MANIA

MANIA

An 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 wellbeing  and happiness , not keeping with ongoing events.

PREDISPOSING FACTORS

•      Biological theories

•      Psychosocial theories

•      The transactional model

BIOLOGICAL THEORIES

•      Genetics

•      Biochemical influences

ü  Biogenic amines

ü  electrolytes

•      Physiological influences

ü  Brain lesions

ü  Medication side effects

  PSYCHOSOCIAL THEORIES

•      Importance declined

•      Mania is viewed as  disease of brain with biological etiologies

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

•      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

•      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

PSYCHOPHARMACOLOGY

•      MOOD STABILIZERS

•      Antimanic - Lithium

•      Anticonvulsant - clonazepam, valproic acid

•      Calcium channel blocker - verapamil

•      ANTIPSYCHOTICS

•      Olanzapine, Risperidone, Quetiapine
Chlorpromazine, Haloperidol

•      SEDTIVES/HYPNOTICS

•      benzodiazepines

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

                                         

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