Manic episodes can be caused by various factors. Most of the time they occur in people with bipolar disorder, which is a devastating psychiatric condition characterized by alternating manias and depressions. But manias also can be caused by drugs of abuse, medications, and more rarely, by medical problems such as hormone imbalances, seizures or brain tumors. Even in people with bipolar disorder, manias don't come out of thin air, but are usually sparked by stress and its evil attendant, sleep loss. This appears to have been the most likely causative factor in the case of Mr. Russell.