often difficult to interrupt these patients. Flight of ideas can result in gross disorganization and incoherence of speech.

I. Patients frequently lack insight into their behavior and resist treatment. J. Patients may become grossly psychotic most frequently with paranoid features.

K. Patients may become assaultive, particularly if psychotic. L. Dysphoria is common at the height of a manic episode, and the patient may become suicidal.

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