Modalities and outcome of treatment in in-patients with acute mania treated in a typical psychiatric department of a university hospital were analysed retrospectively. In particular, potential differences between treatments performed in the 1970s and in the 1980s were evaluated. The analysis refered to 108 consecutive admissions (ICD 9 296.0/2.96.2), 44.4% of the patients received a neuroleptic monotherapy, 40.7%, neuroleptics combined with lithium, 8.3%, neuroleptics combined with carbamazepine, and 2.8%, lithium only. In the 1980s a decrease in the frequency of neuroleptic monotherapy and an increased proportion of combined treatments with lithium or carbamazepine were observed. Within one decade the remission rates increased from 58% to 72%, with significantly decreased duration of hospitalization and a lower incidence of depressive syndromes. The time needed until remission or discharge was significantly shorter after combined treatment with lithium salts than after neuroleptic monotherapy. It is discussed critically that combination with lithium salts for the treatment of acute manias have not yet been sufficiently accepted in psychiatric hospitals.