Someone may sleep far less than usual yet stay full of energy, speak rapidly or rush into major decisions that are out of character. Mania is a marked change in mood, energy and activity1 that can impair judgment. It may involve intense happiness or pronounced irritability. One sign alone cannot establish the diagnosis, but suspected mania needs urgent professional assessment2.
When do you need emergency help now?
Call 997, the ambulance number in Saudi Arabia, if someone is in immediate danger or you cannot keep yourself or another person safe. Also call if any of the following has happened recently and has not been medically assessed: a suicide attempt4, serious injury, poisoning, taking a harmful substance or an overdose. Suspected harmful ingestion or overdose5 is enough to seek help; do not wait for confirmation or symptoms. If that same event has already been medically assessed, follow the care plan for it. Any current danger or new deterioration still needs help3.
Voices commanding harm, rapidly worsening hallucinations, severe agitation or aggression, or speech that has become incoherent also need emergency medical care now16, even without a stated intention to harm.
Sudden confusion also needs emergency medical care now: for example, someone suddenly does not know where they are, or develops a clear new difficulty thinking or paying attention. Physical illness, medicines, alcohol or other substances can be involved. Do not wait for a psychiatric appointment or require a previous diagnosis or a statement about self-harm before seeking help. Go to an emergency department8; call 9977 if travel is unsafe or you cannot keep everyone safe.
If possible, ask someone safe and able to help to stay with you4 or the person you are supporting while you seek care. Do not drive yourself to emergency care5. Have someone else drive you, or call 9977 if safe travel is unavailable. If no suitable companion is available, tell the medical service and seek help without delay. If you are the person offering support and fear for your own safety, move to a safe place and ask for help.
How do you arrange an assessment for possible mania?
Seek urgent medical assessment when mania is suspected, even if no immediate danger is apparent. Do not wait a week, wait for a bipolar disorder diagnosis or wait for someone to say they intend to harm themselves. Feeling energetic and being able to work do not remove the need for assessment2 when an unusual change is affecting judgment and behavior1.
If the person has a doctor or treatment team you can reach, contact them immediately using any agreed contact or crisis plan and explain what has changed. If there is no plan or team, contact details are missing or the team cannot be reached, seek urgent assessment from an available medical service. While everyone remains safe, you can call 937 for medical consultation9 within Saudi Arabia. This service is available around the clock; describe what is happening and ask where to get an appropriate assessment. If you cannot obtain suitable assessment promptly2, go to a hospital emergency department10. Do not wait for a routine appointment or keep calling a service that does not answer. The emergencies described above must not wait for a 937 consultation.
To reach the assessment, ask a safe, capable person to accompany you or arrange safe transport driven by someone else. Do not drive if your judgment or attention has become acutely impaired, or if you have new psychotic experiences10 such as hearing voices others do not hear, even if you feel well. If no suitable support or safe transport is available, tell the medical service and seek care without delay2. Call 9977 if travel is unsafe or you cannot keep everyone safe.
What changes should you describe?
Less sleep is particularly relevant when it comes with a reduced need for sleep: the person sleeps less than usual but does not feel the expected tiredness1 and keeps going. This differs from wanting to sleep, being unable to and then feeling exhausted. Tell the doctor what actually happened; sleep alone does not determine the diagnosis.
Other changes may include faster speech that is hard to interrupt, racing thoughts, increased activity or unusually strong confidence in one's abilities. Behavior may change too. You might notice excessive spending, many new projects13, rash decisions or dangerous driving. Happiness is not essential; irritability may be more prominent1. Describe the difference from the person's usual behavior and its effect on their life, rather than judging them by their enthusiasm or one action.
Hypomania is less severe than mania, does not cause the same marked disruption in daily functioning, and does not involve hallucinations or delusions18. Someone may feel productive and well17 despite unusual changes in sleep and activity. Those changes still matter: tell the clinician about them, rather than trying to grade an episode yourself before deciding whether to seek help. For suspected mania or new psychotic experiences, use the urgent assessment route above2.
Some severe manic episodes involve hallucinations1 or beliefs that do not match reality. These are psychotic symptoms. Their presence alone does not establish bipolar disorder or schizophrenia, or show that someone will harm another person. A clinician needs to assess the experiences10, their context and safety. You do not need to name the disorder before asking for care.
