Bipolar disorder (Mania)

Bipolar disorder is a mental health condition that can cause you to experience episodes of extreme highs and extreme lows. These episodes are called mania and depression.

1. MANIA
Presented by MR KALYANKUMAR Msc(N)

2. Introduction
Mooddisordersalsocalledaffectivedisorders,are
pervasivealterationsinemotionsthataremanifested
bydepression,maniaorboth.Theyinterferewitha
person’slife,plaguinghimorherwithdrasticandlong-
termsadness,agitationorelation.Accompanyingself-
doubt,guiltandanger,alterlifeactivities.

3. Definition
Maniaisadistinctperiodduringwhichmoodisabnormally
andpersistentlyelevated,expansiveorirritable.
(or)
Maniaisanalterationinmoodthatischaracterizedby
extremehappiness,extremeirritabilityandhyperactivity.

4. Etiology
Biologicaltheories:
Genetics:Firstdegreerelatives
Monozygotictwins
Biochemicalinfluences:
ExcessofNorepinephrineanddopamine
Lowserotoninlevel.
Physiological:
Rightsidedlesionsinlimbicsystem,basalgangliaand
thalamus
Enlargedventriclesandsubcorticalwhitematter.

5. Psychodynamictheories:
Faultyfamilydynamicsduringearlylifeare
responsibleforManicbehavioursinalaterlife.

6. Clinical feature
Elevated
mood
Expansive
mood
Irritable
mood

7. Elevated mood has four stages depending on
severity of Manic episodes:
Euphoria:Increasedsenseofpsychological
wellbeingandhappinessnotinkeepingwiththe
ongoingevents.
Elation:ModerateelevationofMoodwith
increasedpsychomotoractivity.
Exaltation:Intenseelevationofmoodwithdelusions
ofGrandeur.
Ecstasy:Severeelevationofmood,intensesenseof
blissfulness.

8. Expansivemoodisunceasingandunselective
enthusiasmforinteractingwithpeopleand
surroundingenvironment.
Irritablemoodmaybepredominant,especially
whenthepersonisstoppedfromdoingwhat
he/shewants.

9. Speechandthought:
Flightofideas:Rapidshiftfromonetopictoanother.
Pressureofspeech:SpeechisForceful,strongand
difficulttointerrupt.UsesPlayfullanguagewith
rhyming,jokingandspeakloudly.
DelusionsofGrandeur
Delusionsofpersecution.

10. Otherfeatures:
Poorjudgement
Highriskactivities
Decreasedtheattentionandconcentration
AbsentInsight
Impulsivebehaviour
Decreasedneedforsleep
Decreasedfoodintakeduetooveractivities.

11. Hypomania
HypomaniaisalesserdegreeofMania.Thereisa
persistentmildelevationofmoodandincreased
senseofpsychologicalwell-beingandhappinessnot
inkeepingwithongoingevents.
ConcentrationandattentionMaybeimpaired.

12. Diagnosis
PsychologicaltestssuchasyoungManiarating
scale
ICD10Diagnosticcriteria.

13. Treatment modalities
Moodstabilizers:
Lithium900-2100mg/day
Carbamazepine600-1800mg/day
Sodiumvalproate600-2600mg/day
Calciumchannelblockers:
Verapamil40-300mg
Antipsychotics:
Olanzapine10-20mg
Chlorpromazine75-200mg

14. Electroconvulsivetherapy
Psychosocialtreatment:Familyandmarital
therapyisusedtodecreaseinterpersonal
difficulties
Cognitivetherapy
Individualpsychotherapy
GroupTherapy

15. Nursing management
NursingassessmentoftheManicpatientshould
includeassessingtheseverityofthedisorder.Asfar
aspossibleallrelevantdatashouldbecollected
fromthepatientaswellasfromhisrelatives,
becausethepatientmaynotalwaysrecognisedthe
extentofhisabnormalbehaviour.

16. Duringassessmentthenurseshouldincludemood
andaffect,thinkingandperceptualability,sleep
disturbance,changesinenergyleveland
characterofspeechpatterns.Assessforsleeping
andeatingpatterns.

17. Summary
Conclusion