Sleep disturbances after an ultra-trail endurance race: a field study.

Makkah is one of the most spiritually significant locations for Muslims and receives millions of pilgrims annually during Hajj and Umrah []. Religious pilgrimages such as Umrah represent profound spiritual and emotional experiences that often involve physical exhaustion, sleep deprivation, disruption of circadian rhythms, crowd-related stress, and heightened spiritual arousal. Although generally beneficial, such environments may precipitate acute psychiatric decompensation in susceptible individuals []. Several place- and culture-associated psychiatric syndromes have been described, including Jerusalem syndrome, Hajj-related psychosis, Stendhal syndrome, and Paris syndrome [-]. To the best of our knowledge, however, this is the first published report describing a late-onset manic episode occurring during Umrah in Makkah. A manic episode is characterized by a sustained period of abnormally elevated, expansive, or irritable mood and increased goal-directed activity or energy, accompanied by features such as inflated self-esteem or grandiosity, reduced need for sleep, pressured speech, flight of ideas, distractibility, and excessive involvement in activities with high potential for harmful consequences []. Untreated, manic episodes typically persist for several months. Pressured speech and increased verbal output are the most common features (approximately 90-98%), followed by psychomotor activation (~87%) and reduced sleep need (~81%); hypersexuality (~57%) and excessive spending (~55%) are less common but characteristic. Psychotic features such as grandiose or persecutory delusions may occur in more severe episodes lasting at least one week or requiring hospitalization [].