What happens in the brain? There is no single established explanation for every episode. In bipolar disorder, research points to genetic and environmental contributions1 and studies differences in brain structure and function. These findings do not, on their own, explain an individual's experience. A brain scan alone does not diagnose mania; assessment considers symptoms2, their course and other possible causes.
If the changes concern a child or teenager under 18, seek an assessment suited to their age. A family doctor or pediatrician can be a starting point for reaching a mental health professional experienced in working with children and teenagers. Signs can overlap with other conditions14 and developmental changes. Do not use adult diagnostic descriptions or treatments to manage a child at home. Immediate danger or sudden confusion still requires emergency help8 now.
How do you speak with someone who feels well or refuses help?
Start with specific observations12 and a simple offer: “I've noticed you're sleeping much less and making big decisions very quickly. I'd like us to get medical advice, and I can come with you.” Listen to their account1 of what is happening and offer help with calling or reaching the assessment. You do not have to agree on the word “mania” to seek a professional opinion10.
Speak calmly and reduce noise and the number of people around them where possible. Suggest postponing major purchases and decisions until things have settled, instead of turning it into a struggle for control. If they describe an unusual belief, avoid arguing to prove it wrong12 or confirming it as true. You can acknowledge their feelings: “I can see this is frightening for you. I'd like us to get help.” A calm environment and rest can support someone while care is being arranged; they are not enough on their own to treat a possible episode1.
If they refuse help, you can call the team or seek urgent medical advice before persuading them that they have a particular diagnosis. If this matches what you have observed, you might say: “They are sleeping much less than usual, and their activity and decisions have changed. They refuse to see a doctor, and I do not know how to arrange safe transport. What should I do next9?” Also mention any danger, new voices10 or difficulty with basic self-care; these details may change how urgently help is needed2.
Follow the medical service’s guidance on getting an assessment. If suitable assessment cannot be obtained promptly, seek help through a hospital emergency department10 and explain the refusal or difficulty taking part. Do not restrain the person12, force them to travel or give them medicine on your own initiative. In immediate danger, move to safety if necessary and call 9977; do not wait for the conversation to succeed.
A short note to help explain what happened
You can copy the rows below and use whichever information you know when calling or attending an assessment. Do not delay seeking care2 to complete them, and say “I don't know” when information is missing. If you are offering support, share your observations and let the person describe their experience10 too, whenever possible.
What to tell the doctor
Brief information you can note
The change and when it began
What was different from usual? When did you notice it? Has anything similar happened before?
Sleep and activity
How much are they sleeping compared with usual? Do they seem tired or keep going? How have their speech or activity changed?
Effect on daily life
Examples involving decisions, spending, work, relationships or difficulty looking after themselves.
Medicines and substances
Current medicines and anything recently started or changed; any alcohol, drugs or other substances you know about.
Safety and support now
Any harm, thoughts of suicide or unusual experiences; who can stay and help safely.
Existing care contacts
Their doctor or treatment team, any agreed plan and contact details, if available.
What might assessment and treatment involve?
The doctor considers physical health and safety, how severe the changes are, how long they have lasted and their effect on daily life. They also ask about previous periods and medicines or substances used. An examination or tests may be needed to investigate other causes10, depending on the assessment. A supporter's observations are useful2, but they do not replace the person's own conversation with the clinician and professional assessment. Clarifying the diagnosis may require following the pattern over time1.
Improved sleep and calmer activity are an opportunity to review what happened and make a plan with the team. They are not a reason to end follow-up yourself. Treatment that controls an episode may differ from treatment that reduces the chance of another one1. Ask when the next review will be and how medicine benefits, side effects and physical health will be monitored2.
Agree on a written plan covering the person's early warning signs2, what to do if they appear, whom to contact during and outside working hours, and an alternative if that contact cannot be reached. A supporter can take part with the person's agreement and to the extent they want. Regular sleep and routines13, avoiding alcohol and drugs1, and practical help with following treatment can support care. They cannot guarantee that every episode will be prevented.
Frequently Asked Questions
What is a manic episode?
