Most inpatient clinicians have little problem recognizing classic mania, as it presents with a familiar complex of signs and symptoms: elation, expansiveness, rapid speech with flight of ideas, grandiosity, spending sprees, and hypersexuality [1]. A manic episode can usually be differentiated from a psychotic break in schizophrenia in that many manic patients will exhibit people-seeking behavior as well as an overall quality of overactivation (Table 3.1). However, this pattern of acute euphoric mania may be less common than in the past. Increasingly, patients require hospitalization for manic symptoms combined with irritability, suicidal preoccupations, and dysphoric mood (in the older literature, in fact, this syndrome was termed “dysphoric mania”). This is the so-called mixed state, which – depending on one’s definition – 40% of bipolar patients will experience at some point in their clinical course [2].