Signs and symptoms
A manic episode is defined in the American Psychiatric Associations diagnostic manual as a "distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration, if hospitalization is necessary)," where the mood is not caused by drugs/medication or a non-mental medical illness (e.g., hyperthyroidism), and: (a) is causing obvious difficulties at work or in social relationships and activities, or (b) requires admission to hospital to protect the person or others, or (c) the person has psychosis.To be classified as a manic episode, while the disturbed mood and an increase in goal-directed activity or energy is present, at least three (or four, if only irritability is present) of the following must have been consistently present:

Inflated self-esteem or grandiosity. Decreased need for sleep (e.g., feels rested after 3 hours of sleep). More talkative than usual, or acts pressured to keep talking. Flights of ideas or subjective experience that thoughts are racing. Increase in goal-directed activity, or psychomotor acceleration. Distractibility (too easily drawn to unimportant or irrelevant external stimuli). Excessive involvement in activities with a high likelihood of painful consequences. (e.g., extravagant shopping, improbable commercial schemes, hypersexuality).Though the activities one participates in while in a manic state are not always negative, those with the potential to have negative outcomes are far more likely.
Low serum ferritin (see below)
Low serum iron
High TIBC (total iron binding capacity), although this can be elevated in cases of anemia of chronic inflammation. It is possible that the fecal occult blood test might be positive, if iron deficiency is the result of gastrointestinal bleeding; although the sensitivity of the test may mean that in some cases it will be negative even with enteral blood loss.As always, laboratory values have to be interpreted with the labs reference values in mind and considering all aspects of the individual clinical situation. Serum ferritin can be elevated in inflammatory conditions; so a normal serum ferritin may not always exclude iron deficiency, and the utility is improved by taking a concurrent C-reactive protein (CRP). The level of serum ferritin that is viewed as "high" depends on the condition. For example, in inflammatory bowel disease the threshold is 100, where as in chronic heart failure (CHF) the levels are 200. Treatment
Before commencing treatment, there should be definitive diagnosis of the underlying cause for iron deficiency. This is particularly the case in older patients, who are most susceptible to colorectal cancer and the gastrointestinal bleeding it often causes. In adults, 60% of patients with iron-deficiency anemia may have underlying gastrointestinal disorders leading to chronic blood loss. It is likely that the cause of the iron deficiency will need treatment as well. Upon diagnosis, the condition can be treated with iron supplements. The choice of supplement will depend upon both the severity of the condition, the required speed of improvement (e.g.