Mania

Kshirabdhi Tanaya
MHN Tutor,SUM nursing college,SOA DTU ,BBSR

1. MANIA PRESENTED BY: Kshirabdhi Tanaya MHN Tutor,SUM nursing college,SOA DTU ,BBSR

2. Classification of mood disorders:- F30 - Manic Episode F31 - Bipolar Affective Disorder F32 - Depressive Episode F33 - Recurrent Depressive Disorder F34 - Persistent Mood Disorder ( cyclothymia and dysthymia ) F38 – other mood disorders F39 – unspecified mood disorder

3. MANIA Mania refers to a n alteration in mood that is expressed by over-activity, mood change ( feelings of elation or irritability ) & self important ideas. This disorder occurs in episodes lasting usually 3-4 months , followed by complete recovery.

4. CLASSIFICATION OF MANIA(ICD10):- F30.0 -Hypomania F30.1-Mania without psychotic symptoms F30.2-Mania with psychotic symptoms F30.8- Other manic episodes F30.9- Manic episode unspecified

5. Features of mania Classical triad symptoms include A) Elated, Unstable Mood B)Increased pressure of speech C)Increased motor activity

6. Stages of mania: Stage-I : Hypomania Stage-2: Acute mania Stage-3: Delirious mania

7. HYPOMANIA Moderate elation of mood Intolerant to criticism Socially aggressive, argumentative Reduced sleep time Not severe to cause significant impairment in social or occupational functioning Psychotic features are usually absent but may be grandiosity present

8. ACUTE MANIA Euphoria or elation of mood Flight of ideas , clang association Violent motor excitement Tears clothes into small ribbon and decorates himself/herself Raised sexual interest with poor impulse control High energy level

9. DELIRIOUS MANIA Very rarely occurs, consciousness with confusion or disorientation Incoherent speech , Word salad Extreme Labile mood Delusion of grandiosity , persecution , religiousity Auditory or visual hallucination Increased psychomotor activity Risk of harming to self or others Totally cut of from external world If untreated Death may occur

10. Aspects Hypomania Mania Duration of symptoms 4days >1week Psychotic features May or may not present May or may not present Social & occupational dysfunction Absent Present Insight into illness Present Absent

11. ETIOLOGY 1-Neurotransmitter and structural hypothesis:- E xcessive levels of nor epinephrine and dopamine. Low levels of serotonin. 2-Genetic consideration :- Monozygotic twins have a higher rate of incidence than normal siblings.First degree relative :5-10% chance. 3-Psychodynamic theory:- Faulty family dynamics during early life are responsible for manic behaviours in later life.(like-loss of parent,child parent relationship)

12. CLINICAL FEATURES :- The following features which should last for at least one week. 1. elevated mood in mania has 4 stages depending on the severity of manic episodes. Euphoria(stage-I):- Increased sense of psychological well-being & happiness not in keeping with ongoing events. Elation(stage-II):- Moderate elevation of mood with increased psychomotor activity. Exaltation(stage-III):- intense elevation of mood with delusions of grandeur. Ecstasy(stage-IV):- Severe elevation of mood, intense sense of rapture or blissfulness seen in stuporous mania

13. STUPOROUS MANIA

14. 2 - Psychomotor activity :- -There is an increased psychomotor activity ranging from over activeness &restlessness to manic excitement. -The person involves in ceaseless activity. 3 - Speech & thought :- Flight of ideas - Rapid shifts from one topic to another. Pressure of speech :-Speech is forceful, strong & difficult to interrupt . Uses playful rhyming , joking , teasing & speaks loudly. Delusions of grandeur Delusions of persecution Distractibility

15. OTHER FEATURES :- Increased sociabilities Impulsive behaviour Disinhibition Hypersexual behaviour Poor judgment Decreased sleep Absent insight Decreased attention& concentration Decreased food intake High risk activities(reckless activity , foolish business investments)

16. TREATMENT :- 1. Pharmacotherapy - Lithium:900-2100mg/day Carbamazepine:600-1800mg/day Sodium valproate :600-2600mg/day Other drugs:clonazepam,calcium channel blockers 2.Electroconvulsive therapy(ECT)- ECT can also be used for acute manic excitement,if not adequately responding to anti-psychotics & lithium. 3.Psychosocial treatment:- Usually Family & Marital therapy is used.

17. NURSING MANAGEMENT FOR MANIA:- Nursing assessment:- Assessing the severity of the disorder. Assessing the patient’s resources & judging the effects of patient’s behaviour on other people. Collect all relevant data from the patient as well as from his relatives.

18. Nursing Diagnosis:- High risk for injury R/T extreme hyperactivity& impulsive behaviour as evidenced by lack of control over purposeless & potentially injurious movements . High risk for violence; self directed or directed at others related to manic excitement as evidenced by delusional thinking& hallucinations . Altered nutrition ,less than body requirements R/t refusal or inability to sit still long enough to eat, evidenced by weight loss,poor muscle tone. Impaired social interaction R/T narcissistic behaviour,evidenced by inability to develop satisfying relationships & manipulation of others for own desires. Self –esteem disturbance R/T unmet dependency needs ,lack of positive feedback, unrealistic self –expectations.