MANIA Presenter – Neha Shrivastava

DefinitionAn abnormally elevated mood state characterized by such symptoms as• Inappropriate elation,• Increased irritability• Severe insomnia,• Grandiose notions,• Increased speed or volume of speech• Disconnected & racing thoughts• Increased sexual activity level• Poor judgment and appropriate

social behavior

HYPOMANIA

• Lesser degree of mania• Mild elevation of mood• Increased sense of

psychological well being and happiness , not keeping with ongoing events.

PREDISPOSING FACTORS

• Biological theories

• Psychosocial theories

• The transactional model

BIOLOGICAL THEORIES

• Genetics• Biochemical influencesBiogenic amineselectrolytes

• Physiological influencesBrain lesionsMedication side effects

PSYCHOSOCIAL THEORIES

• Importance declined• Mania is viewed as disease of

brain with biological etiologies

TRANSACTIONAL MODELPRECIPITATING FACTORS

FAMILY HISTORY OF MANIA

PAST EPISODE OF MANIA

POSSIBLE ELECROLYTE IMBALANCEPOSSIBLE CEREBRAL LESIONS

POSSIBLE MEDICATION SIDE EFFECTS

COGNITIVE APPRAISALPRIMARY-THREAT TO LOSS OF SELF ESTEEM

SECONDARY-INABILITY TO USE COPING MECHANISMS

QUALITY OF RESPONSE

ADAPTIVE MALADAPTIVEUNCOMPLICATED DENIAL OF DEPRESSIONBEREAVEMENT SYMPTOMS OF MANIA

CLINICAL FEATURES

The underlined characteristics are:-• Elevated mood• An increase in quantity & speed of

physical & mental activity

AFFECTIVE SYMPTOMS

• Elevated mood: it has 4 stages depending on 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 elation of mood with Delusions of Grandeur.

• ECSTASY (stage-IV) : severe elevation of mood , intense sense of rapture or blissfullness seen in delirious or stuporous mania

AFFECTIVE SYMPTOMS

• Elevated mood• Expensiveness• Humorousness• Inflated self esteem• Intolerance of criticism• Lack of shame or guilt• Sometimes irritable mood is

predominant• May shift from Euphoria to Depression

or Anger

BEHAVIORAL SYMPTOMS

• Aggressiveness• Grandiose acts• Hyperactivity• Increased motor activity• Irresponsibility• Irritability• Argumentativeness

BEHAVIORAL SYMPTOMS

contd…

• Poor personal grooming• Provocativeness• Increased social activity• Dressed up in gaudy or

flamboyant clothes• Sexual hyperactivity

COGNITIVE SYMPTOMS

• Ambitiousness• Denial of realistic danger• Easily distracted• Flight of ideas• Uses playful language• Speaks loudly• Delusions of grandeur• Delusion of persecution• Lack of judgment • Distractibility

PHYSIOLOGICAL SYMPTOMS

• Dehydration• Inadequate nutrition (due to

over-activity)• Little need of sleep• Weight loss

CLASSIFICATION

• By ICD-10• F-30 = manic episode

DIAGNOSIS

• ICD-10• Psychological tests as Young

mania Rating Scale• MSE

MENTAL STATUS EXAMINATION

• GENERAL APPEARANCE & BEHAVIOR:-

• Psychomotor agitation ; sitting still is difficult

• may wear clothes that reflect elevated mood---brightly colored clothes, flamboyant, attention-getting, Pressured speech

• Interrupts and cannot listen to others

Mood & affect

• Euphoric, grandiosity, and false sense of well-being.

• Mood is quite labile.

Thought process and content • flight of ideas• Cannot connect concepts and jump

from one subject to another

• Circumstantiality and Tangentiality

• Do not consider risks or personal experience, abilities or resources.

• Some experience psychotic features– grandiose delusions

Sensorium and intellectual processes

• Oriented to person and place but rarely to time

• Intellectual function is difficult to assess during the manic phase

• Claims to have many abilities that they do not possess

• Impaired ability to concentrate or pay attention

• If psychotic—may experience hallucination

Judgment and insight

• Easily angered and irritated

• Impulsive and rarely think before acting or speaking

• Insight is limited---believes they are “fine” and have no problems

• Blames any difficulties on others

Self-concept

• Exaggerated self-esteem—believes they can accomplish anything

• A false sense of well being

Roles and Relationships

• Rarely can fulfill role & responsibilities.

• Have trouble at work or school---too distracted and hyperactive to pay attention to children or ADLs.

• Begins many tasks or projects but completes few.

Physiologic and self-care considerations

• Can go days w/o sleep or food and not even realize they are hungry or tired

• Unwilling to stop or unable to rest or sleep

• Ignores personal hygiene• destroy valued items • May physically injure themselves • Tend to ignore or be unaware of

health needs

TREATMENT

• Pharmacotherapy

• Electro-convulsive therapy

• Psychological treatment

• MOOD STABILIZERS• Antimanic - Lithium• Anticonvulsant - clonazepam,

valproic acid• Calcium channel blocker - verapamil• ANTIPSYCHOTICS• Olanzapine, Risperidone, Quetiapine

Chlorpromazine, Haloperidol

• SEDTIVES/HYPNOTICS• benzodiazepines

PSYCHOPHARMACOLOGY

NURSING MANAGEMENT

• ASSESSMENT :-• Severity of disorder.• Knowing the causes.• Resources available.• Judging the effect of

patient’s behavior on other people.

• MSE

Nursing Diagnosis

• Risk for injury related to extreme hyperactivity

• Risk for violence r/t manic excitement

• Imbalanced nutrition less than body requirement related to refusal

• Impaired social interaction r/t egocentric behaviour

THANKS