The course of mania is capricious. In a general way it may be represented by a curve which at first ascends, then remains horizontal for some length of time, and finally gradually descends. But this curve, far from being regular, is interrupted by oscillations indicating either sudden exacerbations or attenuations of the symptoms, or even remissions the duration of which may vary from several minutes to several days.

The progress of the attack may also be interrupted by phenomena of depression which are sometimes quite marked, though very brief in duration. As we shall see later on, this fact contributes to the proof of the homogeneity of manic-depressive phychoses.

The duration of the attack, whatever its form, cannot be predicted. Some attacks terminate in a few hours, deserving a place among the transitory psychoses, others continue for several years.

The prognosis, leaving out the cases in which life is endangered by the intensity of the excitement or by some complication, is favorable as to termination of the attack. Recovery with restitutio ad integrum is the rule.

In some cases recovery has been observed to occur following some acute somatic disease.

Treatment

Rest in bed in these cases performs miracles. It is well accepted and easily instituted. Unfortunately it is not possible at present to say whether or not it actually shortens the duration of the attack.