Mania .....

mania ..

1. Mania PRESENTED BY :- PATEL PRITESH D M.Sc.Nursing in Mental Health

2. Introduction :- Mania is the mood of an abnormally elevated arousal energy level. Mania is a state of extreme physical and emotional elation. The word is derives from the Greek ( mania ) meaning "madness, frenzy” .

3. Definition :- MOOD DISORDERS:- Mood disorders are characterized by a disturbance of mood , accompanied by a full or partial manic or depressive syndrome , which is not due to any other physical or mental disorder . Mania is an alteration in mood that is characterized by extreme happiness , extreme irritability, hyperactivity, little need for sleep and /or racing thoughts which my lead to rapid, speech.

4. Etiology :- 1 Biological theories :- Genetics :- Genetic factors are very important in predisposing an individual to mood disorders. The lifetime risk for the first-degree relatives of patients with bipolar mood disorderis 25% and of normal controls is 7%.The lifetimerisk for the children of one parent with mood disorder is 27%and of both parents with mooddisorder is 74% . The concordance rate for monozygotic twins is 65% ...

5. Con .. Biochemical Influences ( neurotransmitter abnormalities or imbalances ) Biochemical theories A deficiency of norepinephrine and serotonin has been found in depressed patients and they are elevated in mania.

6. Con … 2 . Psychosocial theories :- Both biological and psychosocial factors ( such environmental stressors ) may cause mania .

7. Con… 3 . A person may experience mania as a result of a range of factors, including :- …. Stressful events Genetic factors Biochemical factors (neurotransmitter abnormalities or imbalances) Seasonal influences Bipolar affective disorder (BPAD).

8. Con .. 4 . OTHERS:- Brain injury Brain tumor Dementia High levels of stress Medication side effcet Sleep deprivation Stroke Trauma or abuse

9. Classification :-  Classification According to the symptoms Mania can be classify into 3, these are. 1. Hypomania 2. Acute mania 3. Delirious mania

10. Con … HYPOMANIA :- At this stage the disturbance is not sufficiently severe to cause marked impairment in social or occupational functioning and no require hospitalization . Mood : - cheerful and expensive . Unfulfilled desires will bring irritability . Nature is volatile  .

11. Con … Cognition and Perception :- Ideas of great worth and ability . Flight of ideas . Easily distracted . Goal directed activities are difficult . Activity and behavior : - Increases motor activity .. Talk and laugh too much, usually very loudly and often inappropriately . Increased libido . Anorexia and weight loss in some cases .

12. Con … ACUTE MANIA :- Most individual experience marked impairment in functioning and require hospitalization Mood :- Euphoria and elation Mood is variant easily changing to irritability and anger or even sadness and crying 

13. Con …., Cognition and Perception:- Flight of ideas Accelerated pressured speech which abruptly changes from topic to topic Speech is disorganized Hallucinations and delusions(usually paranoid and grandiose) Attention can be diverted even by small stimuli 

14. Con...... Activity and behavior : - Excessive psychomotor activity  Incresed sexual interest Poor impulse control manipulate others to cary out their wishes, and if things go wrong very skillfully project responsibility for the failure into others . Extremely energetic 

15. Con …. May go for many days without sleep and still don’t feel tired . Neglected hygiene and grooming . Dress may be disorgnized , . Excessive makeup or jwellery  .

16. Con … DELIRIOUS MANIA :- Severe form of mania with clouding of consciousness and intensification of the symptoms associated with acute mania Mood: - Labile May show Feelings of despair. Irritable or indifferent to the environment Panic anxiety may be evident 

17. Con …   Cognition and perception: Clouding of consciousness Confusion, disorientation and sometimes stupor Religiosity delusions of grandeur or persecution Auditory or visual hallucinations

18. Con …. Activity and Behavior : - Psychomotor activity is frenzied and characterized by agitated, purposeless movements Safety of these individuals is at stake unless this activity is reduce . injury to self or others and eventually death could occur without intervention

19. Signs and symptoms Elevated, expansive or irritable Mood:- Elevated mood in mania has four stages depending on the severity of manic episodes; EUPHORIA (Stage-I): Increased sense of psychological well-being and happiness not in keeping with on going events. ELATION (Stage-II): Moderate elevation of mood with increased psychomotor activity EXALTATION (Stage-III): Intense elevation of mood with delusion of grandeur.