Mania is a marked change in mood, energy and activity that can impair judgment. It may involve intense happiness or pronounced irritability. It can occur as part of bipolar disorder, but medicines, alcohol, drugs and some physical illnesses can cause similar symptoms or make them worse. One sign alone cannot establish the diagnosis, but suspected mania needs urgent professional assessment, without waiting a week or for a diagnosis.
What are the signs of mania?
Signs may include a reduced need for sleep: the person sleeps less than usual but does not feel the expected tiredness and keeps going. Other changes may include faster speech that is hard to interrupt, racing thoughts, increased activity, unusually strong confidence, excessive spending, rash decisions or dangerous driving. Happiness is not essential; irritability may be more prominent.
What is the difference between mania and hypomania?
Hypomania is less severe than mania, does not cause the same marked disruption in daily functioning, and does not involve hallucinations or delusions. Someone may feel productive and well despite unusual changes in sleep and activity. Those changes still matter: tell the clinician about them, rather than trying to grade an episode yourself before deciding whether to seek help.
What should I do if someone with mania refuses help?
You can call their treatment team or seek urgent medical advice yourself, and mention any danger, new voices or difficulty with basic self-care. Follow the medical service's guidance; if suitable assessment cannot be obtained promptly, seek help through a hospital emergency department and explain the refusal. Do not restrain them, force them to travel or give them medicine on your own initiative. In immediate danger, move to safety if necessary and call 997; do not wait for the conversation to succeed.
When should I call an ambulance for someone with mania?
Call 997 if someone is in immediate danger or you cannot keep yourself or another person safe. Also call if a suicide attempt, serious injury, poisoning, taking a harmful substance or an overdose happened recently and has not been medically assessed. Suspected harmful ingestion or overdose is enough; do not wait for confirmation or symptoms. Voices commanding harm, rapidly worsening hallucinations, severe agitation or aggression, incoherent speech or sudden confusion also need emergency medical care now, even without a stated intention to harm.
Have someone safe stay with you. Do not drive yourself: someone else can drive, or call 997 if travel is unsafe. Without a companion, tell the medical service without delay. If you fear for your own safety, move somewhere safe and ask for help.
A writer and researcher specializing in psychiatry, she focuses on mental health and the human emotions we experience but cannot always find the words to name. She writes about us—about humanity and the human experience—and simplifies complex topics to offer content that helps us better understand ourselves and life, ultimately making us feel less alone.
Every Tatmeen article is reviewed by care providers licensed by the Saudi Commission for Health Specialties, so what you read is accurate and trustworthy.
This article builds understanding and does not replace a licensed care provider.
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Mania is a marked <a href=\"https://www.nimh.nih.gov/health/publications/bipolar-disorder\" target=\"_blank\" rel=\"noopener noreferrer\">change in mood, energy and activity</a> that can impair judgment. It may involve intense happiness or pronounced irritability. One sign alone cannot establish the diagnosis, but <a href=\"https://www.nice.org.uk/guidance/cg185/chapter/recommendations\" target=\"_blank\" rel=\"noopener noreferrer\">suspected mania needs urgent professional assessment</a>.</p>\n<h2 id=\"article-section-when-do-you-need-emergency-help-now\" data-toc-heading tabindex=\"-1\"><span id=\"when-do-you-need-emergency-help-now-1\" aria-hidden=\"true\"></span>When do you need emergency help now?