Introduction. Few data exist to estimate the burden of manic episodes on healthcare systems or the therapeutic strategies used. This study was undertaken to identify treatment strategies chosen, and to assess the “real-world” direct medical cost of treating manic episodes necessitating hospitalisation. Method. Case record data were reviewed during the three months following hospitalisation for a manic episode in France. Healthcare resource utilisation was assessed, direct costs calculated, and treatment strategies analysed. A total of 137 patients files (51.8% female; mean age: 35 years) were reviewed and data on 185 hospitalisations collected. Results. The mean duration of hospitalisation was 47 days over the study period. The most common treatment strategy during hospitalisation was the combination of a mood stabiliser with a neuroleptic drug (64% of patients at day 30). Anticonvulsants including valproate (39%) and carbamazepine (20%) were more common than lithium (42%). Treatment received during hospitalisation was generally continued after discharge, with a trend away from neuroleptics and towards mood stabilisers. The mean direct costs incurred over the three-month study period was Euro 22 297, with 98.6% of those costs due to hospitalisation. Conclusion. These results confirm that the costs of treating a manic episode are high, and overwhelmingly due to the cost of hospitalisation.