According to an article published in the June 29, 2010, issue of the Vancouver Sun,[1] a University of B.C. professor says that, although there is generally no need to be frightened of someone in a manic episode, within a small group of people with bipolar disorder who experience aggressive thoughts, a few can become violent during a manic episode.

"In the worst state, people lose touch with reality," Edward Taylor, director of the school of social work at UBC Okanagan, said.

"They go into a psychotic state. The individual in a manic state has a great deal of energy, often they go without sleep for long periods of time and many times become extremely aggressive in their thoughts."

However, Taylor also cautioned people not to be afraid of someone just because they are in a manic episode.  He said that although there is often a stubbornness or inability to cooperate, that does not necessarily mean that they will become violent.

He said that most of the time, they will take the entire mania out on themselves and won't get any sleep or will spend time thinking about grandiose ideas.

About 80 per cent of patients respond well to treatment — usually an anti-manic drug like lithium or an anti-seizure drug mixed with an anti-depressant and cognitive behavioral therapy — but that could mean they simply have fewer or less intense episodes, Taylor said.

The other 20 per cent have what Taylor termed hypomania, and so can be more difficult to treat.  In this case, they can lose touch with reality and it can even lead to such bazaar actions as stealing money or spending an entire paycheck on a spending spree.

In a small percentage, Taylor said, the patient may become violent. The majority of those who become physically violent are typically men who use alcohol during a manic episode.

Taylor said men and women can also become more sexual than usual during an episode, and if they drink alcohol they could wind up having sex with multiple unknown partners.

"Let's be clear," he said. "This is not an immoral person. One of the things that happens is when they come out of the manic episode they can't explain why they did it and feel guilty and sad and remorseful.

"It is an excellent example of how the brain takes over and the person is literally a different person than they are."

There are also those who don't become physically violent, but can be aggressive in other ways, like not cooperating with police or arguing.