</h2>\n<p>Call 997, the ambulance number in Saudi Arabia, if someone is in immediate danger or you cannot keep yourself or another person safe. Also call if any of the following has happened recently and has not been medically assessed: a <a href=\"https://medlineplus.gov/ency/article/001554.htm\" target=\"_blank\" rel=\"noopener noreferrer\">suicide attempt</a>, serious injury, poisoning, taking a harmful substance or an overdose. <a href=\"https://www.nhs.uk/conditions/poisoning/\" target=\"_blank\" rel=\"noopener noreferrer\">Suspected harmful ingestion or overdose</a> is enough to seek help; do not wait for confirmation or symptoms. If that same event has already been medically assessed, follow the care plan for it. Any current danger or <a href=\"https://www.nhs.uk/nhs-services/mental-health-services/where-to-get-urgent-help-for-mental-health/\" target=\"_blank\" rel=\"noopener noreferrer\">new deterioration still needs help</a>.</p>\n<p>Voices commanding harm, rapidly worsening hallucinations, severe agitation or aggression, or speech that has become incoherent also <a href=\"https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/hallucinations-hearing-voices/\" target=\"_blank\" rel=\"noopener noreferrer\">need emergency medical care now</a>, even without a stated intention to harm.</p>\n<p><strong>Sudden confusion also needs emergency medical care now:</strong> for example, someone suddenly does not know where they are, or develops a clear new difficulty thinking or paying attention. Physical illness, medicines, alcohol or other substances can be involved. Do not wait for a psychiatric appointment or require a previous diagnosis or a statement about self-harm before seeking help. <a href=\"https://www.nhs.uk/symptoms/confusion/\" target=\"_blank\" rel=\"noopener noreferrer\">Go to an emergency department</a>; <a href=\"https://www.srca.gov.sa/first-aid-awareness/\" target=\"_blank\" rel=\"noopener noreferrer\">call 997</a> if travel is unsafe or you cannot keep everyone safe.</p>\n<p>If possible, ask someone safe and able to help to <a href=\"https://medlineplus.gov/ency/article/001554.htm\" target=\"_blank\" rel=\"noopener noreferrer\">stay with you</a> or the person you are supporting while you seek care. <a href=\"https://www.nhs.uk/conditions/poisoning/\" target=\"_blank\" rel=\"noopener noreferrer\">Do not drive yourself to emergency care</a>. Have someone else drive you, or <a href=\"https://www.srca.gov.sa/first-aid-awareness/\" target=\"_blank\" rel=\"noopener noreferrer\">call 997</a> if safe travel is unavailable. If no suitable companion is available, tell the medical service and seek help without delay. If you are the person offering support and fear for your own safety, move to a safe place and ask for help.</p>\n<h2 id=\"article-section-how-do-you-arrange-an-assessment-for-possible-mania\" data-toc-heading tabindex=\"-1\"><span id=\"how-do-you-arrange-an-assessment-for-possible-mania-2\" aria-hidden=\"true\"></span>How do you arrange an assessment for possible mania?</h2>\n<p><strong>Seek urgent medical assessment when mania is suspected, even if no immediate danger is apparent.</strong> Do not wait a week, wait for a bipolar disorder diagnosis or wait for someone to say they intend to harm themselves. Feeling energetic and being able to work <a href=\"https://www.nice.org.uk/guidance/cg185/chapter/recommendations\" target=\"_blank\" rel=\"noopener noreferrer\">do not remove the need for assessment</a> when an unusual <a href=\"https://www.nimh.nih.gov/health/publications/bipolar-disorder\" target=\"_blank\" rel=\"noopener noreferrer\">change is affecting judgment and behavior</a>.</p>\n<p>If the person has a doctor or treatment team you can reach, contact them immediately using any agreed contact or crisis plan and explain what has changed. If there is no plan or team, contact details are missing or the team cannot be reached, seek urgent assessment from an available medical service. While everyone remains safe, you can <a href=\"https://www.moh.gov.sa/ministry/about/pages/contactus.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">call 937 for medical consultation</a> within Saudi Arabia. This service is available around the clock; describe what is happening and ask where to get an appropriate assessment. If you <a href=\"https://www.nice.org.uk/guidance/cg185/chapter/recommendations\" target=\"_blank\" rel=\"noopener noreferrer\">cannot obtain suitable assessment promptly</a>, go to a <a href=\"https://www.nhs.uk/mental-health/conditions/psychosis/diagnosis/\" target=\"_blank\" rel=\"noopener noreferrer\">hospital emergency department</a>. Do not wait for a routine appointment or keep calling a service that does not answer. The emergencies described above must not wait for a 937 consultation.