(A) Clinical manifestations The typical clinical symptoms of mania are high emotion, running thinking and increased activities. 1, emotional high The patient’s subjective experience is particularly pleasant, feeling good about himself, all day long, cheerful, smiling, full of joyful fun and attitude, and even feel that the sky is extraordinarily clear, the color of the surrounding things is extraordinarily gorgeous, and he also feels incomparable joy and happiness. This high state of mind of the patient is infectious and often resonates with the surrounding people, causing a burst of laughter. Some patients are unstable and unpredictable, sometimes joyful and happy, sometimes excited and angry, despite their high emotions. Some patients are clinically characterized by anger, irritability, and hostility, and do not show high emotion, so they can easily jump like thunder, anger and even vandalism and aggressive behavior, but often quickly turn anger into joy or apologize. When the patient’s emotions are high, the self-esteem is too high, manifesting as arrogance, arrogance, arrogance, arrogance, arrogance and arrogance. Exaggerated notions of being the greatest, the most capable, and the richest in the world may appear. It may even reach the level of exaggerated or rich delusions, but the content is not absurd. Sometimes there can also be relationship delusions, delusions of victimization, etc., which are mostly secondary to emotional highs and usually do not last long. 2.Thinking is faster and faster, and the content of thinking is rich and changeable, and the concepts in the mind come one after another. Sometimes it feels that the tongue is racing with the thoughts, and the words cannot keep up with the speed of thinking, and it often shows that the words increase, and the speech is incessant, and the hands are dancing, and the eyebrows are flying. However, the content of the speech is superficial, and messy and impractical, often giving people the impression that they are talking out of thin air. As the patient’s attention shifts with the situation, the thinking activity is often affected by changes in the surrounding environment, so that the topic suddenly changes, and the content of the speech often changes quickly from one topic to another, i.e., it is manifested as a drifting idea, and some patients can appear phonetic and intentional association. 3, increased activity Performance of high energy, a wide range of interests, fast and agile movements, significantly increased activity, and endurance, busy all day long, often do anything is a tiger’s head and snake’s tail, there is no end, nothing is achieved. The person is nosy and lacks proper judgment of his own behavior, often doing whatever he wants without considering the consequences, such as squandering money at will, being very generous, giving gifts to colleagues or passers-by at will. Focuses on dressing and decorating, but is not decent, attracting the attention of the people around, and even performing in public, joking around. At work, he thinks he has superior intelligence and can solve all problems, and he commands others, reprimands colleagues, is domineering and arrogant, but gets nowhere. He is socially active, treats people casually, often goes to entertainment places, behaves frivolously, and is close to the opposite sex. He feels energetic, has inexhaustible energy, does not know how to get tired, and sleep is significantly reduced. When the disease is serious, the ability of self-control decreases, rude behavior, and even impulsive destruction behavior. 4.Somatic symptoms Since the patient feels good about himself and is energetic, he seldom complains of physical discomfort, and often shows a rosy complexion, eyes with a sense of energy, mildly dilated pupils, accelerated new rate, and symptoms of sympathetic hyperactivity such as constipation. Due to the patient’s extreme excitement and excessive physical exertion, it is easy to cause water loss and weight loss. Patients have increased appetite, hypersexuality and reduced need for sleep. 5.Other symptoms The patient’s active and passive attention is enhanced during manic episodes, but it cannot be sustained and is easily attracted to the surrounding things. The symptoms of shifting with the situation are most obvious in the acute attack period. Some patients have memory enhancement, and diffuse uninhibited, changeable, often full of many details and trivialities, often lose the correct time demarcation of memory, so that it is confused with the past memory and no coherence. When the attack is extremely serious, the patient is in a state of extreme excitement and agitation, there may be brief, fragmentary hallucinations, disorderly behavior without purpose, accompanied by impulsive behavior; there may also be a disorder of consciousness, with delusions, hallucinations and incoherent thinking and other symptoms, called delirium mania. Most patients lose their self-awareness in the early stage of the disease. The milder clinical manifestations of mania are called hypomania. Patients may have high emotion, high energy, increased activity that lasts at least several days, a significant sense of self-importance, inattention, mild profligacy, increased social activity, increased sexual desire, and reduced need for sleep. It sometimes manifests as irritability, conceited pride, and more reckless behavior, but is not accompanied by psychotic symptoms such as hallucinations and delusions. There is a mild impact on social functioning. Some patients sometimes do not reach the degree of affecting social function, and the general public often do not easily notice. Patients with geriatric mania clinically show less elevated state of mind, mainly showing irritability, arrogance, exaggerated concepts and delusions, increased speech, but often more verbose, and may have aggressive behavior. Symptoms such as drifting thoughts and hypersexuality are also less common. The course of the disease is more prolonged. (B) Course and prognosis Whether it is a single manic episode or recurrent mania, most of them are acute or subacute onset, and the good season is late spring and early summer. The age of onset of mania is around 30 years old, of course, there are also early onset, in the 5-6 years old onset, there are also late onset, after 50 years old, but more than 90% of the cases start before 50 years old. The natural course of mania is generally considered to last from a few weeks to 6 months, with an average of about 3 months, and some cases last only a few days, and individual cases can last more than 10 years. Some people believe that recurrent mania, each episode lasts almost similarly, and can become chronic after many episodes, and a few patients have residual mild affective symptoms, and social function is not fully restored to the pre-morbid level. Modern treatment can eventually lead to complete recovery of 50% of patients. It has been suggested that only one episode in a lifetime accounts for only 5% of cases, but others believe it can be as high as 50%. During the first 3 episodes, the interval between each episode becomes shorter and shorter, and the duration of the interval between subsequent episodes does not change. For each attack, the rate of significant and complete remission is 70% to 80%. (C) Treatment Commonly used mood stabilizers Mood stabilizers are drugs that have therapeutic and relapse prevention effects on manic or depressive episodes, and do not cause manic and depressive transitions or lead to more frequent episodes. Currently, the more recognized mood stabilizers lithium carbonate and the antiepileptic drugs valproate, carbamazepine, lamotrigine, topiramate, gabapentin, and second-generation antipsychotic drugs such as clozapine, olanzapine, risperidone and quetiapine may also have certain mood stabilizer effects. Lithium carbonate is the drug of choice for the treatment of manic episodes, and can be used for both acute episodes of mania. It can also be used for the maintenance treatment of the remission period, and the total efficiency is about 80%. Lithium salt also has a preventive effect on the recurrence of mania. Generally speaking. Lithium salt has better effect on mild mania than severe mania. Generally start with a small dose, gradually increase to the therapeutic dose within 3-5 days, and take it in 2-3 times. The effect is usually seen after 1 week. The maintenance treatment dose depends on the condition. The dose should be reduced for the elderly and the infirm. The dose should also be reduced when combined with antidepressants or antipsychotics. In the treatment of acute manic episodes, antipsychotics can be combined with lithium before it takes effect in order to control the patient’s high excitement symptoms and prevent the patient from exhaustion.