As with suicidal thinking and behavior, expressions or actions indicating that someone intends to do physical harm to another person represents an emergency. It’s important not to minimize or discount aggressive threats or overt actions: “He doesn’t mean it.” “She wouldn’t hurt a fly.”
Part of the difficulty for family and friends is that when he’s manic or in a mixed episode the person we know is very different. His ability to control his behavior can be severely impaired, even more so if he’s actively using drugs or alcohol. It’s a bitter lesson to learn that the time to act is before somebody gets hurt.
Those at the greatest risk for being harmed by a person in a mixed or manic state are those closest to him, such as family, parents and spouses in particular, and friends.