Manic episodes typically first manifest in a patient’s 20s, although they may begin as early as adolescence and as late as age 50 or older. Episodes usually begin suddenly, and may escalate rapidly over the course of a few days. Some episodes last from a few weeks to several months.

Mania is associated with many emotions that manifest as related symptoms, including euphoria and increased self-esteem. Patients in the early stages of a manic episode may feel exuberant, energetic and extremely productive.

However, not all the symptoms associated with mania are positive. Patients who are manic often have racing thoughts and are extremely talkative and speak rapidly. They act differently than they normally do. For example, they may begin to collect various items or to stop grooming themselves. They may easily become irritable, hostile or impatient, and may intrude in the lives of others. Mania also makes it difficult to stay focused on one activity, and patients often flit from one task to another.

Feelings of grandiosity are also commonly associated with mania. Patients may falsely believe that they are extremely wealthy and powerful and have an inflated sense of self-esteem. Some believe that they are geniuses, and this can escalate to the delusional belief that they are God.

During severe manic episodes, patients may have hallucinations and begin to believe that they are either being helped or hindered by others. Patients often sleep less, exhibit poor judgment and become excessively and impulsively involved in high stakes, reckless behavior such as road rage, risky sex, substance abuse or impulsive spending.

When behavior becomes so extreme that there is no clear link between mood and behavior, it is known as delirious mania. Patients with this condition are at risk of dying of physical exhaustion if they are not immediately hospitalized and treated.

Patients who are manic are frequently unaware that their feelings are not normal.