Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Mania with immediate danger or physical collapse
Violence, suicidal or reckless behaviour, severe psychosis, exhaustion, dehydration, inability to meet essential needs, postpartum onset or a possible delirium demands urgent assessment rather than routine outpatient diagnostic clarification.
Action: Make the environment safe, use calm low-stimulation engagement and assess ABCDE, glucose, observations, hydration, substances and injury. Arrange same-day specialist mental-health review, protect dependants and other people, and use the least restrictive lawful care route that can manage the identified danger.
Synopsis
Recognise pathological mood elevation through change in energy, activity, sleep, cognition and behaviour, distinguish mania from hypomania by consequence and severity, and identify medical, substance-related and safeguarding emergencies promptly.
Mania or hypomania is an episodic change from baseline involving elevated, expansive or irritable mood together with increased energy or activity; happiness alone is not the syndrome.
Reduced need for sleep means feeling rested after very little sleep, unlike insomnia in which the person wants sleep and feels tired or distressed by its absence.
Look for pressured speech, racing or rapidly shifting thoughts, distractibility, inflated confidence, increased sociability or sexuality, goal-directed activity, spending and risk taking.
Key red flags
Current intent to die, dangerous driving, weapon access, escalating aggression or behaviour that exposes the person or others to immediate serious harm requires an emergency response.
Investigation priorities
01
Longitudinal episode historyFirst step
Define onset, duration, baseline change, previous depression or activation, recovery, triggers and treatment effects.
Management branches
Urgent manic presentationSecure safety and specialist assessment
Marked activation is accompanied by psychosis, serious risk, exhaustion or major functional loss.
Reduce stimulation, maintain personal space, address immediate physical needs and obtain trained help before confrontation escalates.
Assess ABCDE, cognition, substances, medical mimics, suicide and harm scenarios and identify children or vulnerable adults needing protection.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.