case presentation on mania presented by ajay mor

case presntation

1. AJAY Psychiatric c.p

2. MANIA case presentation

3. Presenting complaints A 23 yrs unmarried right handed Marathi speaking , Hindu religious male ganesh sankpal , educated B.E ,coming from chinchwad pune with the complaints of Irritability Wandering behaviour Muttering to self Suspiciousness Loudly speak Auditory hallucination Grandiosity Loss of memory Increased psychomotor activity Flight of ideas

4. HISTORY OF ILLNESS According to informant pt is k/c/o/ psychiatric illness since 4 years was remain untreated till now Patient was shown psychiatric illness in past then he was admitted in hospital 3 years ago but absconded before treatment start since then patient behaviour fluctuatively (having unpredictable ups down )and now as behaviour become unmanageble so he brought to SGH

5. HISTORY OF ILLNESS 4 yrs back his symptoms started within duration of B.E F Y exam period and he was noticed anxious during exam period & he was also noticed to be talking to to self with gesturing of hand when asked him ,then he said its related to study He was noticed above symptoms with running on road without any reason ,sudden stop going temple and said ringing bell in my ears All this behaviour increased and told repeatedly about his behaviour and parent brought to SGH No family history of psychiatric illness

6. DEFINATION OF MANIA Mania refers to a syndrome in which the central features are over activity, mood change (which may be towards elation OR irritability ) and self important ideas

7. Classification of mania (ICD 10) F30 MANIC EPISODE F30.0 HYPOMANIA F30.1 MANIA WITHOUT PSYCHOTIC SYMPTOMS F30.2 MANIA WITH PSYCHOTIC SYMPTOMS F30.8 OTHER MANIC EPISODE F30.9 MANIC EPISODE UNSPECIFIED

8. ETIOLOGY Neurotransmitter and structural hypothesis Excessive level of nor epinephrine and dopamine Imbalance between cholinergic and nor adrenergic system and deficiency of serotonin

9. Genetic consideration Monozygotic (identical) twines have a higher rate of incident than normal siblings and other close relatives Common among the family members of bipolar patient First degree relatives 5-10 % chance Identical twins with bipolar disorders about 40-70% chance

10. Psychodynamic theory Developmental theorists have hypothesized that faulty family dynamics during during early life are responsible for manic behaviors in later life Manic episode as a defense against or denial of depression

11. Clinical features In book Elevated ,Expansive OR irritable mood 1)Euphoria 2)Elation 3)Exaltation 4) Ecstasy In patient Elation and irritable mood 1) irritability 2)wandering behaviour

12. cont In book Psychomotor activity increased Speech and thought Flight of ideas Pressure of speech Delusion of grandiosity Delusion of persecution Distractibility In patient Psychomotor activity increased Speech and thought Flight of ideas Delusion of grandiosity Big talk Speak loudly

13. cont In book Other features increased sociability Impulsive behaviour Poor judgment Decreased sleep Absence of insight Decreased attention and concentration In patient Other features Poor judgment Decreased sleep Loss of memory (amnesia)

14. Objective sings and subjective symptoms of manic patient Objective sings Disturbance in speech Rapid speech Loud ,pressured pressure Easily distracted Over activity Mood lability Weight change Subjective symptoms Feeling of joy Rapid mood swings Sleep disturbance Delusion and hallucination