</p>\n<p>Tell the clinician <a href=\"https://www.nhs.uk/mental-health/conditions/psychosis/diagnosis/\" target=\"_blank\" rel=\"noopener noreferrer\">without delay about new experiences such as hearing voices other people do not hear</a> or holding unusual beliefs that are hard to reconsider. Also report an inability to look after oneself or meet basic needs, or thoughts of suicide. These <a href=\"https://www.nhs.uk/nhs-services/mental-health-services/where-to-get-urgent-help-for-mental-health/\" target=\"_blank\" rel=\"noopener noreferrer\">need urgent professional assessment</a>. <a href=\"https://www.srca.gov.sa/first-aid-awareness/\" target=\"_blank\" rel=\"noopener noreferrer\">Call 997</a> if there is immediate danger or you cannot maintain safety.</p>\n<p>To reach the assessment, ask a safe, capable person to accompany you or arrange safe transport driven by someone else. Do not drive if your judgment or attention has become acutely impaired, or if you have <a href=\"https://www.nhs.uk/mental-health/conditions/psychosis/diagnosis/\" target=\"_blank\" rel=\"noopener noreferrer\">new psychotic experiences</a> such as hearing voices others do not hear, even if you feel well. If no suitable support or safe transport is available, tell the medical service and <a href=\"https://www.nice.org.uk/guidance/cg185/chapter/recommendations\" target=\"_blank\" rel=\"noopener noreferrer\">seek care without delay</a>. <a href=\"https://www.srca.gov.sa/first-aid-awareness/\" target=\"_blank\" rel=\"noopener noreferrer\">Call 997</a> if travel is unsafe or you cannot keep everyone safe.</p>\n<h2 id=\"article-section-what-changes-should-you-describe\" data-toc-heading tabindex=\"-1\"><span id=\"what-changes-should-you-describe-3\" aria-hidden=\"true\"></span>What changes should you describe?</h2>\n<p>Less sleep is particularly relevant when it comes with a <strong>reduced need for sleep</strong>: the person sleeps less than usual but <a href=\"https://www.nimh.nih.gov/health/publications/bipolar-disorder\" target=\"_blank\" rel=\"noopener noreferrer\">does not feel the expected tiredness</a> and keeps going. This differs from wanting to sleep, being unable to and then feeling exhausted. Tell the doctor what actually happened; sleep alone does not determine the diagnosis.</p>\n<p>Other changes may include faster speech that is hard to interrupt, racing thoughts, increased activity or unusually strong confidence in one's abilities. Behavior may change too. You might notice <a href=\"https://www.nhs.uk/mental-health/conditions/bipolar-disorder/\" target=\"_blank\" rel=\"noopener noreferrer\">excessive spending, many new projects</a>, rash decisions or dangerous driving. Happiness <a href=\"https://www.nimh.nih.gov/health/publications/bipolar-disorder\" target=\"_blank\" rel=\"noopener noreferrer\">is not essential; irritability may be more prominent</a>. Describe the difference from the person's usual behavior and its effect on their life, rather than judging them by their enthusiasm or one action.</p>\n<p><strong>Hypomania</strong> is less severe than mania, does not cause the same marked disruption in daily functioning, and <a href=\"https://www.london.hee.nhs.uk/bipolar-disorder\" target=\"_blank\" rel=\"noopener noreferrer\">does not involve hallucinations or delusions</a>. Someone may <a href=\"https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders\" target=\"_blank\" rel=\"noopener noreferrer\">feel productive and well</a> despite unusual changes in sleep and activity. Those changes still matter: tell the clinician about them, rather than trying to grade an episode yourself before deciding whether to seek help. For suspected mania or new psychotic experiences, use the <a href=\"https://www.nice.org.uk/guidance/cg185/chapter/recommendations\" target=\"_blank\" rel=\"noopener noreferrer\">urgent assessment route above</a>.