For all of these, I assume it's a lack of awareness of the manic state. By it's definition, the individual is going to be less cognizant/aware of their surround

For all of these, I assume it's a lack of awareness of the manic state. By it's definition, the individual is going to be less cognizant/aware of their surroundings. Likely they don't have the best memory of these lapses either. I doubt in each of these cases people are making the rational choice to ditch the meds in favor of a state of "pure madness". Instead they probably get fed up with side effects, and decide that "this time won't be as bad", or "I'll just stop taking them for a day".