20. Con .. ECSTASY(Stage-IV): severe elevation of mood, intense sense of rapture or blissfulness. Psychomotor activity:- There is an increased psychomotor activity ranging from over activeness and restlessness to manic excitement. These activities are goal-oriented and based on external environment .

21. Con .. Speech and thought:- Flight of ideas : Thoughts are racing in mind, rapid shifts from one to another . Pressure of speech: Speech is forceful, strong and difficult to interrupt. Uses playful language with punning, rhyming, joking, teasing and speaks loudly. Clang association: These are ideas that are related only by similar or rhyming sounds rather than actual meaning. Delusions of grandeur Delusions of perception Distractibility

22. Con … Other features: Increased sociabilities . Impulsive behavior. Hypersexual and promiscuous behavior Poor judgement . High-risk activities .

23. Con :- Dressed up in gaudy and flamboyant clothes although in severe mania there may be poor self-care Decreased need for sleep(< 3 hour) Decreased food intake due to over-activity Decreased attention and concentration Absent insight

24. DIAGNOSIS:- Psychological tests such as young mania Rating Scale ICD 10 diagnostic criteria Based on sign and symptoms

25. TREATMENT MODALITIES:- PHARMACOTHERAPY: Lithium: 900-2100 mg/day Carbamazepine : 600-1800 mg/day Sodium valproate : 600-2600 mg/day Lamotrigine : 25-200 mg/day Other drugs: clonazepam , calcium, calcium channel blockers, etc.   Electroconvulsive Therapy(ECT) ECT can also can be used for acute manic excitement if not adequately responding to antipsychotic and lithium.

26. Con … Psychosocial Treatment Family and marital therapy is used to decrease intrafamilial and interpersonal difficulties and to reduce or modify stressors. The main purpose is to ensure continuity of treatment and adequate drug compliance. Family therapy Cognitive therapy Group therapy Individual psychotherapy

27. NURSING MANAGEMENT:- Nursing assessment :- Obtain general history of the client including social ,educational , occupational ,economic status ,family , past and present history etc . Perform mental status examination to assess the mental functioning of the client . Perform physical examination to assess any physical illness. Observe for environmental sarroundings ,safety etc .

28. Con … NURSING DIAGNOSIS :- High risk for injury related extreme hyperactivity and impulsive behavior as evidenced by lack of control over purposeless and potentially injurious movements ….., Interventions: Keep environmental stimuli to a minimum; keep lighting and noise level low. Remove hazardous objects and substances, caution the patient when there is possibility of an accident. Assist patient to engage in activities, such as writing, drawing and other physical exercise. Stay with patient as hyperactivity increases. Administer medication as prescribed by physician.

29. Con … High risk for violence; self-directed or directed at others related to manic excitement, delusional thinking and hallucinations. Interventions: Never see a potentially violent person alone . Keep a comfortable distance away from the patient . Be prepared to move, violent patient can strike out suddenly . Maintain a clear exit route for both the staff and patient . Be sure that the patient has no weapons in his possession before approaching him . Keep something like pillow, mattress or blanket wrapped around . Distract the patient momentarily to remove the weapon . Give prescribed antipsychotic medications .

30. Con … Altered nutrition, less than body requirements related to inability to sit still long enough to eat, as evidenced by weight loss . Interventions:- Provide high protein diet, high caloric, nutritious finger food and drinks that can be consumed on the run Find out patient’s like dislike and provide favorite food Provide 6-8 glasses of fluid per day. Have juice and snacks on unit at all times Maintain accurate record of intake, output and calorie count. Weigh patient regularly Supplement diet with vitamins and minerals Walk and sit with patient while he eats

31. Con…. Impaired social interaction related to egocentric and narcissistic behavior as evidenced by inability to make satisfying relationships Interventions:- Recognize that manipulate behavior helps to decrease feelings of insecurity by increasing feelings of power and control Set limits on manipulate behavior. Explain the consequences if limits are violated. Ignore attempts by patients to argue or bargain his way-out of the limit setting. Give positive reinforcement for non-manipulative behaviors .

32. Thank you pritesh d patel , mhn . ppt