</p>\n<p>Some <a href=\"https://www.nimh.nih.gov/health/publications/bipolar-disorder\" target=\"_blank\" rel=\"noopener noreferrer\">severe manic episodes involve hallucinations</a> or beliefs that do not match reality. These are psychotic symptoms. Their presence alone does not establish bipolar disorder or schizophrenia, or show that someone will harm another person. A <a href=\"https://www.nhs.uk/mental-health/conditions/psychosis/diagnosis/\" target=\"_blank\" rel=\"noopener noreferrer\">clinician needs to assess the experiences</a>, their context and safety. You do not need to name the disorder before asking for care.</p>\n<p>Mania can occur as part of bipolar disorder, but medicines, alcohol, drugs and some <a href=\"https://www.nhs.uk/mental-health/conditions/psychosis/diagnosis/\" target=\"_blank\" rel=\"noopener noreferrer\">physical illnesses can cause similar symptoms</a> or make them worse. <a href=\"https://www.nimh.nih.gov/health/publications/bipolar-disorder\" target=\"_blank\" rel=\"noopener noreferrer\">Thyroid disorders are one possibility</a> a doctor may investigate, depending on the situation. These possibilities are <a href=\"https://www.nice.org.uk/guidance/cg185/chapter/recommendations\" target=\"_blank\" rel=\"noopener noreferrer\">reasons to seek assessment</a>, not to wait at home or experiment with stopping a medicine yourself.</p>\n<p><strong>What happens in the brain?</strong> There is no single established explanation for every episode. In bipolar disorder, research points to <a href=\"https://www.nimh.nih.gov/health/publications/bipolar-disorder\" target=\"_blank\" rel=\"noopener noreferrer\">genetic and environmental contributions</a> and studies differences in brain structure and function. These findings do not, on their own, explain an individual's experience. A brain scan alone <a href=\"https://www.nice.org.uk/guidance/cg185/chapter/recommendations\" target=\"_blank\" rel=\"noopener noreferrer\">does not diagnose mania; assessment considers symptoms</a>, their course and other possible causes.</p>\n<p>If the changes concern a child or teenager under 18, seek an assessment suited to their age. A family doctor or pediatrician can be a starting point for reaching a mental health professional experienced in working with children and teenagers. <a href=\"https://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens\" target=\"_blank\" rel=\"noopener noreferrer\">Signs can overlap with other conditions</a> and developmental changes. Do not use adult diagnostic descriptions or treatments to manage a child at home. Immediate danger or <a href=\"https://www.nhs.uk/symptoms/confusion/\" target=\"_blank\" rel=\"noopener noreferrer\">sudden confusion still requires emergency help</a> now.</p>\n<h2 id=\"article-section-how-do-you-speak-with-someone-who-feels-well-or-refuses-help\" data-toc-heading tabindex=\"-1\"><span id=\"how-do-you-speak-with-someone-who-feels-well-or-refuses-help-4\" aria-hidden=\"true\"></span>How do you speak with someone who feels well or refuses help?</h2>\n<p><a href=\"https://hiowhealthcare.nhs.uk/carers-families/advice-and-information-carers/psychological-support-carers/chapter-4-relationship-loved-one\" target=\"_blank\" rel=\"noopener noreferrer\">Start with specific observations</a> and a simple offer: “I've noticed you're sleeping much less and making big decisions very quickly. I'd like us to get medical advice, and I can come with you.” <a href=\"https://www.nimh.nih.gov/health/publications/bipolar-disorder\" target=\"_blank\" rel=\"noopener noreferrer\">Listen to their account</a> of what is happening and offer help with calling or reaching the assessment. You do not have to agree on the word “mania” to <a href=\"https://www.nhs.uk/mental-health/conditions/psychosis/diagnosis/\" target=\"_blank\" rel=\"noopener noreferrer\">seek a professional opinion</a>.</p>\n<p>Speak calmly and reduce noise and the number of people around them where possible. Suggest postponing major purchases and decisions until things have settled, instead of turning it into a struggle for control. If they describe an unusual belief, <a href=\"https://hiowhealthcare.nhs.uk/carers-families/advice-and-information-carers/psychological-support-carers/chapter-4-relationship-loved-one\" target=\"_blank\" rel=\"noopener noreferrer\">avoid arguing to prove it wrong</a> or confirming it as true. You can acknowledge their feelings: “I can see this is frightening for you. I'd like us to get help.” A calm environment and rest can support someone while care is being arranged; they <a href=\"https://www.nimh.nih.gov/health/publications/bipolar-disorder\" target=\"_blank\" rel=\"noopener noreferrer\">are not enough on their own to treat a possible episode</a>.