Mania

MANIA - NURSING

1. MOOD DISORDERS

2. MOOD DISORDERS : Mood/affective Disorders are characterised by a disturbance of mood, accompanied by a full or partial manic or depressive syndrome, which is not due to any other physical and mental disorder.

3. CLASSIFICATION F 30 : MANIC EPISODE F 31: BIPOLAR AFFECTIVE DISORDER F32 : DEPRESSIVE EPISODE F33 : RECURRENT DEPRESSIVE DISORDER F34: PERSISTENT MOOD DISORDER F38 : OTHER MOOD DISORDERS F39 : UNSPECIFIED MOOD DISORDERS

4. DEFINITION Manic behaviour is characterised by “an abnormally and persistently elevated, expansive or irritable mood” - APA

5. Mania refers to a syndrome in which the central features are over activity, mood change and self important ideas.

6. ICD-10 CLASSIFICATION F30-39- mood ( affective disorder) 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

7. PREDISPOSING FACTORS Biological Theories Genetics : Twin study Family study Biochemical influences : biogenic amines ( n.e,sero , dop .) Physiological influences: brain lesions and medication side effects Electrolytes: Psychosocial Theories The Transactional Model

8. ETIOLOGY Neurotransmitter and structural hypothesis Genetic consideration Psychodynamic theories : faulty family dynamics or denial of depression

9. CLASSIFICATION OF MANIA ACCORDING TO APA 2000 Hypomania Acute mania Delirious Mania Delusional mania Secondary mania Chronic mania

10. HYPOMANIA Mood : cheerful and expansive Cognition and perception : Perceptions of the self are exalted, ideas of great worth and ability, easily disturbed , flight of ideas Activity and behaviour : increased motor activity, extroverted and sociable, talk and laugh a lot , increased libido , sometime show in appropriate behaviours

11. ACUTE MANIA Symptoms of acute mania may be a progression in intensification of those experienced in hypo mania euphoria and elation the mood is always subject to frequent variation , easily changing to irritability and anger Rapid thinking , flight of ideas, pressured speech Paranoid and grandiose delusions illusion and hallucination are common. motor activity is excessive, sexual interest is increased, excessively spend money, Hygiene and grooming may be neglected

12. DELIRIOUS MANIA It is a grave form of the disorder characterised by severe clouding of consciousness and representing an intensification of the symptoms associated with acute mania. The mood of this person is labile clouding of consciousness, confusion, disorientation and sometimes stupor. religiosity, delusions of grandeur or persecution, auditory or visual hallucination

13. agitated purposeless movements injury to others or self, and eventually death could occur

14. DELUSIONAL MANIA is characterised by less excitement, more persistent grandiose delusions and even occasional hallucinations.

15. SECONDARY MANIA is due to drugs, thyrotoxicosis, acute and chronic organic mental syndrome, tumors , epilepsy, multiple sclerosis, encephalitis etc.

16. CHRONIC MANIA lose their euphoria, become irritable and resentful and acquire a paranoid like attitude.

17. STAGES OF ELEVATED MOOD EUPHORIA: increased sense of psychological wellbeing and happiness not in keeping with ongoing events ELATION: moderate elevation of mood with increased psychomotor activity EXALTATION: Intense elevation of mood with delusion of grandeur. ECSTASY: severe elevation of mood, intense sense of rapture or blissfulness

18. PSYCHOPATHOLOGY OF MANIA Manic states shows lack of inhibition, apparent quickness of psychological reaction, distractibility and flight of ideas. Elation of mood is accompanied by a feeling of general well- being, which in the manic state is manifested as lack of insight.

19. CLINICAL FEATURES Elevated mood : 4 stages Expansive mood: unceasing and unselective Irritable mood Psychomotor activity Speech and thought Attention

20. SPEECH AND THOUGHT Pressure of speech Flight of ideas Delusion of grandeur Delusion of persecution Distractibility

21. OTHER FEATURES Increased sociability Impulsive behavior Disinhibition Hypersexual and promiscuous behavior Poor judgment High risk activities Decreased need for sleep Absent insight

22. DIAGNOSIS ICD 10 diagnostic criteria Young mania rating scale( RC Young 1978) Based on signs and symptoms

23. TREATMENT Pharmacotherapy Electroconvulsive therapy Psychosocial treatment

24. PHARMACOTHERAPY Lithium – 900-1200 mg/ day Carbamazepine - 600-1800 mg/day Sodium valproate - 600-2600 mg/day

25. NURSING MANAGEMENT  

26. ASSESSMENT

27. NURSING DIAGNOSIS High risk for injury related extreme hyperactivity and impulsive behavior as evidenced by lack of control over purposeless and potentially injurious movements\ High risk for violence; self directed or directed at others related to manic excitement , delusional thinking and hallucinations.

28. Altered nutrition, less than body requirements related to inability to sit still long enough to eat, as evidenced by weight loss. Impaired social interaction related to egocentric and narcissistic behavior as evidenced by inability to make satisfying relationships Self esteem disturbance related to unmet dependency needs and lack of positive feedback Altered family processes related to euphoric mood and grandiose ideas.

29. Thank you