</p>\n<p>If they refuse help, you can call the team or seek urgent medical advice before persuading them that they have a particular diagnosis. If this matches what you have observed, you might say: “They are sleeping much less than usual, and their activity and decisions have changed. They refuse to see a doctor, and I do not know how to arrange safe transport. <a href=\"https://www.moh.gov.sa/ministry/about/pages/contactus.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">What should I do next</a>?” Also mention any danger, <a href=\"https://www.nhs.uk/mental-health/conditions/psychosis/diagnosis/\" target=\"_blank\" rel=\"noopener noreferrer\">new voices</a> or difficulty with basic self-care; these details may change <a href=\"https://www.nice.org.uk/guidance/cg185/chapter/recommendations\" target=\"_blank\" rel=\"noopener noreferrer\">how urgently help is needed</a>.</p>\n<p>Follow the medical service’s guidance on getting an assessment. If suitable assessment cannot be obtained promptly, seek help through a <a href=\"https://www.nhs.uk/mental-health/conditions/psychosis/diagnosis/\" target=\"_blank\" rel=\"noopener noreferrer\">hospital emergency department</a> and explain the refusal or difficulty taking part. <a href=\"https://hiowhealthcare.nhs.uk/carers-families/advice-and-information-carers/psychological-support-carers/chapter-4-relationship-loved-one\" target=\"_blank\" rel=\"noopener noreferrer\">Do not restrain the person</a>, force them to travel or give them medicine on your own initiative. In immediate danger, move to safety if necessary and <a href=\"https://www.srca.gov.sa/first-aid-awareness/\" target=\"_blank\" rel=\"noopener noreferrer\">call 997</a>; do not wait for the conversation to succeed.</p>\n<h2 id=\"article-section-a-short-note-to-help-explain-what-happened\" data-toc-heading tabindex=\"-1\"><span id=\"a-short-note-to-help-explain-what-happened-5\" aria-hidden=\"true\"></span>A short note to help explain what happened</h2>\n<p>You can copy the rows below and use whichever information you know when calling or attending an assessment. <a href=\"https://www.nice.org.uk/guidance/cg185/chapter/recommendations\" target=\"_blank\" rel=\"noopener noreferrer\">Do not delay seeking care</a> to complete them, and say “I don't know” when information is missing. If you are offering support, share your observations and <a href=\"https://www.nhs.uk/mental-health/conditions/psychosis/diagnosis/\" target=\"_blank\" rel=\"noopener noreferrer\">let the person describe their experience</a> too, whenever possible.</p>\n<div class=\"table-block\"><table>\n<thead>\n<tr>\n<th>What to tell the doctor</th>\n<th>Brief information you can note</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>The change and when it began</td>\n<td>What was different from usual? When did you notice it? Has anything similar happened before?</td>\n</tr>\n<tr>\n<td>Sleep and activity</td>\n<td>How much are they sleeping compared with usual? Do they seem tired or keep going? How have their speech or activity changed?</td>\n</tr>\n<tr>\n<td>Effect on daily life</td>\n<td>Examples involving decisions, spending, work, relationships or difficulty looking after themselves.</td>\n</tr>\n<tr>\n<td>Medicines and substances</td>\n<td>Current medicines and anything recently started or changed; any alcohol, drugs or other substances you know about.</td>\n</tr>\n<tr>\n<td>Safety and support now</td>\n<td>Any harm, thoughts of suicide or unusual experiences; who can stay and help safely.</td>\n</tr>\n<tr>\n<td>Existing care contacts</td>\n<td>Their doctor or treatment team, any agreed plan and contact details, if available.</td>\n</tr>\n</tbody>\n</table></div>\n<h2 id=\"article-section-what-might-assessment-and-treatment-involve\" data-toc-heading tabindex=\"-1\"><span id=\"what-might-assessment-and-treatment-involve-6\" aria-hidden=\"true\"></span>What might assessment and treatment involve?</h2>\n<p>The doctor considers physical health and safety, how severe the changes are, how long they have lasted and their effect on daily life. They also ask about previous periods and medicines or substances used. An examination or tests may be needed to <a href=\"https://www.nhs.uk/mental-health/conditions/psychosis/diagnosis/\" target=\"_blank\" rel=\"noopener noreferrer\">investigate other causes</a>, depending on the assessment. A <a href=\"https://www.nice.org.uk/guidance/cg185/chapter/recommendations\" target=\"_blank\" rel=\"noopener noreferrer\">supporter's observations are useful</a>, but they do not replace the person's own conversation with the clinician and professional assessment. Clarifying the diagnosis may require <a href=\"https://www.nimh.nih.gov/health/publications/bipolar-disorder\" target=\"_blank\" rel=\"noopener noreferrer\">following the pattern over time</a>.</p>\n<p>The doctor chooses treatment according to symptoms, health and previous treatment. This may include <a href=\"https://www.nice.org.uk/guidance/cg185/chapter/recommendations\" target=\"_blank\" rel=\"noopener noreferrer\">medicine to control the episode</a>. Severe symptoms, or difficulty providing safe care, <a href=\"https://www.nhs.uk/mental-health/conditions/bipolar-disorder/\" target=\"_blank\" rel=\"noopener noreferrer\">may require hospital treatment</a>; the medical team assesses that need. The plan for an episode may differ from the longer-term treatment plan. <a href=\"https://www.nimh.nih.gov/health/publications/bipolar-disorder\" target=\"_blank\" rel=\"noopener noreferrer\">Psychological support, education and follow-up</a> can help with continuing care alongside medicine when needed.</p>\n<p><a href=\"https://www.nhs.uk/mental-health/conditions/bipolar-disorder/\" target=\"_blank\" rel=\"noopener noreferrer\">Do not start a medicine, change its dose or stop it</a> on your own, even after sleep and activity improve. Ask the doctor about <a href=\"https://www.nimh.nih.gov/health/publications/bipolar-disorder\" target=\"_blank\" rel=\"noopener noreferrer\">expected benefits, side effects and monitoring</a>. Tell them about <a href=\"https://www.nice.org.uk/guidance/cg185/chapter/recommendations\" target=\"_blank\" rel=\"noopener noreferrer\">pregnancy or plans for pregnancy</a> when treatment is being chosen. If an agreed plan already contains medicine instructions, follow the doctor's specific directions. Having a plan does not authorize a family member to invent new doses.</p>\n<h2 id=\"article-section-after-improvement-agree-on-the-next-step\" data-toc-heading tabindex=\"-1\"><span id=\"after-improvement-agree-on-the-next-step-7\" aria-hidden=\"true\"></span>After improvement: agree on the next step</h2>\n<p>Improved sleep and calmer activity are an opportunity to review what happened and make a plan with the team. They are not a reason to end follow-up yourself. Treatment that controls an episode may differ from treatment that <a href=\"https://www.nimh.nih.gov/health/publications/bipolar-disorder\" target=\"_blank\" rel=\"noopener noreferrer\">reduces the chance of another one</a>. Ask when the next review will be and how medicine benefits, side effects and <a href=\"https://www.nice.org.uk/guidance/cg185/chapter/recommendations\" target=\"_blank\" rel=\"noopener noreferrer\">physical health will be monitored</a>.</p>\n<p>Agree on a written plan covering the person's <a href=\"https://www.nice.org.uk/guidance/cg185/chapter/recommendations\" target=\"_blank\" rel=\"noopener noreferrer\">early warning signs</a>, what to do if they appear, whom to contact during and outside working hours, and an alternative if that contact cannot be reached. A supporter can take part with the person's agreement and to the extent they want. <a href=\"https://www.nhs.uk/mental-health/conditions/bipolar-disorder/\" target=\"_blank\" rel=\"noopener noreferrer\">Regular sleep and routines</a>, <a href=\"https://www.nimh.nih.gov/health/publications/bipolar-disorder\" target=\"_blank\" rel=\"noopener noreferrer\">avoiding alcohol and drugs</a>, and practical help with following treatment can support care. They cannot guarantee that every episode will be prevented.</p>\n"}],"inlineCtaSignatures":[],"_experienceAliases":{"v":1,"fields":["html","bodyHtml"],"faqs":[0,1,2,3,4]}},"createdAt":"2024-01-11T21:00:00.000Z","updatedAt":"2026-10-30T20:06:35.982Z","disorderGroups":[{"id":"1e82772d-a1a7-4d29-b475-be9d6b67ae02","slug":"common-mental-issues","arName":"اضطرابات نفسية شائعة","enName":"Common Mental Issues"}],"reviewer":{"arFullName":"فريق تطمين","enFullName":"Tatmeen 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